The role of international organizations in healthcare financing policy in Central and Eastern European countries; The case of the Latvian healthcare financing reforms

This dissertation investigates how international organizations (IOs) influence healthcare financing reforms in Central and Eastern Europe (CEE), focusing on Latvia as a representative case of a structurally weak post-socialist state. Using the Global Social Policy framework, it explores how domestic actors engage with, adapt, or resist IO policy ideas under conditions of limited institutional and fiscal capacity. Based on qualitative content analysis of IO documents and elite interviews, the study examines the healthcare financing policy advice of the World Health Organization, the Organisation for Economic Co-operation and Development, the World Bank, and the Office of the United Nations High Commissioner for Human Rights between 1988 and 2019. The analysis maps IOs’ recommendations across four sub-dimensions of healthcare financing—revenue collection, pooling, purchasing, and coverage—and evaluates their depth and orientation according to paradigmatic, instrumental, and parameter levels of policy change. The findings show that IOs primarily rely on soft governance tools, such as persuasion, benchmarking, and technical assistance, to shape national reforms. However, domestic actors in Latvia demonstrated agency by selectively adopting, adapting, or even misusing IO advice to advance political and institutional objectives. This challenges the conventional view of CEE states as passive policy-takers and highlights the co-productive nature of global–domestic policy interaction. The study contributes to a more nuanced understanding of how soft governance operates in social policymaking and how even weak states exercise strategic agency within asymmetric global governance structures.