New federalism and health policy

The making of health policy in the United States is a complex process that involves the private and public sectors, including multiple levels of government. Five characteristics of the policy process are identified, which establish the means by which policies are formulated and which affect the nature of the policies that emerge. These characteristics include (1) the relationship of the government to the private sector; (2) the distribution of authority and responsibility within a federal system of government; (3) the relationship between policy formation and implementation; (4) a pluralistic ideology as the basis of politics; and (5) incrementalism as the strategy for reform. The article focuses on the impact on health policy of the distribution of authority and responsibility within the federal system, particularly the impact of new federalism policies as they emerged during the past decade. The effects of dual federalism, cooperative federalism, creative federalism, and new federalism are examined in relation to health policies. The article concludes with an examination of the challenge to long-established values and health policies posed by new federalism.     

ORGANIZING THE CORE EXECUTIVE FOR EUROPEAN UNION AFFAIRS: COMPARING FINLAND AND SWEDEN

Examining core executive organization for EU affairs in Finland and Sweden, this article uncovers how change agents used European integration deliberately to strengthen their role in the domestic settings through taking control of EU policy co‐ordination. In both countries, EU membership was an exogenous factor that enabled the offices of the PM to secure a more powerful position and advance their own institutional agendas. This strengthened their leadership role and weakened the respective foreign ministries, whose legitimacy in EU co‐ordination was undermined by the discourse that matters pertaining to this co‐ordination should be treated as domestic policy instead of foreign policy. This discourse proved instrumental in the organizational reforms and core executive restructuring. Both countries also provide evidence of intra‐Nordic organizational learning since the Finnish co‐ordination system was based on lessons drawn from Denmark whereas the subsequent Swedish reform was inspired and legitimized by changes in Finland.     

Federalism and low-maintenance constituencies: Territorial dimensions of economic reform in Argentina

How does the territorial distribution of political and economic resources within national polities influence politics and policy making? This article examines the electoral dynamics of market reform in Argentina between 1989 and 1995. It provides insights into the way that the distribution of economic and institutional resources in federal systems shapes policy making and coalition building options for reformist governments. The electoral viability of the governing Peronist Party during the economic reform period was facilitated by the regional phasing of the costs of market reform. Structural reforms were concentrated primarily on economically developed regions of the country, while public spending and patronage in economically marginal but politically overrepresented regions sustained support for the governing party. Statistical analyses contrast patterns of spending and public sector employment in “metropolitan” and “peripheral” regions of the country during the reform period, as well as the social bases of electoral support in those regions. A conceptual distinction between “high-maintenance” and “low-maintenance” constituencies is also introduced to shed light on the dynamics of patronage spending in contexts of market reform.     

Analysing Local Policy Agendas: How Dutch Municipal Executive Coalitions Allocate Attention

Abstract

This article provides an analysis of the allocation of attention to policy problems on the local level, focusing on the executive agenda of six municipalities in the Netherlands over a 25-year period. It reveals that there is specifically a local politics of attention, showing differences between national and local policy agendas in specific policy areas. We did not find evidence that the political composition of the local executive coalitions leads to agenda differences, revealing the more problem-oriented and pragmatic nature of local politics. We did find evidence of an effect of institutional arrangements between national and local government on shifting patterns of attention, such as due to decentralisation. This shows that the local politics of attention is limited in scope and conditioned by the functions of local government and the institutional arrangements of policy making in the Dutch decentralised unitary state and that rearrangements affect these patterns of attention.     

COMPARING BUSH–CHENEY AND CLINTON–GORE PERFORMANCE MANAGEMENT STRATEGIES: ARE THEY MORE ALIKE THAN DIFFERENT?

Successful performance management strategies are intrinsically linked to the political environment in which public policy‐making occurs. Since the mid‐1990s, many governments have re‐examined how to simultaneously reduce costs, increase performance and achieve results. Public agencies are experimenting with performance measurement and management systems designed to meet public policy goals and respond to citizen demands. Various reform models have been proposed and public administrators now expend considerable time, effort and resources exchanging ‘best practices’, finding ‘best value’, and ‘rethinking’ government operations. Although equally important, less effort has been devoted to performance management (PM) within increasingly complex, ideologically charged and politicized decision‐making environments. Despite significant increases in productivity, more theoretical and empirical research is needed to assist public managers in applying private market‐based alternatives to public service delivery structures. This article compares the PM initiatives of the Clinton–Gore Administration in the United States, known as the National Performance Review (NPR), with President Bush‘s Presidential Management Agenda (PMA). Following the comparison, a theory‐based research agenda is proposed to determine which of many approaches best ‘fits’ the varied and often contradictory systems for delivering public services in a decentralized governance system.     

