The path to universal health insurance : institutional layering of healthcare financing reforms in Singapore, 1990-2015

Abstract

This paper studies healthcare financing reforms in Singapore from 1990 to 2015 via institutional layer-ing. Conceptualized by Eric Schindler and popularized by Kathleen Ann Thelen, institutional layering has held its own weight in the literature on gradual forms of institutional change, bridging the gaps be-tween punctuated equilibrium models and path dependence. This study attempts to add to the empiri-cal body of work on institutional layering, paying particular attention to the socio-political conditions favorable for incremental institutional change to occur. It begins with an overview of the place of in-stitutional layering in the theoretical field on institutional change and follows to explain why and how layering has occurred in the field of healthcare financing reforms from 1990 to 2015. The paper con-cludes with a discussion on the implications for future reform. Tags: Comparative public policy, Healthcare financing, MediShield Life, Institutional layering