How Government and Community Nonprofit Collaboration and Non-Collaboration Affects Public Sector Outcomes

This four state foster care study seeks to understand what practices state public managers perform with regards to community nonprofits that contributes to effectiveness in producing better public sector outcomes. The study produced key player field research data on the conditions under which community nonprofits produce better public sector outcomes.

This article offers reasons as to why some effective community nonprofits were able to achieve collaboration with the public sector, while others were not, despite their effectiveness. Effective public managers in the area of foster care administration permit, and at times recruit, community nonprofits to have an impact on their foster care domain, while ineffective public managers never reach out to community nonprofits as partners or further yet, block nonprofits from access.     

PUBLIC RESPONSIBILITY AND INEQUALITY IN HEALTH INSURANCE COVERAGE: AN EXAMINATION OF AMERICAN STATE HEALTH CARE SYSTEMS

This article examines the effect of the three publicness dimensions on inequality in health insurance coverage across 50 American state‐level health care systems. The analysis validates a Gini‐coefficient measure of Americans' unequal distribution of health insurance coverage across nine income groups and compares public ownership, financing, and control of health care systems across all 50 states from 2002 to 2010. There is a significant and negative relationship between public ownership and inequality in health insurance coverage, although the substantive impact of ownership is relatively small. Both public financing and control substantially reduce inequality in health insurance coverage across income groups. However, both of these must be present in order to be effective at reducing inequality. This article expands our understanding of the link between different institutional arrangements and inequality in health insurance coverage in hybrid health care systems.     

The influence of institutions and culture on health policies: different approaches to integrated care in England and The Netherlands

The concept of integrated care has assumed growing importance on the policy agendas both in England and The Netherlands and elsewhere. It is characterized as health and health care-related social care needed by patients with multi-faceted needs. This article compares policy approaches to integrated care in England and The Netherlands. Differing political strategies and conditions for integrated care correspond to the dissimilarities in the institutional structure and culture of their health care systems. Health care systems are understood as specific national and historical configurations. We review the last decade's relevant policy processes, using the concepts of hierarchy, market and network. The state health care system in England relies mainly on hierarchical steering, thus creating tight network structures for integrated care on the local level. The Netherlands, with its health care system in a public-private mix, has set incentives for voluntary, loosely coupled and partly market-driven cooperation on the local level. Implications for success or failure are mixed in both configurations. Policy recommendations have to be tailored to each systems' characteristics.     

The debate over the U.S. government's role in health care financing:"deja vu,all over again"

Yogi Berra's famous quote captures the continuing debate over the legitimate role of the U.S. government in health care financing. The issues of individual choice, equity of access, and concern about income security are just as unresolved today as they were in the early twentieth century. Until we engage in an explicit national debate on these issues and come to a national consensus on the human and political values underlying our current health care situation, a “solution” to the health care financing problems will never be found. This article discusses the history of the issue of government's involvement in health care financing, American ambivalence about government regulation, and the role of American business as a major health care insurer.     

ECONOMIC DISCOURSE AND THE MARKET: THE CASE OF COMMUNITY CARE

The UK government has introduced fundamental reforms into the provision of social care. The'community care'programme, which was fully implemented in 1993, requires local authorities to assess the needs of potential users, to design an individual package of care that reflects those needs, and to purchase the package from a range of statutory, voluntary and private providers. Thus the new arrangement introduced a'quasi-market'in community care, along the lines of those already operating in other areas of the UK public sector, such as health and education. Hitherto, much analysis of the functioning of such markets has been conducted within a neo-classical economic framework. This article examines the relevance to the complex new community care market of three alternative theoretical perspectives: the transaction costs literature, the Austrian school and the new economic sociology. It is concluded that, although neoclassical economic discourse has been influential in shaping policy, no single perspective can capture all the issues relevant to analysing the market in community care. Therefore, in evaluating the reforms, an eclectic theoretical approach will be required which draws upon a variety of economic discourses.     

DOING BUSINESS IN THE TEMPLE? MANAGERS AND QUALITY ASSURANCE IN THE PUBLIC SERVICES

Quality' is now high on the policy agenda for many of our major public services. This article raises the question of what are the respective roles in securing quality of, on the one hand, professional service deliverers and, on the other, managers. It reviews a range of possible roles for managers and concludes that some of these are likely to be illegitimate and ineffective. Even the more appropriate roles will, however, often prove difficult to establish in practice. The article concludes with an examination of some possible key design features for successful relationships between managers and professional service deliverers. These are examined against the background of specific changes currently underway in the health care and education sectors.     

