Blockchain Papers

Stephen Kaduuli

No abstract is available for this record.

Sebastian Faust, Emilia Käsper, Stefan Lucks

We present an efficient simultaneous broadcast protocol ν-SimCast that allows n players to announce independently chosen values, even if up to t < n players are corrupt. Independence is guaranteed in the partially syn-2 chronous communication model, where communication is structured into rounds, while each round is asynchronous. The ν-SimCast protocol is more efficient than previous constructions. For repeated executions, we reduce the communication and computation complexity by a factor O(n). Combined with a deterministic extractor, ν-SimCast provides a particularly efficient solution for distributed coin-flipping. The protocol does not require any zero-knowledge proofs and is shown to be secure in the standard model under the Decisional Diffie Hellman assumption.

Benjamin Lünenbürger

River floods can be very damaging. Since numerous human responses to floods are possible, the question arises: What is the organization of flood management that leads to the most efficient results? The dissertation first considers flooding and flood management in Germany. Based on that analysis, a theoretical, political-economy model of public flood defense is developed. The basic model is then extended to allow migration between upstream and downstream regions as well as between flood-prone areas and zones without risk. As different flood protection measures have quite different spatial characteristics, the distribution of responsibilities between the different actors is decisive for the overall performance of flood management. The distribution of public responsibilities among the different federal actors is crucial for two reasons. First, there are unidirectional upstream-downstream spillovers that raise the question whether decentralized or centralized provision of public goods is more efficient. Second, benefits from flood protection are concentrated to flood-prone areas near rivers. This concentration creates a natural heterogeneity of preferences for flood defense. These two aspects are also relevant for other issues in water management. Unidirectional spillovers and spatially heterogeneous preferences for public goods challenge the federal organization of flood defense. Following the lead of recent political-economy contributions to fiscal federalism, both aspects are investigated in a two region model with majority voting. Four different decision-making structures are compared: classical decentralization or centralization (based on jurisdictions containing voters both with and without preferences for the public good) and decentralized or centralized single issue authorities (whose jurisdictions, by definition, contain only high preference voters). Decentralized jurisdictions separate upstream and downstream voters, whereas a centralized jurisdiction comprises both groups. It turns out that centralized jurisdictions lead to a very low public good surplus and that either classical decentralization or decentralized single issue authorities achieve the best results under most conditions. The centralized provision of public goods is flawed because there is either an extreme over- or an extreme under-provision of the downstream public good. This can, however, be mitigated if there is a common standard for flood protection or if only the upstream provision of the public good is centralized. Whether or not these two solutions are beneficial depends on the magnitude of spillovers and also on the voting majorities in the two regions. Expanding the model to consider migration led to more complex results. First, citizens can migrate to flood-prone areas. Such migration flows can be induced by too large public flood defense, which is favored if citizens outside of flood-prone areas also finance the public good. Second, migration flow is also influenced by spillovers. The socially efficient population distribution is U-shaped with respect to spillovers. With symmetry assumptions, negative as well as positive unidirectional spillovers favour larger downstream populations. With myopic voters that neglect migration flow, this pattern is not achieved and the downstream population is large for positive spillovers and small for negative spillovers. Centralized jurisdictions are preferable to decentralized ones for smaller spillover effects if migration is possible. This argument is even stronger if voters take migration responses to the provision of public goods into account. The results shed light not only on the federal organization of flood management, but also on the institutional difficulties that arise from the current policy paradigm of the river basin approach to water management.

Tracey Logan

No abstract is available for this record.

