The British National Health Service (NHS) has, since its inception, aimed to make health care available to all regardless of income, and it has managed to achieve this goal while keeping costs lower as a proportion of the gross domestic product than many Western countries and at the same time assuring equitable distribution of resources regionally. Until the reforms introduced by the 1989 White Paper, the NHS was characterized by centralized financing and regulation; despite some problems in the delivery and management of care, the system was a popular one. The new reforms hope to enhance efficiency in the NHS by stimulating competition and further decentralizing the management of health care. However, it is not at all certain that in practice the reforms will have the desired effect. Initial costs will be high, people may not respond to incentives as predicted, and the quality of care and access to it could well deteriorate. Nations planning to use the U.K. system as a model are advised to use caution.
The health care system of the Federal Republic of Germany relies on the private sector for the financing, delivery, and payment of care. However, the private sector is regulated by the government to ensure that broad societal interests are being fulfilled. The system has managed to achieve comprehensive coverage and equal access for all citizens, freedom of choice for patients, high-quality medical care, and cost containment. The reason for this success is a combination of decentralized power and decision making and the establishment of an effective negotiation system that takes place at federal, state, and local levels. The system suffers from some problems, however, which will have to be addressed: the present structuring of hospital and ambulatory care results in excessively long lengths of stay in hospital; drugs are overprescribed; the supply of health professionals does not meet the country's needs; more nursing homes are needed; and eastern Germany must be fully integrated into the system.
The feasibility of the policy of perpetual debt financing, given a particular path for expenditures and taxation, has been questioned over the years. Sargent and Wallace [17] argue that such a policy is not feasible in the sense that the debt/GNP ratio will explode. McCallum [8] and Darby [2] argue that this policy will be feasible if and only if the long-run growth rate of GNP exceeds the after-tax real interest rate. This particular condition was derived under the assumption of Ricardian equivalence, where the growth rate of GNP and the interest rate are exogenously given, and are not affected by the path of debt. Miller and Sargent [9] and Weil [20] make the point that once the assumption of Ricardian equivalence is dropped, then simple comparisons of long-run growth rates and interest rates are not sufficient to determine stability. Tirole [19] and O'Connell and Zeldes [10] demonstrate in Diamond's [3] model, without Ricardian equivalence, that Ponzi games such as this are feasible if and only if the economy is dynamically inefficient without debt. All of these studies assume that the long-run growth rate of GNP is exogenously given. This assumption is particularly strong in the absence of Ricardian equivalence. In a separate literature, a new generation of equilibrium growth models has recently been developed with positive sustained growth in the long-run equilibrium. In these models, long-run growth is endogenously determined, rather than being imposed on the model as some exogenously given process [7; 11; 12; 14; 15].1 All of these models find some way of introducing increasing returns to scale into the neoclassical growth model and yet preserving the fact that it can be interpreted as a decentralized equilibrium. This paper considers the feasibility of perpetual debt financing in an economy where the growth rate of GNP is endogenously determined and is a function of debt levels. The model of endogenous growth presented here is a modified version of the one given in Prescott and Boyd [12]. This particular model is chosen for two reasons. First, agents live for finite lengths of time; so Ricardian equivalence will not hold, in general, in this model. Also, the production function is linear in the capital stock; as will become clear below, this implies that the equilibrium paths of the state variables can be characterized as first order linear difference equations.
The case study of the linkages between departmental-level and national organizations in Peru shows how linkages can play a significant role in national reform. A general overview of current articles on interorganizational linkages and decentralization pertinent to the Peruvian context of control oriented public sectors is provided. The Peruvian institutional context and the constraints faced by decentralized development agencies called departmental development corporations (CORDES) are identified. CORDES members were provincial mayors, representatives of private sector professional and economic organizations, and heads of ministerial field offices, autonomous agencies, and public enterprises. Microregional offices were established and received public funding. USAID channeled funding through the national organizations to the CORDES in the Integrated Regional Development Project (IRD) between 1979-86, and the Disaster Relief, Rehabilitation, and Reconstruction (DRR) Project between 1983-87. The IRD and the DRR are described in addition to the decentralized organization support network established by the 2 projects. There is an analysis of how these interorganizational linkages contributed to conventional uses of linkages and unconventional or institutional reform. Reforms were facilitated by direct persuasion of central agencies to change their administrative regulations, policies, and operating procedures, and extensive lobbying by the support network to pass budgetary reform favoring CORDES and bureaucratic reorientation. Conclusions were reached on 1) the importance of assistance linkages for hastening implementation, building capacity, and overcoming organizational weaknesses (conventional wisdom); 2) the usefulness of vertical linkages in resolving administrative or technical weaknesses (unconventional wisdom); and 3) the usefulness of reinforcing project related units within key national level agencies which increases access to power while specific objectives maintain assistance orientations. Politically marginal agencies are not considered viable. These projects demonstrated that linkages are useful in supporting institutional reform and respecting country self-determination.
