Bureaucracy Versus Markets in Hospital Care: The Dutch Case

In this paper we analyze the bureaucratic negotiation processthat is implied by the budgeting system applied in Dutchhospital care. This system is based on centralized pricesetting while simultaneously allowing for decentralizednegotiations on volumes. We apply a variant of the bureaucracytheory, according to which the bureaucratic agency (in ourcase the joint hospitals) are not allowed to pricediscriminate, but will receive a flat price per unit ofoutput. We find that central price setting, where the insurercannot exploit its information on hospital costs, leads to asuboptimal supply of hospital care.     

New Public Management à la Française: The Case of Regional Hospital Agencies

In 1996, French authorities—committed to developing an innovative, decentralized style of public intervention in a country with a reputation for administrative conservatism and a historical bias toward centralization—created the Regional Hospital Agencies. The author asks whether these agencies exemplify the modernization of French public administration. A survey of all 26 such agencies indicates that they did introduce novel management practices and do, in fact, illustrate New Public Management " à la française."     

Selection Bias in Comparative Research: The Case of Incomplete Data Sets

Selection bias is an important but often neglected problem incomparative research. While comparative case studies pay someattention to this problem, this is less the case in broadercross-national studies, where this problem may appear throughthe way the data used are generated. The article discusses threeexamples: studies of the success of newly formed political parties,research on protest events, and recent work on ethnic conflict.In all cases the data at hand are likely to be afflicted byselection bias. Failing to take into consideration this problemleads to serious biases in the estimation of simple relationships.Empirical examples illustrate a possible solution (a variationof a Tobit model) to the problems in these cases. The articlealso discusses results of Monte Carlo simulations, illustratingunder what conditions the proposed estimation procedures leadto improved results.     

Attitude Responsiveness and Partisan Bias: Direct Experience with the Affordable Care Act

This study evaluates the competing influences of motivated reasoning and personal experience on policy preferences toward the Affordable Care Act. Using cross-sectional and panel survey data, the findings reveal that healthcare attitudes are responsive to information that individuals receive through personal experience. Individuals who experienced a positive change in their insurance situation are found to express more positive views toward the health reform law, while individuals who lost their insurance or experienced an otherwise negative personal impact on their insurance situations express more negative views. The results point to personal experience as a source of information that can influence individuals’ preferences. However, although attitudes are responsive to the quality of one’s personal interactions with the healthcare system, the results also suggest that partisan bias is still at work. Republicans are more likely to blame the health reform law for negative changes in their health insurance situations, while Democrats are more likely to credit the law for positive changes in their situations. These motivated attributions for their personal situations temper how responsive partisans’ attitudes are to information acquired through personal experience.     

The Conditions of Care: Reframing the Debate about Public Sector Ethic

While a growing body of research argues for increased attention to ethics within public administration, scholars diverge on how to conceptualize the character of public ethics. Likewise, empirical evidence regarding the role that ethics plays in the quality of service delivery is rare. The author argues that the concept of a public ethics of care is useful for public administration in welfare states. She examines the idea empirically through a large‐N analysis of frontline bureaucrats within the Swedish Social Insurance Administration. The analysis develops two general measures of a public ethics of care as well as a public ethics of justice. The author proceeds to show a clear presence of an ethics of care in the Swedish public sector. Further, analysis shows that these two ethics measures are supplementary, not contradictory, and that age is the main individual determinant behind ethics of care, strongly correlating with number of years in office. The conclusion underscores how public ethics of care results from acquired experience in fulfilling care‐oriented tasks.     

The Effects of New Public Management: Activity‐based Reimbursement and Efficiency in the Scandinavian Hospital Sectors

Activity‐based reimbursement (ABR) is a key element in the New Public Management reform programme. In recent decades ABR has replaced or supplemented frame‐based reimbursement (FRB) in the Scandinavian hospital sectors, and political decision makers have widely believed that ABR would improve efficiency. This article systematically describes and compares 12 studies and their results to determine whether research supports this belief. The article has two main conclusions. First, existing research provides a much more blurry picture than envisaged by decision makers. Studies with positive and non‐positive results are approximately equal in number, even when the quality of research designs is taken into account. Second, it is quite likely that the blurry picture is caused mainly by the low credibility of the new ABR schemes, which has undermined the incentives for greater efficiency that the new schemes should provide. The issue of credibility is not tested in existing research and is thus a particularly promising avenue for future research into the effects of economic steering tools like ABR.     