Dennis Hofheinz

The selective decommitment problem can be described as follows: assume an adversary receives a number of commitments and then may request openings of, say, half of them. Do the unopened commitments remain secure? Although this question arose more than twenty years ago, no satisfactory answer could be presented so far. We answer the question in several ways: 1. If simulation-based security is desired (i.e., if we demand that the adversary's output can be simulated by a machine that does not see the unopened commitments), then security is not achievable for non-interactive or perfectly binding commitment schemes via black-box reductions to standard cryptographic assumptions. However, we show how to achieve security in this sense with interaction and a non-black-box reduction to one-way permutations. 2. If only indistinguishability of the unopened commitments from random commitments is desired, then security is not achievable for (interactive or non-interactive) perfectly binding commitment schemes, via black-box reductions to standard cryptographic assumptions. However, any statistically hiding scheme does achieve security in this sense. Our results give an almost complete picture when and how security under selective openings can be achieved. Applications of our results include: • Essentially, an encryption scheme must be non-committing in order to achieve provable security against an adaptive adversary. • When implemented with our secure commitment scheme, the interactive proof for graph 3-coloring due to Goldreich et al. becomes zero-knowledge under parallel composition. On the technical side, we develop a technique to show very general impossibility results for black-box proofs.

Per J. Agrell, Jérôme Pouyet

This paper covers network investment problems under decentralized control of regulation, infrastructure ownership and management. The model features two countries managing domestic infrastructures, used simultaneously for downstream international service provision. Initially, the welfare losses from non-cooperative investment financing policy and access pricing are derived. The impact of strategic interaction between the countries' access prices on the choice of financing policy is investigated. Under strict budget balancing, there are no incentives for efficiency improving investments. Further, investment coordination is shown useless in the absence of regulatory coordination. Illustrations from European network regulation policy for energy and rail are presented.

Ellen Sarquah

The Government of Ghana introduced the decentralization concept in 1988 as part of hereffort/determination to make local government administration autonomous in Ghana. Themain aim of the concept was to make the people at the grassroots part of the decision makingprocess with the view to ensuring total socio-economic transformation of the country. Untilthen, decentralization was not a new phenomenon in the politics of Ghana, however, it hassince 1988, assumed a new dimension. New structures and institutions such as the NationalDevelopment Planning Commission (NDPC), and the District Assemblies Common Fund(DACF) were established by law. These structures and institutions sought to transfer means,skills, power and competence to the districts. The DACF is believed to be the majorinnovation under the reform. The fund, which constitutes five percent of the National Income(NI), is disbursed by the central government to the districts through the Office of the CommonFund Administrator. In addition, each DA is required to generate revenues from local sourcesreferred to as Internally Generated Fund (IGF) to supplement the DACF to carry out socioeconomicdevelopment of the local areas.It is against this background that, this study was carried out to describe and explain theimplementation process of the Fiscal Decentralization Policy in the Akuapem South Districtof Ghana. The study set out to describe the assumption that inadequate bureaucratic resources,lack of political resources, poor economic and social resource and lack of inter-governmentalcommunication and enforcement agency may impede effective implementation of the fiscaldecentralization policy in the district. The Mixed method approach of social science researchand a case study approach were used in the study. Interviews and questionnaires were used tosolicit data for the study.The research found out among things that the fiscal decentralization policy is underway.However, the ability and capabilities of the DAs implement the policy is affected by variousseveral factors namely bureaucratic resource such as technical, managerial and financialresource; political resource which implies the acceptance by the bureaucrats of the policy;economic and social resource such as the social condition prevailing at the time of theimplementation; and the inter-organizational communication and enforcement agencieswhich refers to the relationship between the policy makers and the implementers. The studyconcludes that for effective implementation of fiscal decentralization in Ghana there is theneed to provide the necessary resources intended for the policy.2The study seeks to investigate the implementation of the fiscal decentralization policy in theAkuapem South District of Ghana. It aims to highlight some of the challenges confrontingthe district in the implementation of the policy and the strategies being employed to meetthese challenges.

Federica Paci, Elisa Bertino, Sam Kerr, Aaron Lint · 6 authors

No abstract is available for this record.

