Essossinam Pali, Coffi Cyprien Aholou, François Paul Yatta
After several hesitant attempts, Togo has made renewed progress in implementing sustainable decentralization. Municipal and regional elections held in 2019 and 2024 marked a significant institutional step forward. However, this implementation phase remains marked by both achievements and structural challenges. This article explores how local elected officials perceive the decentralization policy and its financing in their municipalities. It formulates the general hypothesis that decentralization fosters the implementation of local public policies when supported by appropriate institutional mechanisms. Based on a quantitative survey conducted in early 2024 among 487 local actors including 477 municipal councilors and 10 prefects the results highlight a range of perceptions. While some elected officials acknowledge improvements in service delivery and institutional support (through tools such as FACT and ANFCT), others stress the persistence of constraints related to financial autonomy, administrative capacities, and citizen participation. The findings suggest that decentralization in Togo is progressing, albeit unevenly, and requires further efforts to consolidate its institutional and operational foundations.
Essossinam Pali, Coffi Cyprien Aholou, François Paul Yatta
Since 2019, Togo has been strengthening financial decentralization through municipalization and the election of municipal councilors. Municipal financial autonomy is a key driver of local governance, allowing municipalities to mobilize their own resources, manage tax and non-tax revenues, and implement development projects. However, despite a legal framework governing local taxation, Togolese municipalities continue to face chronic financial constraints that limit their ability to finance public services and infrastructure. This study examines the mechanisms of financial decentralization in Togo and their contribution to municipal budgets. Using a quantitative approach that combines documentary analysis and interviews with 188 experts and practitioners in local finance, the study identifies the following four primary financing mechanisms: local, national, community-based and international. Among these, own revenues, including tax revenues, non-tax revenues, and revenues from the provision of services, together with government transfers through the Local Authorities Support Fund (FACT) are the main sources of local government finance. However, the results show that several legally defined fiscal instruments remain underutilized or outdated in many municipalities, significantly limiting their effectiveness in mobilizing resources. These results highlight the need to optimize fiscal decentralization strategies in order to strengthen the financial autonomy of municipalities and support sustainable territorial development.
Essossinam Pali, Coffi Cyprien Aholou, François Paul Yatta
Since 2019, Togo has resolutely engaged in the decentralization process marked by communalization and elections of municipal councilors. Financial autonomy constitutes an essential lever for the free administration of municipalities, allowing them to ensure decision-making and the implementation of development projects. However, despite a legal and regulatory framework defining taxation specific to local authorities, Togolese municipalities are often perceived as needing more financial resources. This study aims to map the financing mechanisms for decentralization in Togo and analyze their contribution to municipal budgets. By adopting a quantitative approach combining documentary analysis and interviews with 188 experts and practitioners of local finance from various Togolese structures, four main financing mechanisms were identified: local, national, Community, and international. Among these mechanisms, own resources (in particular from the sale of products and services, fiscal and non-fiscal taxes) and state transfers via the Support Fund for Local Authorities emerge as the primary sources of financing for municipalities. However, the study reveals that several instruments of local mechanisms, although institutionally defined, still need to be updated in many municipalities, thus limiting their effectiveness in resource mobilization. These results highlight the importance of optimizing the management of local mechanisms to strengthen municipalities’ financial autonomy and support territories’ sustainable development.
