A case study of the expanding role of the OECD in global health governance: Combining public administration and international relations perspectives to identify internal and external drivers

Over the last decade or so, the Organisation for Economic Co-operation and Development (OECD) has emerged as a key transnational player in comparative health policy analysis despite lacking a formal mandate in this sector. The OECD plays a ‘soft power’ agenda, setting the tone for the administration of health care both in its member states and on the global health scene as well. The OECD dictates policy processes on such issues as overall health system effectiveness, incentives for cost control and clinical quality, the role of private health insurance in public-private funding mixes and remuneration for medical labour. Its work has contributed to the definition of the nature and scale of health policy problems and has indirectly influenced various national health care performance management regimes. This chapter engages the broad question: why has the OECD come to occupy a central role in transnational health policy processes and how is it possible that the OECD challenges the authority of the World Health Organization (WHO) as the de facto global health ministry despite the OECD’s lack of a formal institutional role? In our examination of this question, we seek to advance understanding of change processes in intergovernmental organizations by complementing traditionally system-level oriented perspectives that are prominent in the international relations literature with an organization-level analysis of a diverse range of internal and external dynamics influenced by public administration scholarship.