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.
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.
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.
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.
Open access
Health Systems, Economic Evaluations, Quality of Life
In an information society, wealth and power are increasingly linked to access to knowledge and control over telecommunications media. Struggles over access to digital media in particular are presenting uniquely contentious First Amendment problems. The creation of about 200 million blogs worldwide has triggered legal action and legislative reform aimed at alleged trademark infringement by bloggers and cybersquatters. Authors and publishers seek expanded rights to curtail unauthorized digital uses for which they are not being compensated, and have sued Google for digitizing and indexing tens of millions of the world's books and periodicals. Finally, Google, Yahoo!, Microsoft, and other Internet and e-commerce firms are trying to beat back plans by the nation's cable and telephone companies to finance upgrades to their networks by levying discriminatory fees on search engines, as well as on Internet content providers and aggregators. Internet users have often been on the losing side of these controversies, as the economic model increasingly adopted by the Supreme Court is that in order to reward corporations for collecting or disseminating information, its free flow in print and electronic form must often be impeded, and its cost to the user increased. This model threatens to empower broadband companies, copyright holders, and trademark owners to restrict the right of the public to utilize digital media for purposes of free speech. This Article argues that digital media such as the broadband Internet, the World Wide Web, and the blogosphere should be at least as free as the press was at the time that the First Amendment was ratified in 1791. In other words, bloggers could not be enjoined or fined for tarnishing the trademarks or goodwill of their employers or other corporations, for trademark law did not prohibit trademark dilution or other non-competitive uses in 1791. Similarly, Web sites and search engines such as Google could not be restrained from digitizing, indexing, andproviding short previews of books and periodicals, for copyright law in 1791 permitted abridgements, adaptations, reviews, and other value-added uses of copyrighted work. Finally, the cable and telephone companies would not be at liberty to levy discriminatory access fees upondigital media outlets, for their ability to monopolize local telecommunications networks is a legacy of anticompetitive state and federal exclusion of new entrants over the past century in violation of the First Amendment. The framers of the First Amendment would no more have countenanced an attempt by Congress and the federal courts to allow private entities enjoying the fruits of past official monopolies to restrain the freedom of speech over an essential facility such as the Internet than they would have endorsed the creation of a series of local book publishing or newspaper monopolies. The framers presumed that information would flow freely and cheaply to citizens and consumers, enabling them to ascertain their true interests without difficulty, and to make decisions accordingly. As Congress considered ratifying the FirstAmendment, Madison declared that by it the liberty of the press is expressly declared to be beyond the reach of this Government. The Supreme Court has construed most of the other amendments in the Bill of Rights to provide at least as much protection against infringement asexisted under the common law in 1791. Opponents of net neutrality requirements have opined that the First Amendment rights of corporate owners of telecommunications infrastructure should trump the First Amendment rights of individual speakers and users of telecommunications media. Under this view, the foremost free speech interests on the Internet are those of broadband infrastructure owners, rather than the senders and recipients of Internet speech such as Web content, blogs, eBooks, or online videos. This line of argument misconceives both the distinctive character of the Internet andthe purposes for which the First Amendment was enacted. The Internet and its principal applications such as the World Wide Web grew as rapidly as they did because they were designed to be open, flexible, and uninhibited by gatekeeper control. The high degree of concentration in the broadband market, the inability of many consumers to switch broadband carriers, and plans by broadband providers to discriminate among different sources of Internet content combine to threaten the Internet as an open, decentralized, low-cost communications platform. TheFirst Amendment is not offended by regulations designed to ensure that firms awarded local telecommunications monopolies by the government exercise their power to restrict mass communication in a manner consistent with the public interest. The overriding purpose of the FirstAmendment is to ensure that readers, listeners, and viewers of public debates obtain access to a wide variety of facts and opinions so as to be able to discern the truth as best they can. Even privileging the speaker's perspective, surely the First Amendment interests of the creators, editors, and aggregators of Web sites, blogs, and online videos - rather than the supposed speech interests of the owners of the wires along which content travels - should prevail in the event of a conflict.
