Credibility, Responsiveness, and the Evolution of NICE: The Regulatory State under Pressure

Abstract:

This presentation draws on my ongoing book project, tentatively entitled The Contested Regulatory State: Politicising Drug Rationing in Advanced Democracies. Theoretically, the book develops an analytical framework for understanding political struggles after the delegation of powers to independent regulatory agencies. I highlight tensions between credibility and responsiveness, two qualities that are often considered as key sources of the legitimacy of independent regulators; I examine how this tension affects the political conflicts over the maintenance of regulatory institutions, shaping policy development over time. Empirically, the book provides a systematic, comparative-historical analysis of drug rationing policies, policies for restricting the funding of pharmaceutical products through the healthcare systems. It offers an in-depth, comprehensive examination of the evolution of drug rationing policies in three major advanced economies with different regulatory decision-making structure – England, France, and Japan – since the late 1980s, the period when debates on reforming regulatory institutions began in earnest. The presentation mainly focuses on the evolution of National Institute for Health and Care Excellence since its creation from a comparative perspective and discusses its implications for other countries and policy sectors.