A guide to health reform

Answers in plain English to almost everything you ever wanted to know about the Clinton initiative--and how it could affect the medical care you get.     

Back to the future: Polish health care reform

In January 1999, the Polish government implemented a new law reorganizing the health care in the country. This paper includes an outline of the changes, the main impact of which consisted of introduction of universal health insurance administered by Health Insurance Funds (“Kasy Chorych”). In June 2001 and 2002, a survey of insurance administrators and health care workers provided data concerning the reception of the new system, the perceived inadequacies, and the postulated changes. The intended objective of privatization of health provisions appears as remote as it was before the changes. The major obstacles are identified as political hurdles, physician resistance, and continued dependence on state allocations.     

Policy entrepreneurship in the development of public sector strategy: the case of London health reform

The development of health policy is recognized as complex; however, there has been little development of the role of agency in this process. Kingdon developed the concept of policy entrepreneur (PE) within his ‘windows’ model. He argued inter-related ‘policy streams' must coincide for important issues to become addressed. The conjoining of these streams may be aided by a policy entrepreneur. We contribute by clarifying the role of the policy entrepreneur and highlighting the translational processes of key actors in creating and aligning policy windows. We analyse the work in London of Professor Sir Ara Darzi as a policy entrepreneur. An important aspect of Darzi's approach was to align a number of important institutional networks to conjoin related problems. Our findings highlight how a policy entrepreneur not only opens policy windows but also yokes together a network to make policy agendas happen. Our contribution reveals the role of clinical leadership in health reform.     

Observations on American administrative reform

This article discusses four types of administrative reform: those connected to fundamental political change, structural reforms, process reforms, and cultural change. It analyses some aspects of the National Performance Review and the Government Performance and Results Act of 1993. It concludes by suggesting that reformers should use a diagnostic model.     

Perspectives on participation in economic policy reform in Africa

This article examines two questions regarding participation in economic policy reform in Africa: how do the circumstances surrounding participation and the ways it occurs influence the economic policy reform process, and can changes to enhance participation lead to improved policy outcomes? The general findings are, first, that the pattern of participation is an important variable in the policy reform process, but that its effects on reform outcomes are strongly mediated by African political and governance factors. Second, increased participation appears to enhance prospects for sustainable reform outcomes, though the weak capacity and responsiveness of the state and the incipient nature of civil society's associational infrastructure in much of Africa limit opportunilimits for institutionalizing participation. It is important to be aware of participation’s limits as well as its potential contribution to economic policy reform in the context of political liberalization, and to recognize the long-term nature of the transition to new modes of state-society cooperation.