Distributed leadership and performance-related employee outcomes in public sector organizations

Distributed leadership is the sharing of leadership tasks between managers and employees. This article demonstrates how a distributed leadership perspective adds to the public administration literature by including an important sensitivity to planned and nonplanned leadership. We propose a theoretical model that explains the impact of distributed leadership on employee outcomes which have a direct or indirect impact on organizational performance in public organizations contingent on alignment with individual leadership capacity and organizational goals. Our empirical analysis in the Danish hospital sector shows initial support for the expected relationships between distributed leadership and performance-related employee outcomes such as job satisfaction and innovative behavior. This indicates that the distributed leadership perspective holds the potential to strengthen service delivery in complex public service organizations while there is weaker support for the notion that the positive impact of distributed leadership depends on individual leadership capacity and their support for organizational goals.     

Managing financial resources in the states: the role of computerized information systems

One of the principal and most visible functions of public managers is the allocation of public funds across multiple, many times competing services and constituencies. This vital process must be as efficient and effective as managerial skills and the application of technology permits. Yet, as the effects of technology escalate, little is known about the application of computerized information systems (CIS) to important strategic and operational, financial management decision-making. This study examines the use of information technology in financial decision-making in state governments. The findings suggest that computerized information systems play central but diverse functions in various financial decisions, but that public managers will continue to play a key role in ensuring that CIS use enhances decision-making capabilities.     

Towards more digital cities? Change in technology use and perceptions across small and medium-sized US cities

ABSTRACT

There is continuous pressure on public managers to adopt information and communication technologies (ICTs) to transform the way cities work. E-government research provides insights on the institutional, organisational, and individual factors that shape technology adoption and use. Yet most studies on small and medium sized cities use cross-sectional data or rely on small samples. We lack a systematic understanding of how technology use in smaller cities has changed over time and where these cities are lagging. Drawing from a multi-year, multi-method national study of city government technology use, we describe advancements and gaps in the enactment of a range of technologies, from social media to open data portals, and explore variation across city population, department type, and manager age. Our findings show that smaller cities still lag in the adoption of key features while local government managers are more inclined to adopt and positively perceive social media than traditional ICTs.     

DEVELOPMENTS IN THE PURCHASING PROCESS IN THE NHS: TOWARDS AN EXPLICIT POLITICS OF RATIONING?

The introduction of the internal market to the National Health Service in Britain marks a major change in the form of provision of health care interventions. This article reports the findings of independent research into the development of the purchasing process in eight purchasing authorities (which collectively purchase health care for 5 per cent of the population of Britain), and considers the extent to which this has led to an explicit politics of rationing in British health care. The structure and organization of purchasing organizations is described, along with their relationship with providers of health care. The ability of purchasing organizations to assess the health needs of the populations for which they purchase health care services, and their ability to influence change in the nature of the services provided, is also examined.     

INFORMATION SYSTEMS AND NEW PUBLIC MANAGEMENT - A VIEW FROM THE CENTRE

The combination of new public management reforms and 'informatization' is presenting opportunities for the re-engineering of government business activities. Awareness and debate about the implications of this are limited however. Structural reforms to public services need to take account of the notion of information stewardship, and an essential competence of public officials is to manage and use information held in trust. Public service reforms which lead both to fragmentation and to the contract culture have implications for information systems development and implementation. Whilst new technology can be used to alter radically the administrative and service delivery systems of government, technical possibilities must be set alongside issues such as the privacy of the individual and the protection of public interest. The article also discusses the role of the Office of Public Services and Science, and HM Treasury, in stimulating appropriate strategies to cope with these dilemmas.     

Public Service Efficacy

This article develops a measure of user capacity called Public Service Efficacy (PSE), which is applied to four sectors: hospitals, elementary schools, day care, and higher education. Tests of validity and reliability indicate good properties and consistent patterns across three of four sectors. The measure differentiates between users of the same services, and it increases with level of education. This indicates that PSE can enable us to identify individual users with low capacity and sectors with low average user capacity and thus improve our ability to address equity concerns and harvest potential benefits from user involvement in public service provision.     

Knowledge Utilization in Canadian Health Service Organizations: A Path Analysis

The aim of this article is to study direct and causality effects of variables involved in knowledge utilization (KU) explanations. Based on a survey of 928 managers and professionals in Canadian health service organizations (HSOs) (ministries, regional health authorities, and hospitals), the results of the path analysis indicate that the extent to which research results are used in policy and practice is influenced by the format of research results, by organizational and contextual variables (e.g., research culture and absorptive capacity), by the formal partnership activities initiated between the producers of research and users (formal linkage mechanisms), and by the user’s relational capital (informal linkage mechanisms), among other variables. Formal and informal linkage mechanisms have a positive and significant impact on KU in different causal explanations. The article shows that utilization processes are interdependent in their causes and effects, and thus complicated to study.     

Health care and AIDS

The acquired immune deficiency syndrome (AIDS) is a harbinger for change in health care. There are many powerful forces poised to transform the industrialized health care structure of the twentieth century, and AIDS may act as either a catalyst or an amplifier for these forces. AIDS could, for example, swamp local resources and thereby help trigger national reform in a health care system that has already lost public confidence. AIDS can also hasten the paradigm shift that is occurring throughout health care. Many of the choices society will confront when dealing with AIDS carry implications beyond health care. Information about who has the disease, for example, already pits traditional individual rights against group interests. Future information systems could make discrimination based upon medical records a nightmare for a growing number of individuals. Yet these systems also offer the hope of accelerated progress against not only AIDS but other major health threats as well. The policy choices that will define society's response to AIDS can best be made in the context of a clearly articulated vision of a society that reflects our deepest values.     

