DECENTRALIZING HEALTH SERVICES IN THE UK: A NEW CONCEPTUAL FRAMEWORK

Decentralization is a central plank of current government health policy. However, it is possible to discern both centralist and decentralist movements in the UK. This paper examines existing frameworks of decentralization in relation to identifying whether policy is decentralist or not and identifies a number of problems that limit their value. Key problems relate to the way decentralization is conceptualized and defined. Existing frameworks are also highly contextualized and are therefore of limited value when applied in different contexts. The paper then presents a new framework which, it is argued, provides a more useful way of examining centralization and decentralization by providing a way of categorizing policies and actions and avoids the problems of being contextually constrained. The paper ends with a discussion of how the framework can be applied in a health context and shows how this framework helps avoid the problems found in previous discussions of decentralization.     

The Environment： Who Cares？!

As the tide of globalization sweeps into every corner of the planet, many worry that Western cultures and values, bolstered by the overwhelming might of Western economies, might wipe out the great diversity of the world that is rooted in and guards the identities of different peoples and nations. To set up a stage for dialogue between the East and West and to air opinions from both perspectives, we launch Brown Eyes, Blue Eyes. In this regular column the chief executive of Cambridge University Press and a vice director-general of the State Council Information Official will comment on topics of concern to both sides, ranging from education and medical care to sciencce and technology.     

The Puzzle of Presidential Leadership: Persuasion, Bargaining, and Policy Consistency

Political science can offer few theoretical generalizations about the exercise of presidential power. From one perspective, this is no disadvantage: there are few presidents, and presidential leadership so intrinsically involves the interplay of ideas and persuasive deliberation that success depends on personal traits and the fit of the president's ideas with the times. Striving for inductive generalizations in such a case would mistake rote scientific method for the pursuit of knowledge. Others argue, however, that the dearth of theoretical generalizations is a temporary weakness, remediable by shifting to a deductive approach. Deductive theorizing can claim insights in other areas once typified by historiographic methods, notably in studies of Congress, and formal models of legislation have been extended to generate hypotheses about transactions between president and Congress. I suggest that neither side of the dilemma offers a satisfactory and complete approach to the puzzle of presidential leadership; it then goes on to specify how the contributions from each side fit together. Rational choice models, based on bargaining as the mode of influence and the repeated game as the image of process, show how institutional structures can produce stable decisions where majority rule tends toward endless cycling. But the cost is that the resulting decisions are typically ad hoc and disjointed. Achieving consistent and coherent policy requires more subtle coordination of individual expectations than legislative organizations can manage, and it is this limitation of bargaining that establishes the potential for presidential leadership. Presidents can attempt to capitalize on this opportunity either by intervening as an additional (but situationally advantaged) bargainer, or by employing persuasion, the explicit appeal to collective goals rather than particularistic trades. I develop the distinction between bargaining and persuasion as alternative strategies of advocacy, and illustrate their use with examples from President Reagan's interactions with Congress over his key economic policy proposals.