Health care expenditures: international comparisons, 1970-80

This article is based on the findings of a study developed to compare health care costs in the United States during 1970-80 with those of six other industrially advanced countries--Canada, France, the Federal Republic of Germany, the Netherlands, Sweden, and the United Kingdom. Although health care expenditures in the United States have traditionally been relatively high, as a share of gross national product, they were exceeded in 1980 in West Germany and Sweden and equaled by the Netherlands. All the countries experienced increases in health care spending that outpaced inflation in other sectors of the economy. For the decade as a whole, the United States encountered a slower rate of growth than most of the other countries, both in terms of actual expenditures and when adjusted for inflation as measured by the Consumer Price Index. As the decade progressed, however, most of the other countries succeeded in slowing their rate of increase to a greater degree than did the United States. The data also suggest that wage inflation was less of a factor in raising the cost of health care in the United States than was the case in most of the other countries.     

Public participation in decision making: A three-step procedure

This article introduces a novel model of public particpation in political decisions. Structured in three consecutive steps, the model is based on the view that stakeholders, experts, and citizens should each contribute to the planning effort their particular expertise and experience. Stakeholders are valuable resources for eliciting concerns and developing evaluative criteria since their interests are at stake and they have already made attempts to structure and approach the issue. Experts are necessary to provide the data base and the functional relationships between options and impacts. Citizens are the potential victims and benefactors of proposed planning measures; they are the best judges to evaluate the different options available on the basis of the concerns and impacts revealed through the other two groups. The three-step model has been developed and frequently applied as a planning tool in West Germany. We compare this experience with the model's first application in the United States, and conclude that the three-step procedure offers a limited, but promising future for democratizing policy making in the United States.     

The creation of neo-liberal corporate bias in transnational medicines control: The industrial shaping and interest dynamics of the European regulatory state

Abstract. Drawing on the political theories of corporatism, neo–liberalism and pluralism, and on comparative empirical research in Brussels, Germany, Sweden and the UK, this article conceptualises the nature of Europeanised medicines regulation. It argues that a marketisation of regulation has been established in the European Union as a result of competition between national regulatory agencies for 'regulatory business' from the pharmaceutical industry. In the pharmaceuticals sector the Europeanised regulatory state is a product of three key factors: (a) the European Commission's commitment to an 'efficiency' regime which would meet the political objectives of a single European market and the commercial agendas of transnational pharmaceutical companies, (b) the endemic corporate bias associated with medicines regulation in the most influential member states, and (c) the considerable success of neo–liberal politics across a number of major member states, including Germany, Sweden and the United Kingdom.     

Electoral competition and the welfare state

The article investigates how parties compete over the welfare state by emphasising specific welfare state issues. The core argument is that two issue-specific factors determine how much parties emphasise individual welfare state issues: the character of policy problems related to the policy issues and the type of social risks involved. To test the argument, a new large-N dataset is employed, with election manifestos from Belgium, Denmark, France, Germany, the Netherlands, Sweden, and the United Kingdom. The dataset contains information on how much parties have talked about health care, education, and labour market protection in national elections since 1980. With the data at hand, it is possible to provide the first systematic investigation of how parties compete for votes over the welfare state. The approach here is able to explain the empirical fact that health care is consistently receiving increased attention everywhere, while particularly labour market protection has witnessed a decline in attention.     

Austerity Regimes at the Local Level: Examining Fiscal Effects of Austerity Commissioners Using a Time-Series Synthetic Control Method

Abstract

From a democratic perspective, the replacement of government or parliament by a public manager to enforce budget discipline marks a serious intervention. Transferred to the local level, the replacement of the mayor and the council in three German municipalities by a state official (a so-called state commissioner) in recent years has raised questions about the legitimacy and adequacy of such a strong interventionist instrument. One crucial answer to be given to this legitimacy issue concerns effectiveness, in other words whether the instrument can fulfill its designated task by improving the local fiscal situation since the fiscal success of the commissioner is a basic prerequisite for legitimacy. By using a time-series approach of the synthetic control method (SCM) and constructing a synthetic comparison case to the town of Altena, an answer regarding the commissioner’s potential to reduce the short-term debt can be given. The commissioner was successful in limiting the debt increase and seems to have reversed the debt trend. This finding supports the effectiveness of rather hierarchical instruments for ensuring fiscal discipline at the local level and thereby adds to broadening the international public management literature on municipal takeovers.     

