This article reviews changes in the organization, delivery and financing of health care and old age services in the UK and Sweden over the past 25 years. User autonomy has become a more important policy objective than equity of access or equality of opportunity, with a greater reliance on market mechanisms for delivering services. The public and politicians seem to be prepared to accept that competition, choice and decentralization may result in a widening of regional and geographical inequalities, and the erosion of the universal character of the welfare state. These developments reflect broader normative shifts in both societies, and are likely to continue and become more widespread in the future, as they will be strongly influenced by demographic and social factors, fiscal constraints and the policies of supranational bodies such as the European Union.
Fundamental changes in China's finance system for social services have decentralized responsibilities for provision to lower levels of government and increased costs to individuals. The more localized, market-oriented approaches to social service provision, together with rising economic inequalities, raise questions about access to social services among China's children. With a multivariate analysis of three waves of the China Health and Nutrition Survey (1989, 1993 and 1997), this article investigates two dimensions of children's social welfare: health care, operationalized as access to health insurance, and education, operationalized as enrolment in and progress through school. Three main results emerge. First, analyses do not suggest an across-the-board decline in access to these child welfare services during the period under consideration. Overall, insurance rates, enrolment rates and grade-for-age attainment improved. Secondly, while results underscore the considerable disadvantages in insurance and education experienced by poorer children in each wave of the survey, there is no evidence that household socio-economic disparities systematically widened. Finally, findings suggest that community resources conditioned the provision of social services, and that dimensions of community level of development and capacity to finance public welfare increasingly mattered for some social services.
Twelve years into the implementation of the Local Government Code of 1991, it is but opportune to assess how the key features of this landmark legislation has contributed to (or detracted from) achieving the balance between local autonomy and accountability. The literature on fiscal decentralization suggests that these two goals are not incompatible. In fact, real autonomy (in the sense of subnational governments being able to link their spending decisions with their revenue/tax decisions) promotes fiscal responsibility. In the context of the ongoing debate in the Philippines, however, local autonomy has been equated (by many LGUs officials) with the independence of LGUs from central government interference. As such, LGU officials have focused more on securing even higher levels of block grants in order to address the widely perceived vertical fiscal imbalance. However, closer scrutiny of the problem indicates that greater tax decentralization, coupled with a well-designed intergovernmental transfer system that includes elements of fiscal equalization and categorical grants conditional on the achievement of minimum service standards, would better enhance the gains that are forthcoming from the decentralization process while minimizing the risks of macro-instability.
Abstract Besides decentralization to executive agencies and social organizations, public management reform involves devolution to sub-national units of activities and the corresponding fiscal resources to finance them. It involves also making public managers more autonomous and more accountable. In synthesis, decentralizationâdelegating authority to lower levelsâis crucial to managerial public administration. Decentralization is a public management strategy, but devolution is a political decision with managerial consequences. Decentralization is often decided top-down and is a strategy for increasing the head-officesâ capacity to achieve proposed objectives, but devolution is usually a response to demands for more local or regional autonomy to which government officials in the central government reluctantly accede.
Even in the wake of the most sweeping campaign finance reform law to be enacted in three decades, further significant reform is inevitable. Special interest money continues to flow through loopholes in the Act, and the Presidential Election Campaign Fund is near collapse. The next reform should encourage broader participation in the political process by individual citizens, both to dilute the power of special interests and to serve independent democratic values that recent Supreme Court jurisprudence has identified as vital to meaningful reform. We propose adopting a refundable tax credit of $100/taxpayer for political contributions to federal candidates and national parties; the credit would be targeted to lowerand middle-income Americans. A refundable tax credit is equivalent to giving each eligible citizen up to $100 annually to use for political contributions. We also present data about the relative importance of political contributions by special interests (corporate, labor and other PACs) and individuals that undermine many of the assumptions on which past reform has been based and that have not been discussed in the legal literature. The data clearly show that small contributions by individuals are the dominant source of money in campaigns, and that the influence of special interest money is subtle, appearing to âpurchaseâ benefits like access, a place on the agenda, and minor policy details. Working from an accurate picture of who really pays for politics, and drawing from the experience at the federal and state levels with similar tax refund programs, we present the tax credit as a reform that is simple, easy to administer, and likely to improve political participation by average Americans. Thus, our proposal, unlike the complicated voucher plan with anonymity put forward by Ackerman and Ayres, is likely to be adopted by Congress; moreover, it will appeal to a bipartisan consensus because it mixes public funding with a decentralized allocation mechanism using a tax subsidy.
