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The existing literature on regime complexity has generally focused on its impact on the behavior of states; in contrast, this article explores its implications for international organizations. Many organizations within the UN system were established in the aftermath of World War II, at a time when they held a de facto monopoly in a given policy field. Gradually, however, institutional proliferation has created a range of institutional overlaps that may have complementary or competitive relationships to the referent organization of the original regime. Developing the concept of challenged institutions, this article explores how international organizations are affected by and strategically respond to growing institutional competition. Through a case study of the Office of the UN High Commissioner for Refugees' response to an increasingly competitive institutional environment, it argues that the concept of challenged institutions highlights the dilemmas faced by multilateral organizations in a rapidly changing landscape of global governance.

This article looks at regime complexes from a state policymaking perspective. It develops a theoretical model in which regime complexes become denser over time while governmental policymaking becomes more coherent. Under this model, interactions between global regime complexes and national policymaking are twofold. On the one hand, greater policy coherence generates negotiated mandates asking for regime connections and complex density. On the other hand, regime-complex density creates more cohesive audiences, which increase incentives for national policy coherence. This co-adjustments model brings states into the discussion of institutional interactions and critically questions the desirability and feasibility of recent calls for joined-up government and whole-of-government approaches.

(1) Background: Older patients frequently require dosing aids, such as multi-dose medication dispensing (MMD) when they experience medication regimen complexity (MRC) with increased drug use. However, the evaluations of the efficacy of MMD alterations remain limited. (2) Methods: A total of 1120 patients were included in the study who were discharged from hospital during the study period of January to March 2019. The Medication Regimen Complexity Index (MRCI) score, a validated 65-item tool in Korea (MRCI-K), was used to quantify MRC. The original MRCI-K scores, representing the typical administration based on prescription information, were compared to recalculated MRCI-K scores measured following MMD during the hospital dispensing period. Differences in MRCI-K across the top four wards based on the numbers of discharge prescription medications were assessed, and the overall scores were categorized into quartiles to identify MMD’s impact within each group. We confirmed the effect of MMD based on the patient’s admission diagnosis depending on MRCI. (3) Results: The mean (standard deviation) of original MRCI scores was 26.2 (13.4), which decreased to 18.9 (8.8) after applying MMD. The decrease in MRCI scores after MMD was statistically significant in all four wards, with the Orthopedic Surgery ward showing the biggest decrease. The patients with MRCI scores in the highest quartile group demonstrated the greatest improvement as a result of the implementation of MMD. Respiratory diseases exhibited the highest baseline MRCI scores due to formulation complexity, and ear, nose, and throat patients demonstrated the most significant reduction in MRC after MMD, depending on the diagnostic criteria at administration. (4) Conclusions: We confirmed the reduction in MRC after applying MMD, as a significant decrease in MRCI-K scores. This study highlights the need to deliver effective pharmacist-led services to identify patients who would benefit from MMD.

Understanding the impact of regime complexes on global governance calls for creative policy thinking. This introduction provides a new and more precise definition of the concept of regime complex. It also suggests specific tools to characterize regime complexes and analyze their impacts on global governance. The articles in this issue deepen the analytical understanding of complexes by examining concrete examples in various domains of global governance such as piracy, taxation, energy, food security, emissions reduction, carbon sinks, biosafety, and refugee governance. In addition to providing an in-depth description of a variety of different regime complexes, this issue is innovative on three accounts: (1) it presents complexes as both barriers and opportunities for global governance and gives explanations for these diverse outcomes; (2) it shows how a broad spectrum of actors is necessary for understanding the creation and evolution of complexes; and (3) it qualifies former claims to the effect that only powerful actors can impact regime complexes.

Key summary points Aim To investigate the factors associated with high medication regimen complexity in older adults. Findings High complexity in older adults was associated with diabetes and asthma/Chronic Obstructive Pulmonary Disease. Message Dosing frequency and additional instructions were medication regime complexity index components that most contributed to the high complexity in medication regime of older adults in primary care. Reducing dose frequency is one strategy to simplify the medication regime complexity of older adults in primary care. Purpose Complex medication regimens are common among older adults and contribute to the occurrence of undesirable health outcomes. This study aims to investigate the factors associated with high medication regimen complexity in older people. Methods A cross-sectional study was conducted with older adults selected from two primary healthcare units. Medication regimen complexity was measured using the Brazilian version of the Medication Regimen Complexity Index. The Pearson’s Chi square test was used to analyse the individual association of each independent variable with high medication regimen complexity. The backward stepwise method was used to obtain the final multivariate logistic regression model. Results We included 227 older adults with a median age of 70 years who were mostly females (70.9%). The median total Medication Regimen Complexity Index was 20.8 for high complexity and 10.5 for patients that were not using high complexity regimens. The Medication Regimen Complexity Index section with higher median scores in both groups was dosing frequency, followed by additional instructions. High complexity was associated with diabetes (OR 5.42; p  = 0.00 2.69–10.93) and asthma/Chronic Obstructive Pulmonary Disease (OR 2.96(1.22–7.18); p  = 0.02). Conclusions Older people in primary care with diabetes and respiratory disease were most likely to have complex medication regimens. Dosing frequency and additional instructions were medication regime complexity index components that most contributed to the high complexity in medication regime of older adults.

