Although both are publicly owned and financed, the health care systems of England and Sweden are widely different in levels of funding, patterns of resource allocation, and types of planning and management. In England, control is more closely tied to national government; in Sweden, it is shared between national and local governments. A comparative analysis of decision making in the two systems reveals critical differences in determinations of how resources are allocated among competing interests, and how resources are used. Interestingly, as the English move toward more decentralization, the Swedes are considering greater central controls, but, in any event, convergence is unlikely.
The rehabilitation of Manhattan's Lower East Side during the last few years has occasioned bitter fights between several ethnic groups. The article analyses the practical and symbolical means used by the Portorican population in order to appropriate a space they considered as being theirs. The cultural factor is a stake in itself as each ethnic group endeavors to mark out and defend a socio-historical « turf. » Symbolic conflicts may conceal other interests â they are nonetheless an end in itself. Political elements are present, too, but the way in which they come between the fighters is proof that the solutions arrived at are at best temporary.
To better understand and implement the extensive World Bank study on the financing of health, this limited article was enjoined to discuss salient features of the study and their potential for implementation. With technology for diagnosis and treatment driving health costs up, we are left with still affordable and all around more effective programs on protection and prevention that would be more cost- and health effective in a world where financial health resources are static or being cut back. Health programs and hospitals are generally inefficient with an underutilization of peripheral services. A redesign of integration systems is discussed. 4 policy reforms do, in effect, constitute a positive and feasible agenda. All of these policies will require great political commitment for their unpopularity. 1st, charging users of health services except those truly unable to pay is deemed more just. 2nd, provisions of insurance or other risk coverage (e.g. social security) need expansion. 3rd, effective use of nongovernment resources, the most vague policy reform, is discussed in terms of its implementation. 4th, decentralization of government health services is a prerequisite for achieving significant reform in financing the services. The main point of the World Bank study is active community participation which stops the paternalistic government-mendicant demanding populace pathology that is common today. A special study is suggested which would involve the World Bank and other internal organizations in analyzing the financial and technical support furnished to strengthen, endorse, and empower the reform policies.
This book provides an overview of the principles used by policy makers in western industrialized countries as they seek to meet the educational needs of cultural and linguistic minorities as diverse as Australian aboriginal peoples, resident foreign workers in Western Europe and Francophone minorities in Canadian provinces. This is a synthesis of information gathered in more than 30 national case studies and consultants' reports prepared for an OECD-sponsored study entitled: Finance, Organisation and Governance of Education for Special Populations. Drawing on this data, the author shows that current policies fit within a relatively simple framework of development by stages, each stage determined by the assumptions used in defining the educational problem to be solved. At the lower end of the scale, methods are borrowed from special education of the mentally retarded; at the upper end, the minorities are treated as equals or near equals in mature bilingual and multilingual nations such as Finland or Switzerland. The emphasis is on showing how policy makers grapple with tradeoffs to determine the best policy mix, such as between centralization and decentralization or between financial incentive schemes and direct regulation, in order to ensure adequate educational services for the minorities. The entire analytical framework is shown to fit within an integrated model linking minority aspirations, public attitudes and governmental policy responses.
The Word Bank Study "Financing Health Services in Developing Countries: An Agenda for Reform" is centered on a thesis of decreased government responsibility for financing health services. The study points out that more basic medical services are needed for the poor, but the aged and increased urbanization are forcing the application of more finances into hospitalization services. The World Bank study incorrectly assumes that the above problem is due to an epidemiologic polarization of rich vs. poor and that the only benefits from curative medicine are private, not societal, benefits. The proposal stemming from these assumptions financially separates curative from preventative services, regardless of its proven costliness and inefficiency. The 4 suggested specific World Bank reforms are: 1) charging fees for the use of health services; 2) provision of insurance or other risk coverage; 3) effective use of nongovernment resources, i.e. private practices, midwives; and 4) decentralization of government health services. These are interesting, although imperfect, solutions to the pressing problem of health care finance. The largest issues may be problems from the fragmentation of health services, cost inflation, and lack of effective controls--issues that are not dealt with in the World Bank study.
0 Until more than a decade ago, financial economists typically explored problems of capital structure and dividend policy under the assumption that operating cash flows or investment decisions were exogenously determined, either with certainty or with an endowed, known distribution. Micro and macro-economic theorists, on the other hand, discussed what might be called operating income maximization, and treated as irrelevant the origin of the funds they allocated between labor and capital. It is now the consensus, I believe, that although these approaches constitute important simplifications, they may obscure some of the more important activities that take place in the firm. Interactions of production and financial decisions have thus been the focus of many recent studies. This research is extremely important for financial decision makers. If indeed it turns out that there are economically significant interactions between production and financing, then proper financial management may be vastly more difficult than typically portrayed in modern textbooks. Most of what is taught in capital budgeting, for example, is based on separation of investment and financing. If in reality this is not the case, then decentralization of the firm's operations can not be maintained, and all decisions will have to be made at the same time. Indeed, the many papers described here show how investment decisions, product pricing, labor negotiations, and market power may all be significantly related to the choice of capital structure. While this survey represents an attempt to assess the economic significance of each interaction, it must be emphasized that, as a casual glance at the references should reveal, we are dealing with on-going research that is not, as yet, supported by sufficient empirical evidence to yield definitive answers.