Latin American social medicine (LASM) emerged as a movement in the 1970s and played an important role in the Brazilian health care reform of the 1980s, both of which focused on decentralization and on health care as a social right. The dominant health care reform model in Latin America has included a market-driven, private subsystem for the insured and a public subsystem for the uninsured and the poor. In contrast, the Mexico City government has launched a comprehensive policy based on social rights and redistribution of resources. A universal pension for senior citizens and free medical services are financed by grants, eliminating routine government corruption and waste. The Mexico City policy reflects the influence of Latin American social medicine. In this article, I outline the basic traits of LASM and those of the prevailing health care reform model in Latin America and describe the Mexico City social and health policy, emphasizing the influence of LASM in values, principles, and concrete programs.
Armed with our 21st-century democracy-finder, suppose we speed back to 17th-century Europe. In one part of Europe or another, we will find roughly 200 regimes we can reasonably call independent states: relatively autonomous, centralized, and well-bounded governments exercising priority in some regards over all other organizations operating within their territories. On four counters marked âBreadth,â âEquality,â âConsultation,â and âProtection,â we take readings for the regimes we locate in a journey throughout the continent. Where and when do we encounter vigorous vibrations of democracy? Let's say we land in the year 1650. We might think it an auspicious year for democratic initiatives: except for continuing struggle between France and Spain the major disruptions of the Thirty Years' War have just ended with the Treaties of Westphalia, great fissures have opened in the Habsburg empire, and the success of their 16th-century rebellion against Spain has finally brought the northern Netherlands international recognition as a highly decentralized independent republic. What do we find? We find plenty of revolution and war, but few signs of settled democracy. Touring the British Isles, we discover a Scotland rebelling openly against English hegemony, and a Scottish military force in northern England backing Charles Stuart's claim to succeed his father Charles I; just last year, England's contentious revolutionaries united temporarily to decapitate King Charles. In Ireland, Catholic leaders are battling not only each other, but also the English invading force of Oliver Cromwell.
This article seeks to explain crossâcantonal variation in public education expenditure between 1985 and 1998. Four possible explanations are located: socioâdemographic and socioâeconomic pressures, the impact of political institutions, the partisan theory, and the power resources of organized interests. Taking the research advantage of Swiss federalism our findings provide strong evidence that educational expenditure is systematically related to the socioâdemographic and socioâeconomic pressures in a given canton. Furthermore, consensus democracy promotes educational finance, while the decentralization of the cantonal polity lessens the educational policy output. Finally, the instruments of direct democracy as well as partisan variables do not seem to account for differences regarding the budget expenditures on education in the Swiss cantons.
South Korea and Taiwan have similar experiences as to political and economic development, i.e., rapid economic growth and democratization. However, the 1997 financial crisis experiences were quite different South Korea was hit hard by the crisis whereas Taiwan was barely touched. Why were the experiences different between South Korea and Taiwan? We argue that economic fundamentals were differential leading up to the crisis. More importantly, the differences in the pace of financial liberalization and the method that South Korea financed its growth particularly in the 1990s were much different than Taiwan's. We also argue that the differential impact of the crisis on the two countries can be attributed to the institutions of their respective political economy, decentralized vs. concentrated industrial structure, and interest group structure that helped in the creation of an autonomous state. Given the dominance of SMEs (small and medium sized enterprises) and the state's control of critical resources along with dispersed and weak interest group structures, economic technocrats in Taiwan were able to employ tough pre and postâcrisis policies to maintain Taiwan's economic viability, whereas South Korea was not able to.
Konstantin Sonin, Centre for Economic Policy Research (United Kingdom)
In a federal state, political leaders of constituent units might protect their enterprises from the federal center (e.g., allowing them not to pay federal taxes). The effectiveness of such protection depends crucially on the ability of local authorities to extract rents from enterprises. They can easily do so, if there are a small number of enterprises with large employment, and local monopolies can be effectively sustained. They cannot do it so easily if regional industry is competitive, political opposition is strong, and the federal center has enough means to enforce payment of taxes. We build a simple model to argue that it is the industrial structure of constituent units that determines political relations between them and the federal centre. The theory is supported by the recent experience of Russia, China, and Argentina.
Two developments flowing from the institutional reforms in The Netherlands of the 1980s currently form âthe usual suspectsâ in a series of scandals or instances of public arousal within the public sector. The first factor is the large-scale decentralization of tasks from central government to provincial and municipal authorities. Initiated under the name of democratization and efficiency this decentralization programme was part of a large package of operations, including deconcentration, deregulation, privatization, and reconsideration, that were to to slim down central government in terms of personnel, tasks and organization. Second, managerialism, i.e. the adoption of business management ideas and concepts by public administrators, entered Dutch public service vocabulary during the second half of the 1980s. Managerialism did not limit itself only to central government agencies but also â and perhaps more succinctly â found openings in provincial and municipal authorities, mainly as a fierce reaction against the âbureaucratismâ of daily administrative practice to counter the relative deprivation perceived by civil servants in relation to their private sector counterparts. This article shows that the decentralization of financial management and the emergence of âreinventionâ ideas have had autonomous but drastic effects. While the former blinded central government and provincial controllers, the latter legitimized practices that even under a private sector regime would have been deemed improbable.
