Strategic Institutional Design: Two Case Studies of Non-Majoritarian Agencies in Health Care Priority-Setting

Abstract

Governments’ decisions to delegate policy decisions to non-majoritarian agencies have been both criticized as attempts at blame avoidance or depoliticization and defended as enhancing the rationality and credibility of decisions. This article focuses not on the decision to delegate, but on the decisions of how and to whom to delegate. We argue that strategic motives are relevant not only in the decision to delegate, but equally, and perhaps more importantly, in the selection of the institutional properties of these non-majoritarian agencies. We present two case studies of health care priority-setting, in England and Germany, to illustrate how governments proceed strategically in institutional design choices and how their decisions affect outcomes.