The game is simple and apparently paradoxical: Prove you know somethingâ an ID number, an access codeâwithout revealing even a single bit of the information itself. The importance is obvious: from credit card numbers to computer passwords, we are increasingly reliant on the secure electronic transmission of what are known as signatures. Yet how can one transmit a signature without potentially revealing to an eavesdropperâor an unethical vendorâall the information he needs in order to masquerade as the sender? Three Israeli computer scientistsâUriel Feige, Amos Fiat and Adi Shamir, of the Weizmann Instituteâfigured out how to play the game, called zero knowledge proofs of identity. They publicized their result at conferences, and they applied for U.S. patent protection. Ironically the United States said disclosure was detrimental to the national security, and imposed a secrecy order. The three Israelis sought relief, and, with intervention from powerful sources, they got it. Though no one will say for certain, it appears that the National Security Agency (NSA), the government decrypter of secrets, stepped in to help. What the research is, and why the NSA had reason to involve itself, is the story we present here. The technical part has its genesis in the work of Stephen Cook and Richard Karp of the early seventies. Our model of a computer is a RAM, a Random Access Machine. At issue is complexity: on a problem of input size m, how many steps does it take as a function of m to solve the problem? Certain problems are easy; by the obvious method, two m x m matrices can be multiplied in O(m 3) steps (although there are considerably more sophisticated algorithms which require only O(m2-376) steps). Other problems are less obvious. The crucial distinction comes between those problems with polynomial time solutions (the class P), and those which require more than polynomial time. The latter are considered, infeasible. What Cook did was to show that the question Is a boolean expression satisfiable? occupies a special place in the hierarchy of problems. It is solvable in polynomial time by a nondeterministic RAM1 (it is in NP, Nondeterministic Polynomial time), and it is as hard as any other problem in NP (it is complete). If satisfiabilit y has a polynomial time solution, so will any other problem in NP. Karp then showed that a number of combinatorial problems shared that characteristic, called NP-completeness, including kcolorability (can the vertices of a given undirected graph be colored with k colors so that no two adjacent vertices have the same color?), knapsack (given » finite set of integers «,, is there a subset which sums to an integer Kl), This article is the seventeenth in the series of Special Articles published in the Notices. The author, Susan Landau, is an assistant professor of computer science at Weslyan University. She received her Ph. D from M.I.T.; her thesis gave a polynomial time method for determining solvability by radicals. Her research interests include computational complexity and algebra.
Interactive proof systems are considered in which the best set of possible verifiers is restricted to the class of probabilistic log-space automata. A. Condon (1988) introduced this model and showed that if the protocols are allowed to run for arbitrarily many rounds, exponential-time languages can be proved to a log-space verifier. To better approximate the usual notion of interactive proof systems, a number of researchers have considered a more realistic, further restricted model in which protocols are polynomially bounded, both in the number of rounds of communication and in the number of computational steps allowed to the verifier. A notion of language-recognition zero-knowledge is defined for this model, and it is shown that anything provable in this model can be proved in language-recognition zero-knowledge.>
While the intuition underlying a zero knowledge proof system [GMR85] is that no âknowledgeâ is leaked by the prover to the verifier, researchers are just beginning to analyze such proof systems in terms of formal notions of knowledge. In this paper, we show how interactive proof systems motivate a new notion of practical knowledge, and we capture the definition of an interactive proof system in terms of practical knowledge. Using this notion of knowledge, we formally capture and prove the intuition that the prover does not leak any knowledge of any fact (other than the fact being proven) during a zero knowledge proof. We extend this result to show that the prover does not leak any knowledge of how to compute any information (such as the factorization of a number) during a zero knowledge proof. Finally, we define the notion of a weak interactive proof in which the prover is limited to probabilistic, polynomial-time computations, and we prove analogous security results for such proof systems. We show that, in a precise sense, any nontrivial weak interactive proof must be a proof about the prover's knowledge, and show that, under natural conditions, the notions of interactive proofs of knowledge defined in [TW87] and [FFS87] are instances of weak interactive proofs.