I. Le NFT en droit : propos introductifsDfinitions du NFT.Il existe de nombreuses dfinitions doctrinales du NFT, lesquelles sont toutes plus ou moins interchangeables.Les NFT (Non Fungible Tokens, ou Jetons Non Fongibles en franais) sont des jetons numriques uniques et indivisibles certifis par une blockchain 1 .Certains auteurs proposent cependant des dfinitions fondes sur une approche technologique.Pour Monsieur Legeais, le NFT est un jeton enregistr dans la blockchain, comportant une suite de caractres alphanumriques rpondant aux rgles de la cryptographie.Ce jeton contient les mtadonnes permettant d'identifier son metteur et l'objet sous-jacent.Selon les rgles dfinies par celui qui a cr le NFT, le fichier vers lequel il renvoie devient donc grce lui unique.Le fichier reste duplicable l'infini, mais le NFT permet dsormais de crer un original cr et authentifi 2 .Rcemment, l' Administration fiscale a propos, certes pour rpondre une question pose en matire de TVA, une dfinition des NFT : Les jetons non fongibles (JNF), communment dnomms NFT en lien avec l'appellation anglaise non fungible tokens , sont des fichiers informatiques uniques, crs et stocks sur un registre numrique de suivi de transactions dnomm chaine de blocs ( blockchain ) 3 .Les NFT seraient ainsi d'aprs leurs caractristiques technologiques des jetons crs par smart contract et dont le propre serait d'tre uniques, donc non fongibles.La catgorie gnrale des jetons serait ainsi compose des jetons fongibles et des jetons non-fongibles.La question est cependant de savoir si les notions technologiques et juridiques de jetons se recoupent o si le droit s'autorise, dans la poursuite de ses objectifs propres, dvier de la technologie.Fongibilit, choses de genre, corps certains, choses fongibles.La fongibilit est une notion du droit des obligations qui s'appuie sur un couple de contraires en droit des biens : les corps certains et des choses de genre.Les choses de genre sont celles qui ne se dfinissent pas par leur individualit, mais par leur espce et leur quantit.Au sein d'un ensemble de choses de genre, chaque chose en vaut une autre.Cette identit se traduit, en droit des obligations, par l'indiffrence du crancier de choses de genre recevoir celles-ci plutt que celles-l.Dans l'excution de l'obligation, les choses de genre sont dites fongibles.Il ne faut cependant pas se mprendre sur la notion de fongibilit : elle ne dpend pas de l'absence d'individualit des choses, mais de l'indiffrence des parties un rapport d'obligation cette individualit. chaque fois que les parties voient les choses comme des quantits et non comme des individualits, il est possible de parler de 1 B. GLEIZE, L'irrsistible ascension des jetons non fongibles in Actualit du droit des technologies nouvelles (
La prévention spécialisée est une mission éducative destinée à permettre aux jeunes en voie de marginalisation de rompre avec l'isolement et retisser des liens avec le reste de la société. Née d'une pratique militante dans l'immédiat après-guerre, elle s'est depuis progressivement institutionnalisée pour relever aujourd'hui de la politique de l'aide sociale à l'enfance.Les éducateurs de rue interviennent sur un territoire délimité et sont directement en prise avec les politiques publiques.Cette thèse interroge les rapports entre un groupe professionnel avec ses modalités d'action et les valeurs qu'il revendique, la mise en œuvre d'un processus de réaménagement de l'Etat - la décentralisation -, et celle de la politique de la ville.Les éléments communs à ces trois démarches (la dimension territoriale en particulier) font l'objet d'analyses de même que les risques de tensions liés à la pression que la prévention spécialisée peut ressentir sous le poids conjugué d'une plus grande proximité des élus et décideurs dans le cadre de la décentralisation, et de l'injonction à prendre part à des dispositifs initiés dans le cadre de la politique de la ville.De fait, la prévention s'est trouvée directement placée sous la tutelle des départements, plus proches que l'Etat. Progressivement, les Conseils généraux se sont emparés de cette compétence et ont assorti leurs financements d'injonctions pesant sur les associations. Cette évolution a pu être constatée en Essonne comme dans le Val-de-Marne en dépit de rythmes et de dynamiques différents.L'étude de l'activité de quatre associations implantées au sein de ces deux départements montre que ces évolutions ne s'effectuent pas sans résistances, sans zones de friction entre des professionnels fréquemment venus à la prévention spécialisée pour l'originalité de ses modalités d'intervention et des élus souhaitant davantage contrôler et orienter l'activité des associations.Les éducateurs sont de plus en plus amenés à travailler en lien avec les établissements scolaires, du fait d'exigences départementales. Ce rapprochement entre la prévention spécialisée et l'Education nationale s'ajoute au travail mené par ailleurs avec les dispositifs relevant de la politique de la ville. La conséquence de la mise en œuvre de ces dynamiques est l'évolution du public rencontré par les éducateurs.La moyenne d'âge des jeunes accompagnés est de plus en plus basse et les