A hand up,not a hand out: Lessons for public policy

For many in our society owning a home is not possible without the help of grass-roots organizations such as Habitat for Humanity. The study of the response of public institutions to personal problems can provide policy makers with valuable information about changing or creating new programs and policies to assist those having difficulty finding decent, affordable housing to own. This paper presents the findings of a study of the relationship between those whose dream did become reality and those who helped them. In addition, this paper presents a model of the process that policy students can use to examine the public responses to private troubles.     

Can Social Innovations in Housing Save Public Money? The Case of Slovakia

ABSTRACT

The paper deals with research into the innovative provision of public services by the non-governmental organizations in the field of housing. The paper describes the legislation of the housing system in Slovakia and aims to analyse innovation in social housing provision. The paper contributes to the knowledge on innovative social housing solutions provided by non-governmental organizations. The use of cost benefit analysis reveals the benefits of innovation in housing provision by an internationally awarded organization ETP Slovakia. The analysis proves the government´s possible savings of public expenditures if it would decide to support the innovative approach in social housing provision.     

The aging of the population and health services

The demographic revolution--engendered in large part by modern medicine--which has led to the extraordinary and continuing increase in the number and proportion of elderly persons in the population has profound implications for health services. The elderly are disproportionately heavy utilizers of health care, primarily because of the prevalence of chronic disease. In the United States most health care for the elderly is financed through public funds, and costs have been increasing at an alarming rate. There is wide consensus that, for all the excellence of performance of the medical care system in treating acute episodes, care of chronic disease is frequently unsatisfactory in both quality and cost. Given the demographic imperatives, reform of mechanisms for chronic care is thus essential.     

“Don't knows” and public opinion towards economic reform: Evidence from Russia

As market reform has spread throughout the globe, both scholars and policy makers have become increasingly interested in measuring public opinion towards economic changes. However, recent research from American politics suggests that special care must be paid to how surveys treat non-respondents to these types of questions. We extend this line of inquiry to a well-known case of large-scale economic reform, Russia in the mid-1990s. Our major finding is that Russians who fail to answer survey questions tend to be consistently less “liberal” than their counterparts who are able to answer such questions. This finding has implications both for our understanding of Russian public opinion in the 1990s, as well as for measuring attitudes towards economic reform more generally.     

THE VALUE OF CHOICE IN PUBLIC POLICY

Conceptualizing and measuring choice is problematic both in theory and in practice. Measuring by counting the alternatives seems counter-intuitive as a smaller set of better or more diverse alternatives seems to provide more choice than one that is simply larger. However, concentrating upon better alternatives leads to choice being defined by welfare or utility which is also counter-intuitive. The implications of this paradox are considered in relation to examples drawn from the choice agenda in British social policy. Empirical difficulties in measuring the welfare gains through implementing greater choice at a time of other central-led policy initiatives such as targets are discussed, and the extant evidence discussed. Criteria for judging whether or not choice has been welfare-enhancing are suggested. It is argued that 'soft choice' where service providers provide information and explain different options is preferable to 'hard' choice of simplistic targets to increase choice by ticking target boxes.     

Privatization in developing countries: ideal and reality

In both developed and developing countries, governments finance, produce, and distribute various goods and services. In recent years, the range of goods provided by government has extended widely, covering many goods which do not meet the purist's definition of “public” goods. As the size of the public sector has increased steadily there has been a growing concern about the effectiveness of the public sector's performance as producer. Critics of this rapid growth argue that the public provision of certain goods is inefficient and have proposed that the private sector replace many current public sector activities, that is, that services be privatized. Since Ronald Reagan took office greater privatization efforts have been pursued in the United States. Paralleling this trend has been a strong endorsement by international and bilateral donor agencies for heavier reliance on the private sector in developing countries.

However, the political, institutional, and economic environments of developing nations are markedly different from those of developed countries. It is not clear that the theories and empirical evidence purported to justify privatization in developed countries are applicable to developing countries.