Adenilda Maria Siqueira de Andrade, Alberice Maria Mendes, Cristiane S. Miguel Cabral de Vasconcelos, Maria Eliza da Mota Reinaux Paes Barreto

O Brasil vem redefinindo o perfil do seu sistema de saúde, reformulando papéis e funções de saúde pública na tentativa de construir responsabilidades locais. Este panorama originou um novo arranjo para o sistema municipal de saúde no qual busca-se a integralidade das ações de saúde a partir da dinâmica do financiamento. Trata-se de um estudo descritivo de base bibliográfica e documental. O estudo apresenta uma revisão sobre o processo da descentralização administrativa/financeira na saúde, sua repercussão no fortalecimento da atenção básica tendo a estratégia saúde da família como elemento propulsor da forte expansão observada nesse componente da atenção à saúde, bem como as conseqüências da descentralização na gestão dos trabalhadores de saúde. Discute o papel das Normas Operacionais do SUS, em especial da Norma Operacional Básica - NOB/96 com a implantação do Piso da Atenção Básica (PAB) como referencial para a ampliação dos investimentos na atenção básica, o papel relevante da Lei de Responsabilidade Fiscal que além de impor limites aos gastos, também estabelece diretrizes para a elaboração, execução e avaliação do orçamento público, e o Pacto pela Saúde firmado entre as três esferas de governo com a atenção voltada para os princípios e diretrizes articulados e integrados nos Pactos pela Vida, em Defesa do SUS e de Gestão. Destaca-se o forte papel indutor do nível federal de gestão do SUS, que através de mecanismos de financiamento reordena as ações e serviços de saúde no nível local

Jay D. Aronson

No abstract is available for this record.

Sonia Esteban Laleona, Pablo de Frutos Madrazo, María José Prieto Jano

Traditionally, the academic debates about the benefits that the existence of multilevel government structures provide have been directly related to the gains in efficiency that derive from the processes of decentralization of the Public Sector. However, as of the last decades, the Public Finance has broadened its analysis towards other questions, one of them being if the fiscal decentralization influences positively in the economic growth of a country. The objective of this document is to provide a "reading guide" for this new line of investigation on the influence of fiscal decentralization on regional economic growth.

Anwar Shah

The book is divided into two parts. The
\n first part macro federalism provides a fresh look at
\n emerging constitutional challenges arising from
\n globalization and the information revolution, as well as the
\n dynamic-efficiency and growth implications of existing
\n federal constitutions. Several aspects of these systems are
\n examined: (a) institutional design to achieve internal
\n economic union; (b) policies for regional development; (c)
\n conduct of monetary policy; (d) coordination of fiscal
\n policies, with a special emphasis on tax harmonization; and
\n (e) management of risks of insolvency from sub-national
\n borrowing. The second part of the book local finance
\n provides a comparative perspective on local finances and
\n measures the progress of decentralized governance reforms in
\n developing countries.

Charisma Malixi

This study proceeds from the obvious assumption that without revenue powers and expendi-ture autonomy any devolution of functions on local governments remains hollow. Without resources local self-government is an exercise without much scope for decision-making. But even if local governments do have adequate revenue powers, their fiscal autonomy may be curtailed by utterly restrictive and, often Byzantine, administrative regulations of the central state, erratic interventions by the central government and – for fear of being not returned to office in future elections - a lack of will among local leaders to utilize the revenue powers vested in local authorities. 
<br>\tAlthough there is a plethora of literature on decentralization in the Philippines, the literature reflects what Linn,48 Smoke,49 and Smoke, Martinez-Vasquez and Peterson 50 have deplored elsewhere in relation to fiscal decentralization in more general terms: there is not much systematic research on how the Local Government Code of 1991 affected the fiscal capabilities of local governments. Most of the decentralization literature stands in the tradi-tion of the old institutionalism 51 and thus strongly centers on legal-institutional aspects and the historical evolution of decentralization in the Philippines. The few serious studies are by now dated 52 or are difficult to access because they are studies commissioned by bilateral and multilateral donor organizations.53 
<br>\tThe main objective of this study is thus to explore as to what extent in the Philip-pines the devolution of functions has been accompanied by an adequate allocation of re-sources to local governments. Local fiscal capacities are thus considered as the litmus test for the success of decentralization reforms in the Philippines. 
<br>This dissertation is organized into five parts. Chapter 1 discusses the theoretical foun-dation of decentralization as well as the study’s significance, scope and limitations, and methodology. In particular, the theoretical foundation lays down the debate between centrali-zation and decentralization as well as the differing contexts – political and economic - of de-centralization. The research question and the study’s possible contribution were also ex-plained in this chapter.
<br>Chapter 2 describes the Philippines’ political-legal structure and its local government system. It also briefly outlines the major changes brought about by the Local Government Code of 1991, the most extensive reform legislation on local governments in the country’s history. 
<br>Chapter 3 presents the overall or macro-view of decentralization in the Philippines. First, decentralization and local autonomy were explained using the Local Government Code of 1991 wherein the new Code became a catalyst to personnel, functional and fiscal decen-tralization. Second, the local financing structure was described by presenting the trends and dynamics between the central and local governments in obtaining the consolidated LGU in-come and expenditures from 1985 (pre-LGC of 1991) until 2001 (after the passage of the LGC of 1991). Third, the Local Government Code and the LGU Performance were evaluated using the results of the Local Productivity and Performance Measurement System (LPPMS) as a self-assessment tool. 
<br>Chapter 4 presents the case studies in Bataan and Pampanga on fund sourcing as well as the performance of the Central Luzon Region in local fiscal administration. The case studies will show the experiences of the provinces, cities and municipalities in resource mobilization under the regime of decentralization. This Chapter will also show the impact of inflation or increase in prices in the increase in income on whether the inflation to increase in income leads to real growth in a particular locality. 
<br>Chapter 5 provides an analysis of the results and observations of the study.

