Some basic facts of public goods theory are presented in the primitive set-up of a collection of projects devoid of any linear structure. There is a single private good. Characterizations of Pareto optimal and core states in terms of valuation functions (i.e. supporting “prices”) are obtained. Voluntary financing schemes are discussed.
Stephen T. Miller, Roger Vander Zwagg, Melanie Joyner, John W. Runyan
Observations of a publicly-financed system for the medical care of a large number of persons with chronic diseases have been made over seven years. The system combines decentralized, nurse-staffed neighborhood clinics, operated by a public health department, with a central referral clinic for consultations and the management of complicated problems. After seven years in the chronic disease program 55% of 1,004 patients with diagnoses of diabetes mellitus, hypertension, and cardiac diseases were still receiving care, 19% had died, and 26% had been lost to the program. In the seventh year, the mean diastolic blood pressure in hypertensives was 84 mm Hg and the mean serum glucose in diabetics was 203 mg/dl. For the group under care, hospital days/1000/year were 74% of the rate during the year before referral to the program and out-patient visits/1000/year were approximately the same as before referral. However, two-thirds of the visits, formerly made to a public hospital, were now being made to neighborhood clinics. The system appears to be an effective method of providing medical services for persons who formerly used the public hospital as their source of outpatient care.
Open access
Primary Care and Health Outcomes
Chronic Disease Management Strategies
Health Systems, Economic Evaluations, Quality of Life
This paper describes the development and activities of the Sarvodaya Movement, a grass-roots mutual-aid movement based on traditional Buddhist social values. Started by high school students and teachers in 1947 as a community-service organization the Movement is open to all individuals and has attracted thousands of volunteers in 1200 villages. Sarvodaya Shramadana emphasizes improvement in the standard of living through the development of local resources by the community itself, strengthening of the family and the village unit, discouragement of large-scale industrialization and removal of forms of exploitation, such as caste, race discrimination, large-scale land ownership, and so on. Key to all of the Movement's activities is the concept of self-reliance, self-realization, nondependence at both the individual and the village level. The mutual sharing of labor not only accomplishes the work of the community, creating the physical infrastructure for economic improvement, but serves as a revolutionary technique to awaken people to their own potential. The movement organizes villages into functional groups by age and occupation and trains community workers who are chosen by the villages themselves. In each village, work starts on short-term strategies to relieve debt, provide health care and educate the population and long-term strategies to generate sustained, unified community spirit and sufficient income to avoid use of outside credit. The Movement's specific projects include surveys of nutritional deficiencies, the community kitchen program, preschool program, day care centers, children's library service and community health programs. The Movement is now changing from a centrally-coordinated organization toward decentralized organization based in 52 Extension Centers and run, at the national level, by an Executive Council of 35, a 6-man board and 9 coordinators. The Movement was self-financed by members for the 1st 10 years but has used outside financing in the last 10 years. Through establishment of economic activities, the Movement hopes to be self-reliant by 1985.
An early evaluation o the Home Insulation Program indicates that it is possible to carry on major conservation programs that result in a substantial saving to Tennessee Valley Authority (TVA) customers both from reduced electric bills and from reduction in electric system cost. The evidence from the TVA program strongly indicates that many utilities could realize benefits for themselves and their customers by implementing a comprehensive program for decentralized electricity, load management, cogeneration, and conservation. Of course, any financial benefit to the utility would be contingent on the treatment of costs associated with these programs on the balance sheet, on the income statement, and in allowable rate of return calculations. In particular, utility financing of customer installation of energy conservation and renewable energy systems must be treated in a manner that allows the utility to earn an acceptable rate of return. The Pacific Power and Light (PPL) Residential Energy Efficiency Rider is an example of how this can be handled. The program is beneficial to the utility because the entire cost of the weatherization measure can be added to the rate base with the customer paying the carrying charges on the capital. The customer benefits from the borrowing at themore » utility's cost of capital until the time of sale, at which time the value of the improvements is realized as a higher sale price for the house. While the value of such programs must be calculated on an individual basis, the authors feel that many utilities, particularly those that are in a position that makes it difficult to add new conventional capacity, could profit from the implementation of these programs. 1 reference, 2 figures, 6 tables.« less
