Understanding the process of seeking long-term care (LTC) in old age helps identify what contributes to delays and inequalities in accessing it. Current research highlights the roles of individual and policy factors, but pays little attention to how these factors interact. This qualitative study aims to fill this gap by identifying facilitating factors and mechanisms in the initial approaches to LTC policies. It examines care-seeking in two towns in northern Italy, where a demand-based approach, high fragmentation and poor coordination pose significant challenges. In a bottom-up approach to policy implementation, the experiences and perspectives of both care-seekers and professionals are integrated. Indeed, the data collection (April 2023–May 2024) triangulates 100+ hours of participant observation and semi-structured or vignette-based interviews. The study finds that care-seeking entails three interrelated steps: recognising care needs, being willing to receive LTC, and reaching an entry point. At each stage, three mechanisms operate at intrapersonal and interpersonal levels and can be promoted by LTC policies to facilitate care-seeking, especially for those experiencing barriers. The mechanisms are (1) taking the initiative to raise awareness of care needs and share information about available solutions; (2) fostering trust between professionals and care-seekers, who often rely on confidential relationships to discuss care arrangements; and (3) combining primary information with tailored guidance on the local offer, enabling care-seekers to make informed decisions. The findings provide actionable insights into policies and practices that facilitate care-seeking, and offer a conceptual framework that explains the driving factors behind this process and its mechanisms.

The analytical framework, “policy innovation through bureaucratic reorganization,” elucidates how the policy implementation process can be restructured to affect its outputs. Three steps from the framework are applied to the case of Republican officeholders between 1906 and 1913, who centralized their control over immigration, by adding naturalization and enforcement in the new Bureau of Immigration & Naturalization. The Roosevelt and Taft administrations used budgeting, staffing, and infrastructure to regulate immigration and naturalization laws, pivoting between easing and tightening them (resource adjustment). The shifts responded to coalitions for and against immigration (coalition management). Until the Bureau became obsolete and was reconfigured (system redesign). Although immigration was open in the Progressive Era, this study reveals how Republicans managed inflows with mixed results, leading to the structural foundation for the restrictive laws that followed. This furthers the immigration history and political control literatures as they emphasize policymaking through legislative and procedural, not structural, means.

This article posits that the multi-level governance literature can benefit from administrative burden theory if scholars are interested in understanding under which conditions policy implementation fails. To support this argument, we build on these two bodies of research to examine how implicit welfare rescaling – where the central government expands its role in a previously devolved policy – may increase administrative burdens for claimants, and to what extent local welfare systems can help to mitigate these burdens despite lacking coordination. To address these research aims, we assess the implementation of the “Ingreso Mínimo Vital,” a national minimum income scheme introduced in Spain within a fragmented regional system. Qualitative fieldwork with frontline professionals and policy experts shows that welfare rescaling heightened claimants’ administrative burdens due to inter-institutional misfit among governance levels. This imposed substantial learning, compliance, and psychological costs on claimants, making frontline professionals essential for guiding them through these challenges.

Improved health data governance is urgently needed due to the increasing use of digital technologies that facilitate the collection of health data and growing demand to use that data in artificial intelligence (AI) models that contribute to improving health outcomes. While most of the discussion around health data governance is focused on policy and regulation, we present a practical perspective. We focus on the context of low-resource government health systems, using first-hand experience of the Zanzibar health system as a specific case study, and examine three aspects of data governance: informed consent, data access and security, and data quality. We discuss the barriers to obtaining meaningful informed consent, highlighting the need for more research to determine how to effectively communicate about data and AI and to design effective consent processes. We then report on the process of introducing data access management and information security guidelines into the Zanzibar health system, demonstrating the gaps in capacity and resources that must be addressed during the implementation of a health data governance policy in a low-resource government system. Finally, we discuss the quality of service delivery data in low-resource health systems such as Zanzibar’s, highlighting that a large quantity of data does not necessarily ensure its suitability for AI development. Poor data quality can be addressed to some extent through improved data governance, but the problem is inextricably linked to the weakness of a health system, and therefore AI-quality data cannot be obtained through technological or data governance measures alone.

