Advancing Empirics and Theory for a Deeper Political Economy Analysis; Comment on “Health Coverage and Financial Protection in Uganda: A Political Economy Perspective”

Document Type : Commentary


Rockefeller College of Public Affairs and Policy, University at Albany, SUNY, Albany, NY, USA


At its core, political economy analysis involves examination of the relationship between the state and the market. A number of country case studies have emerged in recent years that aim to identify political economy factors facilitating or impeding health sector reforms towards universal coverage. In this commentary, we expand Nannini and colleagues’ analysis to elaborate on how political economy analyses can better inform policy design towards more successful reforms in low- and middle-income countries (LMICs) by drawing more heavily on improved research design and theory. We suggest three ways that political economy studies could make deeper claims by historicizing analyses, going comparative and/or by grounding findings more deeply in theory.


  1. Nannini M, Biggeri M, Putoto G. Health coverage and financial protection in Uganda: a political economy perspective. Int J Health Policy Manag. 2021;11(9):1894-1904. doi:34172/ijhpm.2021.116
  2. Harris J. The politics of expanding healthcare access to the poor and informal sectors. Sociol Forum. 2019;34(4):818-837. doi:1111/socf.12551
  3. Croke K, Mohd Yusoff MB, Abdullah Z, et al. The political economy of health financing reform in Malaysia. Health Policy Plan. 2019;34(10):732-739. doi:1093/heapol/czz089
  4. Chemouni B. The political path to universal health coverage: power, ideas and community-based health insurance in Rwanda. World Dev. 2018;106:87-98. doi:1016/j.worlddev.2018.01.023
  5. Novignon J, Lanko C, Arthur E. Political economy and the pursuit of universal health coverage in Ghana: a case study of the National Health Insurance Scheme. Health Policy Plan. 2021;36(Suppl 1):i14-i21. doi:1093/heapol/czab061
  6. Mhazo AT, Maponga CC. The political economy of health financing reforms in Zimbabwe: a scoping review. Int J Equity Health. 2022;21(1):42. doi:1186/s12939-022-01646-z
  7. Rizvi SS, Douglas R, Williams OD, Hill PS. The political economy of universal health coverage: a systematic narrative review. Health Policy Plan. 2020;35(3):364-372. doi:1093/heapol/czz171
  8. Thelen K. Historical institutionalism in comparative politics. Annu Rev Polit Sci. 1999;2(1):369-404. doi:1146/annurev.polisci.2.1.369
  9. Pierson P. Politics in Time: History, Institutions, and Social Analysis. Princeton University Press; 2004.
  10. Campbell AL. Policy feedbacks and the impact of policy designs on public opinion. J Health Polit Policy Law. 2011;36(6):961-973. doi:1215/03616878-1460542
  11. Harris J, Libardi Maia J. Universal healthcare does not look the same everywhere: divergent experiences with the private sector in Brazil and Thailand. Glob Public Health. 2022;17(9):1809-1826. doi:1080/17441692.2021.1981973
  12. Tuohy CH. Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada. Oxford University Press; 1999.
  13. Lieberman ES. Causal inference in historical institutional analysis: a specification of periodization strategies. Comp Polit Stud. 2001;34(9):1011-1035. doi:1177/0010414001034009003
  14. Korpi W. Power resources and employer-centered approaches in explanations of welfare states and varieties of capitalism: protagonists, consenters, and antagonists. World Polit. 2006;58(2):167-206. doi:1353/wp.2006.0026
  15. King G, Keohane RO, Verba S. Designing Social Inquiry: Scientific Inference in Qualitative Research. Princeton University Press; 1994.
  16. Reich MR, Harris J, Ikegami N, et al. Moving towards universal health coverage: lessons from 11 country studies. Lancet. 2016;387(10020):811-816. doi:1016/s0140-6736(15)60002-2
  17. Wong J. Healthy Democracies: Welfare Politics in Taiwan and South Korea. Cornell University Press; 2004.
  18. Harris J. Achieving Access: Professional Movements and the Politics of Health Universalism. Cornell University Press; 2017.
  19. Hall PA. The role of interests, institutions, and ideas in the comparative political economy of the industrialized nations. In: Lichbach MI, Zuckerman AS. Comparative Politics: Rationality, Culture, and Structure. Cambridge University Press; 1997:174-207.
  20. Farber R, Harris J. American medical sociology and health problems in the global south. Sociol Perspect. 2022;65(5):848-868. doi:1177/07311214211067763

Articles in Press, Corrected Proof
Available Online from 13 August 2023
  • Receive Date: 15 July 2022
  • Revise Date: 08 August 2023
  • Accept Date: 09 August 2023
  • First Publish Date: 13 August 2023