In response to the problems faced by large, centralized organizations, many developing countries are exploring ways to decentralize the management of their road networks in order to use funds more efficiently and to reduce the size of central government. This note discusses taxonomy of administrative and financing decentralization options and proposes a framework for analysis.
In Germany, small firms are financed chiefly by small banks, which are grouped into two systems: the savings banks (Sparkassen) and the credit cooperatives. The government actively supports the financing of investments in small industry - especially business start-ups. The author explains how small firms are financed in Germany. The author contends that small and meduim-size firms contribute a lot to the German economy. Small firms are not subject to the control institutions - such as supervisory board seats, proxy voting and equity holdings - that shape the relationships between large firms and large banks. The author also points out that small banks, which are part of a decentralized market structure, over come imperfections in the financial market by building institutions that supersede the market mechanism. The savings bank and credit cooperatives systems have each developed an internal capital, not unlike those within large banks operating nationwide. Only central institutions participate in the domestic money market, to place the system's excess liquidity or to raise funds to cover the systems deficits. Also, the funding programs of the government banks can be seen as a refinancing mechanism that especially helps small banks. The same is true for rediscountable trade bills.
Discusses the effect of a decentralized approach to research and development facility location in the multinational corporation. Presents the comparative advantages of locating R&D facilities in strategic locations around the world. Examines the commitment required by a corporation to have an effective and flexible international research organization. Suggests that, if a company wants truly to be a âplayerâ in the international marketplace, one that is able to compete on both product quality and cost, a decentralized structure which allows for the establishment of autonomous R&D entities is necessary. Substantial risks are involved. Presents research and actual company histories to suggest that these risks could be offset with benefits from the strategic placement of research and development centres on a worldwide basis.
Abstract Papua New Guinea decentralized a wide range of health functions to provincial governments between 1977 and 1983. The national Department of Health (DOH) was given no role in provincial budget and staffing decisions, and the national health budget was fragmented into the health components of provincial budgets. The impact of decentralization on health workforce development was particularly severe and largely unforeseen. Many difficulties were inherent in the manner in which decentralization regulations structured power relationships. Others arose as a result of the administrative confusion and inflamed relationships that accompanied the forceful transfer of power from a very reluctant national DOH to the provinces. Even though policy formulation and planning were retained as national functions, decentralization hampered their effective execution. Human resource data bases deteriorated, responsibility for planning became confused, and the ability of the DOH to implement its planning decisions was compromised. In reality, health workforce planning was carried out by the Departments of Finance and Planning, and Personnel Management through the annual budgetary process of provincial financial limits and staff ceilings, without any attempt to assess health service needs, either in the country as a whole or between the provinces. Decentralization brought a need for new management skills, and it complicated administrative relationships between training institutions and the provinces. The Papua New Guinea experience has shown that in a decentralized health service, there is a great potential for conflict between national goals and the aspirations of individual provinces. To achieve an equitable, appropriate and effective staffing of services, standards must be formulated as the basis for planning and conflict resolution. Effective linkages between central government departments and between the national and provincial health authorities must be developed, and management and technical skills of health managers improved.
The previous communal system in Yugoslavia (since 1955) did not prove viable. Owing to its great size (nearly 500 km 2 and more than 40,000 inhabitants), municipality in this period didn't affirm itself as a real community. Having many abilities in developmental planning, it was at the same time dependent on the state in the spheres of finance and normative regulations. The difference between the sphere of local government (LG) and state politics was substantially blurred. Given the changing social conditions (introduction of market economy, political pluralism and the forms of parliamentarian democracy), the need for repeated establishment of the system of local government based on the altered position of citizens in the political system becomes evident. In this environment it is necessary to reestimate the experiences of LG in particular Yugoslav regions (republics) before World War II, and simultaneously, take selectively into account the experiences and development in other developed European countries. This article compares the constitutional regulations of LG among particular Yugoslav republics, and between them and the characteristic orientations in other European countries, enlightening it with the aspect of actual processes and demands of centralization and decentralization, regionalism, moving the regulation of communal and other everyday needs closer to the people in LG, all in the sense of postâbehavioristic trends of the âbottomâupâ approach to the processes of decisionâmaking.