BACKGROUND: The Ministry of Defense budget constitutes 16% of the state budget. The budget for the Ministry of Health and for civilian health care is derived from the state budget. The health care funds receive their budgets from several sources. The capitation formula, which is determined by law, is the main factor that affects the size of the budget each fund receives. OBJECTIVE: The objective of this study is to describe the manner of planning, managing, monitoring, and controlling the budget allocated to medical services, which is a public budget for soldiers. METHODS: Several parameters are suggested for comparison, including the interface with the civilian health system, the method for budgeting a health care system, possible results of managing a medically centered budget, and the possibilities for monitoring the provided services. We also examine the potential for decentralization of authority. CONCLUSIONS: Managing the budget and locating appropriate alternatives, as well as the availability and accessibility of medical services, are important for procurement and for forming contracts with both military and civilian systems. Turnover based on updated information might serve to improve future health services.
Elmer S. Soriano, David M. Dror, Erwin Gaspar A. Alampay, Jolande
A sustainable health reinsurance system can be fashioned for the informal sector by mobilizing social and economic forces operating within individual communities. The economic analysis in part 1 of this book draws conclusions from success stories in industrial countries and failures in low- and medium-income countries. This analysis leads to the premise that decentralized development of microinsurance units, operating in a market segment left out by for-profit health insurance firms and by national schemes, can be stabilized financially through their affiliation with a reinsurance facility-Social Re' (part 1, this volume; Dror and Duru 2000, pp. 30-40; Dror 2001). Dror, Preker, and Jakab, in chapter 2 of this book, explain how the sociological dimension would theoretically affect the performance of a microinsurer. Findings of the Institute of Medicine reaffirm the active interplay of biology, psychology, behavior, and society in determining people's health attitudes. The institute further reports that, although people's attitudes and actions can readily be altered, these changes need support and reinforcement over time to guarantee better health. Attitudinal and behavioral changes are best prolonged through interventions at multiple levels, from the individual to society at large (Institute of Medicine 2001, pp. 1-1-1-8). Efforts are required to address the psychosocial factors that influence health status, including, for example, proposing measures such as microinsurance to persuade individuals to accept a healthy way of life and permanently modify their health behavior. Microinsurance schemes provide individuals, households, and communities mechanisms for financing their health through group risk-pooling mechanisms, leading to a sustained improvement in their access to health services. Higher up on the social scale, well-evaluated interventions at the organizational level should be encouraged, giving credit to organizations' vital role in influencing individual behavioL Still farther up the scale, community involvement in health-promotion strategies should not be overlooked, because some disease-related factors that are beyond an individual's capacity to modify can be significantly minimized through community efforts. Community empowerment, social support, and other values that protect members from stress are strengthened through community-level interventions. Finally, interventions at the societal level recognize the role of collective organizations influencing individuals' everyday existence (Institute of Medicine 2001, pp. 1-1-1-8). Underlying assumptions are that members' affiliation with microinsurers is voluntary (individuals can join, stay enrolled, or withdraw at will) and that microinsurers will voluntarily join Social Re. A clue is therefore needed about the considerations that shape individual and collective choices. According to one opinion, The underlying economic motivation for joining a microinsurance unit is assumed to be a desire to seek reciprocity in sustaining risk-sharing arrangements among essentially self-interested individuals (Dror and jacquier 1999, p. 79). This assumption implies that joining a microinsurance unit (and Social Re) is a predictable, rational economic choice by self-interested individuals to maximize total utility (optimal choice theory), and an act of reciprocity, in which giving and getting are somehow linked. According to the utility motive, people will join if they can benefit from joining. However, considering that many people will pay a health insurance premium without getting any cash benefits (if they stay healthy), is it really clear what each individual would consider as his or her exact utility from being insured? As Herrnstein points out, because utility cannot be directly observed, it must be inferred from behavior, from the choices individuals make. Thus, utility is synonymous with the modem concept of reinforcement in behavioral psychology (Herrnstein 1997, p. 226). Dror and Jacquier mention a second motive for joining a microinsurance unit: people's desire to improve their health by controlling their living and working conditions. This control is linked to a deep-rooted human need to seek voluntary and repeated interaction with others in daily life (Dror and Jacquier 1999, p. 80). These interactions may provide material reciprocity or they may reflect altruistic, nonmaterial interactions. The three authors mentioned above suggest that, to understand how microinsurers can attract and retain their clients, they have to know what shapes their clients' behavior in their specific operating context. The same reasoning applies to a microinsurer's decision to affiliate with Social Re. Since Social Re will be piloted in the Philippines, this examination will be done with reference to that country and culture. The rest of this chapter will provide an overview of the social and institutional structure of Philippine rural and informal society and the attitudes toward solidarity, risk, and insurance that influence choices and help shape the role of microinsurance. This role is quite different from what could be conjured from classical economic theory on utility, as will be shown. This analysis leads to the conclusion that in the rural Philippines, the introduction of insurance and reinsurance hinges as much, perhaps more, on the structure of society than on the profile of risks and the existence of a market for insurance.