Is Bigger Really Better? A Comparative Analysis of Municipal Mergers in Australian and Japanese Local Government

While structural reform by means of municipal mergers has been employed in many different countries, council consolidation has been especially marked in Australian and Japanese local government. This suggests that much can be learned by examining amalgamation through the analytical prism of comparative analysis. In this article, we investigate structural reform through municipal amalgamation in Australian and Japanese local government by examining the aims of amalgamation, the methods employed by public policy makers and the outcomes which were achieved. From this comparative analysis, we attempt to draw some broader lessons for local government policy making aimed at local government reform.     

Local Government Modernisation in England: A Critical Review of the LGMA Evaluation Studies

New Labour has subjected English local government to an unparalleled period of reform. This article reviews the Local Government Modernisation Agenda evaluation studies commissioned by central government. The review identifies valuable insights from the studies into the contemporary state of English local government, central government and central–local relations. However, the studies also illustrate the need for research on public service reform to include analyses of the political origins of reform policies and the political–bureaucratic issues involved in their implementation. It is also argued that future research needs to rediscover the value of studying local politics ‘in the round’, the impact of socio-economic and non-local factors on local policy outcomes and the role of new sources of policy influence in the channels of central–local relations.     

The Maintenance of Executive Capacity in Germany: Revisiting the Annual Budget of the European Union

This article considers the executive capacity of the German government to coordinate the annual budget of the European Union in the post‐Maastricht period. It identifies and elaborates two broad sets of factors essential to the development of this routinized policy process: internal executive coordination through specialized administrative techniques and coordination with external actors through multi‐level institutional adjustments. The emergent picture shows the success of the Federal government in maintaining its executive capacity within an Europeanized policy sector.     

Exorcising the ghost of the politics-administration dichotomy: an institutional theory of administration policy making

This article takes implementation theory one critical step further. It argues that administrative policy making is a separate, distinguishable process, not a stage in or component of the legislative policy-making process. In addition, it argues that the institutional setting for policy making has a major influence on policy ideas, choices, and actions. Administrative agencies form a distinct institutional setting for policy politics, and setting influences policy outcomes. The implications of the institutional perspective for understanding policy making, policy analysis, and the legitimacy of public organizations are examined.

The ghost of the politics-administration dichotomy haunts implementation theory. Although numerous scholars have declared the dichotomy dead,⁽¹⁾ administrative policy making is still seen as a component or step in the policy process that is dominated by elected officials. For example, Kelman recently examined the different institutional settings of policy making.⁽²⁾ Elected officials, in his view, are and should remain the primary source of policy ideas and choices while administrators remain responsible for translating these ideas and choices into practice. Other scholars underscore the lack of effective control by legislators and elected executives. But even those who acknowledge administrative initiative and autonomy see administrators as servants, however weak their masters.

This article takes implementation theory one critical step farther. It argues that administrative policy making is a separate, distinguishable process—not merely a stage in or component of legislative policy making. Policies can and do originate in administrative agencies. These innovations gather supporters and critics, are tested and refined, and can become part of the routine with little, if any, involvement by elected officials or political appointees. Legislation and executive orders commonly ratify existing administrative policies rather than initiate administrative involvement.

In addition, the institutional setting for policy making has a major influence on policy ideas, choices, and actions. Administrative agencies form a distinct institutional setting for policy politics. The institutional setting, it is argued, influences policy outcomes. Administrative policy making is not, however, an entirely discrete process. It intersects with legislative policy making at important and predictable points. The two policy processes, legislative and administrative, are loosely and variably coupled.⁽³⁾ The central distinction is that administrative policy making is dominated by the ideas, norms, routines, and choices of nonelected public employees, whereas legislative policy making is dominated by the perspectives of elected officials. Administrative policy making can occur in the bureaucracies of the President or of Congress.

The argument that these two processes—legislative and administrative—are distinct does not, however, deny their essential overlap. The overlap between these two fundamentally different policy settings has fostered the delusion that there is only one policy setting with legislative and administrative components. Clearly elected officials influence administrative policy making, and, just as clearly, administrators influence legislative policy making.⁽⁴⁾ Nevertheless, their interaction remains obscure without a clearer perception of the profound differences between the two settings. As stated, the importance of administrative policy making seems obvious and uncontroversial, but its implications are strongly resisted.⁽⁵⁾

Public administration and implementation theories have not adequately recognized the importance of administrative policy making in modem welfare states.⁽⁶⁾ Before more fully developing these ideas, four examples of administrative policy making are briefly reviewed.     