préoccupations prises en considération par les équipes relèvent de plus en plus du lien avec l'école. La participation des associations de prévention spécialisée aux mesures de responsabilisation constitue une évolution majeure pour ce secteur d'intervention.En privilégiant les jeunes de 11 à 16 ans, les associations restreignent l'accompagnement des jeunes adultes de 18 à 25 ans.Si ce délaissement partiel des jeunes adultes est variable d'une association à une autre, le phénomène est suffisamment global pour susciter des interrogations au sein des équipes éducatives elles-mêmes ; les profils qui constituaient le cœur de l'intervention en prévention spécialisée tendent à devenir de moins en moins prioritaires.L'idée de prévenir les ruptures de parcours en accompagnant les jeunes plus tôt se justifie, mais à effectifs constants, elle amène les équipes éducatives à privilégier certains publics et certaines interventions au détriment d'autres. Le travail de rue, dimension emblématique du travail en prévention spécialisée est ainsi perçu en régression au sein des associations.La décentralisation, la politique de la ville ont participé à la réduction des marges de manœuvre, de l'autonomie des associations de prévention spécialisée. Si le travail demandé prend sens, il participe d'une aseptisation d'une prévention spécialisée ne disposant pas des ressources pour répondre aux commandes qui lui sont adressées tout en maintenant le cœur de ses interventions traditionnelles auprès d'un public de jeunes adultes en voie de marginalisation.
Offers an overview of the decentralization process in Burkina Faso beginning in 1991 with reforms to introduce a pluralist local democracy and improve local development in the face of bankruptcy. The territorial organization includes a decentralized level of regional and local government units and a deconcentrated level of administrative units that recognize the influential component of the customary power structure. Analysis of the decentralized budget, comprised of current and capital sections, shows controversy over ambiguity in the text of laws relating to the constraint of budget balance because provisions are liable to diverse interpretations. Ten areas of competence were transferred to the territorial collectives (CTs) using the principle of progressiveness signifying that the transfer of powers to local governments be carried out gradually. Statistical data on CT expenditures and revenues are abundant, but poorly organized and show that the ratios between capital expenditures and current expenditures are high, and revenues are inconsistent with resources.
Conceived in the Bismarckian mould in response to The Social Question as it manifested
itself in the late nineteenth century, the Belgian welfare system followed a fairly conventional continental trajectory up until the worldwide economic recession of the early
1970s.
It was the same climate of social unrest during the recessionary 1880s that had led Ottovon Bismarck to institute the first labour protection laws and social security provisions in
Germany that triggered the introduction of similar laws and provisions in Belgium. To
be clear, social security arrangements had by then already emerged on a voluntary basis,
usually within the context of mutual societies and such organizations, most of which had
a much broader purpose than providing social security. These mutual societies and organizations were organized along ideological lines, the Christian-Democrat and the Socialist
being the most prominent. The pluralist, decentralized and autonomous nature of social
security and social welfare provision did not change once the state started taking up a
regulatory and standardizing role. But out of a patchwork of arrangements emerged a
compulsory and increasingly universal system of social security and health care (Deleeck,
2001).
A long phase of incremental, though at times still erratic expansion of various, mostlyoccupationally segregated social security schemes culminated in the ‘Social Pact’ of 1944.
Born in the exceptional atmosphere of solidarity and consensualism of the final days of
the war, the Pact marked a consolidation of the welfare system. The Social Pact, while
extending compulsory social security coverage, confirmed the subsidiary principle in the
sense that non-governmental organizations (i.e. unions and mutual societies) remained
responsible for the administration of benefits. In addition, national agencies were created
for those not affiliated to such organizations. The role of the state remained, as before,
very much in a regulatory and complementary role.
The 1950s and 1960s were essentially a period of incremental expansion. Belgium’ssocial protection system came to maturity just before the economic crisis struck. With
the main social security pillars in place, by and large in the Bismarckian mould, all thathappened laws on
assistance (providing a minimum income guarantee to all citizens), the law on guaranteed
child benefit (ensuring access to child benefits all to those not covered under the social
security scheme) and the law on the guaranteed minimum pension (ensuring a minimum
pension for all pensioners).