Social assistance as the technique providing means-tested income guaranteed financed by general taxation in Spain is composed by different benefits. There is not a only one policy, but different measures oriented to different groups of population and organised by different public administrations. During the last two decades, the different levels of public administration have implemented a set of benefits, which observed together can considered as the Spanish âsafety netâ. The main lines of this development has been: a) fragmented in different protection systems (unemployment, pensions, social services), b) subsidiary of the development of these systems and c) decentralized in different levels of public administration (mainly in regional level, i.e. Autonomous Communities).
In the course of the present transition in Russian society, a new system of social security has been developed. The previous Soviet system has been replaced by a system of four more or less independent social funds, covering the main branches of social security. These funds are supposed to be run according to insurance principles and to be financed by contributions, mainly from employers. Given the difficult economic and social situation of the country, there have been increasing demands for effectiveness in the management of the different funds and also in the management of the whole social security system. The results of this study show that the social funds have developed different organizational structures with different degrees of centralization and decentralization. Only one of the funds seems to be relatively wellâfunctioning and effective, while the others have experienced more or less serious problems in fulfilling their main tasks and functions. The most serious problems, however, seem to stem from the structure of the social security system as a whole, which is perceived as fragmented and badly coordinated. In order to improve the coordination of the system, there have been proposals to merge two or more funds into a unified social security organization. This strategy is open to question, however, since it would increase the bureaucracy of the system. There are other ways in which the structure of the social security system might be advanced. Such developments should be based on an analysis of the system from the perspective of the individual client or patient.
ABSTRACT Administrative reform in China has followed a different path from reform in OECD countries. Because of its different point of departure (relatively underdeveloped, centrally planned economy, and one party monopoly) reform in China has included establishing a market economy, strengthening market regulations, and institutionalizing civil service. There are some similarities between China and OECD countries, however. Both China and developed capitalist democracies have tried to downsize their public sectors, corporatize some government departments, and decentralize administration. Contrary to stated policy goals of Chinese government, net result of these changes has been to strengthen state. Moreover, reform has left both developmental and predatory natures of Chinese state intact. There is some evidence, however, that Chinese state is now seeking to become more neutral vis-a-vis INTRODUCTION Spared by economic crises and informed by New Right, public-sector reform in developed capitalist democracies has involved decentralization, deregulation, privatization, and marketization (Lane, 1997:1; Rainey, 1998: 19; Hood, 1991). The implication of these changes was that size and role of state would shrink. According to this scenario, a lean core state would remain to manage most activities indirectly. Most public goods and services would be provided by business-like executive agencies or by private sector and non-profit organizations under contract. Globalization and need to compete in an increasingly integrated market have had an impact on developing countries as well and they, too, have been encouraged to reform their public sectors. Because China has come to public sector reform from a radically different starting point from developed capitalist democracies (relatively underdeveloped, centrally planned, and ruled by a one-party monopoly), reform in world's most populous country has taken its own path. Still, reform in China has also sought a smaller, less intrusive state. This goal is neatly captured in official Chinese slogan: small government, large society. The evidence now indicates, however, that in spite if years of reform both in China and overseas, position of state remains relatively strong. The statist orientation of public-sector reform is evident in western democracies. In OECD countries, for example, although size of civil service has shrunk in many cases (including Australia, Canada, New Zealand, UK, and USA), public expenditure as a percentage of gross national product has remained remarkably stable (Ferlie et al. 1996:2-3) because the public sector continues to finance and deliver core goods and services that are of major significance to as a whole: health, education, research and development, criminal justice, and social security (Ibid., 3). In China, case is even clearer. Not only has size of public sector, especially government, been immune to years of attempted downsizing but also position of state as a result of public sector reform, especially local state, remains as strong as ever. The goal of small government, large society has yet to be realized. CONTEXT China is divided into 30 provinces or provincial-level units ranging in population from 2 million (Tibet) to over 110 million (Sichuan) people. Average provincial population is 30 to 40 million, larger than population of many countries. Provinces are subdivided into prefectures (there were 110 such units by end of 1997) or prefectural cities (22 in 1997). Prefectures in turn are subdivided into counties (1,693 in 1997) or county-level cities (442). Cities are further divided into 727 districts (State Statistical Bureau, 1998:3). Territorially based party committees, each with its own bureaucracy, manage government and economy at each administrative level (Lieberthal, 1995). âŠ
Recent comparative education policy studies show that even though there seems to be similar patterns and trends in higher education reforms in East Asian societies, the recently initiated higher education reforms have had very diverse agendas. Thus, the considerable convergence of policy rhetoric and general policy objectives may not satisfactorily explain the complicated processes of changes and the dynamic interactions between global, regional and local forces that shape education policy-making in individual countries. This article discusses globalization effects on national policy, with particular reference to how the higher education sector in Taiwan has transformed itself under the global tide of marketization and decentralization. There are a lot of changes similar to both higher education in Taiwan and that of elsewhere, which suggests that Taiwan's higher education has been affected by the trends of globalization. But before we jump to this conclusion, maybe we should also bear in mind an alternative hypothesis that local factors are crucial and determining factors for change. The core of the article is to examine the ways and strategies the Taiwan Government has adopted to reform its higher education systems in response to the changing local socio-economic political context and regional-global environments, with a particular focus on provision, regulation and financing.