This study examined the current decentralized system in Indonesia for increased disparities in educational expenditures across districts. It also examined the impact of these on the quality of education at public junior secondary education. The study used the most recently available data from the Ministry of National Education (MONE) and Central Bureau of Statistics (BPS) covering 1999/00 and 2002/03. These data measured district level school expenditures, demographic and socio-economic variables.The study found that the current decentralized system in Indonesia increased fiscal capacities for education at districts. Unfortunately, increases in the fiscal capacities for education led to increased disparities in education expenditures per student, creating growing gaps in fiscal capacities for education across districts. Districts which received larger general allocation funds (DAU) per capita were also more likely to allocate more funding for education, whether or not they were poor or wealthy districts. This fact was reflected by the finding that district GRDP per capita in sub-national regions of Java-Bali and Sumatera had no impact on districts' education expenditures per student. In addition, the sub-provincial districts of the Kota (more urban) and Kabupaten (less urban) also differed in the way that they allocated funding for education. The Kota in the Sumatera region tended to allocate significantly more for education than did the Kabupaten. At the same time, the Kota in Java-Bali did not allocate significantly more for education than the Kabupaten. Teacher compensation was national, so funding variance was measured by locally controlled variables. The most significant impact on student achievement were teaching and learning process expenditures (textbooks, libraries, labs, field trips, etc.). The study concluded that increased funding, combined with more efficient budget allocations, were keys to quality improvement. Policy recommendations include: a) targeting DAU transfers to reduce the gaps in fiscal capacity for education across districts; b) rewarding districts with effective budget allocations that support improved student achievement; and c) placing education closer to the center of development and security policy. Better government monitoring and district transparency is needed for this major investment. Improved policy research and reporting capacities are needed, including annual reports on decentralization policy implementation.
Albert J. Jovell, Robert J. Blendon, María Dolors Navarro, Channtal Fleischfresser · 7 authors
BACKGROUND: Fifteen years ago, public opinion surveys in Spain showed substantial dissatisfaction with the health-care system. Since that time, health-care in Spain has undergone significant changes, including a decentralization of the system, an increase in spending and a change in the way the system is financed. OBJECTIVE: This study examines how Spanish citizens rate the performance of their health system today, both as compared with other sectors of society and as compared with earlier time periods. METHODS: Data are drawn from nationally representative telephone surveys of the non-institutionalized adult Spanish population (age 18 years and over). The study was carried out in two phases: October-November 2005 (n = 3,010) and January 2006 (n = 2,101). RESULTS: The majority of the Spanish population thinks the health system needs to be changed. The problems cited relate mostly to long wait times to get health-care. Nevertheless, over the last 15 years, the proportion of people who have very negative views about the health system has decreased by half. The majority believes that not enough money is spent on health-care, but few people would support an increase in taxes to provide additional funding. The survey finds the National Health System's institutions and health professionals to be more highly trusted than other institutions and professional groups in the country. CONCLUSIONS: Government policy-makers in Spain face a dilemma: the public wants more health spending to decrease wait times, but there is substantial resistance to increasing taxes as a means to finance improvements in the system's capacity.