In this paper we present a study of privatization using the case of Honduras. We examine the policy shift from “direct administration” to “contracting out” for three construction activities: urban upgrading for housing projects, rural primary schools, and rural roads. The purpose of our study is threefold. First, we test key hypotheses pertaining to the effectiveness of privatization, focusing on three aspects: cost, time, and quality. Second, we identify major factors which affect the performance of this privatization approach. Third, we document the impact of privatization as it influences the political and institutional settings of Honduras. Our main finding is that contracting out in Honduras has not led to the common expectations of its proponents because of institutional barriers and limited competitiveness in the market. These findings suggest that privatization can not produce goods and services efficiently without substantial reform in the market and regulatory procedures. Policy makers also need to consider carefully multiple objectives at the national level in making decisions about privatization.     

'Out Of Sight, Out Of Mind': Assessing The Impact Of Markets For Children's Residential Care

This article is concerned with assessing the effectiveness of markets for complex professional services in social care. The issue is explored through an account of developments in the children's residential care sector. Over the past five years there has been a steady expansion in the role of external markets in this area. However, this was not required by the Children Act 1989 and has become the subject of considerable debate between policy makers and practitioners. While some favour an extension of choice, others argue that a further decline in local authority run provision will be both costly and detrimental in terms of meeting key policy goals. In order to assess these claims, reference is made to the findings of a study of purchasing practices for children's residential care in twelve local authorities in England and Wales. The impact of the emerging market is analysed along two dimensions. Firstly, we assess how far it is operating efficiently, concentrating on market structure, information and transaction costs. Secondly, attention is given to the impact of market changes on the policy objectives of: localized placements; ensuring adequate safeguards; and matching needs and services. The results reveal that there have been significant costs associated with markets in children's services. In a context of government efforts to promote modes of service delivery on the basis of 'what works', these difficulties have certain implications. Not only do they draw attention to the need for greater collaboration between purchasers and providers, they also point to the continued relevance and usefulness of local authority managed provision.     

Control versus consent in long-term care case management programs: implications for public policy

Case management programs for long-term care include the dual public policy goals of providing access to services and ensuring the efficient and effective application of public funds. We will use a paradigm for social policy development that proposes a conflict between control and consent motives of social policy makers. Illustrations of the limitations and positive elements of control versus consent as applied to case management will be presented.

We will discuss how the tension between these approaches can be used to develop policy that balances the goals of access and cost-effectiveness.     

Dynamism and Enterprise

Abstract

The aim of this paper is to see how Asian female entrepreneurs in the United Kingdom have developed and to increase our understanding of this entrepreneurial minority. The study looks at some of the more successful Asian women who are prominent in the United Kingdom by being featured in the top 200 Asian rich list. Both primary and secondary sources were used to profile these women. Open ended face-to-face interviews were also conducted with Asian women from second/third generations who had some business ownership stake in the more traditional low value added, labour intensive businesses. Questions centred around why they started their business, the support they received, the challenges facing them specifically as Asian women in business both at start up and beyond, their aspirations for the future of the business and their motivations.

The findings show that the gap appears to have widened between the more successful Asian business woman and those women who are still opting for low value added, labour intensive firms. The practical implications of this study are that Asian women are an increasingly important part of the SME group and thus increasing the quality of business provision, advice, start up and growth would make this vital sector even more productive. This study will also help sensitise and inform business support agents, banks, advisors both public sector and private. Understanding the needs of this entrepreneurial minority is important for academic, policy makers and support professionals.     

Performance pledges–power to the consumer or a quagmire in public service legitimation?

One of the latest initiatives in Hong Kong's public sector reform is the launch of “performance pledges” in 1992, which have essentially been modelled on citizen's charters in the United Kingdom. While the stated aims of performance pledges, citizen's charters, or similar initiatives, are to raise the standard of public services and to make such services answer better to the needs of ordinary people, hence “empowering” the public service consumers, this latest consumerist trend in public management has more far-reaching implications, both in terms of the organization as well as the legitimation of public service provision. This article examines such implications, with specific reference to the Hong Kong situation, and argues that the outcome of the development seems to point to the empowerment of public managers rather than the consumers as the official rhetoric would imply.     