Evaluates changes in the welfare system in Sweden, the UK and the USA over a decade, basing arguments on the divergence of economic globalization and domestic forces. Presents brief economic snapshots of each country, stating quite categorically that the welfare state is an impediment to capitalist profitâmaking, hence all three nations have retrenched welfare systems in the hope of remaining globally economically competitive. Lays the responsibility for retrenchment firmly at the door of conservative political parties. Takes into account public opinion, national institutional structures, multiculturalism and class issues. Explores domestic structures of accumulation (DSA) and refers to changes in the international economy, particularly the Bretton Woods system (Pax Americana), and notes how the economic health of nations mirrors that of the US. Investigates the roles of multinationals and direct foreign investment in the global economy, returning to how economic policy affects the welfare state. Points out the changes made to the welfare state through privatization, decentralization and modification of public sector financing. Concludes that the main result has been an increase in earnings inequality and poverty.
The past eighteen years have witnessed a shift in the locus of much public sector service provision from elected and heavily regulated local government to the more opaque, appointed sector of quasiâautonomous nonâgovernmental organizations (QUANGOs). This shift has been the basis of much debate about the nature of democratic accountability and whether the users of public services are empowered by such decentralization. What has yet to be considered is how the displacement of local authority representation and service delivery may affect different groups of service users. This article is concerned with such issues in relation to women as consumers of public services who, from genuine political as well as expedient motivations, have been relatively well represented by local authorities. The concern here is that as decision making moves away from public view, the need to be seen to accommodate difference is lost, and representative diversity will suffer.
The article discusses the role of Scandinavian local governments in providing welfare state services. Wide-ranging social care services are probably the most distinctive feature of the Scandinavian welfare societies. These services, in the main, have been financed publicly and provided by local government. The traditional principle of Scandinavian local self-government, requiring local autonomy, and the goal of a welfare state providing a uniformly equal service to all is, however, a contradiction in terms. How have the Scandinavian countries dealt with this dilemma? This question is discussed by an examination of the day-care service policies in the four Scandinavian countries. Two distinct Scandinavian policy-models seem to emerge, one that primarily respects the local discretion of municipalities and the other that favours a more centralised approach. Norway represents the local autonomy model, Sweden and Finland exemplify the centrally directed model, while Denmark displays features from both models. During the 1990s, the main responsibility for social services has been decentralized also in Sweden and Finland. At the same time, Scandinavian local government action has turned to a more liberal direction.
The author focuses on the link between local government decentralization and democracy in Eastern Europe. It is shown that decentralization is a multidimensional concept and that actual local government systems can be positioned differently on each dimension (functions, control, and finance) depending on the implicit model of local government. Formal and substantive definitions of democracy are distinguished and some conventional measures examined; it is concluded that decentralization and democracy do not necessarily go together. The degree of decentralization and implicit models of postsocialist local government in Eastern Europe are then outlined, with a focus on the contrast between Budapest and Moscow. The development of social movements in the two capitals is taken as an index of substantive democracy and is shown to be influenced not only by the extent of decentralization but also by other features of the local political context. This illustrates the earlier argument that the relation between decentralization and democracy is an empirically variable one rather than a necessary one.
Since public officials in the United States may lack the courage and political will to significantly raise payroll taxes or the contain Social Security, Medicare and Medicaid benefits, Americans can anticipate that; (a) future generations increasingly will pay for these entitlements; (b) additional cutbacks to providers in Medicare, Medicaid and health maintenance organization reimbursement will hasten the current thrust of hospitals, physicians and insurers in forming huge health networks with their powerful managed care plans; and, (c) many of these new alliances will function as virtual monopolies--eventually resulting in the public proposing that state health services commissions be established. This article then suggests that future modifications in how the United States health delivery system be organized and financed preferably should be along the lines of the German multi-player, multi-tier, self-governing, decentralized, quasi-private, quasi-public model; and, also patterned after experiences of the State of Arizona's Medicaid program. It concludes that what America needs most is a hybrid of the European global budgetary targets to constrain total health expenditures, and the competitive managed care concept to curtail use patterns and to enhance quality.