In the Nordic countries, health care is an integral part of what is often termed the Scandinavian (or Nordic) model of the welfare state (Esping-Andersen 1990). Thus, health care is generally seen as a public responsibility, with universal access, negligible user fees, and a strong focus on equity (Martinussen & Magnussen 2009). In this chapter we discuss the Nordic model of health care primarily by focusing on one country, Norway.We also highlight similarities and differences between Norway and the other Nordic countries. While Norway is a small country in terms of population, it covers a large area and thus geographical equity is an important issue. This is reflected throughout the system; in structural issues, in choice of (political and administrative) governance models, and in choice of financing system. Although Norway, as are the other Nordic countries, is characterized by a tradition of locally elected governments (municipalities and counties), health policy and healthcare reforms in the past 15 years serve as illustrations of the potential conflicts between public articipation, local governance, and a stated goal of national equity. These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
In Germany, regional and local jurisdictions are the place where in many policy fields administrative resources are located, and where the relevant organizational actors ā both public and private ā implement social policies (Banting and Corbett 2002). Decision-making about benefits and beneficiaries as well as social policy financing, however, tend to be highly centralized. Subnational ( LƤnder -) governments have strong participation rights in such decisions, yet there are few areas in which individual BundeslƤnder can shape institutions or policies unilaterally or autonomously (Ziblatt 2002: 628 ff.).There is, therefore, no clear allocation of authority over the making and implementation of (health) policy across territorial levels (Jordan 2008: 168). Decision-making, control over finances, implementation, and supervision of performance are in different hands. These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
With successive English governments extolling the virtues of greater choice and control within welfare services, there is growing debate about concepts such as direct payments and personal budgets (in the UK and in many developed countries). With the evidence base inevitably patchy and incomplete, there have been increasing criticisms of these approaches from the social care trade press and from academic policy commentators alike. Against this background, this paper reviews the concerns that are emerging and explores some of the limitations of current debatesāmany of which make an implicit appeal to āthe evidenceā in order to justify increasingly polarised views. In particular, the paper argues that many current accounts are based on an imperfect understanding of the principles at stake; on a failure to apply the same burden of proof to the old system as well as the new; on prior attitudes to state services and to current social care; and on a potentially limited adherence to more traditional forms of evidence-based practice.
Using a panel of province-level data, we investigate the effects of political party affiliations of local chief executives on the financing and delivery of devolved health services, where arguably the opportunities for and potential gains from inter-local governmental unit (LGU) cooperation abound. Despite these potential gains, the proportion of mayors that belong to the same party as the governor are found not to have any direct, independent and statistically significant effects on the local chief executives' ability to secure additional resources from the national government and other external sources, mobilize greater spending on local health services or improve select health service outputs. However, the re-election status of mayors and governors is found to have a direct, independent and positive impact on some of these indicators. These results support the view that narrow electoral objectives more than party platforms remain the dominant influence in local fiscal decisions under decentralization.
The literature is still undecided on whether sub-state elections conform more to a national or regional logic of voting. In this article, I argue that the impact of national politics on regional elections is contingent upon the level of decentralization. I hypothesize that the greater the number of policy areas and resources in the hands of regional governments, the lesser the influence of national coat-tails on regional elections. Using the electoral results of the Spanish Socialist Party in national and regional elections from 1979 to 2009, the empirical analysis shows that regional politiciansā electoral performance is correlated to that of their national counterparts. However, this correlation has weakened as regional governments have gained greater decision-making and financing powers. This has been particularly evident in elections when the regional branch of the party rules a single-party government and competes against strong regionalist parties.
Sweden has obligatory sickness and disability insurance which is both financed (from payroll taxes) and administrated by the government. In order to receive sickness benefits, insured individuals must have certificates issued by a medical doctor. Since health care is administrated at the county level, this means that monitoring is, to some extent, decentralized at a lower jurisdictional level than the funding and governance of the insurance. This paper studies one consequence of such decentralization: the effet on individual sickness absence when such certificates are not approved be the Sickness Insurance Agency (SIA) and are instead re-remitted to the doctor completion and, potential, reapproval by the SIA. We find that this re-remission increases the length of sickness absence spells by an average of 30 percent. A suggestive test of the reason for the observed effect indicates that it is due to a decrease in health caused by increased stress related to the uncertainty about entitlement and future sickness benefits. Given that added resorces improve the quality of the patients' medical certificates, directed intergovernmental grants from the state to the counties would be cost saving.