The increasing density of international regimes has contributed to the proliferation of overlap across agreements, conflicts among international obligations, and confusion regarding what international and bilateral obligations cover an issue. This symposium examines the consequences of this “international regime complexity” for subsequent politics. What analytical insights can be gained by thinking about any single agreement as being embedded in a larger web of international rules and regimes? Karen Alter and Sophie Meunier's introductory essay defines international regime complexity and identifies the mechanisms through which it may influence the politics of international cooperation. Short contributions analyze how international regime complexity affects politics in specific issue areas: trade (Christina Davis), linkages between human rights and trade (Emilie Hafner-Burton), intellectual property (Laurence Helfer), security politics (Stephanie Hofmann), refugee politics (Alexander Betts), and election monitoring (Judith Kelley). Daniel Drezner concludes by arguing that international regime complexity may well benefit the powerful more than others.

International organizations (IOs) increasingly pool resources and expertise. Under what conditions do they pool rather than compete when their activities overlap? Drawing on elite interviews, I argue that even though many cooperation decisions are made by staff possessing high degrees of autonomy from member state principals, IOs are more likely to pool resources when their leading stakeholders are geopolitically aligned. Regardless of whether member states directly oversee the negotiation of these arrangements, staff design policies that are amenable to major stakeholders. I test this argument with regression analysis of an original data set that documents patterns of co-financing and information sharing among IOs in the development issue area. I further supplement these tests with an elite survey experiment deployed via LinkedIn to bureaucrats from various development IOs. Across the board, I find evidence consistent with my theory.

The proliferation and scope expansion of regional organizations (ROs) is one of the most prominent features in contemporary international politics. In particular, many regional economic organizations (REOs) have expanded into the security realm. This trend has often resulted in an overlap with regional security organizations (RSOs) already in place. This study sheds light on this phenomenon by identifying the conditions under which REOs trespass into the security policy domain despite the fact that preexisting RSOs already fulfill security functions. We argue that the presence of strategic rivalries is an important driver of the creation and depth of organizational overlap through scope expansion. Specifically, RSOs that include significant interstate rivalries propel a subgroup of like-minded states to advance and deepen security cooperation through their existing REOs. Using an original data set of security cooperation within economic and security ROs and a quantitative analysis, we find substantial support for this argument.

The international response to armed conflict in Africa often takes the form of a regime complex characterized by institutional proliferation, overlap, unclear hierarchies, and multiple interconnections. At the same time, the course of conflict is hardly predictable. In such an environment, how can component units (institutional fora) of a regime complex effectively govern through complexity? We explore this question by focusing on the EU as an important actor within regime complexes. Building on the regime complexity literature and complexity theory, we identify four conditions. We argue that actors who operate as resource hubs, create complementarity, support system self-organization, and practice adaptive forms of peacebuilding are best placed to manage regime complexity. Empirically we probe these assumptions in the context of the Sahelian security regime complex and the role the EU is playing in it.

Over the past decade, an increasingly sophisticated literature has sought to capture the nature, sources, and consequences of a novel empirical phenomenon in world politics: the growing complexity of global governance. However, this literature has paid only limited attention to questions of measurement, which is a prerequisite for a more comprehensive understanding of global governance complexity across space and time. In taking a first step in this direction, we make two contributions in the article. First, we propose new quantitative measures that gauge the extent of complexity in global governance, which we conceptualize as the degree to which global governance institutions overlap. Dyadic, weighted, directed-dyadic, and monadic measures enable a multifaceted understanding of this important development in world politics. Second, we illustrate these measures by applying them to an updated version of the most comprehensive data set on the design of intergovernmental organizations (IGOs): the Measure of International Authority (MIA). This allows us to identify cross-sectional and temporal patterns in the extent to which important IGOs, which tend to form the core of sprawling regime complexes in many issue areas, overlap. We conclude by outlining notable implications for, and potential applications of, our measures for research on institutional design and evolution, legitimacy, and legitimation, as well as effectiveness and performance. This discussion underscores the utility of the proposed measures, as both dependent and independent variables, to researchers examining the sources and consequences of institutional overlap in global governance and beyond.