| During the late eighties and early nineties states were extremely active in health care reform. As in many other areas, states varied widely in the extent to which they adopted health care reforms. Sociological theory has focused on several theoretical frameworks to explain the adoption of social welfare policy, including socioeconomic and need factors, interest group influence, and institutional and political characteristics of states.; Health care reform in the United States remains undertheorized. Most accounts examine only the failure of comprehensive national reform, or examine the few states which attempted to adopt universal coverage. Health care reform at the state-level was extensive during this period however. This dissertation argues that research should differentiate between the degree to which reforms were market-oriented and the degree to which the reforms were government-sponsored.; Three models were created: socioeconomic and need factors, interest group influence and institutional politics. Logistic regression was used to analyze the primary reforms of the period which were Medicaid expansions, children's health care programs, high-risk pools, purchasing alliances and small group insurance reforms. Universal coverage legislation was also examined, although the small number of cases precluded a quantitative analysis. Based on the results, it was determined that institutional politics and interest group influence were most closely associated with the adoption of health care reforms which were categorized as high government-sponsored policies. It is expected that viewing other social policy in terms of the degree of market-orientation and government-sponsorship would yield similar results. |