Suppose your netmail is being erratically censored by Captain Yossarian. Whenever you send a message, he censors each bit of the message with probability 1/2, replacing each censored bit by some reserved character. Well versed in such concepts as redundancy, this is no real problem to you. The question is, can it actually be turned around and used to your advantage? We answer this question strongly in the affirmative. We show that this protocol, more commonly known as oblivious transfer, can be used to simulate a more sophisticated protocol, known as oblivious circuit evaluation([Y]). We also show that with such a communication channel, one can have completely noninteractive zero-knowledge proofs of statements in NP. These results do not use any complexity-theoretic assumptions. We can show that they have applications to a variety of models in which oblivious transfer can be done.
Michael Ben-Or, Shafi Goldwasser, Joe Kilian, Avi Widgerson
Quite complex cryptographic machinery has been developed based on the assumption that one-way functions exist, yet we know of only a few possible such candidates. It is important at this time to find alternative foundations to the design of secure cryptography. We introduce a new model of generalized interactive proofs as a step in this direction. We prove that all NP languages have perfect zero-knowledge proof-systems in this model, without making any intractability assumptions.
Brotowasisto, Oscar Gish, Ridwan Malik, Paramita Sudharto
This paper describes health care financing and expenditures in Indonesia, a developing country spending around $US 9.40 per capita annually for health care (2.6% of GOP). Per capita health care spending has held constant in real terms over the last five years. The public sector accounts for 36.8% of all health care expenditure, or 43.1% if health care spending by state enterprises is included. About 13% of the population, almost all of them government employees and their families, are covered by some form of health insurance. In 1984, 62% of the population was spending privately â at then current exchange rates â an average of $US 2.70 per capita annually for health care, another 30% averaged $US 8.35 each, and the upper 9% $US 31.90. The Government is reviewing various âsocial financingâ mechanisms with a view to expanding health insurance coverage both for those in formal wage employment and the bulk of the population which remains either on the land or is part of the âinformalâ sector. Steps are also being taken to increase the efficient use of resources by, among other things, making greater use of evaluation techniques and economic methodologies. Such efforts are coupled with more decentralized authority being given to the provinces and districts. Particularly important to future health efforts is the further expansion of community-based activities, especially in the form of the Posyandu (integrated health post).
We show that interaction in any zero-knowledge proof can be replaced by sharing a common, short, random string. We use this result to construct the first public-key cryptosystem secure against chosen ciphertext attack.
This paper analyzes one method governments employ to circumvent the discipline of a competitive system of fiscal federalism - intergovernmental collusion in the form of intergovernmental grants. Grants, it is argued, serve to encourage the expansion of the public sector by concentrating taxing powers in the hands of the central government and by weakening the fiscal discipline imposed on governments forced to self-finance their expenditures. The results reported suggest that intergovernmental grants do encourage growth in the public sector. The results offer further support for the use of monopoly government assumptions in public sector modeling.
In the current environment of general budget stringency in developing countries it is unrealistic to push for more spending for health services. The answer to this health crisis is to relieve government of much of the responsibility for financing those kinds of health services for which the benefits to society as a whole (as opposed to direct benefits to the users of the service) are low freeing resources to finance those services for which benefits are high. The intent is to relieve government of the burden of spending on health care for the rich freeing resources for more spending for the poor. Individuals with sufficient income should pay for their curative care. The financing and provision of these private health services should be shifted to a combination of the nongovernment sector and a sector reorganized to be more financially self-sufficient. A shift such as this would increase the resources available for those types of health services which are goods and currently are underfunded public health programs such as immunization vector control some prenatal and maternal care sanitary waste disposal and health education. Also such a shift would increase the resources available for simple curative care and referral for the poor who now only have limited access to low quality services of this nature. Government efforts to cover the full costs of health care for everyone from general revenues have contributed to 3 sets of problems in the health systems of many countries: an allocation problem -- insufficient spending on cost-effective health activities; an internal efficiency problem -- inefficient programs; and an equity problem -- inequitable distribution of benefits from health services. 4 policies for health financing are proposed to raise revenues for important health programs increase the efficiency of health services and make the system better serve the poor. These are: charging users of health facilities; providing insurance or other risk coverage; strengthening nongovernmental health activities; and decentralizing government health services. A table summarizes the effects of each of the 4 options for reform in alleviating health sector problems.
Decentralization of public program administration and financing to subnational units of government is examined in the context of hospital and nursing home assistance programs in the United States. Do subnational governments (i.e., states) adapt service utilization controls and tighter program eligibility during periods of fiscal austerity? Are these actions affected by expenditure levels, state budget balances, tax revenues, and the state's proportion of low income persons? Published data covering the period 1978-1982 from each of the 50 U.S. states were analyzed using multiple regression. States with a low proportion of low-income persons and a high per capita tax base were likely to increase minimum income eligibility standards to keep pace with inflation. All other states, regardless of fiscal condition, tended toward more restrictive income standards. States were equally likely to adopt utilization controls for health and long-term care services regardless of state revenue or health expenditures.