Health care expenditures in nine industrialized countries, 1960-76

This article reports the findings of a study developed to compare health care costs in the United States with those of eight other industrially advanced countries over the period 1960-76. All of the countries studied were found to share with the United States the problem of increased health care spending that has outpaced inflation in other sectors of the economy and continues to consume a growing share of national resources. The American growth rate in these expenditures has, in fact, been lower than that of all other coutries. Though U.S. health care expenditures have traditionally been relatively high when measured as a share of gross national product, Canada outspent the United States in this respect during the 1960's. In most recent years, West Germany, the Netherlands, and Sweden have devoted a larger share of GNP to health care than has the United States.     

The organizational cohesion and political access of business: a study of comprehensive associations

Abstract. This article utilizes an internationally comparative data set to examine the potentiality of comprehensive business associations to define and articulate the interests of business as a whole. We argue that the organizational structures of comprehensive associations - the degree to which they integrate diverse interest areas and they compete with one another- are critical to the degree of probable influence gained in a given country. Using data from seven countries - Austria. Canada, the Federal Republic of Germany, Italy, Sweden, Switzerland, and the United Kingdom - a concept of business cohesion is constructed based on these structural properties. Having differentiated among the countries in terms of the cohesion of business associations, we then relate these differences to variations in the participation of associations in the formulation and implementation of public policy.     

Rationality,Power, Management and Symbols: Four Images of Regulatory Impact Assessment

Impact assessment is the pivotal instrument in the recent wave of regulatory reforms labeled ‘better regulation’. Although the economics of impact assessment has been the subject of a vast literature, less is known about its political properties. Within a comparative framework, this article provides conjectures on four images of impact assessment – that is, rational policy making, political control of the bureaucracy, public management reform, and symbolic action. Looking at six countries with a long experience of impact assessment and the European Union, the article first builds expectations about the diffusion of the images across countries, and then proceeds to measurement by using both objective and interpretative/subjective indicators. The findings seem to support the public management reform image – a conclusion that suggests further specifications about administrative traditions and change. Sweden and Denmark are not using impact assessment to foster instrumental rationality or increase the political control of bureaucracies and, together with the Netherlands, rank high on the symbolic action scale. The United States – and to a lesser extent Canada and the United Kingdom – have a multi‐purpose approach to impact assessment. The case of the European Union defies prior expectations, showing much more usage than anticipated.     

Beyond Kyoto: Climate Change Policy in Multilevel Governance Systems

Climate change policy has commonly been framed as a matter of international governance for which global policy strategies can be readily employed. The decade of experience following the 1997 signing of the Kyoto Protocol suggests a far more complex process involving a wide range of policy options and varied engagement by multiple levels of governance systems. The respective experiences of the United States and Canada suggest that formal engagement in the international realm of policy is not a good indicator of domestic policy development or emissions reductions. The different contexts of intergovernmental relations, varied resources available to subnational governments for policy development and implementation, and role of subnational leaders in policy formation have emerged as important factors in explaining national differences between these North American neighbors. Consequently, climate change increasingly presents itself as a challenge not only of international relations but also of multilevel governance, thereby creating considerable opportunity to learn from domestic policy experimentation.     

On party attachment in Western Europe and the utility of eurobarometer data

An analysis of 25 Eurobarometer surveys conducted between 1974 and 1988 in each of the European Community member‐countries shows that there is no single trend discernible throughout Western Europe. Although levels of party attachment are decreasing in most member‐states, four different patterns have emerged, and they closely relate to more general developments in the respective party systems. These patterns are: strong dealignment (Ireland); peripheral dealignment (United Kingdom and Italy); post‐realignment (Denmark, France, the Netherlands, Greece, Belgium); and stable alignment (West Germany).     