Sara Biancini

We consider the regulation of national firms in a common market. Regulators can influence the production of national firms but they incur in a positive cost of public funds. First, we show that market integration is welfare improving if and only if the efficiency gains compensate for the negative public finance effect (related to business stealing). We also show that supranational competition can have very different consequences on the rent seeking behaviour of firms, depending on cost correlation and ex-ante technological risk. Finally, we characterize the global optimum and show how it can be sustained in a decentralized bargaining solution.

Cosmas Ambe, Minga Negash

No abstract is available for this record.

Irem Aktug

Modern computing platforms strive to support mobile code without putting system security at stake. These platforms can be viewed as open systems, as the mobile code adds new components to the running system. Establishing that such platforms function correctly can be divided into two steps. First, it is shown that the system functions correctly regardless of the mobile components that join it, provided that they satisfy certain assumptions. These assumptions can, for instance, restrict the behavior of the component to ensure that the security policy of the platform is not violated. Second, the mobile component is checked to satisfy its assumptions, before it is allowed to join the system. This thesis presents algorithmic verification techniques to support this methodology. In the first two parts, we present techniques for the verification of open systems relative to the given component assumptions. In the third part, a technique for the quick certification of mobile code is presented for the case where a particular type of program rewriting is used as a means of enforcing the component assumptions.In the first part of this study, we present a framework for the verification of open systems based on explicit state space representation. We propose Extended Modal Transition Systems (EMTS) as a suitable structure for representing the state space of open systems when assumptions on components are written in the modal μ-calculus. EMTSs are based on the Modal Transition Systems (MTS) of Larsen and provide a formalism for graphical specification and facilitate a thorough understanding of the system by visualization. In interactive verification, this state space representation enables proof reuse and aids the user guiding the verification process. We present a construction of state space representations from process algebraic open system descriptions based on a maximal model construction for the modal μ-calculus. The construction is sound and complete for systems with a single unknown component and sound for those without dynamic process reation. We also suggest a tableau-based proof system for establishing temporal properties of open systems represented as EMTS. The proof system is sound in general and complete for prime formulae.The problem of open system correctness also arises in compositional verification, where the problem of showing a global property of a system is reduced to showing local properties of components. In the second part, we extend an existing compositional verification framework for Java bytecode programs. The framework employs control flow graphs with procedures to model component implementations and open systems for the purpose of checking control-flow properties. We generalize these models to capture exceptional and multi-threaded behavior. The resulting control flow graphs are specifically tailored to support the compositional verification principle; however, they are sufficiently intuitive and standard to be useful on their own. We describe how the models can be extracted from program code and give preliminary experimental results for our implementation of the extraction of control flow graphs with exceptions. We also discuss further tool support and practical applications of the method.In the third part of the thesis, we develop a technique for the certification of safe mobile code, by adapting the proof-carrying code scheme of Necula to the case of security policies expressed as security automata. In particular, we describe how proofs of policy compliance can be automatically generated for programs that include a monitor for the desired policy. A monitor is an entity that observes the execution of a program and terminates the program if a violation to the property is about to occur. One way to implement such a monitor is by rewriting the program to make it self-monitoring. Given a property, we characterize self-monitoring of Java bytecode programs for this property by an annotation scheme with annotations in the style of Floyd-Hoare logics. The annotations generated by this scheme can be extended in a straightforward way to form a correctness proof in the sense of axiomatic semantics of programs. The proof generated in this manner essentially establishes that the program satisfies the property because it contains a monitor for it. The annotations that comprise the proofs are simple and efficiently checkable, thus facilitate certification of mobile code on devices with restricted computing power such as mobile phones.