This paper analyzes the policy model of the Brazilian Ministry of Health from 1990 to 2002. The methodology included interviews with key actors in the national health policy, document review, and analysis of the Federal budget and official databases. The Brazilian Ministry of Health underwent major changes under the influence of the health reform agenda and the liberal State reform agenda prevailing in the 1990s, shaped by two movements: institutional unification of national policy control and political/administrative decentralization. The Federal role was diminished in terms of direct services provision, and there were changes in financing and regulation. The model in the late 1990s featured strong Federal induction of States and municipalities and the adoption of market regulation strategies. There is no record of a long-term planning effort, which favors distortions in the Federal intervention model and hinders solutions to structural problems in the Brazilian health system.
“Front-loading” primaries and caucuses - the movement of state delegate selection contests to the beginning of the nomination calendar - is problematic for the integrity of the presidential nominating system. Because it results from decentralized decision making by self-interested states, front-loading also poses a problem for federalism. Indeed, most proposed remedies for front-loading would impinge on federalism in some manner. In analyzing those remedies, one must assess their interaction with federalism both procedurally and substantively. For example, a federally imposed national primary would be harmful to federalism on both dimensions; regional primaries negotiated among states would be best for federalism procedurally but are of dubious efficacy; the national parties have an ambiguous relationship to federalism; and a change in federal campaign finance rules would seek to combine a centralized process with a decentralized result. The best solution might be to use available central levers to try to change campaign dynamics and thus the incentives for states to schedule their primaries early.
This thesis examines the Brazilian municipalism after the Constitution of 1988. It verifies the municipalities performance in the provision of local health services vis--vis the decentralization of this policy due to the creation of the SUS (Unified Health System). It argues that the process of health services decentralization developed during the 90's presented two different steps: the step of autonomist decentralization, between 1990 and 1998, when the municipalities were totally free to choose their own local health policies; and the step of the driven decentralization, after the creation of the Basic Assistance Floor -PAB, when the municipalities started receiving targeted incomes, which could be used exclusively for specific health programs, determined by the Health Department. However, as we demonstrate, the both steps were incapable to decrease the extant regional inequalities in what regards the supply, the access and the financing of municipal health services. To summarize, we demonstrate that the inequalities in health produced by our federalism were not balanced through the outline of policies that municipalized the health services.
The background of this research is the fall of the New Order Regime which occurred in 1998, followed closely behind by the creation of local autonomy policy. This policy was issued based on Law Numer 22/1999 (Local Government) and Law Numer 25/1999 (Intergovernmental Finance). Both laws have changed the local public administration from a centralized into a decentralized system and also caused reform in some components such as planning, organization, personnel, and finance. Even though Law Number 22/1999 had been implemented for four years, the reform seemed very tardy. In fact, several regions showed a progress tendency that was the reverse of the expectation. For this reason, the question that will be formulated in this research is 'Why was there a different level of performance of local public administration reform after the local autonomy implementation in Indonesia?' The conceptual framework of this research is outlined as follows: it is presumed that the performance of Local Public Administration Reform is determinedby two major independent variables that are interrelated. These are the Central Government Role Variable and the Response of Local Government and its Environment toward the Reform. The Central Government Role consists of two variables Decentralization as an Architecture Reform Variable and the Policy Reform Variable. Both major variables interrelate with some varibles at the local level such as the Mayor/Regent's Role, the Response of Bureaucrats and Politicians to Local Public Administration Reform, and the Response of Civil Society to the Reform.
Deepak Singh highlights one of the emerging approaches to global data, Freebase. Recall that at scifoo we also heard about Google's offer to host scientific data: I am attracted by Freebase/Metaweb and also DBPedia/openlink. These are technologies which build ontological-supported repositories where large amounts of metadata can be centrally stored.