Government versus Opposition at the Polls: How Governing Status Affects the Impact of Policy Positions

We argue that governing status affects how voters react to extreme versus moderate policy positions. Being in government forces parties to compromise and to accept ideologically unappealing choices as the best among available alternatives. Steady exposure to government parties in this role and frequent policy compromise by governing parties lead voters to discount the positions of parties when they are in government. Hence, government parties do better in elections when they offset this discounting by taking relatively extreme positions. The relative absence of this discounting dynamic for opposition parties, on the other hand, means that they perform better by taking more moderate positions, as the standard Downsian model would predict. We present evidence from national elections in Germany, the Netherlands, Norway, Sweden, and the United Kingdom, 1971–2005, to support this claim.     

Politics, Profession and Law: The Legal Development of Compulsory Intervention towards Substance Abusers in Scandinavian Social Law

The legal foundation of compulsory interventions towards substance abusers in Scandinavian social law has moved from similarity to dissimilarity. The aim of this article is to explain this development by focusing on the relationship between three general discourses in the preparation of these acts in Norway, Sweden and Denmark. The political-democratic discourse focuses on the relationship between law and politics (law as a political instrument); the professional discourse emphasises the relationship between welfare professions and law (law as a professional tool); and the legal discourse draws attention to the importance of legal principles (law as an institution). In Sweden, the process has been strongly politicised and influenced by the political 'war on drugs', resulting in a comprehensive use of coercion towards substance abusers. In Denmark, the process has also been dominated by the political discourse. This process, however, was far less politicised than in Sweden, and no actor has pressed for extensive authority to apply such measures in social policy. In Norway, the process has been strongly influenced by legal discourse emphasising the legal security of the substance abusers, resulting in legislation that is more constricted than in Sweden. In none of these countries have welfare professionals played an active role in pressing for coercive measures in this field of social policy; in fact, they have generally opposed such measures.     

National styles of regulation: Child care in three countries

An analysis of child care regulations in Germany, Sweden, and the United States reveals distinctive national policy styles. A ‘social constructionist’ perspective, with its emphasis on variable problem definitions, helps to explain such differences. However, a full understanding of regulatory differences requires attention to regulatory solutions as well. By disaggregating the concept of regulation, we are able to demonstrate rather different rank-orderings of our three countries in their regulatory solutions. We attribute these differences to cultural, institutional, and political characteristics of the three countries.     

Interactions between scientists and public officials: A comparison of the use of science in regulatory programs in the United States and West Germany

This essay compares and contrasts important attributes of the use of scientific knowledge and judgment in regulatory decisions in the United States and West Germany. It decribes the broader historical context for such decisions in each country. Although the system in America exhibits considerable conflict and assumption of adversarial positions, it is argued that a more fundamental attribute of the system is that policy decisions are reviewed according to rules of evidence and its interpretation. Similarly, although the German system involves a great deal of consultation, a more fundamental aspect of policy decisions there is that of the determination of the social obligation to act. In the United States, it is more important that a decisionmaker has properly developed and interpreted the evidence than that he or she has consulted with all the relevant parties. In Germany, the order of importance of the two is reversed.Based on seminars given in Berlin in December 1984 at the International Institute for Environment and Society of the Science Center Berlin and in Washington, DC in January 1985 at the National Research Council of the National Academy of Sciences.The author, a National Research Council Fellow, wishes to thank his colleagues in Berlin and Washington for their comments, many of which have been integrated into this essay. The ideas presented here, however, remain the responsibility of the author.     

Estimating Aggregate Policy Reform Effects: New Baselines for Registration, Participation, and Representation

Statistical models are often extended to explore the aggregateimpact of policy reforms. After discussing these techniquesand the incorporation of prediction uncertainty, this articleexamines the effects of registration reform in an analytic frameworkthat explicitly considers the two stages that defined electoralparticipation throughout the 20th century in the United States—registrationand then voting. Using selection bias techniques, the effectsof counterfactual registration reform conditions are exploredon the aggregate level of participation and the nature of representationin the electoral process. These offer a richer baseline of theimpact of policy changes than previous work by directly exploringthe expected level of dropoff in going to the polls by new registrants.Results indicate that the dropoff between registration and votingwould be expected to increase as more individuals become registered.In addition, while turnout due to reforms among projected "newregistrants" shows potentially larger biases than those amongexisting registrants, because of the different bases of registrationthe changes would still lead to a modest reduction in the disparitybetween actual group sizes and their role in elections.     