Chen Su, Tiejian Luo, Wei Liu, Jinliang Song · 5 authors

In an e-Science environment, large-scale distributed resources in autonomous domains are aggregated by unified collaborative platforms to support scientific research across organizational boundaries. In order to enhance the scalability of access management, an integrated approach for decentralizing the task from resource owners to administrators on the platform is needed. We propose an extensible access management framework to meet this requirement by supporting an administrative delegation policy. This feature allows administrators on the platform to make new policies based on the original policies made by resources owners. An access protocol that merges SAML and XACML is also included in the framework. It defines how distributed parties operate with each other to make decentralized authorization decisions.

M. van Someren, Vera Hollink

🥇 ProtectedPool ➤ Web3 Smart DeFi Wallet 🔐 . Your New DeFi Experience:: 🔐 Secure, Smart, Simple. Double Approvals. Add extra confirmation of any transaction with 2FA solutions including Google Authenticator or hardware security keys. Self-custodial Solutions. Protected Pool is built on smart contracts that interact with wallets, not persons or companies. A new wallet - a new smart-contract. Zero Trust Protocol. No one can be trusted unless verified. Your wallet is the only way to get access to your funds.

Jan Camenisch, Rafik Chaabouni, Abhi Shelat

No abstract is available for this record.

Burton E. Swanson, Krishna M. Singh, Mala Narang Reddy

No abstract is available for this record.

Melissa Chase

Non-interactive zero-knowledge (NIZK) proofs can be an extremely powerful tool, allowing one to prove a statement in a single message without revealing any information besides the truth of the statement. Blum et al. showed that NIZK proof systems exist for all languages in NP. However, in practice, NIZK proofs are rarely used, because existing protocols are extremely inefficient. Here we examine some useful languages for which we can give efficient proof system. We define two useful building blocks: one for proving that a message has been signed, and a second for proving that a value has been chosen according to a pseudorandom function. We give applications of these building blocks to anonymous credential systems, to electronic cash, and to the design of other efficient NIZK proofs systems.

Anna Fabiańska, Alban Quadrat

The purpose of this paper is to give four new applications of the Quillen-Suslin theorem to mathematical systems theory. Using a constructive version of the Quillen-Suslin theorem, also known as Serre's conjecture, we show how to effectively compute flat outputs and injective parametrizations of flat multidimensional linear systems. We prove that a flat multidimensional linear system is algebraically equivalent to the controllable 1-D dimensional linear systems obtained by setting all but one functional operator to zero in the polynomial matrix defining the system. In particular, we show that a flat ordinary differential time-delay linear system is algebraically equivalent to the corresponding ordinary differential system without delay, i.e., the controllable ordinary differential linear system obtained by setting all the delay amplitudes to zero. We also give a constructive proof of a generalization of Serre's conjecture known as Lin-Bose's conjecture. Moreover, we show how to constructively compute (weakly) left-/right-/doubly coprime factorizations of rational transfer matrices over a commutative polynomial ring. The Quillen-Suslin theorem also plays a central part in the so-called decomposition problem of linear functional systems studied in the literature of symbolic computation. In particular, we show how the basis computation of certain free modules, coming from projectors of the endomorphism ring of the module associated with the system, allows us to obtain unimodular matrices which transform the system matrix into an equivalent block-triangular or a block-diagonal form. Finally, we demonstrate the package QuillenSuslin which, to our knowledge, contains the first implementation of the Quillen-Suslin theorem in a computer algebra system as well as the different algorithms developed in the paper.

