Three Worlds of Institutional Change: Back-End, Front-End, and Informal Change in the Contemporary Welfare State

Abstract

While the financing of many existing welfare programs have been ‘sticky’ and resistant to change, through the 1980s reformers have radically altered the ways services are produced and administered. Much of the literature on institutional change has focused on either articulating the sources of continuity or the modes of change, rather than specifying why some parts of institutions are more open to change than others. This paper looks to address these questions. To do so, it first pulls apart the different costs of change, distinguishing among economic, political and sociological costs. It then turns to examining three modes of partial change that occur across varying cost structures: ‘back-end’ change where economic costs fall while other costs remain high, ‘front-end’ change where political costs fall while others remain high, and ‘informal’ change where sociological costs fall while others remain high. It examines this variation through the cases of health and welfare reform in the United States and the United Kingdom, showing that different cost-configurations led to different types of change and empowered different actors to engage in change.