It was just after these final pieces had been put in place that Belgium’s social protectionsystem was challenged in a most profound way. Belgium’s economy was particularly hard
hit by the oil price shocks and the subsequent economic downturn of the 1970s and
1980s. An early industrializer, Belgium’s economy was still heavily reliant on manufacturing industry, much of which tended to be comparatively energy intensive and,
therefore, particularly sensitive to the energy price shocks. The share of industrial employment (including mining and construction) in total employment, which was still around
40 per cent in 1975, fell rapidly in the years thereafter, reflecting major structural
adjustments in steel, coal and textile industries. During the 1970s and also during the
1980s, Belgium recorded among the largest relative job losses in manufacturing industry
in the Organisation for Economic Co-operation and Development (OECD) area. The
consequences were particularly severe because entire cities and even regions remained
heavily dependent on industrial employment. The collapse in the demand for labour
occurred precisely at a time when many youngsters (the sizable post-war baby boom
cohort) and women were entering the labour market.
It was in this context that a massive increase in benefit dependency, particularlyunemployment benefit dependency, ensued. This happened in most continental European welfare states but virtually nowhere was it as dramatic, relatively speaking, as in
Belgium. Today Belgium still epitomizes continental Europe’s ‘welfare without work’
conundrum. Belgium spends more on unemployment benefits, relatively speaking, than
just about any other EU member state (Table 2.1). While its unemployment rate is
around the EU15 average (Table 2.3), its employment rate remains among the lowest of
the northern continental European Welfare Systems. Around one in four people of
working age lives on some kind of replacement benefit. While still enjoying a comparatively low poverty rate, Belgium has been slipping down the tables during the lastboth political as the
to move towards an ‘active welfare state’, Belgium’s corporatist system has not shown a
real capacity to deal with the root problems of sluggish job growth and persistent high
benefit dependency. In addition, Belgium is facing some very particular problems owing
to its particular history of linguistic conflict, a problem exacerbated by regional economic
divergence.
This chapter sketches some of the key developments within Belgium’s welfare systemover the past three decades and discusses the principal challenges facing it today.
This article proposes a secondary analysis of data collected on four French cities as part of an European research project, entitled "Rescaling Social Welfare Policies. A Comparative Study on the Path towards Multi-level Governance in Europe". The field-work provided a profusion of data on the so-called "2nd wave of decentralization" (2004-2005) that hardly fit into the standardized frame designed for international comparisons. It appears that this territorial re-organization combines opposite movements depending on the point of view adopted (bottom-up or top-down) and the type of public action considered (planning, funding, defining eligibility criteria etc.). The rescaling processes that occurred within the four field-sites have ambiguous effects as regards regulation. On the one hand, theoretically speaking, they turn market competition into an attractive model. But, on the other hand, they have practical implications (limited market size and lack of expertise within local governments for example) which prevent this autonomous mechanism of regulation from achieving efficiency. This finally induces constant bargaining which leads case managers to using informal procedures in the selection of beneficiaries within the official target population and give rise to disparities in access to welfare programs across the four field-sites but also within each site depending on the institutional entry point.
