Author ORCID Identifier
Document Type
Article
Publication Date
Summer 6-3-2025
Keywords
COVID-19, institutional change, healthcare governance, decision space, accountability, political authority, decentralization, public health financing, responsibility, critical juncture
Abstract
This introduction to the 2025 capstone symposium lays the conceptual groundwork for a new approach to analyzing institutional change in healthcare systems triggered by the COVID-19 pandemic. Departing from conventional legal-institutional perspectives, it extends the decision space framework developed by Bossert (1998) to capture both formal authority and the de-facto responsibilities exercised by public and non-public actors. By disaggregating health responsibilities across levels of government and sectors—public, private, and hybrid—and operationalizing these as quantifiable indicators over time, the framework allows for real-time and comparative assessment of institutional transformation. The pandemic is treated as a critical juncture that exposed and reconfigured political responsibility and authority. The framework emphasizes that institutional change stems not only from legal reform but also from strategic shifts in authority behavior, shaped by public expectations and observed policy actions. The introduction previews the five chapters that follow, each offering an empirically grounded analysis of institutional stability, adaptation, or transformation in national healthcare systems. Together, they suggest that the COVID-19 crisis catalyzed uneven but potentially lasting changes in health governance, dependent on prior institutional configurations and strategic political responses.
Recommended Citation
Shvetsova, O., 2025. Institutional change in healthcare as brought about by the critical juncture of the COVID-19 pandemic: Introduction. In: Proceedings of the Capstone Symposium: Responsibility, Accountability, Authority, and the Decision Space Framework: Institutional Change in Healthcare as Brought About by the Critical Juncture of the COVID-19 Pandemic, 29 April 2025. Citizenship, Rights, and Human Security Working Papers Series, Binghamton University, No. 117, 17 June 2025.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