Experiences of a learning organization in the public sector

This article explores the experience of a municipal government agency as it confronts the challenges and opportunities of meeting seemingly unlimited demands with limited resources. The City of Scottsdale, Arizona, enjoys a national reputation for innovative approaches to public policy issues. This article examines Scottsdale's efforts to create a learning organization, through a Venture Team which represents a core strategy for continuous improvement and lifelong learning.     

THE ENTERPRISE FORMULA,NEW PUBLIC MANAGEMENT AND THE ITALIAN HEALTH CARE SYSTEM: REMEDY OR CONTAGION?

Health care services represent an extraordinary experimental ground for introducing wider political and institutional transformations of the state. The adoption of entrepreneurialism into European health care systems has strengthened technocratic decision making over traditional mechanisms of political control. In Italy, in the midst of a severe legitimacy crisis affecting the administrative and political systems at the beginning of the 1990s, New Public Management ideas seemed ‘the’ remedy against the pathological politicization of distributive politics. Much hope has been placed since in a new and ascending group of general managers, entrusted with the ambitious mission of running health care services more efficiently and with the unenviable expectation of resuscitating public trust in welfare institutions. By analysing the 1992 Amato government’s landmark health care reform in its substantive changes, this paper explores the last decade’s main reform trajectories of Italian health care reforms that irreversibly transformed its institutional arrangements and organizational structure, namely the enterprise formula and the regionalization of the health care sector. The paper suggests that the political turmoil of 1992–94 served as catalyst for radical policy change and argues that the single most important explanation for the enactment of New Public Management‐type reforms rests in a new executive reinterpretation of its legislative prerogatives and function.     

Weberian Public Administration Versus New Public Management in Eastern Europe: The Case of Romania

As a recent member of the European Union (EU), Romania aligned its public policies to Westernized models of civil service reform. This article critically analyzes the impact of Human Resource Management (HRM) models as compared to a Weberian Easternized public administration culture, which continues to display strong hierarchical relationships, rather than the “networked” governance favored by some Western European countries.

The focus will be on the development of HRM policies and practices, taking as a set of case studies Romanian central government organizations. The key problem to be addressed is to understand why such organizations remain locked in ineffective systems of personnel administration. Yet, Romania, along with other Eastern European states, has been exposed to international reform movements in public management through policy transfer. The article will look for evidence of New Public Management (NPM)-type practices, in addition to HRM.

Moreover, the countries of Eastern Europe are far from homogeneous, and so an understanding of both the institutional and cultural context is crucial to ascertain the acceptability of NPM. In the case of Romania, this article considers HRM developments in a multi-culturally influenced state, which has also experienced Socialist regimes. However, policy innovations have started to appear, not only as a consequence of the international diffusion of “good practice” and “policy learning, ” but also stemming from the demands of European directives. Thus, the aim of this article will be to assess the role of policy learning in relation to HR reform in the public service.     

EXPERTISE AND POLICY‐MAKING: LEGAL PROFESSIONALS IN LOCAL GOVERNMENT

Professional influence in policy‐making is generally believed to rest on professionals successfully laying claim to access to expertise – knowledge, understanding or experience – not available to others, above all politicians. On the basis of a 2005 survey of nearly 800 lawyers serving in local authorities in England and Wales, this article explores the relationship between specialization and political influence. Lawyers who shape policy use conventional routes for political influence, establish contacts with political officeholders, tend to identify less with the profession at large and are less likely to see themselves as specialists in any field of law. This means that the relationship between expertise and political power is complex and that the notion that professionals use their expertise to shape policy should be treated with some caution.     

Current challenges of the mexican state and of mexican public administration

This article deals with the problems that the Mexican government will need to face in order to go on with the reform of the state. The cycle of such a reform (privatization, liberalization and democratization) is already closing down. While ending this process, however, Mexico also started to see an increasing number of demands calling for administrative reform and, above all, the federalization of government and public administration. This is what the author calls the strategic agenda of the Mexican government.

In order to implement the administrative reform, the author favors enhancing the accountability of the Mexican government, by increasing public participation in the policy and decision making processes. With regard to the federalization of government and public administration, Aguilar proposes the implementation of policy tools never used in Mexico, such as fiscal federalism (categorical and block grants, for instance), together with new constitutional, political and administrative arrangements.     