Changes in public policy with respect to governance structures require complementary changes in public policy concerning the financing of educational services. Drawing on their findings from studies in Australia, England and the USA, the authors present a framework to clarify what is happening in the restructuring of school governance and to project the implications for public policy concerning the finance of schooling. The political system is represented by a decision matrix which arrays the decisions that have to be made about financing schools (who gets what, when and how) with the primary decision makers (society, the educating profession and families). The decisionâmaking process is shown to be a dynamic one, causing the nature of acceptable decisions to change along with politicalâeconomic environments and with priorities given to policy objectives. Using the model, the implications of alternative centralization/decentralization strategies for school finance policy are examined under varying circumstances.
Bangladesh has a population of 115 million people, and the economic growth rate of 3.7% during the 1980s was undermined by rapid population growth. The annual population growth rate was 3% in the 1960s and early 1970s, 2.5% between 1981-91 decreasing to 2.3% in 1991. The average of number of children is 4.6/woman compared with 7 in the 1960s. Infant mortality dropped from 150/1000 births in 1976 to 118/1000 in 1991. Life expectancy rose from 47 to 54 years. The 1991 Contraceptive Prevalence Survey showed that 39.9% of married women under 50 use contraceptives in 1991 vs. 18.6% in 1981. The use of modern methods increased from 10.9% in 1981 to 31.2% in 1991, while traditional methods rose from 7.7% to 8.7%. Sterilization was most prevalent in 1981. 29,000 female family planning (FP) workers were aggressively engaged in dispensing FP services in 1990. The Social Marketing Company sells pills, condoms, and oral rehydration salts through 130,000 retail outlets. The 1989 Contraceptive Prevalence Survey showed that 40% of pill and condom users obtained them from this network, and 95.4% of women knew about 4 methods of contraception. In 1990 there were 120 private organizations providing contraceptive services. Some of the components of the government FP program include field worker distribution door-to-door of injectable contraceptives (50% injectable usage rate in the Matlab project); recordkeeping activities; a satellite clinic network with access to contraceptive services; and decentralization through the Upazila (subdistrict) approach. The logistics system of FP has improved the warehousing, transportation, and management information system. Foreign aid (mainly USAID) financing of contraceptives helped avert 14.4 million births between 1974-90. The increase of contraceptive prevalence to 50% by 1997 would avert another 21.9 million births during 1991-96 (replacement fertility requires 70% prevalence.
The article first proposes a framework within which to assess the potential of health sector reforms in Latin America for primary health care (PHC). Two dimensions are recognized: the scope of the reforms, content, and the means of participation that are put into play. This framework is then complemented through a critique of the often-sought but little-analyzed PHC reform strategies of decentralization and health sector integration. The analytical framework is next directed to the financing of health services, a chief aspect of any reform aiming toward PHC. Two facets of health service finance are first distinguished: its formal aspect as a means for economic subsistence and growth, and its substantive aspect as a means to promote the rational use of services and thus improvement of health. Once finance is understood in this microeconomic perspective, the focus shifts to the analysis of health care reforms at the macro, health policy level. The article concludes by positing that PHC is in essence a new health care paradigm, oriented by the values of universality, redistribution, integration, plurality, quality, and efficiency.
The case is strong for declaring an inadequacy of export finance for small business. In 1988â90, the documentation has expanded beyond that of academic research and claims by the Small Business Administration to Congressional testimony by exporters and bankers, surveys by trade associations of manufacturers and bankers, and investigations by the Government's export finance agency as well as our central bank. Nonetheless, small business is exhorted to look abroad in its marketing efforts and so to participate in reducing the U.S. trade deficit. As one means of alleviating this international marketing challenge, the ExportâImport Bank of the United States (Eximbank) has moved to convert a pilot program of 1988â89 into a fallâfledged decentralized effort to deliver export finance to qualified small firms. The intention is that carefully trained administrators in selected states will be able to match qualified exporters with financial institutions and thereby assure that the small firms receive working capital in adequate quantity to meet terms and conditions of an export contract. While Eximbank's staff is poised to support the marketing and credit analysis work of the state/local administrators, this paper examines the need for a fully cooperative effort among four parties or groups in the face of a national retrenchment by many banks in the provision of export finance for small firms.