The French health-care system is almost totally under the supervision of the government, which defines the general orientation of health policy. For example, a health-care policy for cancer treatment will be developed in France within the next 5 years. The government organizes the initial formation of all categories of health professionals and so controls the number of professionals in each category. In France, 4500 medical students graduate each year. Demographic problems at the present time are caused by the quota for all medical professions. The government also ensures that the number and location of hospitals are adequate for the needs of the French population. It supervises public hospitals and the management of private clinics, with the objective of providing a consistent standard of care in all health-care structures. The government also proposes the health budget for parliament's approval. In 1996, in line with the concept of decentralization, which means ‘to think globally but act locally’, regional agencies for hospital care were created in each administrative region. They are responsible for the strategic and economic supervision of hospitals, and for the organization of regional health care. However, they have no authority with regard to ambulatory care, thus creating a gap between hospital and ambulatory care in France, which represents a great obstacle to the coordination of care for disabled and elderly people. The French health-care system is a mixed system, being both etatic and liberal. There is a collective health insurance program in place based on incomes; the premium payments are automatically deducted from salaries. The rate is determined each year by the government for an equilibrated budget. Patients have completely free access to all medical care, including hospitals and choice of practitioners. They can have as many consultations and hospitalizations as they want. Furthermore, public and private health structures coexist. Sixty-five percent of hospitals are public and 35% are private. Ambulatory care structures are mainly private (95%). Therefore, although the French system is complex, comprising etatic and private organizations, it functions well. Furthermore, freedom and heterogeneity are probably the main guarantees of quality of health care in France, even if the cost is high and constantly increasing. In France, the number of available hospital beds for acute care (short-stay units), rehabilitation, long-term care and psychiatry is high (Table 1). The rates per 1000 people are the highest in Europe. However, the number of beds for disabled geriatric patients is low: 400 000 beds in retirement homes and 68 000 beds in long-term care units. There is a very long queue to get into such establishments. For psychiatric institutions, there are a total of 6430 beds. The number of health professionals is quite high (Table 2), but they are growing older and demographic problems will arise in the next 10 years. To finance the health-care system, including ambulatory and hospital care, a budget is approved by parliament annually. Ten percent of the gross domestic product (GDP) is devoted to the health-care system (130bn euros), including public hospitals, private hospitals, ambulatory care organizations and pharmacies (Table 3). The budget is being constantly increased. Patients can get a refund of the total cost of health care. For example, refunds for hospitalization costs are between 80% and 100%. For ambulatory care, refunds are between 70% and 100% and for drugs, between 35% and 100%. Health care is free for the homeless and poor people (100% refund). There is a list of 30 severe diseases, including Alzheimer's disease (AD), for which patients are entitled to a 100% refund. Last year, the treatment of AD was listed as a national priority and the government established a care program for the disease. Two main initiatives were proposed. The first one is diagnosis, particularly early diagnosis, as only half of the patients are diagnosed in France. In regard to this, the program proposed the development of memory clinics and regional expert centers. The second initiative is to provide better care for people with AD. This covers ethical issues, the possibility of family caregivers benefiting from some help, financial aid, and the creation of social day-care centers. Hospital care for people with AD is totally paid for by the social security system. Various options are available: short-stay units, rehabilitation units, and day hospitals (of which there are too few) for diagnosis and rehabilitation. Furthermore, people with AD are generally not very welcome in traditional short-stay and rehabilitation units, and it is very difficult to get them a place in such units. Memory clinics are being developed and regional expert centers will be created next year to assist in the early diagnosis of the disease. An expert center must meet specific defined criteria. It must have a multidisciplinary team (neurologists, geriatricians, psychiatrists, and neuropsychologists) and a day hospital for disease diagnosis (capable of handling at least 100 new patients a year). It must also be a source of expertise in research, possess postgraduate knowledge about dementia, and be the centre of a network including general practitioners, ambulatory neurologists and memory clinics of the first degree. Ambulatory care for people with AD is provided by neurologists and psychiatrists (both in insufficient numbers), and by general practitioners, who are not accurately trained for dementia care. Very few geriatricians are included in ambulatory care. Nurses, orthophonists, and physiotherapists are also involved, but again, they are insufficient in number. In other words, social day-care centers should be developed. Social support for patients is financed by a new prestation, the ‘APA’ (personalized prestation for the promotion of autonomy). This prestation was defined in 2002. The amount of the prestation is calculated according to the loss of autonomy. Patients are classified into six groups upon evaluation of their autonomy. It is possible for patients to buy the time of professional social workers and caregivers. The highest level of financial aid they can obtain is 1200 euros per month. Today, 50% of patients are being looked after only by family caregivers. Nursing homes are currently evolving in France. Retirement homes and long-term care units now belong to a single category. The total living expenses comprise three parts: food and housing costs are borne by the patients (through family or social aid); nursing costs are covered by the APA prestation and patients (or their families); and the total cost of medical care is covered by social security (100%). In conclusion, the French health-care system is quite unique since it involves both etatic and liberal organizations. It is an excellent system for patients because of low medical costs, but it requires a high cost of maintenance.