Health care reform in Israel: An historical and sociopolitical conundrum

A new and comprehensive National Health Insurance Law was implemented in Israel on January 1, 1995. This major health care reform initiative culminated an effort lasting several decades to assure broad universal health care coverage for the population as a matter of national law. Issues that affected the development of the reform package included 1) the formation of sick funds that provide care to over 96% of the population as part of other powerful sociopolitical organizations, 2) the historical development of parallel private July 16, 1995 and governmental health care systems before Israel became a state in 1948 and the post-state maintenance of multiple health care delivery systems, and 3) the close interactions of health care systems and the political processes and parties of the nation. This paper describes the effects of these forces on resisting changes that were widely accepted as being necessary to expand access, control rising health care costs, and improve the efficiency of the nation's health care system.     

Self-rated health and barriers to healthcare in Ukraine: The pivotal role of gender and its intersections

The ongoing health crisis in the Ukraine has persisted for 48 years with a clear division of gender-based outcomes as seen in the decline of male life expectancy and stagnation of female longevity. The purpose of this paper is to investigate differences in self-rated health and system barriers to health care applicable to gender and its intersections because of the differing negative health outcomes for men and women. Intersectionality theory provides an analytic framework for interpreting our results. Utilizing a nationwide sample of the Ukrainian population (N = 1908), we found that low socioeconomic status (SES) women rate their health worse than men generally and any other socioeconomic group. Yet women also face the greatest barriers to health care until older ages when the ailments of men cause them to likewise face the obstacles. In reviewing the barrier to health care scale, one barrier—that of health care services being too expensive—dominated the responses with some 52.5 percent of the sample reporting it. Consequently, the greatest problem in Ukraine with respect to health reform reported by the population is the out-of-pocket costs for care in a system that is officially free. These costs, constituting some 40 percent of all national health expenditures, affect women and the aged the most.     

Locating Al Qaeda's Center of Gravity: The Role of Middle Managers

This article claims that the ongoing debate about the structure and dynamics of Al Qaeda has failed to appreciate the importance of an organizational layer that is situated between the top leadership and the grass-roots. Rather than being “leaderless,” it is the group's middle management that holds Al Qaeda together. In Clausewitzian terms, Al Qaeda's middle managers represent a center of gravity—a “hub of … power and movement”—that facilitates the grass-roots’ integration into the organization and provides the top leadership with the global reach it needs in order to carry out its terrorist campaign, especially in Europe and North America. They are, in other words, the connective tissue that makes Al Qaeda work. The article substantiates this hypothesis by providing a number of case studies of Al Qaeda middle managers, which illustrate the critical role they have played in integrating the grass-roots with the top leadership. The policy implications are both obvious and important. If neither the top leadership nor the grass-roots alone can provide Al Qaeda with strategic momentum, it will be essential to identify and neutralize the middle managers, and—in doing so—“cause the network to collapse on itself.”     

Towards developing new partnerships in public services: users as consumers, citizens and/or co-producers in health and social care in England and Sweden

The causes and effects of marketization of public services have been analysed extensively in the literature, but there is relatively little research on how those policies impact on the development of new forms of governance, and the role of users in these new arrangements. This study reviews examples of competition, freedom of choice and personalized care in health and social services in England and Sweden, in order to examine the type of relationships emerging between the user/consumer vis-à-vis market driven providers and various agencies of the state under the marketized welfare. The article focuses on the possible roles users might assume in new hybrid arrangements between markets, collaborations and steering. A user typology: namely, that of a consumer, citizen, co-producer and responsibilized agent in various governance arrangements, is then suggested. The article concludes by arguing that pro-market policies instead of meeting the alleged needs of post-modern users for individualized public services are likely to promote a new type of highly volatile and fragile partnerships, and create a new subordinated user who has no choice but to ‘choose’ services they have little control over.     

AN INFORMATION PROCESSING PERSPECTIVE ON DECISION MAKING IN THE EUROPEAN UNION

Two decades after the introduction of the punctuated equilibrium model, information processing theory now offers one of the most comprehensive analytical perspectives on decision making in public administration and policy research. This article applies information processing analysis to the decision making process in the European Union (EU). Towards this end, the article inquires into the organizational foundations of information processing at successive levels of administrative and legislative decision making and shows how this analytical perspective can be used to gain a better understanding of policy dynamics at the supranational level. The article argues that information processing in the EU is likely to produce distinct policy dynamics in key respects. It identifies promising avenues for future research and discusses some of the issues this evolving theoretical framework should address in order to allow for a more comprehensive exploration of this analytical perspective in the context of the EU.