People in the United States have generally ignored Canada's long experience with extensive public financing and management of its health system. This is unfortunate because the two countries are similar in so many ways that Canada's experience is very pertinent to the continuing debate in the United States over increasing government involvement in health care. Two lessons emerge from Canada's experience. First, while many in the United States are dubious about more government involvement in health care, Canada's overall experience has been favorable. Second, Canada's experience suggests some specific forms that such public involvement should take to improve the performance of the health system. One important reason for Canada's favorable experience has been the decentralization of government decision-making. Constitutionally, the ten provinces have jurisdiction over most health services, so they are key decision-makers. The federal government, however, has had an important role in the shaping of Canada's health system, most importantly by offering subsidies to provinces willing to establish certain health programs that meet its standards. Canada's extensive public financing of health services is the most striking difference between its health system and that of the United States. In each province all medically necessary physician services and most inpatient and outpatient hospital services are publicly financed for all residents. Hospital services have been publicly financed for more than twenty years and physician services for more than ten years. Provincial agencies administer the programs, reimbursing physicians predominantly on a fee-for-service basis. Hospitals typically receive biweekly payments based on their provincially approved budgets. The provincial plans are financed jointly by the federal and provincial governments, largely from their general revenues. Few now bother to collect premiums or special health taxes, and minimal use is made of deterrent charges. The provinces vary considerably in the extent to which other personal health services are publicly financed. For example, some finance dental services for children; some, prescription drugs for people aged sixty-five years and over.
With the increasingly rapid urban growth in Nigeria in recent decades, and with its consequent multiplication and complication of the urban problems of traffic and transport, housing, health, and sanitation, the need for a more purposeful planning and management of cities has come to attract increased public policy attention. The institutional and organizational setting for city planning and management, particularly the role of municipal governments in these activities, still remain colonial and therefore ill-suited to the demands of present urban developments. City planning and management responsibilities are so fragmented among so many institutions and organizations that the municipal local governments have had very little authority over what happens in the city. The overlapping responsibilities of the various institutions make for conflicts and the net result is general inefficiency in the planning and management of many cities. The recent (1976) Local Government Reforms which aimed at decentralizing some functions from the state and federal governments to local governments do not seem to have altered the weak position of municipal governments in city planning and city management matters. The aim of this paper is to put the origin of the weak position of municipal governments in city planning and management into political and historical perspective. It also seeks to argue that until city planning and management responsibilities are centralized on strong, autonomous municipal governments, headed by popularly elected urban chief executives, the present chaos in Nigerian cities is likely to continue.
<p>&#8220;Web3&#8221; is now part of our collective imaginaries, even if the specifics of what the buzzword entails remain murky and inaccessible to many. Originally coined in 2014 by Gavin Wood, co-founder of Ethereum, to describe &#8220;a decentralised internet ecosystem based on blockchain,&#8221; the term took off after the NFT boom of 2021, catalysed by the embrace of the crypto ecosystem by the likes of Silicon Valley venture capital firm Andreessen Horowitz (a16z).</p>\n<p>Like other social technologies, the swirl of narrative, attention and capital around web3 are as much part of its utility as the tools themselves. Mainstream discourses around &#8220;the web3 space&#8221;—and the blockchains, non-fungible tokens (NFTs), cryptocurrencies, decentralised web (dweb) frameworks that make it up—have been shaped by a cacophony of criticism, partiality and hype, played out over the past five years on Twitter and Discord.</p>\n<p><em>Future Art Ecosystems 3: Art x Decentralised Tech (FAE3)</em> attempts to take a long(er) view on the impact of decentralised technologies and imaginaries on the structures and processes that underpin the development of 21st-century cultural infrastructure, specifically art and advanced technologies (AxAT). The downward slope of the hype cycle towards another &#8220;crypto winter&#8221;—as well as a market correction in the wider tech industry—is a good time to take a sober view of the lessons, potentials and affordances that have been generated over these years of energetic innovation and speculative boom and bust&#8230;</p>\n
The administrative system of England after the Norman Conquest has been described as “the adaptation of the ancient customary institutions of a decentralized system to the uses of [the Norman and Angevin kings‘] highly centralized administration”. 1 It was complex, adaptable, efficient to a high degree, and constantly changing. It had only a few of the features of a modern bureaucracy, as “government” to the medieval man did not imply anything resembling the modern state and its workings. It meant the practical expression of the rights owed to the king by his subjects and the duties of the king to his people. Its chief functions were the raising of finance and the administration of justice.