Regulation and its modes: the European experience

There is a general trend in Europe, both at the national and Community level, toward greater specialization and institutionalization of regulatory functions. This essay presents three different but related sets of reasons that help to explain the rise of the regulatory state in Europe, and even why regulation seems to be becoming the new frontier of public policy and administration. A first set of reasons has to do with the failure of nationalization as a mode of regulation and the process of privatization, which have led to new regulatory bodies. The second set of factors, related to the increasing complexity and internationalization of the tasks facing policy makers, has led to new or stronger regulatory bodies at the Community level. The third set has to do with the role of the European Community as an independent “fourth branch of government” for the European nations. This latter trend has some problems, as the lack of transparency of the decision-making process. However, this problem can be solved. Moreover, the explanations for the rise of independent regulatory agencies echo many characteristic themes of the politics of efficiency, being recently rediscovered. The conviction that policy should be right, rather than the result of group struggle, leads to demands that policymakers should combine technical expertise and public deliberation to achive decisions that are substantively correct and politically legitimated.     

POLICY DIFFERENCES WITHIN THE UNITED KINGDOM: THE CASE OF HOUSING POLICY IN NORTHERN IRELAND 1979–89

This article examines, through a case study of housing, the extent to which national housing policies under the Thatcher government were modified or deflected at the N. Ireland regional level. Three aspects of housing policy - housing expenditure, public sector rents and the 'right-to-buy' legislation are considered and the roles of key actors within the territorial community described. Although similarities with GB housing policy emerge, there is evidence of a distinctive regional approach. Factors which influenced a N. Ireland-specific policy approach are considered and the potential for variance in the future outlined.     

Reforming New Zealand's health care system

In common with many OECD countries, New Zealand has been engaged in a process of reforming the nation's health care system. In New Zealand's case the reforms have been particularly far reaching and effected within a remarkably short time frame. In 1991 the policy framework was made public, and the legislation to underpin the changes enacted in 1993. Shadow bureaucracies anticipating the reforms were set up as early as 1991, however, thus allowing for the changes to be effected in advance of legislation. Thus in the space of a few years, the social security model of health care, which had been in place for over half a century, was transformed into a system characterised by managed competition. This article begins by briefly describing the social security model of health care, and its inherent problems. I go on to analyze the reforms, focusing on the problems of the previous system that the reforms were intended to address. The major planks of the new system are identified, namely the separation of purchasing of health services from provision and creating a competitive market; the distinction between “personal” and “population” health services; establishment of a core of services to which all citizens are entitled; and the integration and capping of funding for health services, and increasing cost-sharing. Of these policies, only the separation of purchasing and provision of health care and the integration of funding for health services have to date been fully implemented, the remainder having been delayed, modified or abandoned. The health care system has arguably been only partially reformed, therefore.     

The health care state in the information age

The computerization of the medical record has important implications for the governance of health care, and the importance of health care means that changes wrought there are indicative of changes in government as a whole. This paper draws on work in public policy, medical sociology and studies of science and technology, as well as on cross–national empirical research in Britain and France. It describes the recent development of information policy in health care as an exercise in state–building, realized specifically in the governance of the health professions. The paper concludes with a discussion of what is both new and not so new in the form and extent of state power which emerges.     

The changing dynamics of policy experiment in Singapore: does the 2011 general election make a difference?

The city-state of Singapore is proactive in harnessing policy experimentation to incubate innovations, transfer knowledge and facilitate collaborations across different public sectors. Given the country’s strong knack for pragmatism, international practices and lessons are usually first tested and adapted in policy experiments before scaling up to nationwide policies. Singapore’s practice of policy experimentation, however, has also demonstrated evolution over time. This article reviews the evolving role of experimentation in Singapore’s policy decision-making and implementation, and analyses pilot programmes in public housing to elicit the key attributes and commonalities of its policy experiments. It finds that policy experiments have been increasingly used after the 2011 general election, which witnessed a radical political rebalancing in Singapore’s governance history. Pilot projects have thus transformed from a utilitarian to citizen-centric, design-thinking approach after 2011. Pilot programmes are used for multiple purposes in policy innovations, among which civil service mentoring, knowledge transfer and cross-boundary collaboration are the values primarily pursued. The article discusses the contributions of the findings to the literature and policy implications for practitioners.     

