The Role of Emotional Entrepreneurs in Health Policy Reforms During the Greek Bailouts: What Makes Reform Successful and Why?

The paper maps out the emotional economy around health care, and collects evidence from interviews with health policy-related elites and stakeholders in Greece, tracing the process of implementation to identify how emotions affect sticky points and the configuration of pro- and anti-change coalitions. In August 2018, the Greek government announced the exit from the bailout agreement – known as Memorandum of Understanding (MoU). Nonetheless, the advocacy of an exit has not been accompanied by effective structural reforms to allow Greece to maintain future stability. Health policy is one of the challenging areas of reform regarding efficiency, effectiveness and social impact. Despite consecutive MoUs (2010, 2012 and 2015), heath policy has been slow-moving regarding reform with some successes and failures. This paper explores the reasons behind the variable implementation of reforms in health policy to identify obstacles and constraints. Despite being mandated by MoUs, why did some health reforms succeed while others failed to be implemented? Using the Multiple Streams Framework (MSF) and blending ideas from theories of bounded rationality and policy bubbles, the paper hypothesises that implementation outcomes are due to three factors: the strategies and power of the main non-state coalition partner (the medical profession), the size of resources needed for successful implementation, and the ability (or not) of government to mobilise public opinion. Nonetheless, it is important to illuminate the emotional mechanisms that affect the outlook of those factors and decisions that do not necessary reflect the best course of action. To that extent, the paper examines three cases: the liberalisation of the pharmacy profession (successful implementation), family doctor reforms (partial implementation), and the referral system (unsuccessful implementation). The paper concludes with implications about theories of implementation in light of possible obstacles to incorporate the manifestation of emotions in this policy stage.