Making sense of stakeholder responses to impending major policy reform in the private healthcare sector

Abstract

Implementing policy change is notoriously difficult, often marred by chronic delays or outright failure to achieve its originally desired mandate. This challenge drew the attention of many scholars who, over the years, published many studies attempting to describe and analyse what the policy change process looks like and most notably, strategies on how to better manage it. However, most of these studies tacitly committed themselves to strategic issues of managing change from a policy-maker s perspective, with very little consideration of what the change process actually looks and feels like from the perspective of the change recipients. Yet, it goes without saying that responses of these change recipients directly affect the outcomes of the change process. This study sought to address this gap in literature by exploring South Africa s prevailing National Healthcare Insurance (NHI) policy reform. Using a qualitative design and theoretical insights from political sciences, social sciences and organisational studies, the study analysed how the relevant stakeholders in the private healthcare industry were variously thinking about and responding to the proposed reforms. The findings of the study emphasised the critical role of temporally sequenced historical events in shaping an industry and influencing its change orientation. The study also weighed in on scholarly debates that challenged general characterisation of any recipients contradictory opinions as resistance to change . In this study, the stakeholders seemingly antagonistic attitudes and responses to the NHI policy were not necessarily a contestation against change in itself. Instead, the conflict was over compatibility with the policy s implicit secondary goals. This contestation evoked opinions and responses so strong that it overshadowed the stakeholders initial felt need for change. From this perspective, this research argued for a distinction to be drawn between diagnostic congruence and goal congruence. It further proposed that paying diligent attention to formulating an accurate diagnosis of the problems to be addressed through policy change could attenuate haggling and achieve far better results than finding the best way to attain an agreed upon goal across all relevant stakeholders.