The role of tool calibrations and policy specifications in policy change: evidence from healthcare reform efforts in Korea 1990-2020

Policy studies have addressed many issues on the topic of policy change, generally following the ideas about policy composition set out by Hall and others. These typically view ‘significant’ policy change as related to alterations in the macro elements of policies, namely policy paradigms and governance preferences. These studies have also examined the roles of meso-level policy objectives and policy instrument preferences in these dynamics but see these as subsequent or subordinate to more macro-level changes. In contrast, the role of changes in policy specifications and tool calibrations at the micro-level of policies remain under-investigated and under-theorized despite growing recognition of their sometimes transformative role in policy dynamics. This paper re-examines foundational work on policy change in order to develop a clearer understanding of the content and significance of both calibrations and policy specifications. The significance of these insights is illustrated through a case study of recent healthcare policy reform efforts in South Korea after 1988 which highlights the role that micro-level policy changes played in shaping broader and deeper policy changes over the period.