HPM Brown Bag Seminar

How and Why Complexity Contributes to the Capture of Payment Policy by Interest Groups
12:00 pm
1:00 pm
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4th Floor Conference Room
Miriam Laugesen, PhD
Assistant Professor, Department of Health Policy and Management
Department of Health Policy and Management
Open to the Columbia Community
Growing complexity in the economy and society seems inevitable, especially given increasing technological innovation. In policymaking, people have argued that complexity independently influences how, where, and what gets decided. We know, for example, that interest groups more successfully influence polices when the issues are complex and low in priority among the public and legislators (Gormley 1986). In general, however, as a concept and in empirical terms, our knowledge of when and why the level of complexity independently influences policy decisions is limited. I develop a theory of policy complexity and demonstrate how issue complexity allows participants in the process to achieve their goals. The analysis is based on my close observation of how more than 7,000 physician services are priced in Medicare. I find that complexity demands a lot from participants in the policy process, and participating is both time and resource intensive. I show how participants benefit from the complexity of the policy process, however, because complexity reduces scrutiny and creates opportunities for participants to advance their interests. Evidence is presented from key informant interviews, observation of decision-makers in action, and quantitative analyses of policy changes.


Dahlia Rivera