Information, market government, and health policy: a study of health data organizations in the states.

Information is essential to the success of market-oriented policies. Information on health care costs and quality is collected and distributed by state governments through health data organizations (HDOs) to enhance competition and lower costs in the medical industry and to improve consumer choice among medical alternatives. This article examines the information collected, produced, and distributed by state health data organizations in Colorado and Pennsylvania. Findings reveal that information was not the objective determinant of choice and competition as market-oriented policy designers had hoped. Nor did market-oriented bureaucracies produce and distribute data readily accessible for public choice. Instead, information produced and distributed by these HDOs was the result of political and bureaucratic exercises that conform much more to classic interest group policymaking and captured bureaucracies than to contemporary market-oriented government ideals. The findings underscore the extraordinary difficulties facing federal-level policy designers as they contemplate introducing market-oriented health care policies on the national level.     

Ideas and inducements in mental health policy.

Between 1946 and 1963, federal officials sought to change the national practice of providing mental health care, away from state-run mental institutions and toward outpatient care based in local communities. These policy makers relied on two policy instruments, ideas and inducements. Both instruments contributed to unexpectedly significant changes in federal, state, and local policy. I conclude that a policy instrument framework helps to disentangle the strands of successful public management, and that it is useful to think of ideas as policy instruments that offer leverage on policy outcomes.     

Local government decentralization and the health sector in Tanzania

An evaluation of primary-level healthcare undertaken in Tanzania 1989-91 found that district health managers felt powerless to address health care performance weaknesses, although the district is the unit to which government management functions have been decentralized. In order to understand the managers views, this article analyses the pattern of decentralization within the health system from their perspective. It reviews the hislorical development of government structures and the theory and practice of decentralization within Tanzania. The matrix of accountability for health care has become very confusing, with multiple and cross-cutting flows of authority within and between levels of the system. District health managers have limited authority to take management action, such as managing resources, in ways that would begin to address problems of inefficiency and poor quality of care within primary care. District health management also suffers from weak resource allocation and financial management piocedures. The main obstacles preventing more effective management are: resource constraints; conflicts between the demands for central control and local discretion; limited institutional capacity; and political and cultural influences over the implementation of decentralization. Evaluation of past experience suggests that future policy influencing the organizational structure of government health services must be developed cautiously, recognizing the critical importance of complementary action to develop both institutional capacity and political and economic support for the health system.     

Policy convergence and divergence in Belgium: Education and health care

Due to the far-reaching devolution of policy competences, Belgium allows for a structured comparison of policy convergence or divergence between Flanders and Wallonia. Focusing on the link between the federal state and the development of policy-making in the regions, this article establishes far-reaching policy divergence between the Flemish and French Communities for education policy, and a beginning of divergence in health care. Radical changes in Flemish education policy have redefined the role of the state. In health care, divergence grows in terms of regulating access to the medical professions and defining the output of medical care. The explanation for this policy divergence lies in political factors more than in policy-related features. Political entrepreneurs play a determining role in seizing upon opportunities to trigger and support change.     

Policy termination in mental health: The hidden agenda

Three policy termination objectives can be analyzed in the field of mental health: the move to phase-down, and in some instances close, large state institutions for the mentally disabled; the elimination in some states of indefinite involuntary commitment procedures; and the attempt to transfer responsibility for the provision of direct services from the state level to local government and/or private providers of care. Initiatives in these areas have come from the executive, the legislature, consumer organizations, and most recently from the public interest law community through the use of litigation. Termination in this field, however, has met with increasing resistance because of the failure in many instances to pair these objectives with positive program development. In some states, the result has been the dismantling of one system without the commitment of resources necessary to encourage the development of an alternative system.     

Competitive bidding and states' purchase of services: the case of mental health care in Massachusetts.

Over the past two decades states have significantly increased their use of competitive bidding to purchase health and social services from private agencies. Competitive contracting is thought to facilitate program administration, to reduce costs, and to increase the quality of delivered services. We evaluate these claims in light of Massachusetts' experience with competitive contracting for mental health care. We find that few of the expected benefits are achieved. In practice, supposedly competitive bidding systems often degenerate into administratively complicated negotiations between the state and private monopolies. This results in higher costs and lower quality of services. In light of this negative assessment, three strategies for reform are proposed and evaluated.     

Staff transfer and management in the government health sector in Balochistan,Pakistan: problems and context

Despite the existence of rigid civil service systems in many developing countries providing relative stability of public officials, staff posting and transfers are often based on short‐term political criteria. This means high staff circulation in key government posts, leading to a situation of ‘instability within stability’. This article analyses high staff circulation in the government health services in Balochistan, Pakistan. The analysis is based on literature review, a small pilot study and authors' experience in the province. The article notes that high staff turnover and, more specifically, circulation are context‐specific. Four issues are raised. Firstly, the extent of staff turnover is analysed and references are made to its frequency, the organization and cadre. Secondly, the social and political underpinning of high staff circulation is outlined: political patronage, low implementation of rules, staff preferences and public sector control. Thirdly, the problems of staff turnover are raised with specific reference to the problems of continuity, change and participation. Fourthly, the issue of solutions is raised at two levels: structural change to lessen high staff turnover, and dealing with it on a day‐to‐day managerial level. Lastly, substantive and methodological issues are raised with respect to taking the analysis further. Copyright © 2000 John Wiley & Sons, Ltd.     