Sandra Krtalić, Alessandro Gasparini

Most modern countries, whether they are unitary or federal, have several levels of territorial government as one of the imperatives of the modern organization of the state, operating in order to meet the most disparate needs encountered at lower levels of government.Different countries have different levels of government, and each of them a different hierarchy of public administration bodies where citizens decide on the offer of public services and their financing through elections.While the role of the central level of government is today in the creation of a national infrastructure and development of a better qualified workforce in order to make the state competitive internationally, the importance of the local government is before all in the creation of the entrepreneurial infrastructure, transport and communications.Therefore, it becomes clear that lower levels of government have an increasingly important role in the development of the country so that a growing number of countries worldwide are implementing reforms in the area of fiscal decentralization.Nevertheless, although desirable, fiscal decentralization is not an easy task for any state.There are numerous problems and obstacles in that process, which influence the decision on decentralization, fiscal smoothing and the issue of state intervention.

Richard B. Saltman

A major shift appears to be underway in Europe in the relationship between national, regional, and local control over health sector decision-making. Since World War II, a central thrust of health policy has been to decentralize key dimensions of decision-making authority to increasingly lower levels of government, as well as (in Social Health Insurance systems and recently in some tax-based systems) to private sector organizations.1 This strategy, to adapt Kondratiev's business-cycle framework,2 has been one of two overlapping ‘long waves’ that helped frame structural decisions in most Western European health systems. The second wave—market-influenced-entrepreneurialism—has run simultaneously with decentralization since the late 1980s. However, while this second, market-oriented wave has generated considerable controversy in some health policy circles, the concept of decentralization was readily accepted in many national policy contexts. As a result, over the second half of the 20th century, expanded decentralization of authority to regional, municipal and non-governmental control has become part of the ‘received wisdom’ about what good health policy should include. In the tax-funded health systems in Nordic countries, for example, most administrative and managerial responsibility as well as substantial political (policy) and fiscal decision-making control has been decentralized inside the public sector: from national to regional level (somatic hospitals in Norway in 1970; mental hospitals in Sweden in 1967), from regional to municipal level (elderly residential care in Sweden in 1992), and from national to municipal level (effective decision-making control over central hospitals in Finland in 1993). In the tax-funded health systems in Southern Europe, most administrative and managerial as well as many political (but not key fiscal) responsibilities were devolved from national to regional governments in Spain (to the 17 autonomous communities from 1981 to 2003), and in Italy (to 22 regional governments starting in the late 1980s). In social health insurance funded countries in continental Europe such as Germany and the Netherlands, most administrative and managerial as well as many fiscal (but not key political) decisions have long been delegated to private not-for-profit bodies (sickness funds and hospitals), under a form of ‘enforced self-regulation’ grounded in explicit national statutory responsibilities.3 In many cases, this particular form of decentralization has been in place since those systems’ inception. In the more state-based social insurance systems that have emerged since 1990 in many Central European countries, various forms of decentralization have been utilized. Reacting strongly to the prior highly centralized Semashko model, countries decentralized ownership of hospitals from national to regional (Hungary) and local (Estonia, Poland) governments. The Czech Republic even termed its decentralization of hospital ownership to municipal governments as ‘privatization’. In similar fashion, centralized funding structures of the Communist period were decentralized into regional social health insurance funds in countries such as Poland, the Czech Republic and Slovakia. The strategic role of decentralization was further strengthened by changes in overall governmental structures in Europe. During the 1980s and 1990s, national governments increasingly ceded areas of sovereign power upward to European Union bodies, while at the same time that they were losing responsibilities downward to increasingly assertive regions—a process captured by the popular 1990s discussion about a ‘Europe of Regions’. This overall reduction in the role of national governments served to reinforce the health sector experience that the era of centralized power at the national level in Europe was fast receding. In the first years of the 21st century, however, this conventional wisdom has started to come undone. Far from continuing to recede, the role of the state in the health sector has begun to strengthen measurably. Instead of reinforcing the continued decentralization of authority away from national governments, state institutions have reversed course and are seizing responsibility for substantive political and fiscal decision-making in European