The aim of the paper is to conduct a research on an impact of blockchain technology platform on the financial sector through cryptocurrency, and an impact on other industries.. The subject of research is not only this technology but also its commercial exploitation. In order to understand the platform, the starting point of this research is an analysis of how the technology functions, after that the advantages for business and economic transaction are identified, and finally the paper deals with an impact of new technology on business, above all on financial operations. The basic hypothesis is that blockchain has achieved a great impact on financial sector, also it has the potential to radically change only the financial sector but also the way we buy and sell, our interaction with the authorities as a way of verifying the ownership from the authorship and the organic food production. Using the available data and synthesis of knowledge from the fields of technology, economics, finance, and politics, 4 scenarios were set up for the future of underlying technology. The scenario approach combined with trend analysis in order to prove the starting hypothesis with high reliability. The research results show that the technology being investigated already has a profound impact on the financial sector, that it is in the initial phase of changing many industries, with the likelihood that they will change them significantly in the next five to ten years. Businesses increasingly discover the power of this technology to exploit the benefits of the Fourth Technological Revolution.
Foreword ix Sergio C. Trindade, Executive Director, United Nations Centre for Science and Technology for Development (UNCSTD) Introduction 1 A. S. Bhalla Part I: Favorable Policies and Programs 13 1. Centralized versus Decentralized Policy Toward Small and Medium Enterprises 17 John Marcum 2. Technological Policy for Small and Medium Enterprises: The Canadian Experience 29 Paul Dufour 3. Technology Policy for Small and Medium Enterprises in The Netherlands 47 Walter Zegveld 4. Technological Transformation of Small and Medium Enterprises in China 55 Guan Ze-wen et al. 5. Technology Promotion Programs for Small Enterprises: The Philippine Experience 67 Quintin G. Tan vi Contents Part II: Building Technological Capabilities 79 6. Innovations and Small Producers in Developing Countries 83 A. S. Bhalla 7. Building Indigenous Technological Capability Through Foreign Assistance to Small/Medium Enterprises 101 J. M. Hekland 8. A New Approach to Innovation in Traditional Industries: The Italian Experience 109 Danielle Mazzonis and Mario Pianta 9. Building Technological Capability of Finnish Small Industry Through Risk-financing 127 Veikko O. Vuorikari 10. Technological Transformation of Small Enterprises in Zhejiang Province, China 139 Wu Tianzu 11. Technological Characteristics and Change in Small Industrial Enterprises in Guangdong Province, China 153 Guan Ze-wen et al. 12. Management and Technological Capabilities of Malaysian Small and Medium Enterprises: Constraints and Potential 167 Ahmad Zahdi Bin Jamil and Rahimah Bt. Md. Said 13. Development of Design and Manufacturing Capabilities in a Small Nigerian Company 175 Sam Chukwujekwu Part III: Institutions and Infrastructure 183 14. Nurturing Microenterprises and Technological Innovation through Business Incubation Process 187 Rustam Lalkaka and Hu Ping 15. Institutions for Promoting Technological Modernization of Indian Small Enterprises 203 C. V: S. Ratnam 16. Technical and Managerial Extension Services for Korean Small and Medium Enterprises 213 Kyung Tae Lee Contents vii 17. Cooperation between Research and Educational Institutions and Small Enterprises in China 221 Cai Liyi 18. Infrastructural Requirements of Information Technology and Small and Medium Enterprises 233 Karl Ganzhorn The Seminar Report 247 Select Bibliography 271 Index 275 Notes on the Contributors 283
Abstract Since Zimbabwe won its independence in 1980, the country's leaders have embarked on an ambitious programme of decentralization and local government reform. At the same time, urban conditions in the country have become increasingly difficult. This paper examines major aspects of urban local government finances in this environment of reform and growing fiscal pressures, with special reference to the experience of Harare City Council. It is argued that some relative successes have been recorded, although a number of undesirable elements of colonial practices and various fiscal problem persist.