Attitudes towards reforming primary care in Belgium: effects of a stakeholders’ network in a pluralist context

Objectives: Health care policies are influenced by different types of actors influencing each other. However, it is unclear how such networks of actors shape policy orientation. We describe a nomination network of influential stakeholders and its effect on attitudes to reforming primary care. Methods: Face-to-face interviews were carried out in Belgium with 102 elite stakeholders. Each interviewee was asked to score solutions for improving the role of general practice in the health care system and to nominate up to six influential stakeholders. Social Network and multivariate analyses were used to describe the nomination network and its effect on attitudes to reform. Results: The network was highly centralised and homophilous for language groups. Although Belgium has a strong pluralist tradition of decision-making, policymakers were very much central to the network (average indegree=10.8), as compared to professional representatives (6.9). Influential stakeholders supported an enhanced role for the GP but did not support radically new policies. Conclusion: Social network analysis contributes to understanding why health care reforms may languish in pluralistic, decentralised health care systems: the central position of a stakeholder in the network structure is related to perceived influence, but does not favour a radical policy orientation. Moreover, language-group homophily in the perceived influence network leads to a weak coalition that only favours small-step reform.

Affiliations

Citations

APA
Chicago
FWB

Lorant, V., Rihoux, B., & Nicaise, P. (2016). Attitudes towards reforming primary care in Belgium: effects of a stakeholders’ network in a pluralist context. Journal of Health Services Research & Policy, 21(4), 235-242. https://doi.org/10.1177/1355819616639072 (Original work published 2016)