Propuestas objetivas para potenciar el control y disminuir la corrupción

The third aim was to identify factors that may have impeded or promoted ODA reform attempts from 1990-1994. Primary and secondary data were collected and analyzed to complete this aim. Secondary data included articles from the business, consumer, and medical press, as well as gray literature documents. The Congressional testimony from the 1990-1994 hearings also provided data and insights. Primary data were derived from ten informant interviews. The informant interview guide can be found in Appendix C.

Aim 3 was semi-structured based on the Multiple Streams model (Kingdon 1995) of policy development. This meant that the following elements and factors in the development and failure of the ODA amendments were explored: 1) Problem definition, i.e., how the problem defined, and whether stakeholders agreed that a problem existed; 2) policy solution; 3) politics; 4) the broader climate (political, social, economic climate), and, 5) individuals that were influential in the process. (Kingdon refers to these individuals as policy entrepreneurs, but this term was not used in the informant interviews, nor was it used in the reviewed

documents.) Hypotheses about what might impede or favor passage of legislation were developed in the proposal phase of this research (see Table 2). Having these hypotheses in mind a priori served as a reminder of what to look for in the reviewed documents, as well as what to probe for in the informant interviews.

Selected articles and reports that informed Aim 3 were also used to inform Aim 1. These were described previously in this chapter. A description of the Congressional

testimony informed Aim 3 and Aim 2, and have already been described in this chapter. The informant interviews and the process of gaining Institutional Review Approval to conduct these interviews will now be described. A description of the sample, as well as the

recruitment and interviewing process, will follow.

In June 2008, an application was submitted to University of North Carolina’s Office of Human Research Ethics Institutional Review Board (IRB) for “Determination Whether Research or Similar Activities Require IRB Approval.” After one resubmission, the application was approved in July 2008. It was determined that IRB approval was not

required because the submitted list of potential informants were considered “elected officials.”9

In late October 2008, 16 potential informants were sent an email or mailed letter that contained a request for a 20-30 minute phone interview. For a copy of the correspondence, see Appendix D.

Ten (63%) informants agreed to an interview, and the interviews were completed by phone in the month of November 2008. One potential informant responded to the

interview request, but declined the interview. The remaining 5 simply did not respond to the interview request. Informants were told that their responses would remain anonymous and confidential. Hence, the sample will be described in general terms.

The purposive sample of 10 informants was drawn from an initial target list of 16 potential informants. Purposive sampling is useful for gathering opinions from specific predefined groups. Hence, the target list included individuals from four different ODA stakeholder groups: 1) federal government, 2) industry, 3) patients, and 4) payers. The list also included three health policy experts that advised multiple stakeholder groups. The process of creating the initial target list of 16 included identifying individuals that met most of the following criteria: 1) individuals that were leaders of relevant organizations or

initiatives, e.g. leaders of the stakeholder groups listed in Appendix F, members of congress that chaired the hearings and sponsored the proposed ODA reforms in the 1990s, or presidents of the companies that were involved in the debate of the 1990s reforms; 2) individuals that spoke at the 1990-1994 hearings; and, 3) individuals that have advised key stakeholder groups on the proposed ODA reforms as a consultant or researcher. Targeted informants also had to be locatable, which generally meant that they were not deceased or

9 _{The targeted informant list was not limited to officials elected to government service. The preliminary list}

retired. The target list of 16 informants was reviewed and approved by the dissertation committee chair before anyone was contacted.

One to two informants from each of the four stakeholder groups were interviewed. All of the three targeted health policy experts were interviewed. Characteristics of the

informants included: three of the ten informants had testified at one or more ODA hearings. Three had published articles on the ODA. At least two had participated in drafting the ODA legislation. Of note, most informants had worked in multiple capacities throughout their careers, e.g., some informants started in the federal government (e.g., Food and Drug Administration and the Office of Management and Budget) but later worked in industry, or as health policy advisors.

That interviewees may not remember events of 14 to 18 years ago was anticipated by this researcher. Before each scheduled interview this researcher reviewed publications, quotes and Congressional testimony by, and about, the individual interviewee. This background preparation enabled the researcher to jog the interviewee’s memory when necessary, and focus the interview around the given “facts” of the situation. While 14-18 years ago remained difficult for informants to remember, about a third of informants seemed to readily recall details of the players and events surrounding the 1990-1994 ODA amendments. Others qualified their answers with caveats such as, “that was a long time ago, but I think . . .”

Generally, informants repeated facts, statements, and themes that were already available in several articles that reviewed the 1990-1994 amendments. Hence, results from the interviews seem to validate the published reports and vice versa. Note that findings from the informant interviews are combined with that of the document reviews and discussed in Chapters 5 and 6