THE ROLE OF POLITICS AND INSTITUTIONS IN THE ITALIAN ADMINISTRATIVE REFORM TRAJECTORY

This article applies broad conceptual categories of comparative politics to the explanation of administrative reforms in Italy. It takes as its argument some lines of influence on public sector reform of the features of the party system in Italy, the executive‐legislative balance, the politician‐bureaucrat relationship, and the role of administrative law. In the search for explanations for the trajectory of administrative reform, pre‐existing political and institutional factors also have to be interpreted through the lens of negotiated change occurring via processes of conversion and layering involving new and old institutions that has taken place in Italy since the ‘political crisis' began in 1992.     

Culture Governance: Governing Self‐Reflexive Modernity

Political and administrative analysis is today said to be taking a narrative turn: to learning by telling and listening to the different stories that constitute political life. However, this new approach to studying the decentring of politics and policy as multiple discursive practices carries a new grand narrative too. A new connection between political authority and political community is taking shape outside the spheres of modern government and representative democracy. Political authority is becoming increasingly both communicative and interactive in order for it to be able to meet complexity with complexity. It is employed for reforming institutions by opening them towards the culture and by tying them to the political attributes and capacities of self‐reflexive individuals and to the transformation and self‐transformation of their conduct. I call this development culture governance. Culture governance is about how political authority must increasingly operate through capacities for self‐and co‐governance and therefore needs to act upon, reform, and utilize individual and collective conduct so that it might be amenable to its rule (Bang 2003; Dean 2003). Culture governance represents a new kind of top‐down steering; it is neither hierarchical nor bureaucratic but empowering and self‐disciplining. It manifests itself as various forms of joined‐up government and network governance and proclaims itself to be genuinely democratic and dialogical. This I shall show by a study of local Danish politics and policy in Copenhagen. Culture governance, I shall argue, constitutes a formidable challenge and threat to democracy, in attempting to colonize the whole field of public reason, everyday political engagement, democratic deliberation, and so on, by its own systems logic of success, effectiveness or influence. It seeks to take charge of the working of the more spontaneous, less programmed and more lowly organized politics of the ordinary in political communities, thus undermining the very idea of a non‐strategic public reasoning as founding the practices of freedoms.     

ON THE BUREAUCRACY OF BUREAUCRACIES: ANALYSING THE SIZE AND ORGANIZATION OF OVERHEAD IN PUBLIC ORGANIZATIONS

Governments across the globe try to rebalance their budgets by rationalizing overhead operations. When overhead‐reducing policies are adopted, it is important to understand why some central government organizations have a higher overhead than others, and why organizational models to produce overhead efficiencies are used to different degrees. This study focuses on the Flemish context to analyse differences between central government organizations in the size and organization of two overhead processes: human resources management (HRM) and finance and control (FIN). Significant effects are found for autonomy, organizational size, spatial dispersion and budgetary stress, yet effects vary according to whether HRM or FIN is considered and whether the focus is on the size or the organization of HRM or FIN. Our findings have practical implications to get a process‐sensitive understanding of the size and organization of overhead, and theoretical implications as they cast light on factors that shape decision‐making in public organizations.     

CORE EXECUTIVE STUDIES IN BRITAIN

Discussions of core executive operations in Britain have focused on a limited controversy about whether monocratic control is exercised by the premier or whether more collegial decision making persists in Cabinet. An extended typology of institutionalist views is examined, including the prime ministerial clique interpretation, models of ministerial government, segmented decision making, and bureaucratic coordination. This restricted debate reflects normative anxieties about Britain's unbalanced constitution, party-structured legislature and an inadequate rational policy process inside the executive. New directions for core executive research are examined, including the analysis of decisional studies, more disaggregated and differentiated accounts of the core executive, coalition politics in the core executive, and the analysis of leadership influences.     

GOVERNMENT LEGITIMACY AND THE LABOUR MARKET: A COMPARATIVE ANALYSIS OF EMPLOYMENT EXCHANGES

This article addresses the recent claim that cross-national policy variations reflect in part differences in institutional origins and state characteristics. It provides a detailed analysis of how states institutionalized public employment exchanges. The authors argue that public employment exchanges will shape the legitimacy of government intervention in the labour market, and thus affect the environment for subsequent labour market policy. Two measures of legitimacy are used. First, the attitude of employers and trades unionists toward exchanges. Second, the role of exchanges in administering unemployment benefits. Cross-national differences in exchanges' legitimacy contribute to an explanation of why different states have different labour market policies.