Joann P. Cobb PASCAL'S WAGER AND TWO MODERN LOSERS Blaise Pascal addressed his argument of the wager to the seventeenth -century sceptic confronting the failure of reason to answer the question, "Does God exist?" Pascal in his zeal for conversion of the free-thinker intended the wager on the affirmative answer as only a last-ditch appeal to self-interest and as a predisposition for the infusion of faith, and modern opinion has been influenced by Voltaire's disparaging comment that it is indecent to introduce the concept of a game involving gain and loss to the grave subject of the existence of God. But three centuries later, the wager has a relevance to the society shaped by logical positivism and existential "angst" that has not been entirely overlooked. Two modern short stories present wagerers who lose: Granny Weatherall in Katherine Anne Porter's "The Jilting of Granny Weatherall" and The Misfit in Flannery O'Connor's "A Good Man Is Hard to Find." These contemporary gamblers illustrate an implication of the argument unexploited by Pascal, but the frequent inclusion of these stories in anthologies and textbooks testifies to the compelling pertinence of the "game." The most appropriate position in the Pense'es for the fragment containing the argument of the wager is still the subject of some debate, but most editors place it after Pascal has delineated the miseries of the human condition and the paradoxical status of mankind. A mixture of misery and greatness, man is endlessly frustrated: "We desire truth, and find within us naught but uncertainty. We seek happiness, and find only misery and death. We are incapable of not desiring truth and happiness, and are incapable of certainty or happiness" (p. 87). Man's greatness, for Pascal, consists in knowledge of his own misery as he confronts the human situation: "No great elevation of soul is needed to understand that here below is no true and solid satisfaction; that all our pleasures are but vanity, that our woes are infinite, and that lastly death, which threatens us every moment, must infallibly 187 188Philosophy and Literature in a few years land us in the dreadful necessity of being forever either annihilated or miserable" (p. 105). Such understanding leads to thought of the Infinite, but "if there is a God, He is infinitely incomprehensible" and we are incapable of knowing by the light of nature "what He is, or whether He is" (p. 117). Yet, Pascal says, "a game is on, at the other end of . . . infinite distance, and heads or tails will turn up." Pascal argues that man must wager for he is "embarked," and he cites the odds of the game's outcome as it will affect man's happiness: "Let us weigh gain and loss in calling heads that God is. Reckon these two chances: if you win, you win all; if you lose, you lose naught" (p. 119). Pascal secures the assent of the postulated listener with repeated assertions that the chances of success are even, while the possible gain is infinitely disproportionate to the stake. Pascal's "unbeliever" gives up without much fight, agreeing that he will wager though he cannot believe. In a much criticized passage, Pascal then prescribes the sceptic's course: seek a decrease of human passions, rather than an increase of divine proofs, make believe you believe by using the ritual of the Catholic religion, and this will bring you to believe. And Pascal repeats the question: "What have you to lose?" (p. 121). Pascal's answer, of course, is "nothing" (rien), and he describes the attributes of the sceptic who follows the path of the believer: "You will be faithful, honest, humble, grateful, beneficent, a good friend, true. ... I tell you that you will gain in this life, and that at every step you take on this road you will see such certainty of gain, such nothingness in what you risk, that you will at last realize that you have wagered on something certain and infinite, for which you have risked naught" (pp. 121, 123). But a modern reader is not so quick to agree that "naught" is at stake: "Unmoved by the apologist's disparagement...
The reaction of public utilities to the addition (and competitive) sources of energy supplied by solar technologies will have a significant impact on the commercialization of solar energy. Decentralized applications of solar energy need utility-produced power to back up the energy produced by solar means. The cost and availability of this power will largely determine the acceptance of solar energy. There are three legal issues surrounding the role of utilities in the solar commercialization effort: (1) the extent to which utilities may own, sell, lease, finance, or service solar devices for utility customers; (2) the degree to which solar-powered utilities may be able to compete with existing utilities; and (3) the degree to which various utility rate structures will be allowed to penalize decentralized solar users. The impact of state constitutional and statutory provisions upon these issues is examined, along with relevant federal constitutional doctrines. Finally, the statutes of the National Energy Act, many of which specifically address the above issues, are discussed.