health care systems. It now appears that in the near-term future only administrative and managerial authority—e.g. day-to-day operating decisions—will remain decentralized to lower level and/or non-governmental organizations. These counter-indications can be observed in many of the health systems noted earlier. In the tax-funded system in Norway, the national government took over political and administrative/managerial responsibility for all hospitals in the entire country in January 2002, removing control from the 19 regional governments (counties) that had previously owned and operated the public hospitals and transferring the administrative role to five newly created regional bodies appointed from Oslo. The national government also set out new rules for how these regions were to manage their hospitals—as ‘public enterprises’. Fiscal responsibility for health care remained, as before, a national responsibility. In Denmark, the national government initiated a major re-structuring of the health sector in January 2006. In the new configuration, the number of regional governments was reduced from 14 to 5, and their powers were greatly reduced. Fiscal and most political responsibilities were centralized back to the national government, with certain prevention and chronic care issues being re-allocated to the municipalities (also consolidated, from 271 to 98). At the end of these changes, the new regions retained little more than administrative and managerial responsibility for hospitals. A similar pattern of regional consolidation and a strengthening of the state role appears to be underway in Sweden and Finland. In Sweden, a royal commission is expected to recommend that the number of regional level governments (which have responsibilities for hospital and also primary care) be reduced from the current 21 to between 6 and 8. Similarly, in Finland, the national government is expected to propose that the number of central hospital districts, currently 22, be reduced to 18, and also that the number of municipalities (responsible for primary, nursing home and home care services) be reduced from 450 to about 250. In the United Kingdom, similar recentralization can be seen in the transformation of England's Regional Health Authorities from line to support functions, as well as in current plans to reduce the number of Primary Care Trusts from 300 to 150. In Ireland, key operating responsibilities were recently shifted from regional health care boards to a health executive at central level and the regional boards were abolished. A parallel, if less aggressive, thrust toward more state control over both political and fiscal decisions can also be observed in several social health insurance funded countries. In the Netherlands, the national government in 2006 changed the health system's funding structure from a sliding 50% employee/50% employee paid model to a 100% individually paid fixed premium, supplemented by social assistance funds (e.g. taxes) for low income citizens. The Dutch government also, since the late 1990s, has been ratcheting up the percentage of total expenditures for which the private not-for-profit sickness funds are at risk, forcing funds to manage their money more efficiently. In Germany, the federal government in 2009 is scheduled to take on responsibility for pooling all social health insurance contributions and then allocating them to the sickness funds on a prospective, risk adjusted, capitation basis. While this funding model has been in place in the neighboring Netherlands for many years, in Germany it would represent a major move toward centralizing fiscal responsibilities away from the private not-for-profit sickness funds and into the hands of a national government body. In Central Europe, Poland, in 2003, pulled operating control over its social health insurance system away from 17 regional funds and back into the Ministry of Health. From the perspective of national health policymakers, this process of re-centralization appears to reflect a complex set of concerns. Structurally, there is substantial worry about the aging of their populations (e.g. more elderly), the rapid growth of expensive new clinical technologies, and the economic constraints on health sector funding generated by European regionalization as well as the globalization of markets. Administratively, there is evidence in countries like Finland and Norway (also concerns in Denmark) that local control over health sector decision-making has led to increased disparities in services provided and in outcomes to vulnerable populations—in short, that decentralization has heightened equity problems. Economically, there are worries that local finance bases are insufficient to fund expensive future care needs, and that local administrative arrangements are inefficient and duplicative. Politically—an important factor in Northern European tax-funded countries—there is a sense among national politicians that they are being blamed when the health system fails to meet the expectations of the citizenry, and that national policymakers need to have the necessary organizational levers to correct these problems. Technically, the introduction of electronic medical records and other computerized reporting systems has reduced the transaction costs of information and made it feasible to more closely monitor health system performance from a central level. While many of these dilemmas with decentralization were predicted earlier in theoretical assessments,4 one can see strong elements of their concrete manifestation in the current movement toward re-centralization. Moreover, since these causal factors are long-term in nature, their