Аннотация
Persistent policy failures in health systems are widely recognized, with inappropriate policy mixes identified as a key contributing factor. However, why inappropriate policy tools get selected is not well understood in health policy research. Studies in policy sciences suggest that the choice of policy tools is determined by the existing governance mode and the underlying logic of the policy regime. If the chosen governance mode does not align well with contextual conditions, the nature of the problem, and policy capacity, it leads to the inappropriate selection of policy tools. We illustrate this through a case study of health system reforms in India, where persistent policy failures have sparked extensive discussions of various reform proposals. Our narrative review of the literature and relevant documents reveals that current debates are grounded in policy beliefs and assumptions about governance arrangements. We identify several of these assumptions and provide evidence that calls them into question, indicating a need to reorient the discussion surrounding health system reforms. We argue for a deeper understanding of policy beliefs shaping governance arrangements in the health sector to improve the selection of appropriate tools. The findings have important implications for health policy in developing countries with mixed health systems.