Clashing Imperatives: Coordination, Conflicts, and the Orientations of Drug Pricing Policy

Governments often face multiple imperatives at once that are contradictory or conflictual with each other. While public policy scholars have acknowledged the importance of policy coordination and ‘joined-up’ government in tackling such issues, the mechanisms behind, and the conditions under which, the balance between different policy goals shift over time and vary across contexts have remained undertheorised. When and how does one policy goal prevail over others? This paper addresses this question through a study of drug pricing and reimbursement policy – a policy area where different policy goals, including health, fiscal, and industrial policies, intersect. Across the industrialised world, technological advances and demographic change have presented governments with oft-contradictory pressures, including containing costs, ensuring citizens’ access, and promoting the pharmaceutical industry. The paper compares the policy trajectories of drug pricing in Japan, France, and the UK since the post-war decades – three advanced economies that are a home to the major pharmaceutical industry and have faced the common pressures but differed in their sectoral institutional arrangements. Combining cross-national and over-time comparisons with process tracing, it shows how institutional arrangements that allow inter-ministerial coordination, or lack thereof, among the relevant ministries – including the ministries of health, finance, and industry – have affected the representation of interests and have thereby shaped the policy orientation of drug pricing. By highlighting the role of inter-ministerial institutional arrangements in policy orientations in an area that is simultaneously important for economic growth and the sustainability of the welfare state, the paper seeks to contribute to the literatures on policy coordination, welfare state reforms, and industrial strategies.