The institutional environment of elementary education funding in Brazil suffered several modifications in the last decades, mainly during the 1990's. In order to join the prioritization of elementary education to the decentralization of educational public policies – leading it to local level – the federal government promoted a deep reform in the legal framework, even through constitutional amendments that became important rules for education funding. One of the major changes was the creation of the 'Elementary Education Development and Maintenance and Teachers Valorization Fund' (Fundo de Manutenção e Desenvolvimento do Ensino Fundamental e Valorização do Magistério – FUNDEF) destined to the financing of elementary education in Brazil. Despite these reforms, the situation of elementary education in Brazil is still extremely precarious: neither does it fulfills the needs of its people, nor is compatible with Brazilian State economical capacities. From the analytical standpoint, with basis on the 'New Institutional Economy' theoretical reference, the creation of earmarked revenues for education policies is considered the main financing rule for elementary education, and served to reduce several transaction costs. These costs are associated to the discontinuity of actions and to the opportunistic behavior of the players involved in the public policies’ scenario. Among these players are representatives of the executive, legislative and public powers, state bureaucracy and civil society. This thesis seeks to evaluate if this set of education financing strategies - created by earmarked revenues mainly for elementary education - is sufficient condition to achieve the efficiency required to carry out those education policies, or if other effects, linked to the strategy or not, contribute to the maintenance of inefficiencies. This thesis uses as theoretical reference the 'New Institutional Economy', which is mainly based in the works by North (1988 and 1990), Williamson (1985) and Miller (1992). This reference focuses on the central role of institutions in the evaluation of social-economical problems. Thus, the first session of the thesis aims at describing the core elements of this theory, such as the concepts of formal and informal rules, transaction costs and governance structures. Based on this initial structure, the theoretical model used in the thesis is built and can be considered as an adaptation of the New Institution Economy approach for organizations in the public sector. This model takes into consideration important elements and characteristics of institutions, players and governance structures that should be accounted for when analyzing public organizations. Under the light of this theoretical model, the institutional array developed for elementary education financing in Brazilian cities is analyzed into further detail; comprehending the institutional scenario, that is, the rules of the game, and the behavior of the players face to these rules. In order to empirically test the theoretical assumptions of this thesis, a case study is carried out in the city of São Paulo. The present thesis aims at contributing to the discussions on the necessary changes on education policies, with special emphasis in the institutional adequacy between the formal rules established to the policies and the characteristics, values and skills of the players involved in the implementation of these rules. The very institutional theory anticipates that the disregard of these factors implies the possibility of occurring transaction costs associated to public manager control costs and to the opportunistic behavior of the players involved in the public policies’ scenario. Therefore, even in the existence of earmarked revenues, the efficient conduction of public education policies will not be guarantied.
Across the broad issues of decentralized governance in the Philippines, the process of fiscal decentralization continues to require thoroughgoing analysis vis-à-vis the incessant protests against purportedly unfair distribution and use of the country’s fiscal resources. This paper analyzes the institutional framework defining the country’s intergovernmental fiscal relations that would highlight the critical role of central-local political structures in shaping fiscal decentralization. It examines how the policy standardization, resource coordination and allocation, and monitoring and evaluation in the country’s intergovernmental finance affect the distribution, generation and use of fiscal resources. Key issues noted include : 1) limited devolution of budget; 2) constrained intergovernmental fiscal transfer system (insufficient and unlawful allocation of funds; lack of transparency and exercise of discretionary powers in the use of fiscal resources); and 3) low levels of local revenue generation. These issues intersect along a contradiction of powers between the local and central government politicians which predominates in an intergovernmental fiscal structure evaluated in this study as lacking in meaningful institutionalization. The basic paradigm of this paper is based on the assumption that decentralization as a political process can best be operated within the framework of centrally-led institutionalization.
