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The persistence of cliques in the post‐communist state. The case of deniability in drug reimbursement policy in Poland[Note 1. Thanks to Łukasz Raciborski from the Institute of Sociology, ...]
Author(s) -
Ozierański Piotr,
King Lawrence
Publication year - 2016
Publication title -
the british journal of sociology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.826
H-Index - 92
eISSN - 1468-4446
pISSN - 0007-1315
DOI - 10.1111/1468-4446.12193
Subject(s) - communism , accountability , reimbursement , communist state , politics , political science , law and economics , public administration , sociology , political economy , law , health care
This article explores a key question in political sociology: Can post‐communist policy‐making be described with classical theories of the Western state or do we need a theory of the specificity of the post‐communist state? In so doing, we consider Janine Wedel's clique theory, concerned with informal social actors and processes in post‐communist transition. We conducted a case study of drug reimbursement policy in Poland, using 109 stakeholder interviews, official documents and media coverage. Drawing on ‘sensitizing concepts’ from Wedel's theory, especially the notion of ‘deniability’, we developed an explanation of why Poland's reimbursement policy combined suboptimal outcomes, procedural irregularities with limited accountability of key stakeholders. We argue that deniability was created through four main mechanisms: (1) blurred boundaries between different types of state authority allowing for the dispersion of blame for controversial policy decisions; (2) bridging different sectors by ‘institutional nomads’, who often escaped existing conflicts of interest regulations; (3) institutional nomads’ ‘flexible’ methods of influence premised on managing roles and representations; and (4) coordination of resources and influence by elite cliques monopolizing exclusive policy expertise. Overall, the greatest power over drug reimbursement was often associated with lowest accountability. We suggest, therefore, that the clique theory can be generalized from its home domain of explanation in foreign aid and privatizations to more technologically advanced policies in Poland and other post‐communist countries. This conclusion is not identical, however, with arguing the uniqueness of the post‐communist state. Rather, we show potential for using Wedel's account to analyse policy‐making in Western democracies and indicate scope for its possible integration with the classical theories of the state.