Performance Management and Public Sector Reform: The Norwegian Hospital Reform

This article addresses the development of new performance management systems related to public sector reforms. One such system is Management by Objectives and Results (MBOR), based on an official OECD model. Such a system tries to establish unambiguous goals, objectivity, and incentive elements into often traditionally trust-based systems embedded in a complex political-administrative context. To analyze such performance management systems and how they work in practice, we focus on a recent reform of the hospital structure in Norway. Using a broad institutional perspective, we argue that the MBOR-system in Norway is a mixed and complex system encompassing different kinds of logic. These include instrumental elements from the new performance management systems combined with ad hoc preventive efforts by the political leadership, the influence of cultural constraints, elements of rather inappropriate self-interested action, and pressure from the environment. The study reveals that the hospital reform in Norway in practice can be seen as an integrated model, combining informal trust-based approaches and formal performance management measures. It also shows that negative side effects and dysfunctions might occur.     

Termination Theory and National Climate Change Mitigation Programs: The Case of New Zealand

In 2008 New Zealand (NZ) changed from a Labour‐led to a National‐led government, and this resulted in a shift to government's carbon emission mitigation strategy, including the abandonment of the Communities for Climate Protection (CCP) and the Carbon Neutral Public Service (CNPS) programs. Using deLeon's seminal model for program termination, the objective of this research is to determine why NZ's newly elected government discontinued these initiatives. This empirical research is investigative and probing, and comprises a series of semi‐structured interviews with senior managers responsible for the delivery of the respective program within their organization. The architects of each program are also investigated. In the end, this study finds that while economic constraints and programmatic inefficiencies may have played a contributing role, political ideology is the primary rationale for the termination of the CNPS and the CCP‐NZ programs.     

Nonmission–Based Values in Results–Oriented Public Management: The Case of Freedom of Information

Since the 1940s, Congress and the federal courts have sought to make U.S. federal administration more responsive to democratic–constitutional values, including representation, participation, transparency, and individual rights. As manifested in the National Performance Review, the New Public Management emphasis on results may reduce attention to these values, which for most agencies are not intrinsically mission–based. Freedom of information illustrates the problem of protecting nonmission–based, democratic–constitutional values in results–oriented public management. Agencies' annual performance plans under the Government Performance and Results Act overwhelmingly ignore freedom of information, even though it is a legal requirement and performance measures for it are readily available. This study concludes that focusing on results may weaken commitment to democratic–constitutional values by default. It suggests that using a balanced scorecard approach in performance plans could enhance attention to freedom of information and other democratic–constitutional values.     

Industrial Relations and Public Sector Reform: The Victorian Case

Few anticipated the radical program of public sector reform introduced by the Kennett government. A commitment to downsizing, markets and privatisation has transformed employment relations in the Victorian public sector. Familiar institutions have disappeared, major employment areas have been restructured, and jurisdiction for much public sector industrial relations has been transferred to the Commonwealth. Despite some industrial unrest, and occasional successes, public sector unions have been unable to fend off this ideological assault on traditional patterns of public sector employment.     

Vertical Competition in Unitary States: The Case of Italy

In unitary states – states in whichconstitutional powers are owned by thecentral government – vertical competitioncan generate stable outcomes, that isoutcomes that do not unravel througharbitrary repossessions by the center.Stability is a product of institutionalcommitment devices. Through these ademocratic government, though it cannotbind successor governments, can effectivelyoblige them to respect some of thedecisions it has made. A number of suchcommitment devices exist in Italy; theymake possible stable vertical competitionbetween central and regional governments.     