The purpose of this study is to explore, from Social Security Reform in 1945 to present, the evolutions social welfare policies in France and their characteristics. The aspect with which this study is concerned is that of change of state role and the responses to new social risks. The following points were found through this study. First, as time passes, the state role has increased on the side of administration and funding of social welfare in France. Especially, ons of the philosophy of social security reform in 1945 was, based on social democracy, autonomous management by insured persons in social insurance. For it, members of social insurance fund committee are composed by the direct election on which insured persons have participated. However, from the mid-1990s, the method of its composition han changed definitely into designation by the representative organization of the employer and the worker. In addition, the state has increased son power in social insurance funding by the creation of purposive tax as CSG and CRDS and the parliament`s control on the fiscal balance of social security. Second, to the difference of social insurance, the decentralization was dominant in the domain of social assistance and social service (in french action sociale). This phenomenon has began to appear during the socialist government in the first half of 1980. Third and finally, this study has found the implementation of the new policies concerned with the responses to new social risks, especially poverty and social exclusion. In 2000, the CMU has been introduced to protect persons who were excluded from the coverage of health insurance. the rSa, in 2009, has the purpose of overcoming the poverty and social exclusion problem by introducing the concept ``workfare`` which is dominant in contemporary welfare states. Considering that Korea`s welfare state is faced with dual challenges, namely coping not only the traditional social risks but also the new social risks, this case research gives us many lessons.
In 1991, the Philippines joined a growing list of countries that reformed health planning through decentralization. Reformers viewed decentralization as a tool that would solve multiple problems, leading to more meaningful democracy and more effective health planning. Today, nearly two decades after the passage of decentralization legislation, questions about the effectiveness of the reforms persist. Inadequate financing, inequity, and a lack of meaningful participation remain challenges, in many ways mirroring broader weaknesses of Philippine democracy. These concerns pose questions regarding the nature of contemporary decentralization, democratization, and health planning and whether these three strategies are indeed mutually enforcing.
The Croatian ādecentralization packageā from mid-2001 has shown how multiple pressures for shifting power to the local level may actually result in relative failure. The central government has ceded the control in particular policy sectors by shifting responsibilities for certain educational, welfare and health services to the counties and municipalities. However, the decentralization initiative was excessively marked as very limited and strongly labeled by the vertical policy dimension, expressing the dominance of top-down incentives of the central government in comparison to bottom-up initiatives stemming from the local government units. The 2001 decentralized package did not substantially increase the portion of local governments finance in total public finance, showing a failure to provide local government units with stronger fiscal capacity. The central government bodies also did not take into account the alternative proposals made by various policy actors ranging from academic institutions, researchers in NGOs, and associations of local government organizations. All these things have contributed to a relatively negligible influence of the horizontal policy dimension on the decentralization outcome. The whole process can therefore be described as centrally controlled decentralization, or decentralization from above.
Conceived in the Bismarckian mould in response to The Social Question as it manifested
itself in the late nineteenth century, the Belgian welfare system followed a fairly conventional continental trajectory up until the worldwide economic recession of the early
1970s.
It was the same climate of social unrest during the recessionary 1880s that had led Ottovon Bismarck to institute the ļ¬rst labour protection laws and social security provisions in
Germany that triggered the introduction of similar laws and provisions in Belgium. To
be clear, social security arrangements had by then already emerged on a voluntary basis,
usually within the context of mutual societies and such organizations, most of which had
a much broader purpose than providing social security. These mutual societies and organizations were organized along ideological lines, the Christian-Democrat and the Socialist
being the most prominent. The pluralist, decentralized and autonomous nature of social
security and social welfare provision did not change once the state started taking up a
regulatory and standardizing role. But out of a patchwork of arrangements emerged a
compulsory and increasingly universal system of social security and health care (Deleeck,
2001).
A long phase of incremental, though at times still erratic expansion of various, mostlyoccupationally segregated social security schemes culminated in the āSocial Pactā of 1944.
Born in the exceptional atmosphere of solidarity and consensualism of the ļ¬nal days of
the war, the Pact marked a consolidation of the welfare system. The Social Pact, while
extending compulsory social security coverage, conļ¬rmed the subsidiary principle in the
sense that non-governmental organizations (i.e. unions and mutual societies) remained
responsible for the administration of beneļ¬ts. In addition, national agencies were created
for those not aļ¬liated to such organizations. The role of the state remained, as before,
very much in a regulatory and complementary role.