The literature on the deomposition of mathematical programs as models for organizational design and resource allocation in decentralized organizations is extensive. Although models differ in detail, all conceptualize the allocation problem as a multi-level managerial coordination procedure, involving local (divisional) and global (organization-wide) resources, in which informational automony is to be maintained. That is, coordination of resource usage by relatively autonomous divisions is to be effected in these models without any one agent in the organization accumulating complete knowledge of the technical resource transformations, payoff or cost coefficients and detailed plans that divisions utilize in converting resources to useful ends. Unfortunately there has been little empirical investigation into the implementational problems of applying these models in decentralized organizations. This study reports on an experiment with human subjects as decision makers in a simulated decentralized organization. The formulation of the overall resource-allocation problem as a linear program permitted two forms of coordination: price-directive in which transfer pricing is used to allocate resources, and resource-directive in which a rationing or budgeting approach is used. Both schemes can be shown to solve the overall organizational problem but impose different information, communication, and decision-making structures upon the subject managers. The experiment was designed to examine comparative managerial performance by the subjects, as central coordinating agents, under the alternative transfer pricing and budgeting schemes. Within each of these schemes two levels of decision time pressure were also introduced to examine its impact upon subject performance. The purpose of the investigation was to study the influence of organizational design (allocation scheme) and situational factors (time pressure) upon human decision-making under carefully controlled experimental conditions. The experimental setting was that of a decentralized university incorporating three subordinate college divisions and one coordinating agent, the president's office. The colleges were modeled as linear programs and the coordination function was assigned to the experimental subjects. In the price-directive scheme a subject assigned a transfer price to each of two global resources in each planning iteration. In the resource-directive scheme a subject directly allocated amounts of the two global resources to each of the colleges in each planning iteration. Consistent with decomposition theory, feedback to the subject in the form of aggregate resource demands (price-direction) or individual bids for higher resource allocations (resource-direction) was given to initiate a new planning iteration. The budgetary goal utilized by subjects was to maximize net dollar contribution from colleges to the university under prespecified quality-of-education constraints. After several planning iterations each subject finalized the resource allocations, terminating the experiment. The hypotheses were that resource-directive subjects would outperform price-directive subjects, that high decision time pressure would exacerbate decision making and that subjects would outperform decomposition algorithms in early iterations. Data from the experiment did not support the first two hypotheses; the third was confirmed. Aside from concluding that strategic factors (organizational design) and tactical factors (time pressure) strongly influence decision making behavior, several specific implications can be tentatively drawn. In similar settings transfer pricing schemes may be preferable to traditional budgeting schemes for planning resource allocations. Furthermore, the potential exists for profitable use of man-machine procedures for resource allocation involving decision support technology in the form of decomposition models to augment human decision heuristics. Finally, experimental methods offer a vehicle for addressing human factors and implementational considerations missing from current analytic models.
