Delegation of Clinical Authority, Administrative Culture and Policy Adoption: A Comparative Analysis

Numerous countries have adopted reforms that allow medical personnel other than physicians to engage in tasks that traditionally were exclusively performed by physicians. This policy is controversial because it challenges the medical profession’s traditional boundaries. This study is an exercise in comparative policy research based on the experience of 18 Organisation for Economic Co-operation and Development countries. It evaluates the contribution of different structural factors–socioeconomic, cultural, and institutional–to policy adoption. Based on both quantitative analysis and an examination of how delegation unfolded in Israel, the role of administrative culture is highlighted: a category that combines cultural legacies and institutional properties in explaining policy adoption. It is argued that because, in entrepreneurial administrative cultures, administrators are more likely to possess a managerial mindset than in Rechtsstaat cultures, and also have more institutional leeway for action, delegation is more likely to be adopted in the former.