Since the 18th National Congress of the Chinese Communist Party in November 2012, the Party school system has been subject to several reforms. How well these reforms have been implemented in lower-level Party schools has received little attention because access is difficult to obtain. We conducted on-site investigations, interviews with cadres and surveys of trainees at a county/district-level Party school in an economically typical city and county. Our findings show that operational dilemmas lead to the perfunctory implementation of policy that is substantively deficient. These operational dilemmas are likely to be found in varying degrees in other county/district Party schools. Our finding that cadre education and training policy is implemented in a pro forma manner suggests that cadres may not be receiving the ideological education and practical training intended for them by the centre.

There are significant barriers to accessing health and social care services in Ireland including high user charges, long waits and limited availability of some services. While a number of reform proposals have committed to improving access to health care, implementation of these proposals has been limited. The aim of this paper is to identify and discuss policy implementation failures concerned with improving access to health and social care services in Ireland. Four potential reasons for the repeated failure to implement stated reform proposals are identified including a failure to identify and address the practicalities of implementation, competing health care demands, the political cycle and stakeholder resistance. While there has been a shift in Irish health care policy documents in the last 10 years with increasing emphasis on ensuring access to health care based on need rather than ability to pay, a repeated failure to implement the proposed reforms raises questions as to whether there is a real commitment to improving access to health care.

Temporary Assistance for Needy Families (TANF) was born out of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act in the backdrop of highly racialised and otherizing fears about the mythical “welfare queen.” However, the perception of Black exploitation of public benefits to White detriment is not exclusively a modern phenomenon. One of its original manifestations can be found in White reactions to the Freedmen’s Bureau during the post-Civil War period of Reconstruction. We therefore argue that state decisions to allocate spending towards cash assistance and coercive programmes designed to motivate work participation and regulate private behaviour are shaped by the imprint of this historic institution. Using TANF spending data from 2001 to 2019 and data on Freedmen’s Bureau field offices, we find evidence of a link between these offices’ historic prevalence and contemporary, coercive allocations. However, we find little evidence that this link extends to spending towards cash assistance.

Many studies put forward the argument that local policy experimentation, a key feature of China's policy process in the Hu Jintao era, has been paralysed by Xi Jinping's (re)centralization of political power – otherwise known as “top-level design.” This narrative suggests that local policymakers have become increasingly risk-averse owing to the anti-corruption campaign and are therefore unwilling to experiment. This article, however, argues that local governments are still expected to innovate with new policy solutions and now will be punished if they do not. By introducing the analytical framework of “experimentation under pressure” and drawing on an analysis of over 3,000 local government regulations and fieldwork data related to foreign investment attraction policies in two localities, Foshan and Ganzhou, the authors highlight new features developing within current experimental policy cycles. Local cadres now have no choice but to experiment as the political risk of shirking the direct command to experiment may be higher than the inherent risk of experimentation itself.

Labor Secretary Frances Perkins championed liberal immigration policies between 1933 and 1940. Some efforts were successful, but most were not due to political, economic, and social constraints on immigration policy making, especially in Congress. Yet, she reorganized the enforcement functions of her department when she created the Immigration and Naturalization Service. Narratives abound about the period, though few delve into this reorganization. In this article, I share an analytical framework that I developed, “policy innovation through bureaucratic reorganization,” to explain how Perkins temporarily eased the debarments, as well as deportations, of newcomers by adjusting agency resources, including staffing, budget, and infrastructure. I describe how she responded to pressures from immigration restrictionists by tightening these functions. My narrative adds to the literature on immigration policy history, which has not fully appreciated the role of bureaucratic reorganization. This research bolsters the perspective in political control theory that bureaucratic structure merits as much attention as does legislation as a tool for control.