Paul Gertler, Harry Anthony Patrinos, Marta Rubio Codina
Mexico's Compensatory education programs provide extra resources to primary schools that enroll students in highly disadvantaged rural communities, thus increasing the supply of education.By reducing the price of schooling through school stipends conditional on school attendance and performance, Oportunidades is increasing the demand for schooling amongst its eligible beneficiary households.This study exploits the different phasing-in over time and space across these interventions to test their degree of complementarity (or substitutability).We focus on the effects on intermediate school quality indicators (failure, repetition and dropout) of teacher training, provision of supplies, and empowerment and financing of parent associations -on the supply side; and conditional on attendance cash transfers -on the demand side.Difference-in-difference estimates prove reducing the opportunity cost of schooling and decentralizing school management at the lower level as effective measures in improving educational outcomes.No robust evidence of synergies between the two interventions is found.
This article analyses the relationship between decentralization and the extent of fiscal discipline in the Swiss cantons between 1984 and 2000. From a theoretical point of view, decentralization and federalism can be associated with both an expansive and a dampening effect on government debt. On the one hand, decentralized structures have been argued to lead to a reduction of debt due to inherent competition between the member states and the multitude of veto positions which restrict public intervention. On the other hand, decentralization has been claimed to contribute to an increase of public debt as it involves expensive functional and organizational duplications as well as cost-intensive, often debt-financed, compromise solutions between a large number of actors that operate in an uncoordinated and contradictory way. Our empirical results show that in periods of prosperous economic development, the architecture of state structure has no impact on debt. However, the degree of decentralization influences debt in economically poor times: In phases of economic recession, administratively decentralized cantons implement a more economical budgetary policy than centralized Swiss member states.
Christine Lao Peña, Ariadna García‐Prado, Olympia Icochea
In recent years, Central American countries have been implementing strategies to expand basic health services to remote and poor rural areas. In most cases, health extension services have been carried out by contracting with nongovernmental organizations (NGOs) and other nonpublic entities to manage or deliver health services. However, contracting with non-state providers has not been easily accepted in these countries as it is often seen as arising out of an ideological desire to privatize publicly financed health services or ultimately to limit or end government involvement in health care. This is what is happening in Honduras, where the Ministry of Health is promoting the extension of services with a community based approach within a decentralization strategy framework. The new health services extension models in Honduras rely on organizational and management arrangements that differ from the traditional Ministry of Health (MOH) health facility model. In particular, the facilities are managed by their communities under different legal and institutional arrangements, depending upon their organizational structures. Their staff are not civil servants, and, as a result, their management has considerably more flexibility in hiring and firing workers. In addition, they have multiple sources of financing. Patients contribute to the financing of these arrangements either with co-payments or pre-payments according to level of income (the sliding scale is determined by the community). The purpose of this study is to identify and compare the costs, efficiency, quality and coverage, as well as the institutional arrangements and organizational structure of the alternative models with one another, and with the traditional services delivery approach of the MOH to determine the feasibility of scaling-up these innovative models of extension of health services. To this purpose, we conducted a health facility survey to collect information on (i) Perceived quality, (ii) Technical quality, (iii) Accessibility (with regards to providers), (iv) Accessibility to communities, and (v) Price/out of pocket payments from users. In addition, the cost of providing key elements of the service package is estimated, including: (i) coverage for vaccination, well-baby care, prenatal care and curative consultations for acute respiratory infection and diarrheic disease, (ii) use of iron supplementation among pregnant women, (iii) knowledge and use of oral re-hydration among women, and (iv) use of vaccination cards for infants. Information on outputs produced have been collected based on these components, as well as their inputs over the last 3 months at each of the facilities. The cost of providing selected components of the basic package of health services in each type of facility was calculated. Results from our analysis show that even though the overall cost of service delivery in the new community models is higher, access to basic health services and quality of care, both technical and perceived, are generally better than in the traditional public health care facilities. Findings also indicate that the new models are more cost efficient than the traditional MOH health care centers suggesting the feasibility of either scaling up these new models and/or alternatively reforming certain aspects of the traditional health care facilities.