Science vs. government: A reconsideration

A content analysis is made of arms control arguments made in the Senate Committee on Foreign Relations and its Subcommittee on Disarmament by five groups: government scientists, academic scientists, politicians, military persons and citizens.It is found that government scientists are closer in their argumentation to other government persons than to their fellow scientists. It is argued that access rather than professionalism is the important independent variable to consider in predicting policy-related behavior.The author wishes to thank Professor Davis Bobrow for his advice throughout the course of this study.     

在哲学教学中渗透心理健康教育的尝试

思想政治教育课不仅仅是单纯的传授知识,更重要的是塑造人的全面素质,促进人的全面而自由的发展。可见,促进中职学生的人格完善和心理健康是思想政治教育育人作用的基本因素。如果在哲学常识的教学中,我们有意识地渗透心理健康教育,会得到理想的效果。根据中职哲学基础知识的内容,以其中一些观点为突破口,结合心理健康的内涵,寻找它们的最佳结合点。     

Ideology and performance: service delivery in a community mental health center

This study examines the relationships between ideology and service delivery performance in an established community mental health center which is beginning major structural changes. Ideological pluralism among several separate and internally-cohesive units within one organization led to diversity in staff productivity. The implications of ideological pluralism for planned organizational change, policy implementation and administration are explored.     

Learning from the pioneers: Modernizing local government. Part one

At the end of the century, we are in a position to look back over a decade of restructuring local governments. Our evaluation of the reform movement underway throughout the world indicates a “dialectic of modernization”: considerable progress in some areas, stagnation or erosion in others, and challenges that demand attention. Based on comparative case studies of local governments, this article identifies and discusses several major trends-positive and negative-observed in the experience of reform governments in various countries. It also identifies conditions for lasting success of local government reform. Two companion articles set out the central challenges that now face local governments: making the transition to strategic management, and redefining the interfaces between local administration and its political, social, and economic environment.     

Sustaining excellence in government: the Singapore experience

This article describes PS21—a programme for adapting Singapore's public service to the needs of the twenty-first century—against the backdrop of Singapore's recent history, including the challenges posed by the island's small size, its sudden independence and its multi-ethnic population. The ability to sustain four decades of economic adaptation and public service adjustment is seen to be intimately linked with the goals of governance and the quality of leadership in the Republic. (© 1997 by John Wiley & Sons, Ltd.)     

The “Role” of Nationalism in Chinese Foreign Policy: A Reactive Model of Nationalism & Conflict

A growing literature has sought to address the question of Chinese nationalism, and particularly whether or not its rise over the last decade could make China more prone to international conflict. Yet these discussions have often not been well grounded in either theories of nationalism or international relations (IR) theory. This paper will seek to fill this gap by using a constructivist approach to examine how nationalism is constituted by the interaction of states. By doing so, it will be argued that Chinese nationalism can best be understood as a reactive response to international events rather than domestic political manipulation. Michael Alan Brittingham is a visiting assistant professor in the Department of Political Science and International Studies at McDaniel College. He has previously taught at the University of Louisville. In 2005, he completed his dissertation entitled, “Reactive Nationalism and Its Prospects for Conflict: The Taiwan Issue, Sino-US Relations, & the ‘Role’ of Nationalism in Chinese Foreign Policy” in the Department of Political Science at the University of Pittsburgh. His current research interests include international relations theory, Chinese foreign policy, and nationalism.     

Population policies in Argentina: 1870-1989. A government viewpoint

"The purposes of this paper are to analyze the Argentine legislation between 1870 and 1989 that has directly or indirectly affected the dynamics and structure of population, as well as to reveal the ideology of population policies supported by hegemonic social forces. This analysis takes into consideration the different development strategies that have been implemented. Our study explores the way in which the different governments have approached the issue of population, and, more specifically, it analyzes the relation between public policies, population policies, development strategies, and political processes represented in State laws." (SUMMARY IN ENG)     

Urban local government finance in Nigeria: The case of Onitsha local government

Onitsha, located along the route that connects south-western and south-eastern Nigeria, has a very financially dynamic local government. Over one-quarter of the total revenues of this local government come from its market and motor parks. This is an unusual source for a local government that has perhaps the largest per capita revenue in Nigeria—almost N40, compared with the national average of N4.9. The procedure for collecting this revenue is regarded as highly successful since there is greater reliance on the citizens than tax officials. The volume of revenues collected has allowed the council maintain a large surplus revenue over a long period of time, which enables it to carry out important programmes of primary and adult education. It is also beginning to develop its property revenue collection system in collaboration with the Anambra State government.     

Cooperation of government,science and industry in R & D—A systems view

The paper investigates the roles of government, science and industry in meeting the R & D requirements of our society. It considers the present state of the art of the cooperation involved, emphasizes the need for integrated planning, programming, and budgeting in research, development and technology, and comments on the European technology crisis.This paper presented in part at the First International R & D Management Conference Vienna, October 1970. The paper represents the personal views of the author. Full address: Adenauer-Allee 120, 5300 Bonn, Germany.     

Regional government in the Sudan

Decentralization has been a central concern in the Sudan and has inspired a far reaching restructuring of government. Following a transfer of substantial functions from central government ministries to province councils in 1979 new regional governments were created in 1980 as a level of government between provinces and the central government. This article describes the reasons for the introduction of regional government, the aims for it and the structure of government created.