The 1950s and 1960s were essentially a period of incremental expansion. Belgiumāssocial protection system came to maturity just before the economic crisis struck. With
the main social security pillars in place, by and large in the Bismarckian mould, all thathappened laws on
assistance (providing a minimum income guarantee to all citizens), the law on guaranteed
child beneļ¬t (ensuring access to child beneļ¬ts all to those not covered under the social
security scheme) and the law on the guaranteed minimum pension (ensuring a minimum
pension for all pensioners).
It was just after these ļ¬nal pieces had been put in place that Belgiumās social protectionsystem was challenged in a most profound way. Belgiumās economy was particularly hard
hit by the oil price shocks and the subsequent economic downturn of the 1970s and
1980s. An early industrializer, Belgiumās economy was still heavily reliant on manufacturing industry, much of which tended to be comparatively energy intensive and,
therefore, particularly sensitive to the energy price shocks. The share of industrial employment (including mining and construction) in total employment, which was still around
40 per cent in 1975, fell rapidly in the years thereafter, reļ¬ecting major structural
adjustments in steel, coal and textile industries. During the 1970s and also during the
1980s, Belgium recorded among the largest relative job losses in manufacturing industry
in the Organisation for Economic Co-operation and Development (OECD) area. The
consequences were particularly severe because entire cities and even regions remained
heavily dependent on industrial employment. The collapse in the demand for labour
occurred precisely at a time when many youngsters (the sizable post-war baby boom
cohort) and women were entering the labour market.
It was in this context that a massive increase in beneļ¬t dependency, particularlyunemployment beneļ¬t dependency, ensued. This happened in most continental European welfare states but virtually nowhere was it as dramatic, relatively speaking, as in
Belgium. Today Belgium still epitomizes continental Europeās āwelfare without workā
conundrum. Belgium spends more on unemployment beneļ¬ts, relatively speaking, than
just about any other EU member state (Table 2.1). While its unemployment rate is
around the EU15 average (Table 2.3), its employment rate remains among the lowest of
the northern continental European Welfare Systems. Around one in four people of
working age lives on some kind of replacement beneļ¬t. While still enjoying a comparatively low poverty rate, Belgium has been slipping down the tables during the lastboth political as the
to move towards an āactive welfare stateā, Belgiumās corporatist system has not shown a
real capacity to deal with the root problems of sluggish job growth and persistent high
beneļ¬t dependency. In addition, Belgium is facing some very particular problems owing
to its particular history of linguistic conļ¬ict, a problem exacerbated by regional economic
divergence.
This chapter sketches some of the key developments within Belgiumās welfare systemover the past three decades and discusses the principal challenges facing it today.
Why do the states seem to be pursuing different types of policy innovation in their health reform? Why so some seem to follow a "solidarity principle," while others seem guided by a commitment to "actuarial fairness"? Our analysis highlights the reciprocal influence of stakeholder mobilization and public policy over time. We find that early policy choices about how to achieve cost containment led the states down different paths of reform. In the 1970s and 1980s, states that featured oligopolistic or near-monopolistic markets for private insurance (usually dominated by Blue Cross) and strong urban-academic hospitals tended to adopt regulatory strategies for cost containment that led to broader forms of pooling and financing the costs of health risks--which subsequently positioned them to pursue major, solidaristic reform on favorable terms. On the other hand, states with competitive markets for private insurance and weak, decentralized hospitals tended to adopt market-based strategies for cost containment that led to the hypersegmentation of risk and the uneven financing of costs--thereby encouraging the proliferation of incremental policies that reinforce the principle of actuarial fairness. We illustrate our analysis with a brief comparison of Massachusetts and California, and we conclude with some thoughts on what our findings imply for the federal role in catalyzing health reform.
Healthcare Policy and Management
Health Systems, Economic Evaluations, Quality of Life
This book presents a comprehensive, theory-based analysis of Japanās public sector. Particular emphasis is directed at developing tools that can be applied to theoretically and empirically clarify essential economic concerns in Japanās public sector. These include macroeconomic incidence of fiscal decentralization, dependence on government bonds for covering financial deficits, and social security reform. In analyzing Japanās underperforming public sector, the authors develop and recommend policy solutions aimed at achieving Japanās growth potential, improving the quality of the public sector, and strengthening the sectorās contribution to the Japanese economy.
This article addresses the relationship between political decentralization and the organization of political parties in Great Britain and Spain, focusing on the Labour Party and the Socialist Party, respectively. It assesses two rival accounts of this relationship: Caramani's `nationalization of politics' thesis and Chhibber and Kollman's rational choice institutionalist account in their book The Formation of National Party Systems. It argues that both accounts are seriously incomplete, and on occasion misleading, because of their unwillingness to consider the autonomous role of political parties as advocates of institutional change and as organizational entities. The article develops this argument by studying the role of the British Labour Party and the Spanish Socialists in proposing devolution reforms, and their organizational and strategic responses to them. It concludes that the reductive theories cited above fail to capture the real picture, because parties cannot only mitigate the effects of institutional change, they are also the architects of these changes and shape institutions to suit their strategic ends.