The structure of foreign policy attitudes in transatlantic perspective: Comparing the United States,United Kingdom,France and Germany

While public opinion about foreign policy has been studied extensively in the United States, there is less systematic research of foreign policy opinions in other countries. Given that public opinion about international affairs affects who gets elected in democracies and then constrains the foreign policies available to leaders once elected, both comparative politics and international relations scholarship benefit from more systematic investigation of foreign policy attitudes outside the United States. Using new data, this article presents a common set of core constructs structuring both American and European attitudes about foreign policy. Surveys conducted in four countries (the United States, the United Kingdom, France and Germany) provide an expanded set of foreign policy‐related survey items that are analysed using exploratory structural equation modeling (ESEM). Measurement equivalence is specifically tested and a common four‐factor structure that fits the data in all four countries is found. Consequently, valid, direct comparisons of the foreign policy preferences of four world powers are made. In the process, the four‐factor model confirms and expands previous work on the structure of foreign policy attitudes. The article also demonstrates the capability of ESEM in testing the dimensionality and cross‐national equivalence of social science concepts.     

TAX SHARING IN AUSTRALIA AND WEST GERMANY*

Abstract: Certain aspects of the new Australian tax sharing arrangements are analysed against the background of West German experiences. Emphasis is laid on Federal-State relations in outlining the basic characteristics of the German machinery and the Australian arrangements. Compared to the Australian situation, the tax sharing base in West Germany is much broader and has indeed contributed to the safeguarding of State autonomy to a large extent. On the other hand, the German States have no individual power to legislate on taxes or tax surcharges. Although tax sharing is a powerful instrument in mitigating financial imbalances in a federation, it tends to conflict with the idea of a centrally controlled stabilization and distribution policy. In Germany, tax sharing is complemented by a complex coordination machinery stabilizing joint decision making of the Federal government and the States. In areas such as demand management, financial planning and allocation policies there seems to be need for such complementary arrangements, since tax sharing alone cannot achieve sufficient coordination among the different administrative levels of a federation.     

Between deepening and widening: Role conflict in Germany's enlargement policy

Although Germany is the principal proponent of the EU's eastern enlargement, it has at times found it difficult to reconcile this aim with its desire to promote deeper EU integration. The use of role theory illustrates these conflicting priorities. West Germany's post‐war role in European politics was that of a promoter of deeper integration; the deepening of West European integration thus became part of the self‐conception of West German foreign policy‐making élites. The changed situation after 1990 placed new demands on German foreign policy makers. West Germany's traditional self‐conception as an integration deepener conflicted with the desire on behalf of unified Germany to press for EU enlargement. However, although German policy makers employed a variety of strategies in order to pursue their incongruous foreign‐policy aims, their principal concern remained with the deepening of western integration.     

Evaluating the effectiveness of policies related to drunk driving

New findings are presented on the effectiveness (in terms of fatal crash reductions) of state‐level public policies related to drunk driving. Conventional estimates of policy effects might be biased because of the endogeneity of policies; this concern is addressed by analyzing the time pattern of policy effects with respect to the date of adoption. For the 0.08 BAC law, the results suggest that a bias upward exists, but the policy is still somewhat effective. Graduated licensing programs for young drivers and the Mothers Against Drunk Driving (MADD) organization are also evaluated for the first time in this type of analysis. The estimated time pattern of effects for graduated licensing suggest that its effects are also overstated in conventional analyses, but the policy is still effective for young drivers. The estimates for MADD do not imply an effect, but this result could be due to the crudeness of the variable used. © 2003 by the Association for Public Policy Analysis and Management.