The note focuses on the leading role of \n local level institutions (LLIs) in Burkina Faso, in rural \n decentralization, and poverty eradication, to enhance \n equitable prosperity. It is based on the study undertaken by \n the National Decentralization Commission in Burkina Faso, \n which draws on case studies in Sanmatenga, Sissili, Houet, \n and Yatenga, and, presents sociological evidence that \n certain high-performing LLIs contribute to equitable \n economic development. Economic findings support this, \n showing that both lower inequality levels, and lower poverty \n levels, are linked to a high degree of internal village \n organization. Contextually, LLIs surround, connect, and \n manage communities, incorporating many different kinds of \n indigenous organizations, and functions. Three categories of \n institutions active at the local level are identified: value \n institutions, which focus on activating, and maintaining the \n stability of local governance, and values of the society; \n production institutions, focused on accessing resources from \n the national government, so as to increase productivity; \n and, service-asset management institutions, which integrate \n productivity, and growth values, focused on managing, and \n expanding local assets for sustainable development. External \n aid will need to map these LLIs to guide pro-poor \n investment, and financing of community driven development, \n and encourage local governments to formalize participation.
Abstract In France, like in other Western European countries, the third sector has been on a steady increase during the last decades. Similar to the situation in Germany, the French Third Sector is predominately financed by public money that is concentrated on those subsections which form the core of the welfare state: education, health and social services. However, public funding is currently being reduced and against this background, government and nonprofit-organizations are looking for new ways of cooperation. In other words, in France the partnership of the Third Sector with government is changing as well as its position and role in the French welfare mix. Introduction In the following the results of the Johns Hopkins Nonprofit Sector Comparative Project for France will be presented, thus outlining: * the overall size of the Third Sector in France in 1995, * its composition, * its revenue sources, and * its recent evolution. Thereafter, the Third Sector's central role in labour market policies will be discussed. In France, many new jobs, new markets and new skills have initially been explored by volunteer work. Combined with a trend towards professionalisation this knowledge served as a blueprint for paid labour. Moreover, the changing role of the nonprofit organizations as partners in a new welfare mix will be analysed. The recent Assises de la Vie Associative - a major event which gathered in February 1999 more than 2,500 nonprofit leaders, many government representatives and eight ministers including the Prime Minister was a kind of celebration of the government nonprofit sector partnership. But beyond this temporary event the relationship is not so clearly defined and in some subfields it includes a newcomer: the for-profit sector. I. Dimension of the French Nonprofit Sector As stated elsewhere (Archambault 1997 a, 1997 b), the French nonprofit sector developed only quite recently, associations - the generic form for most nonprofit organizations - being illegal during the whole 19th Century until a nearly centenarian act legalized them. During the 1960s and the 1970s the French Nonprofit Sector slowly grew in a context of state-provided welfare. More recently the decentralization of 1982 broke with a millenary Jacobin tradition which was a major incentive for the Third Sector to contract with local authorities. Graph 1 shows this recent growth: today between 60,000 and 70,000 associations are created per year, more than three times the average of the 1960s. [GRAPH OMITTED] A. Overall Size of the French Third Sector In 1995 full-time-equivalent employment was 975,000 including religion and 960,000 excluding religion - that is 5 per cent of the total employment or the total agricultural employment or the total employment of all consumption-goods-manufacturing industries in 1995. In addition to this paid employment, millions of volunteers are working in the Third Sector. One French individual out of four declare to be a volunteer. The total operating expenditures of the Third Sector in 1995 was FF 290 billion (44.2 billion Euro), which is the equivalent of the turnover of the public utilities industry or the mechanical engineering industry. These figures do not include the estimated monetary value of volunteering which would raise the sum by some 70 per cent. Therefore, the economic activity of the French Third Sector - which is frequently a by-product of its social role - is significant and sizeable. In a comparative perspective France is a middle weight - graph 2 shows the nonprofit share of total employment by country. The French third sector ranks exactly at the average level among the 22 countries which were included in the statistical part of the project. Germany is in a similar position. Graph 2: Nonprofit share of total employment by country, 1995 Netherlands 12. …
A bstract . The French health care delivery system is characterized, on the one hand, by a centralized and socialized decision making process as far as financing is concerned, yet on the other hand, the regulation of activities is highly decentralized and governed mainly by individual physicians on a private basis. Today, the health care scene seems to be stuck in a process within which each new reform leads to yet another reform, In this movement, the role played by academic health economists is increasing. The French health care delivery system and its dynamics are described and two major topics which wilt be at stake in the years to come, the remuneration of physicians and the financing of hospitals are considered. The challenge facing health economists who have to consider the system as a system, is examined. The relationships between the political arena and the researcher's ivory tower appears to be is one of the keys for the future of the health care system. It is demonstrated that, in this area too, few barriers have fallen.