Switzerland is a federal state with a surface area of 4I,288 km2 and a population of about 6.4 million (I976) of which about I million are foreigners; it consists of 26 cantons and half-cantons with different cultures, languages and religious persuasions. As in many other branches of public life, education in Switzerland is decentralized. Besides, most of the cantons share their charges with the communes. So, although each canton and its communes is autonomous as far as education is concerned, be it compulsory attendance at school, which is generally from 8 to 9 years, or secondary or university education, the Confederation essentially looks after the tasks that cannot be satisfactorily undertaken by the local or regional authorities. It particularly plays a compensating role when the financial charges and the possibilities of education are not equally divided among all the cantons. This is the reason why it is turning its attention in particular to vocational training: professional apprenticeships and technical schools. In this way, vocational training forms a homogeneous part of our educational system. In connection with this the Confederation is able partly to protect the interests of those cantons with no university. It also regulates medical studies; furthermore, this competency has led to a harmonization of 'maturity examinations' (secondary school leaving examinations) in the whole country. Primary school education is compulsory and free of charge in state schools. Each canton has its own laws and regulations. This diversity in school systems is a hindrance to the migration of families. For this reason there have been attempts made to harmonise the system; in French Switzerland a common programme for the six French-speaking cantons for the first four years of primary school has been established. Thanks to the agreement on school co-ordination, made by the cantonal Directors of education, the age of entrance to primary school (6 years) and the duration of compulsory attendance at school (g years) will soon be uniform in Switzerland. The communes play an important part in this sector of education. They intervene in particular through the local school committees. Primary schools are financed by the communes and the cantons. Private schools also
The meteoric decline in hardware costs now in progress will result in computing becoming a personnel-intensive enterprise. Most of this personnel will be devoted to software development and support of computing users. The financing and budgeting in most university computing centers is centered on hardware and computing cycles. How, then, can university computing best adapt to the changing economic structure of the information processing industry?Who should provide user support services? The central computing service center? Individual departments and/or colleges? Are there significant economies of scale in user support? If there are, do they outweigh the responsiveness that can be provided by a decentralized network of user support services?Who should pay for user support services? The users? The university? If the university pays, should centralized or decentralized arrangements be made for the services?Who should determine the level of expenditure on user support services? The market? The departments and colleges? The central administration? The computing center management?What will be the policy implications of the alternate answers to the questions above? Will they enhance or retard the decentralization of computing services? Will they encourage users to depend on internal or external facilities? Will they lead to a growth or decline of user support activity within the computing center?All of the above questions are now and have been debated strenuously regarding the provision of computing cycles. There is every reason to believe that the same debate will take place regarding support services. Strong user support services will be the sine qua non of high quality university computing in the future, and it will not be available unless we deal promptly with the issues of pricing, budgeting, and organization outlined above.
The «New Towns » experience. A tentative reply to J.-P. Alduy. (J.-E. Roul-lier, p. 79-104) «Few equally ambitious urbanistic projects have been conceived, adopted, planned and carried out so rapidly as have the New Towns. » J.-E. Roullier quotes this remark of J.-P. Alduy and makes of it the central question to which an answer must be found in order to grasp the dynamism of the New Towns. After criticizing J.-P. Alduy' s thesis (the New Towns as a «beacon» project of the technology), J.-E. Roullier puts forward three sets of explanatory hypotheses that call for examination, verification and comparative research : a widespread consensus on the aims ; the existence of the Paris region district with its own budget and resources, a unique insitution in France ; lastly , a decentralized system for the creation of the New Towns giving full responsibility to all the parties concerned, especially the elected officials and Government representatives — a non-technocratic arrangement compared with other Western experiences of the same type. Aside from these considerations, the former high-ranking official of the Groupe central des villes nouvelles (Central Agency for New Towns) feels that the French New Town experience merits careful examination with particular attention to the following points : — the coincidence, at least from the historic standpoint, of the New Towns achievement with the phase of economic expansion and rapid urbanization in France (1960-1975) ; — the «technocracy» : its composition, the role of the various groups that constitute it ; — the 1962-1967 period witnessed the establishment of the New Town project and the setting up of the basic mechanisms required for its implementation : A careful analysis of the motivations, the power relationships, the role of the various actors during that period would be useful. The way the project was set up and financed, the organization and working methods of the various agencies concerned with its implementation, marked a break with the habitual behavior of the French administration, upsetting previous balances. Examples of this are the Central Agency for New Towns, the constant support of the Finance Minister for the New Towns, the working methods put into practice that forced Government officials to establish a different type of relationship with the local elected authorities and those directly responsible for carrying out the operations. In conclusion, J.-E. Roullier spells out the «lesson» of the New Towns : As opposed to the generally «dis-articulated» functioning of the chain of urbanism agents and officials, the New Towns experience is a successful example of a different way of operating which «re-articulates », on the one hand, responsible community groupings having at their disposal the programmed means required but limited role of stimulation, assistance, for an overall facilities policy, and, on guidance, and supervision. This is an the other, permanent interdisciplinary interpretation substantially different from teams working on the spot in contact Alduy' s view of an all-powerful techno- with the builders and fulfilling a vital cracy, arm of the central state apparatus.