According to the World Bank, over 80 countries currently plan some form of fiscal decentralization. This group includes Japan, a highly centralized tax state, which in 1995 put in place a law and associated high-profile institutions to promote fiscal and administrative decentralization. But the process in Japan has quickly become bogged down. This dissertation asks why there are hurdles confronting fiscal decentralization in Japan. My research uses the fiscal sociology approach and highlights bureaucratic interests in Japan's intergovernmental tax regime, one that is especially interesting in comparison with other advanced industrial countries. Fully 70 percent of all government spending in Japan is done by subnational levels of government, and 51 percent of the central state's current operating expenditures are transfers downward that serve to support that high rate of local spending. And though Japan is a centralized state, over a third of its taxation is collected locallly. In consequence, Japan is quite anomalous when set alongside a representrative sample of federal and unitary states. No other country among the nine OECD nations used, for comparative purposes, in this dissertation combines such high fiscal transfers with heavy levels of subnational spending and taxation. And no other country gives close control over a large terrain of subnational taxation to a central-state agency (the Ministry of Home Affairs). The ministry's vast bureaucratic turf brings it into conflict with the Ministry of Finance, as both seek to maintain or expand their fiscal jurisdiction. They are thus not interested in fiscal decentralization in large part because they are busy fighting "trench wars" with each other on these tax fields. This dissertation hence undertakes a detailed analysis of intergovernmental fiscal history in Japan, focusing in particular on the Ministry of Home Affairs' ambiguous role in the Japanese state. The case studies of inter-bureaucratic fiscal politics include the Local Allocation Tax (a large general subsidy) as well as an array of taxes on the fields of income, assets and consumption.
Charles R. Hankla Assistant Professor Department of Political Science Georgia State University PO Box 4069 Atlanta, Georgia 30302-4069 chankla@gsu.edu Phone: 404-413-6172 Fax: 404-413-6156 Abstract What political factors influence the allocation of economic patronage in democracies? Answering this question is vital to improving our knowledge of how states and markets interact. In this paper, I argue that changing levels of party centralization can drive important changes in the allocation of state largess. When governing parties are centralized, national party leaders will control sources of patronage, targeting benefits to particularly influential regions and industries. By contrast, when governing parties are decentralized, influential sub-national party leaders will advocate for their constituents, allocating patronage evenly through a national logroll. I find evidence for these relationships by comparing Indiaās distribution process for industrial licenses and government finance under a decentralized Congress Party (1954-61) to its distribution process under a centralized Congress Party (1969-75).
The economic transition in China since the late 1970s has led not only to drastic social transformations but also rapid advancements in science and technology, as well as a revolution in information and communications technology. In order to enhance the global competence of the Chinese population in coping with the challenges of the knowledge-based economy, the higher education sector has been going through restructuring along the lines of marketization, privatization and decentralization. Responding to the challenges of globalization, the Chinese government has opened up the education market by allowing private/minban higher education institutions and even overseas universities to offer academic programmes in the mainland. Hence, we have witnessed a proliferation of education providers, a diversification of education financing, and an increase in private-public partnerships in education provision since the policy of educational decentralization was introduced in the mid-1980s. This article sets out to examine the politics of educational decentralization in this wider policy context by critically analysing the tensions between the central education ministry, conventional minban higher education institutions and the newly emerging state-endorsed independent minban colleges (second-tier colleges or independent colleges). It also reflects critically upon the policy implications for the evolving "governed market" in education, and analyses the challenges for the new regulatory regime now that the higher education sector has become highly diversified in post-Mao China.
What political factors influence the allocation of economic patronage in democracies? Answering this question is vital to improving our knowledge of how states and markets interact. In this paper, I argue that changing levels of party centralization can drive important changes in the allocation of state largess. When governing parties are centralized, national party leaders will control sources of patronage, targeting benefits to particularly influential regions and industries. By contrast, when governing parties are decentralized, influential sub-national party leaders will advocate for their constituents, allocating patronage evenly through a national logroll. I find evidence for these relationships by comparing India's distribution process for industrial licenses and government finance under a decentralized Congress Party (1954-61) to its distribution process under a centralized Congress Party (1969-75).