recent importance lends strength to the argument that re-centralization may indeed represent a long-term structural shift in national health strategies. Several important questions arise from these examples of re-centralizaton in both tax funded as well as social health insurance funded health systems. One is whether the observed changes represent more than just the normal ebb-and-flow of policy development in European health systems, and instead signal a fundamental shift in the overall pattern of these decisions. A related question is whether political and fiscal authority will continue to migrate from regional and municipal to national government, leaving mostly administrative and managerial forms of control at the lower levels. The underlying issue here concerns the mix of national and local authority that typically exists within most European health care systems, and whether the main bias in structuring that mix might be changing from one favouring decentralizing to local governments into one that favors centralizing authority back to national governments. Posed more provocatively, one might ask whether a new “long wave” of re-centralization has now begun, pointing toward a health policy future of stronger national governments and weaker regional, local, and delegated private (SHI) institutions. There are—as Kuhn's theory about the complexities of paradigm shift would predict5—several confounding factors in arriving at satisfactory answers to these questions. One issue concerns whether a new ‘long wave’ of re-centralization can co-exist comfortably—as decentralization did—with the parallel long-wave pattern of market-influenced entrepreneurial measures, particularly in tax-funded health systems. Will re-centralization and entrepreneurialism reinforce each other, as happened previously with decentralized local units? Second, there are several exceptions to this broad pattern of increasing re-centralization across European health systems. One clear exception is in countries with serious ethnic conflicts, for example Bosnia-Herzegovina and Macedonia in the Balkans, and also in Belgium. Recent history suggests that decentralization may be essential in these highly charged political environments, in that various forms of local control are typically linked to the survival of the state itself. Another conceptually messy question concerns the pattern of continued regional decentralization of health sector decisions in Southern European countries like Italy and Spain. Regional governments in these two countries have fiercely defended their recently gained authority in the health sector, and have forced their less convinced central governments (Spain in 2003, for example) to tread carefully in designing new national programs to monitor performance or set standards for quality and outcomes. Of course, Spain and Italy both have histories of earlier regional sovereignty. Moreover, both are geographically larger and have bigger populations than Nordic countries—although they are roughly equal in size to the United Kingdom and also Poland. There is, further, within both Italian and Spanish regions a tendency toward greater internal centralization inside the regions themselves. Despite these caveats, however, it appears that Italy and Spain are pursuing greater decentralization at the same point in time that Northern European countries are shifting away from decentralization in their health systems. This brief review of recent health sector patterns raises a series of questions that do not allow for easy answers. A further complicating factor is the apparent lack of fit between continued local control over services to the elderly (home care, social assistance, also nursing home care) and increasing central control over fiscal and policy decisions in the overall health sector, which implies that re-centralization may soon confront key structural limitations. The current distribution of health sector evidence does suggest, however, that many European health systems will continue to see a tightening of state controls, especially over fiscal and quality-related matters. In this clash between national and local governments, it would appear that, on balance, democratic control at the national level will strengthen, taking increased authority over political and fiscal decisions, while democratic control at the regional and municipal level will weaken, and be increasingly focused only on administrative and managerial decisions. Moreover, given the rapid melting of public–private boundaries within many European health systems, this greater state role will likely be combined with growing public as well as private sector entrepreneurialism, despite the appearance that greater reliance on market-oriented decisions contradicts tighter state control over health system behaviour. While the particular balance between increased state controls and increased entrepreneurial initiatives will vary from country to country, this new blend of two ‘long waves’, with increasing levels of state authority over key health sector decisions, will likely define the future policymaking framework for many European health systems in the near-term future. Earlier versions of this argument were presented at the Third International Health Policy Conference in Jerusalem (December 2006) and the Annual Meeting of the European Public Health Association in Helsinki (October 2007). This version has benefited from comments made by a number of colleagues at both meetings, and especially from Josep Figueras, David Chinitz and Charles Phelps. An earlier version of this article is included in the conference proceedings of the Jerusalem meeting.