This paper studies the effects of stock market valuation on research investment, the rate of innovation, and welfare. In the presence of financing constraints for R&D investment, episodes of high market valuation can ease these constraints and raise the economy-wide investment in R&D and the rate of innovation. If the decentralized equilibrium rate of innovation is inefficiently low, then such episodes may lead to an increase in aggregate welfare even if the higher valuation is not entirely justified by fundamentals. We present a Schumpeterian-style growth model with a costly financial intermediation process to characterize the relationship between market value, entry of new firms, and the aggregate rate of innovation. We use the model to measure the welfare consequences of a stock market run-up that may only partly be justified by fundamentals. In particular, we apply the model to the US economy in the 1990s and calibrate the impact of the NASDAQ boom on the rate of innovation, growth and welfare. The welfare effect depends on the underlying change in fundamentals. We find that with an acceleration in US trend productivity growth from a pre-1995 rate of 1.4% to a rate of 2.0% per annum, the NASDAQ boom will have resulted in a net welfare gain of 0.55%. If the new growth rate is as high as 3%, the net gain was 1.35% of the present discounted value of consumption.
The present work tries to evaluate the present Law of Municipal Co-participation of the Province of Buenos Aires from the point of view of the capacity of financing of the cost of the municipal health sector in the Province of Buenos Aires. The "health component" explains the 37% of the distribution of the co-participable mass. The implicit "prices" of the selected variables, influence the "what" and "how" to produce goods in health. This is why the controversies between the fiscal objectives shaped in the normative variant of the method and the assigning eficiency of the sector, as well as the fairness in health, central objectives of the sanitary policy, are put in evidence. As a conclusion and after analysing the results of the distribution, I attempt to demonstrate that in a system of distribution of funds, where variables that try to partially measure the activity of a government function are included, where the criterion to repay the cost of the decentralized public services reigns, in the specific case of health it transforms into a signal that confirms and deepens the assigning inefficiency and the inequality in the distribution.
Decentralization in Senegal and its most visible pillar, municipalization, give rise to several issues. A<br />strong general sentiment exists that, once political quitus acquired, elected officials seem to content<br />themselves with the representative democracy that brought them to local power. In particular, these<br />issues are manifested by the populations' distrust of local public action and by social divisions, in which<br />underdevelopment remains very visible.<br />Several attempts at reform have been carried out between 1966 and 1996 with the laws on regionalization.<br />Local government authorities have conducted several experiments, often with foreign impetus,<br />particularly as a result of decentralized cooperation. Although it soon becomes clear that a considerable<br />part of this impetus comes from abroad, the experiment carried out in Saint Louis, with the help of<br />decentralized cooperation in the form of the Lille-Saint-Louis Partnership, demonstrated that it is possible<br />for local development to become a reality. Despite constraints faced by the city and its Institution, local<br />politicians expressed a willingness to relay outside impetus.<br />What lessons can be learned from this process?<br />To what extent do the funding and construction of infrastructures, mainly financed by foreign sources,<br />help strengthen the vision and abilities of elected officials to conduct development policy, while taking<br />into account the point of view and expectations of different social groups? On a more general level, how<br />do the systems set up in Saint Louis (Agence de Développement Communal or Municipal Development<br />Agency, and Conseils de Quartier or Neighbourhood Councils) encourage democratic, efficient and<br />transparent management by local government?<br />In examining these questions through a thesis, the goal was, on one hand, to build upon ten-years' field<br />experience in an academic framework and, on the other hand, to gain sufficient perspective in order to<br />problematize the various development practices induced by this experiment, in a context characterized<br />by an exceptionally complex game and system of actors. Working toward these two aims led to further<br />questioning of the transformations which Saint Louis has undergone and their impact on the ability of the<br />municipality to maintain control over communal development projects as contracting owner, which, along<br />with the strengthening of local democracy, seem essential foundations for a municipalization worthy of<br />such a name.