Assessing the ‘Troika effect’ on Greek governance: has national decision-making on e-prescription changed with the Troika?
Creators: name: KOLOKOTSA, JULIA HAMILTON
Publisher: name: University of Surrey
Year: 2021
Subjects: Decision-making
Troika
Policy-making
E-prescription
Reform challenged
Financial crisis
Greece

description: When Greece required an economic adjustment programme during the 2010 eurozone crisis, conditions included monitoring by the Troika, which has proven controversial. Reformist government ministers leveraged Troika pressure throughout their national healthcare institutions to curb excess pharmaceutical spending. Reformists had earlier initiated e-prescription to this end, but had been unable to advance it, given fierce resistance. Inserting e-prescription into the adjustment programme, reformists expected Troika assistance to progress it. The research asks: how has the Troika influenced Greece’s e-prescription decision-making? It explores external intervention on domestic reforms to determine the “Troika effect” as distinct from narratives of opportunism, and illustrates the causal path of e-prescription’s decision-making process, by examining the period from its launch (October 2009) prior to the arrival of the Troika, to cabinet approval of the policy (October 2010).
description: The scarcity of published records created by Greece’s informal decision-making complicates efforts to explore the Troika’s impact. Data challenges are addressed through open-ended elite interviews featuring prime ministers and other ministers, advisors and Troika representatives, which are process-traced to illuminate previously opaque sequences of decision-making and the Troika’s impact therein. Positing that the style of decision-making in Greece was intractable, the research explored whether ministers 1) were minimally impacted by the Troika, 2) used the Troika directly, 3) took inspiration from the Troika or 4) adopted Troika suggestions without questioning. The thesis argues that the Troika influences e-prescription decision-making, yet this influence is conditioned by ministers. Using Historical and Discursive Institutionalism to capture the shifts in strategy and narrative that emerged between competing actors, the study refines widely accepted statements in the literature that the Troika imposed decisions throughout its involvement. Findings reveal that Troika influence was strongest on processes and instruments yet weakest on institutions and narratives, particularly ministers’ use of the Troika for their own objectives. Troika influence catalysed change where reformists wanted to make advances but could not do so independently. An informal compromise – postulated from the evidence gathered – accentuated the need for the Troika to communicate more broadly whilst the billions in savings from e-prescription attest to the value of persistence and decisiveness. Overall, the thesis contributes to our knowledge of how behind-the-scenes e-prescription policy-making pushed against resistance. Through elucidating reform processes, the thesis deepens knowledge of Greek decision-making. By extension, the study contributes to understanding an evolving form of external influence on national outcomes and processes. Finally, the thesis adds to the conceptual debate on the intersections of Historical and Discursive Institutionalisms bringing dynamic explanations of policy and policy-making change to match real world events.