DOCTORS AND DEFICITS: REGULATING THE MEDICAL PROFESSION IN FRANCE

This paper seeks to analyze the political factors involved in health care delivery in a modern industrial welfare state and to illustrate how the transformation of the French state has affected the policymaking environment surrounding this particular issue. Cultural traditions rooted in the nineteenth century seriously circumscribed the role of the state in de-the conditions of medical practice. Nonetheless, pressures emerging since 1945 for the provision of a wide array of social services have drawn the state into ever closer regulation of the health sector. The economic constraints of the past decade resulted in state-imposed cost-containment policies which accentuated the trend toward politicization of health care. In consequence, and despite the rear-guard defensive tactics of the medical profession, the French state has succeeded in firmly establishing its primacy in this major area of public policy.     

PUBLIC EXPENDITURE AND POLICY IMPLEMENTATION: THE CASE OF COMMUNITY CARE

This article explores the contention that the conventions of public expenditure accounting conceal, rather than reveal, the real nature and implications of resource trends. A benchmark — a constant level of service output — is established as a basis for examining the relationship between trends in expenditure inputs and service outputs. Changes in unit costs are identified as the major source of deviation between expenditure and output trends. The impact of resource constraint on policy and policy-implementation is then examined in relation to one, essentially stable, area of policy in the personal social services: community care.
The meaning of the term'policy' is far from straightforward and community care is best understood as the interaction of relatively independent streams of policy, towards service outputs and resource inputs, extant in both central and local government. Mechanisms by which policy streams could be reconciled are of particular interest and an innovative example — joint finance — is examined in some detail.     

Health care reform in britain and the united- states: Public or market-led? a review

The organization of health care in the US and Britain is based on different historical, ideological and political assumptions. This paper draws on those assumptions to describe the current health care crisis and proposed reforms. Central to the discussion is an analysis of the forms of public and market-led provision of health care in operation, particularly in relation to the role of the state and their implications for access, cost, and quality.     

Supporting Effective Citizenship in Local Government: Engaging,Educating and Empowering Local Citizens

Civic-republican theories suggest that an active citizenry is associated with community cohesion, better political institutions and inclusive democratic decision making. The influence of these arguments on the UK Labour government has led policy makers to focus attention on strategies to promote citizenship at a local level. In particular, English local authorities are expected to provide ‘support for citizenship’ as part of their wider duty to promote ‘effective community engagement’. The ways in which they can do this are various, ranging from the simple provision of information to direct support for community networks and groups. This article reports the findings of an extensive study of English councils' efforts to engage, educate and empower local citizens. The paper concludes that although local authorities have made significant progress in recent years in widening the structures for communicating with, and engaging citizens, there remains considerable scope for improving activities that address the learning implications of effective citizenship.     

Social insurance financing for long-term care: creative public policy to halt pauperization of the elderly and disabled in nursing homes

Long-term care (LTC) in institutions is one of the last major remaining gaps in the social insurance safety net provided to beneficiaries of Social Security.⁽¹⁾ However, Medicaid pays almost half of the costs of nursing home care after institutionalized elderly or disabled persons become impoverished. Structural reasons make it impossible for private insurance to cover institutional LTC for the bulk of the elderly and disabled. The paper demonstrates that there is an efficient, equitable and feasible social insurance solution to this serious social problem.

The second section details a plan for a Medicare Part C Trust Fund to cover extended stays in nursing homes by Social Security beneficiaries (virtually the entire elderly population and most of the long-term disabled). It involves: (1) maintenance of current government funding indexed to inflation; (2) a premium taken from the cost-of-living allowances (COLAs) due to beneficiaries in the years immediately after they qualify for Social Security; (3) a substantial copayment; (4) a deductible consisting of the first three months of nursing home care; (5) a two-year waiting period between qualification for Social Security and full LTC coverage. The three revenue streams will all increase automatically with inflation. The plan is designed to cover only institutional LTC costs in order to reduce complexity, minimize the price tag and maximize its political chances. However, it could be expanded to cover home and community-based care.

The second half of the analysis explores the policy justifications supporting such a plan and considers the political reasons why this carefully crafted proposal might appeal to moderate conservatives as well as to progressives.