INTERNATIONAL HEALTH CARE REFORM: THE NEED FOR COMPREHENSIVE MICRO-COMPARATIVE ANALYSIS

Microcomparison, or single‐component analysis, of health care systems offers a potentially better basis for reform than traditional macrocomparison analysis of aggregate elements. Using macroanalysis, available evidence shows that Germany provides cheaper but more effective hospital care than the United States. To find the causes for this outcome, we developed a microanalytic model of hospital administrators’ perceptions, financial ratios, medical outcomes, and pharmaceutical costs. However, only data on pharmaceutical costs were available and similar in both countries. Our significant outcome was development of a microcomparative model that gives world medical care providers new criteria for analyzing and improving cost to care rafios.     

DEREGULATION OF PARAPROFESSIONALS AND HEALTH CARE COST CONTAINMENT: THE CASE OF DENTISTRY

The author argues that the development of satisfactory market models in dentistry and other health care areas is crucial to a realistic examination of various deregulation proposals. He argues that such examinations cannot rely on the logic of economics alone, but must be rooted in empirical analyses well-founded in theory. Using expanded function dental auxiliaries as an example, the author demonstrates the complexities of the issues involved and the relevance of political economy models.     

THE HEALTH CARE FINANCIAL CRISIS: REORGANIZATION AND EVIDENCE-BASED MEDICINE AS A RESPONSE TO AN "UNHOLY TRINITY"

The key issues of the health care system are often conceptualized as involving three basic dimensions: 1) the quality of health care provided, 2) access to the health care system, and 3) the cost of health care. Following two decades of rapidly escalating health costs throughout advanced industrial societies, the relationships among these three dimensions now constitute what has been called an “unholy trinity” in that improvements along one dimension will almost inevitably provoke problems in terms of one or both of the others. This symposium examines two distinct types of reform that have been developed in response to the crisis in health care costs. The first focuses upon attempts to reorganize existing institutions in order to make them more effective and cost‐efficient. The second considers the move toward “evidence‐based medicine,” that is, more critically evaluating health care outcomes to make sure that treatments are effective and cost‐efficient.     

ADMINISTRATIVE REFORM AND ECONOMIC DEVELOPMENT: CONCEPTS, ISSUES, AND THE NATIONAL EXPERIENCE

This symposium examines issues related to the links between administrative reform policy and economic development policy. The symposium introduction paper consists of two parts. First, it offers an overview of the background of theoretical and conceptual issues that are important to the connection between administrative reform and economic development. The issues reviewed include the role of government in economic development, the importance of public policy and management to economic development, the contribution of development administration, and the need of administrative reform to remove bureaucratic problems and promote efficiency. Next, the introduction paper provides a brief summary of the research arguments and findings addressed in the following six articles. They include an evaluation of administrative reform in Arab world economic growth, an examination of administrative reform and economic development in Latin America and the Caribbean, a political economy analysis of policy reform in Korea, a study of the implementation of privatization strategies in India's public sector reform, a discussion of the concerns between efficiency and ethics in China's economic development, and the study of administrative and economic development in Mongolia. The implications of the research findings and the need for further study of the linkage between administrative reform and economic development are emphasized in the conclusion.     

THE ADMINISTRATION OF FRENCH NATIONAL ECONOMIC PLANNING: LESSONS FOR AUSTRALIA

"We are therefore giving priority to setting up economic planning machinery with industry and employee co-operation to restore strong but balanced economic growth."—E. G. Whitlam, The Australian , 14th May, 1973.     

MENTAL HEALTH CARE FOR OLDER PERSONS: NETWORKING AS A RESPONSE TO ORGANIZATIONAL CHALLENGES1

We use case study methodology to examine the degree of cooperation and coordination among organizations providing mental health care to older persons. Mail surveys and in‐depth interviews were employed to gather data from human service organizations in one relatively rural county of Upstate New York. We find that organizations that are older and provide larger numbers of services tend to have a higher degree of integration with other organizations. There is little evidence of formal coordination of services. Informal cooperation, at least on an ad hoc basis, is common, though. Older persons with chronic mental health problems are relatively well served by the system. Older persons whose mental health problems are associated with the aging process are not well served by the system. The growth of mental health managed care has increased competition among many organizations, further fragmenting a weakly integrated system.     

PERFORMING AUDITORS?: ASSESSING AND REPORTING THE PERFORMANCE OF NATIONAL AUDIT OFFICES—A THREE-COUNTRY COMPARISON

Abstract: This article reviews self-assessment and reporting strategies of national audit offices in the United Kingdom, Sweden and Australia and develops a framework for the reporting of their performance. There is a common emphasis in the audit office objectives on serving their primary client and on improving the performance of the public sector, but there are differences in emphasis regarding the clients being served. The differing approaches to assessing and reporting their own performance can in part be attributed to differences between their mandates, objectives and identification of the clients being served. The audit offices have developed complementary internal quality assurance processes which generate additional performance information and have been subject to external peer reviews which assess and report on their performance. A framework is developed which clarifies the relationship between audit office objectives and the measures used. It involves a hierarchy of performance parameters, including effectiveness, efficiency and workload and gives priority to meeting the needs of the primary client. The study has revealed that significant progress is being made in particular areas of assessing and reporting audit office performance and this should encourage audit offices to share their experiences internationally to enhance their own accountability to their primary clients and the communities they serve.     

THE CORVAIR, THE PINTO AND CORPORATE BEHAVIOR: IMPLICATIONS FOR REGULATORY REFORM

Top corporate management responds to what is socially desirable when the costs and economic benefits provide the incentive to do so. Even when changing directions to match what is thought to be socially desirable would produce long-term profit maximization, some firms may stay with what is socially undesirable for what is perceived as a greater short-term profit maximization. Halpern suggests that such short-term profit decisions made by General Motors with the Corvair, and by Ford with the Pinto, backfired. A key problem is seen as the time lag between corporate misdeeds and the final judgment of courts or the government.