Abstract Equity and solidarity are key issues in the current political debate concerning the Swiss health care system and possible reforms to it. Equal access to medical care has always been a basic principle which has been strongly supported by all political parties and is reflected in the legal framework. Because the health care system is highly decentralized, assigning most of the responsibilities to the 26 cantons, these legal statements exist predominantly on the cantonal level. For example, the communities are compelled by cantonal law to guarantee access to those who need it but cannot afford it (Undritz 1987, p. 21). However, no such consensus exists with respect to health care financing. The conservative parties favour financing schemes which promote efficiency but are regressive (such as a high share of private financing, high co-insurance rates, and deductibles). By contrast, the parties with a strong social committment support financing schemes which are progressive (high share of tax-financing, low co-insurance rates, and deductibles, free care). In the 1980s, the actual development was characterized by a decreasing share of tax-financing and increased co-insurance rates, thus increasing the regressiveness of the financing system. However, this development is likely to be reversed in the near future. A referendum is pending, proposing a massive increase in the share of tax-financed health care, and seems to have a good chance of winning the vote. These developments should be kept in mind when interpreting our empirical findings which related to the situation in 1982.
Ten years after the decentralization laws were adopted by the French Parliament, the once-and-for-all effects of the changes introduced have had time to work themselves out and the observed evolutions can safely be assumed to reflect the permanent functioning of the French system of local goverments in their new institutional environment. The present paper reviews some of the major consequences of the reforms, mostly on local public finance. It stresses the potential dangers of a system in which, due to the disproportionate share of some taxes and to the important role of central government in financing, locally elected authorities may well not be «accountable» enough. In addition, the equalization properties of existing inter-governmental grants seem much too limited compared to the tendencies, inherent in the current system of local finance, to strong polarization of economic development and to geographic segregation of population according to income levels.
Selecting a Communication Service Organization : the Ministry of Finance Determining what type of organization to select is a very central question for a communication service and the success of its activities. Based on an initial assessment, what communication strategy should be adopted, which type of organization should be selected, how can central and decentralized structures be connected ?
The present article is a critical account of the official report from the Commission of Inquiry on Health and Social Services in Quebec (la Commission Rochon). This report is first examined in light of the socio-political context of Quebec society in the '80s with a particular emphasis on factors which directly influenced the development of the Commission's work. The author then presents the main elements of the report. He stresses the quality and appropriateness of studies bearing on Quebec social evolution during the last 20 years and on the identification of health and social problems in the present time. He reminds us of the radical diagnosis made on the organization of health services. The principal options for more adequate health system orientations are then studied in the context of debates following the report publication, two years ago, particularly concerning issues of regional decentralization and financing. The author finally stresses the new challenges of today in social health management, while showing the profound continuity existing between the Commission's works and those of the Castonguay Commission, at the beginning of the '70s.
