Interactive governance and implementation effectiveness in India's National Health Insurance Program

Many public sector programs, such as those directed at public health, are often multiagency tasks where structural incongruity in the program design is liable to emerge over time from changing operational requirements. Yet, successful implementation remains possible because of the interactions and relationships between implementation parties that encourage cooperation and collaboration despite incongruence in the program design. We examine how the dynamics of these interparty relationships influence implementation success in a comparative study of India's National Health Insurance Scheme. We find that implementation parties exhibiting support and complementarity in their interactions created a virtuous cycle of continually encouraging better performance and vice versa. Thus, our findings exhibit a distinct functionary role of interparty interactions and relationships for eliciting effective implementation and governance. The analysis also showcases the need for policy makers and policy designers to be cognizant of the inadvertent introduction of structural inconsistencies and veto points into program designs and their potential influence on implementation outcomes.