Branding and Franchising a Public Policy: The Case of the Gateway Review Process 2001–2010

One of the more interesting features of contemporary policy‐making is the way in which certain policies and administrative processes have been branded. While this is not yet a common feature, it does appear to be one that is increasing in importance. This article looks at the phenomenon through a consideration of one particularly interesting case; the Gateway Review Process (subsequently Gateway), a policy with a related set of administrative processes which is both branded and franchised. Gateway also seems a successful example of a much more common feature of contemporary policy making: policy transfer. It has been transferred from the UK to five Australian jurisdictions, New Zealand and Holland. This article examines the extent to which the branding, and indeed the franchising, of Gateway is responsible for the putative success of that transfer. We begin with a very brief consideration of the literature on branding and franchising to situate our discussion, before outlining the ways in which branding and politics intersect. In the main part of the article we focus on the branding of public policy and on the Gateway case.     

Educational Vouchers: The Case for Public Choice Reconsidered

Parental choice and operational efficiency are the key features proponents use to promote the desirability of educational voucher programs. The argument is that educational vouchers increase competition among schools by allowing parents the freedom to choose which schools their children attend. In turn, competition improves the performance of individual schools. This article argues that, as currently put forth, the case for vouchers minimizes the special position of public schools with respect to their equity goals. Equity, arguably, has been one of the most significant tenets of public education policy in the last half-century. Moreover, vouchers have significant hidden costs that could compromise any efficiency.     

Confidence in Institutions in Post-Communist Societies: The Case of the Baltic States

The transition from totalitarian to democratic rule in the Baltic states raises the question of conditions for regime legitimacy and stability. The article focuses on the level of confidence people have in institutions after change of regime. The confidence in political and social institutions is at a surprisingly low level. The data suggest that people have more confidence in institutions producing symbols than they have in policy-making and implementing institutions. There is also evidence to show that leaders are more trusted than institutions as such. A survey of the potential background variables shows that people with higher education have lower confidence in institutions than the less well educated. But low confidence in institutions does not necessarily spell gloomy prospects for procedural democratic development, as long as the elites do have some popular support and the capacity for consensual integration.     

The Political Economy of Transition in Post-Socialist Systems: The Case of the Baltic States

The nature of the failed socialist systems calls for a transition which is as comprehensive in its objectives as were the systems themselves before they failed. Hence, the transition to democracy in the post-socialist systems cannot be treated as separate from the transition to a market economy and national independence. The critical part of the transition is the economic reforms inasmuch as the institutions of the planned economy are the major power base for the conservative elites. To be successful, the economic transition must be able - in both the short and the long term - to command political support, to achieve social acceptance of the distributional consequences involved and to be compatible with democratic institutions. Analysis reveals that in the case of the Baltic states widespread support for the transition to a market economy can be detected and that the democratically elected governments have so far been fairly active in establishing a legal framework for transition, but appear unable to implement the necessary stabilization policy. The reforms have produced strong social protests, and the governments have been under pressure to maintain social guarantees during the period of transition. The non-Baltic minorities in particular defend previous social privileges and are distressed by their uncertain status after independence. The ultimate outcome of political and economic transition in the Baltic states, therefore, remains in doubt.     

Accountability and Entrepreneurial Public Management: The Case of the Orange County Investment Fund

This article presents a conceptual framework that illustrates four distinct types of accountability environments facing public managers. The framework is used as a heuristic tool to examine the broad facts and contexts surrounding the bankruptcy of the Orange County, California investment pool. The framework also suggests management philosophies and strategies that are appropriate for each type of accountability environment.     

Accountability in Public Service Quasi‐markets: The Case of the Australian National Disability Insurance Scheme

Australia's National Disability Insurance Scheme (NDIS) represents the latest in a worldwide shift towards individualised funding models for the delivery of care services. However, market‐based models for care deliveries bring new considerations and dilemmas for accountability. Drawing on previous work by Dickinson et al. (2014), we examine a range of accountability dilemmas developing within the early implementation of the NDIS. These relate to accountability for the following: care outcomes, the spending of public money, care workers, and advocacy and market function. Examining these accountability dilemmas reveals differences in underpinning assumptions within the design and on‐going implementation of the NDIS, suggesting a plurality of logics within the scheme, which are in tension with one another. The contribution of this paper is to set out the accountability dilemmas, analyse them according to their underpinning logics, and present the NDIS as having potential to be a hybrid institution (Skelcher and Smith 2015). How these dilemmas will be settled is crucial to the implementation and ultimate operation of the scheme.