Understanding the evolution of competing institutional logics in the marketization of care: a stage model analysis of Australia's National Disability Insurance Scheme

Salignac, Fanny, Barkemeyer, Ralf, Franklin-Johnson, Elizabeth and Dzhengiz, Tulin ORCID: https://orcid.org/0000-0001-7909-6612 (2024) Understanding the evolution of competing institutional logics in the marketization of care: a stage model analysis of Australia's National Disability Insurance Scheme. Health Policy, 149. 105173. ISSN 0168-8510

Accepted Version File will be available on: 29 September 2025. Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (692kB)

Abstract

This study explores the marketization of healthcare through a stage model analysis, focusing on Australia's National Disability Insurance Scheme (NDIS). By employing mixed methods, including sentiment and frequency analysis as well as qualitative content analysis of policy documents and media coverage, we trace the NDIS's evolution and the interplay of competing social welfare and market logics over time. Our findings underline that the evolution and interplay between competing institutional logics follow a stage model of institutional change, detailing pre-emergence, orientation, contestation, consolidation, and normalization phases. Additionally, we observe a shift in dominant institutional logics across different stages, demonstrating the critical role of media and public sentiment in shaping discourse about the marketization of care, which intertwines with policy decision-making. Our findings emphasize the importance of adaptive engagement and communication strategies by policymakers to avoid marginalizing vulnerable groups as institutional logics evolve, especially in the latter stages of the process when a dominant logic has emerged. The study highlights the complex dynamics of institutional change and offers insights for both researchers and practitioners in the healthcare sector, shedding light on the coevolution of competing logics in the policy development and implementation process. [Abstract copyright: Copyright © 2024. Published by Elsevier B.V.]