The interplay between economic and political logics: path dependency in health care in England

The purpose of this article is to use the ideas of path dependency to understand why policies implemented by governments for health care in England were and are suboptimal in terms of the control of total costs, the equitable distribution of hospital services, and efficiency in delivery. We do this by relating the economic logic of achieving these objectives to the political logic of a state-hierarchical system in which ministers are accountable for the effects of policies and doctors largely decide the supply and demand of health care. The initial policy path of the National Health Service (NHS) controlled costs but lacked systems to achieve equity and efficiency in the funding of hospitals. Policies were introduced to achieve equity, but not efficiency, in the 1970s. The Thatcher government sought efficiency through a budgetary squeeze in the 1980s, which culminated in the NHS funding crisis of 1987 - 1988. The result was the policies of the NHS internal market, which promised efficiency by introducing a purchaser-provider split and a system of provider competition in which money would follow the patient. These promises justified an injection of extra funds for three years, but only a pallid model of the internal market was implemented. The Blair government abandoned the rhetoric of competition but maintained the purchaser-provider split and continued to constrain total NHS costs, which resulted in the funding crisis of 1998 - 1999. Current policies are to substantially increase spending on health care and reintroduce a system of provider competition in which money will follow the patient.     

Japan's United Nations Peacekeeping Dilemma

The Peacekeeping Operations (PKO) Law was passed in Japan in 1992, after much debate and controversy over the question of sending SDF troops on UN peacekeeping missions. The limits implicit in the "Five Principles" of that Law mean, however, the SDF cannot participate in UN PKO missions in any meaningful way. In this article, Kimberly Marten Zisk, Associate Professor at Barnard College, Columbia University, addresses the issues behind the arguments for and against a more active Japanese UN PKO participation. The strong antimilitarist sentiment which arose as a reaction to the specter of the Pacific War, and the fears of her neighbors, in addition to domestic political concerns, are all contributory factors to Japan's reluctance for a more active UN PKO role. Nevertheless, Zisk states that a s a "middle power" in international relations, and one that is very keen for a seat on the United Nations Permanent Security Council, it is puzzling that Japan should have placed so many restrictions on the SDF's PKO. She argues that for any comprehensive study of Japanese defense policy and PKO, the bureaucratic influences on peacekeeping policy should also be taken into account.     

Constitutional Irregularities in the British Imperial Courts of Vice Admiralty during the Mid-Nineteenth Century

During the mid-nineteenth century there were between forty and fifty courts of vice admiralty located in colonies across the British empire. They were imperial institutions, whose officers were supposed to be appointed by the High Court of Admiralty in London. However, the complexity and obscurity of the official process, combined with the lack of priority given to the courts by imperial and colonial officials alike meant that many of these courts experienced unfilled vacancies and irregular appointments. This article discusses the shortcomings of the vice admiralty system that gave rise to these irregularities, and led to the passage of the Vice Admiralty Courts Act in 1863. It demonstrates that the courts were ineffective instruments of imperial authority, and that by the time the 1863 Act was passed their integration into the regular colonial courts was inevitable.     

Verfassungsgerichte und Verfassungsvergleichung: Die Perspektive des Europäischen Gerichtshofs für Menschenrechte

In seiner jüngeren Rechtsprechung bedient sich der EGMR in zunehmendem Maße rechtsvergleichender Argumente. Eine Differenzierung zwischen einfachrechtlicher und verfassungsrechtlicher Rechtsvergleichung findet dabei allerdings nicht statt. Der Beitrag versucht, die vorliegende Judikatur zu systematisieren und auf diese Weise einen ersten Schritt auf dem Weg hin zum angemahnten dogmatischen Konzept im Umgang mit verfassungsvergleichenden Argumenten bei der Auslegung der EMRK zu unternehmen.     

Representation,agendas and institutions

Dynamic agenda representation can be understood through the transmission of the priorities of the public onto the policy priorities of government. The pattern of representation in policy agendas is mediated through institutions due to friction (i.e., organisational and cognitive costs imposed on change) in decision making and variation in the scarcity of policy makers' attention. This article builds on extant studies of the correspondence between public priorities and the policy activities of government, undertaking time‐series analyses using data for the United States and the United Kingdom, from 1951 to 2003, relating to executive speeches, laws and budgets in combination with data on public opinion about the ‘most important problem’. The results show that the responsiveness of policy agendas to public priorities is greater when institutions are subject to less friction (i.e., executive speeches subject to few formal rules and involving a limited number of actors) and declines as friction against policy change increases (i.e., laws and budgets subject to a greater number of veto points and political interests/coalitions).     

Interpreting Statutory Purpose – Lessons from Yemshaw v Hounslow London Borough Council

Yemshaw v Hounslow LBC is a significant case in the fields of housing and family law, as well as giving rise to important issues as to the judicial role and statutory interpretation more broadly. This note critically analyses the reasoning of the Supreme Court in Yemshaw, in which the principal issue was whether the definition of ‘violence’ for the purposes of the Housing Act 1996 extended to non‐physical as well as physical forms of harm. In rejecting the view of the Court of Appeal, the Supreme Court adopted a wider definition of violence to encompass emotional and psychological as well as financial abuse. This commentary adopts a fresh stance by examining closely the context surrounding the enactment of the Housing Act 1996 and how this informs the question of statutory interpretation. In so doing, the author suggests that the interpretation employed by the court is significantly undermined.     

The successful use of consultancies in aid‐financed public sector management reform: a consultant's eye view of some things which matter

Independent consultants, often contracted through consultancy firms, are important players in donor attempts to trigger and guide institutional change processes in recipient government structures and practices. However, little is known about the efficacy or ‘success’ of such consultancies. This article explores some of the issues involved. Following a discussion of the problems of defining ‘success’, we present an analytical framework which can be used in all kinds of contexts to generate information relevant to institutional change programmes, and to the design of consultancies to help carry the change processes along. Such information can be used to predict the likely success of intervening at all, for designing the elements of an intervention, and for ongoing monitoring of implementation. We apply the framework to eight consultancies which were undertaken in three different change contexts: post‐communist regimes in the early transitional period; aid‐dependent regimes committed to ‘politics‐as‐usual’ and the longer‐term highjacking of donor funds by patron – clientelist structures. We summarize the main lessons which emerge from our case studies in the form of criteria for judging whether and how (responsible) donors and/or consultants should get involved in change projects. Donors, consultancy companies and consultants should all be thinking of ways to exclude irresponsible parties and behaviour from aid‐financed institutional transformation processes. Copyright © 2000 John Wiley & Sons, Ltd.