Policy Entrepreneurs and the Design of Public Policy: The Case of the National Health Insurance Law in Israel

Abstract2How do policy entrepreneurs implement in practice the things theory suggests they should do? This article suggests various insights into the influence of policy entrepreneurs on the formulation of public policy. Using a broad definition of the concept of policy entrepreneur, the article identifies the main characteristics of entrepreneurial activities, describes various strategies that the policy entrepreneur may employ, and develops a model of successful and effective policy entrepreneurship. Using an analysis of the design of the Israel National Health Law of 1994 as a case study, the article emphasizes the importance of policy entrepreneurs in the public policy arena and provides several insights into the conditions for their activity, their motivations and main strategies.Keywords: Policy Entrepreneurship, Policy Change, Health Care Policy, Reform.IntroductionOver the last decades the concept of entrepreneurship has diffused into the scholarly discourse that deals with public policy and management (Roberts & King, 1991). Since the 1980's, a variety of studies have used this idea to explain various case studies and policy results. Many scholars use concepts such as political entrepreneur (Meydani, 2008; Schneider & Teske, 1992), institutional entrepreneurship (Campbell, 2004; DiMaggio, 1988), public entrepreneurs (Ostrom, 2005; Schneider, Teske & Mintrom, 1995; Schnellenbach, 2007), policy entrepreneurs (Kingdon, 1984/1995), evolutionary policy maker (Witt, 2003) and executive entrepreneur (Roberts & King, 1991) to provide a new perspective on various phenomena related to politics and administration. However, the literature often uses the same concepts to explain different phenomena, making it difficult to clearly define and understand policy entrepreneurs.Recently, Mintrom & Norman (2009, pp. 654-658) presented an integration of policy entrepreneurship and five different theories of policy change. At the end of their article, they claim that this concept is yet to be broadly integrated within analyses of policy change. New insights have also started to emerge concerning the sequencing of policy entrepreneurship over long periods of time, how the broader political climate can affect the context for policy entrepreneurs, how they frame problems, and how they work with others. Nevertheless, room remains for more conceptual development and empirical testing. Mintrom & Norman suggest two directions for fruitful future work. First, there is a need for closer study of the motivations and strategies of policy entrepreneurs. Second, there is also a need for more study of the interactions between policy entrepreneurs and their specific policy contexts. This paper focuses on these needs.On June 15, 1994 the Israeli parliament (Knesset) passed the National Health Insurance Law (hereafter: NHIL) after decades of attempts and efforts to legislate or devise national health insurance. The application of the NHIL to all residents of Israel marked the end of a struggle of almost 70 years' duration, which began even before the State of Israel was established (Shvarts, 1998). The primary aim of this article is to analyze the design of the NHIL on the basis of a conceptual framework using theoretical tools taken from public policy and administration, and new institutional approaches, while focusing on the concept of entrepreneurs. In this context, we will outline the main characteristics of entrepreneurial activity and describe various strategies available to the policy entrepreneur. The theoretical insights developed in this article could, without extrapolating too far, offer some tentative lessons for other healthcare systems and reforms.The textual sources used in the empirical analysis include legislative documents, reports and the minutes of various committee meetings in and outside of the Knesset, print and online press sources and professional and lay literature (e. …