The extraordinarily rapid advance of microelectronics is causing a rapid drop in both the cost and economy of scale of computing equipment. In less than a decade, the powerful economic incentive for centralizing the production of computing cycles has reversed. Simultaneously, the productivity of computing professionals has not kept pace with inflation, and it appears that staff productivity gains will be difficult to achieve in a decentralized environment.Distribution of computing equipment is making support for the individual computer user more difficult in the following ways:-- There is a need for support of multiple types of small computer hardware.-- There is a need to maintain multiple operating systems and versions of applications software.-- There is little knowledge and experience in providing documentation, user training, and consulting support in a highly distributed multi-architecture computing environment.This paper outlines Cornell's response to the challenge of decentralized computing. The paper details the rationale, planning, organization, financing, and staffing for the new Decentralized Academic Computer Support group in Cornell Computing Services. In addition, the responsibilities of that group and its interaction with the other groups in Computing Services is described. Finally, attention is given to the relationship between Computing Services and the Cornell community regarding small computers.The accelerating trend of decentralizing the production of computing cycles presents user support groups with both a challenge and an opportunity. Failure to respond will result in more expensive and lower quality computing for the university community as well as declining utilization of user support services.
672 BOOK REVIEWS not with the evil that fear has to do with, but rather with " the eminence of the divine good, by whose power some evil can be inflicted." And in the ad 2 St. Thomas quickly tosses aside the objection, as not being about the gift of foar at all, because that objection had to do with the sort of fear which has evil for its object. Plainly, the position now is that the gift of fear does not have any sort of evil for its object. That is not the position either of the De spe or the ST 2-2 (and seems at odds also with ST 2-2.19.9. ad 2 and ad 3) . And if reverence, an act of the gift of fear, is a form of fear, what has become of the position that the objectof fear is evil? All I mean to argue here is that Guindon should have presented a full-dress discussion of this issue, not the few remarks such as he gives at pp. 77-79 and 246-247. This is especially so in view of his own judgment concerning the importance of the doctrine at stake: thus, at p. 319, he can speak of St. Thomas's keen awareness of the ultimate foundation of fear, namely the finitude of the creature faced with the infinity of God. A much less serious point: Guindon's use of the expression "la pedagogic nouvelle" for the learning process proper to the New Law (cf. p. 139, p. 323, etc.). "Pedagogue" suggests the stern discipline proper to the Old Law (cf. p. 134). At p. 330 he speaks with more finesse, in my opinion, using "pedagogic" for the Old Law and "education" for the New. The book is well proof-read by today's standards, but on p. 359, the first mode of amor sui (wrongly numbered" 3 ") has a lacuna: this at an important moment of the discussion. The size of the numbers used to designate the notes is inconveniently small. College dominicain de philosophie et de theologie Ottawa, Ontario, Canada LAWRENCE DEWAN, 0. P. Theology in a New Key. By ROBERT McAFEE BROWN. Philadelphia: Westminster Press, 1978. Pp. 212. $6.95. This appealing book is an introduction to a body of literature, Latin American liberation theology, that is not well-known in the Englishspeaking world. Thanks to Orbis Books, founded by the Maryknoll Fathers, the principal books and documents of this theology are available in English. Still, since the method of this theology is of recent origin, and since its starting point is very disturbing to the industrialized countries of the West, it is not easy to understand what is being said by this theology. What is this disturbing starting point? According to the theology of liberation, the Gospel can be grasped only if we analyse the concrete form which BOOK REVIEWS 678 evil takes in our society and understand the Christian message as God's initiative summoning and directing us to overcome evil. According to the Latin American theologians, the dominant systemic evil in their society is the international capitalistic system that inflicts on this society economic and cultural dependency, pushes large sections of the population into destitution and early mortality, and creates in the middle classes a distorted perception of reality. Robert McAfee Brown, a well-known Protestant theologian, is famous for his ability to introduce a wide Christian audience to issues discussed in high theology. Brown writes about learned things in a simple and direct style and relates them to people's experiences. He knows where the mind and heart of the Protestant community are. For him, theology is never a conversation confined to academics: 1t must always involve the believing community. This is so because Christian truth is propter salutem. The conversation with the local congregation protects the theologian from losing the thread. The book under review is a brilliant application of this method to an explosive topic. Can one kee'P a congregation in their seats while explaining to them that capitalism may have a distorting effect on the perception of God and divine salvation? Brown does it. Brown offers us a propaedeutic of...