The Limited Resource Effect: A Comparative Policy Analysis of Mandated Health Policy in Resource Constrained Bureaucratic Organizations

Kara McKenzie Elam, The University of Texas School of Public Health


Legislated policies are not self-implementing. This study was conducted to understand how, in a policymaking system where policy design is often divorced from policy implementation, bureaucratic organizations with limited monetary and human resource capacity can successfully implement mandated health policies. The study used two research methods to assert the importance of local context-specific factors on policymaking, while emphasizing the interaction of a policy with its setting. First, a critical literature review was conducted in which the need for a complementary dialogue between well-established policymaking models, contextual adaptation, and discretion for the local policy implementation environment was argued. Second, Quantitative Comparative Analysis was utilized to ascertain the combinations of necessary and sufficient conditions for the successful implementation of the school entry immunization mandate in school districts in the United States with 70,000 or more enrolled students. The analytic results created a conjunctural diagnostic map of the necessary and sufficient economic, institutional, and social determinant influential conditions in the local environment for policy implementation success. The utilization of this map as a diagnostic tool will assist case-comparable implementing organizations with limited resources that attempt the implementation of an equivalent health policy. ^ The study's findings are informative for public health policy designers aspiring to create health policies to be implemented by comparable large bureaucratic organizations. Policies that, when passed, will have a higher degree of successful implementation if the findings are taken into account when designing policy. An understanding by all policy actors of the complexities associated with the policy implementation process is critical for public health policies to meet their objectives of improving population health. The policy implementation guidance offered by the study's results is neither standardized nor generalizable. Rather, it is context-specific and, if efficiently leveraged by policymakers and implementers, could conclude in higher rates of achievable policy implementation success.^

Subject Area

Public health|Political science

Recommended Citation

Elam, Kara McKenzie, "The Limited Resource Effect: A Comparative Policy Analysis of Mandated Health Policy in Resource Constrained Bureaucratic Organizations" (2018). Texas Medical Center Dissertations (via ProQuest). AAI10793012.