Implementation Theory Revisited . . . Again: Lessons from the State Children's Health Insurance Program

Academic Article


  • This article examines the implementation of the State Children's Health Insurance Program (SCHIP) in three states: Massachusetts, Georgia, and Ohio. It examines the effectiveness of four theoretical driving forces in explaining implementation using a multiple case study analysis. Data were compiled using legislative histories, key informant interviews, public record, and media content analysis and were analyzed using a triangulation of sources. Findings suggest that the driving forces as conceptualized in the literature are only partially helpful when examining the implementation of federal redistributive health policy in these states. A pursuit of rationality approach was the most explanatory of the driving forces followed by an organizational-policy fit when there was limited capacity to implement new policy. Overall, implementation was found to be more related to state-level capacity and the state's previous programmatic experiences. Policy innovation was more likely to occur when capacity was high and where goals agreement drove the process.
  • Authors


    Publication Date

  • April 2009
  • Published In


  • 8.3 Policy, ethics and research governance
  • Clinical Research
  • Health Services
  • Digital Object Identifier (doi)

    Start Page

  • 309
  • End Page

  • 336
  • Volume

  • 37
  • Issue

  • 2