Public Policy in the Passive-Aggressive State: Health Care Reform in Bosnia-Hercegovina 1995–2001

Abstract

This article uses Bosnia and Hercegovina as a prototype of an emerging subset of weak states, the passive-aggressive state. Appearing as the result of agreements ending civil strife, the general characteristics of the passive-aggressive state include complex power-sharing arrangements at the centre and local institutions that are designed for capture by parties to the conflict, which in turn creates a weak and segmented civil society. As a result, only the international community can devise and financially support policy reform, but it must rely on the state to implement the reform. Dependent on international support for its own survival, the centre rhetorically embraces reform while local institutions engage in passive resistance to block it. This article uses three examples of health care reform in Bosnia to illustrate the difficulties of reform in these types of states. The paper concludes with observations on how strengthening the powers of the central government and reorienting international aid towards civil society might alleviate some of the structural problems of passive-aggressive states. passive-aggressive: Of, relating to, or having a personality disorder characterised by habitual passive resistance to demands for adequate performance in occupational or social situations, as by procrastination, stubbornness, sullenness, and inefficiency (American Heritage Dictionary of the English Language, 4th Edition).