Alain Fonteneau, Alain Gubian, Henri Sterdyniak, Christine Verpeaux
What Prospects for French Social Security ? A. Fonteneau, A. Gubian, H. Sterdyniak, C. Verpeaux In the future, the ageing of the population, increases in health expenditures, the rise of unemployment and the necessity to encourage the birth rate will make the problems of the social security more acute. Is it possible to finance spreading social transfers without undermining economic growth ? Could one reform the social welfare system to avoid the extension of transfers ? To get clearer social choices and to aim at macroeconomic balance, social benefits should be financed only by households. Workers would contribute to the insurance role of social security ; income tax would provide for solidarity. Shifting all contributions on to wage earners and raising wages accordingly would have no short-term impact. However, employers would be assured that gross costs were not to be increased and indeed would remain stable. Replacing employers' contributions by a turnover tax or by VAT would not result in better economic performance. Substituting part of the employers' contributions by a tax on machines would stimulate the saving of capital and employment. A solution of liberal obedience that would separate solidarity financed by the Government from privately financed individual insurance seems neither viable nor desirable. As far as health expenditures are concerned, the development of private insurances would deny the principle of equality of all men in respect of medical care. Insurance companies would be tempted to make a select among their potential clients and to exclude those who present too many risks. Two other ways seem to be more promising, even though they include risks. In the first case a centralized control of the care supply is based on an assessment system of medical techniques. In the second one, coordinated networks of care are based on decentralization.
Abstract: This paper focuses on the degree of financial independence of local governments in the province of Quebec. The author shows that even if the Municipal Finance Reform (Bill 57) succeeded in achieving its goals, the level of financial dependence of local governments in Quebec remains among the highest in North America. Scenarios for further decentralization of financing and spending powers in Quebec are then briefly investigated. Sommaire. Cet essai discute de l'autonomie financière des localités québécoises. L'auteur souligne que mm̌ si la réforme de la fiscalitë municipale (Loi 57) a atteint ses objectifs, le degré d'autonomie financière des localités au Qukbec demeure un des plus faibles en Amérique du Nord. Plusieurs scénarios sont présentés dans l'optique d'une plus grande décentralisation des pouvoirs de financement et de dépense au Québec. “… N'est‐ce pas une chose véritablement stupéfiante de voir une nation, plusieurs nations, toute l'humanité bientôt, dire à ses sages, à ses sorciers:” Je vous aime‐rai et je vous ferai grands, si vous me persuadez que nous progressons sans le vouloir, inévitablement ‐ en dormant; débarrassez‐vous de la responsabilité, voilez pour nous l'humiliation des comparaisons, sophistiquez l'histoire, et vous pourrez vous appeler les sages des sages 1 .“
A study of the process of administrative decentralization in the period of 1950 - 1983 is the subject of the present article. The substantial part of the discussion is devoted to presentation of actions undertaken after 1981, i.e. in the course of changes brought about by presidential and parliamentary elections. As far as the period to 1931 is concerned, the authors view its organizational moves as a manifestation of deconcentration of power tendencies, rather that a genuine decentralization. Legal acts enacted after 1981 prove a real will of the legislator to carry out a decentralization process. The article discusses in detail all acts and decrees regulating a new competence division between local communities and the state, changes in executive powers in regions and departments, new functions of regions,, new role of state representatives in communities, principles of financing and control a posteriori, possibilities of communities intervention in economic and social matters. All that results in eliminating the state's tutelage on local communities in the respect of administration and financing. The period which has passed since 1981 is too short to allow drawing any far reaching conclusions. It is therefore advised to undertake an attempt at resuming that new stage of decentralization after a certain time.
The reform of decentralization in Belgium Recent developments of the Belgian territorial administration reflect the constitutional problems that have arisen in Belgium since the 1970 reform which reorganized the State by setting up three autonomous regions according to the cultural duality of the country, viz Flanders, Wallonia, and the bilingual region of Brussels. The regionalization of the State is followed up by another reform movement which aims at strengthening the local administrative level of municipalities : the association and federation of communes. There are hence at present five administrative levels : State, region, province, association-federation of communes, commune. This reform, which is still provisional, allows for a complex administrative organization, at times rather incoherent, comprising too many levels of decision-making with often rather vague or ill-defined terms of reference. This has brought about a trend towards simplification of institutions leading some critics to advocate an increase in powers, according to relevant matters, either at the central (State or region) or at the local level. Without contesting the good reasons for such a criticism, the author is neverthe-less reluctant to endorse such a position which would imply that the existence of the intermediary administrative level (the traditional provinces) would be open to question, whereas he feels that it has a role to play in that this is the adequate level to handle a number of managerial tasks.