Document Type




Format of Original

48 p.

Publication Date



Duke University Press

Source Publication

Journal of Health Politics, Policy and Law

Source ISSN


Original Item ID

DOI: 10.1215/03616878-3702746; PubMed Central: PMID: 27729442


Prices are a significant driver of health care cost in the United States. Existing research on the politics of health system reform has emphasized the limited nature of policy entrepreneurs’ efforts at solving the problem of rising prices through direct regulation at the state level. Yet this literature fails to account for how change agents in the states gradually reconfigured the politics of prices, forging new, transparency-based policy instruments called all-payer claims databases (APCDs), which are designed to empower consumers, purchasers, and states to make informed market and policy choices. Drawing on pragmatist institutional theory, this article shows how APCDs emerged as the dominant model for reforming health care prices. While APCD advocates faced significant institutional barriers to policy change, we show how they reconfigured existing ideas, tactical repertoires, and legal-technical infrastructures to develop a politically and technologically robust reform. Our analysis has important implications for theories of how change agents overcome structural barriers to health reform.


Accepted version. Journal of Health Politics, Policy and Law, Vol 42, No. 1 (February 2017): pg. 5-52. DOI. © 2017 Duke University Press. Used with permission.