Rethinking accountability in complex and horizontal network delivery systems

This paper revisits the conventional notion of accountability rooted in bureaucratic and hierarchical structures of government and advances an alternative conceptualization more useful for analyzing complex horizontal network delivery systems. Although such systems are increasingly prevalent, they often exacerbate the problem of accountability in the public sector. By examining regional economic development policy implementation in Manitoba, this article illustrates the prospects and challenges of adapting conventional constructs of accountability to horizontal network delivery systems.     

Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non‐Expansion States

The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference‐in‐difference‐in‐differences models that exploit cross‐sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre‐ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non‐expansion states. Our preferred specification suggests that, at the average pre‐treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer‐provided and non‐group coverage. The coverage gains from the full ACA were largest for those without a college degree, non‐whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage.     

Buyer Beware: How Market Structure Affects Contracting and Company Performance in the Private Military Industry

Private military and security companies are integral components of the defense and intelligence operations of some of the world's most powerful states. Despite the increasingly pivotal role of contractors, analysts have yet to develop theories explaining when governments should outsource national security responsibilities or what conditions cause private defense markets to function efficiently. This inquiry addresses this gap in the literature by demonstrating that varying market structures—that is, the quantity of firms providing similar services and the number and purchasing power of those buying these services—have significant effects on costs, oversight, and company performance in the private defense industry. A principal–agent framework is developed to explain variation in the performance of firms in different markets across the industry. Evaluation of three private defense markets yields the surprising conclusion that monopsony, rather than a competitive market, is the ideal structure for governments outsourcing aspects of national defense.     

NGO networks in Central Asia and global civil society: potentials and limitations

Based on research carried out by INTRAC (International NGO Training & Research Centre) in 2006–2007 in four countries of Central Asia for Oxfam–Novib, the article investigates NGO networks and their international links in the context of current theory on civil society and global civil society. Three case studies of NGOs working in service delivery, community development and free media are examined to show the diversity of aims and the potential and challenges of networking in the region. Civil society advocacy at national and international levels is analysed with a fourth case study on the campaign conducted in Kyrgyzstan against joining the World Bank's Highly Indebted Poor Countries programme. This example shows a more radical, alternative mode of civil society activism. The article emphasizes the importance of national- and regional-level networking and poses the question of whether NGOs in Central Asia can shift from their current positions on the periphery of global movements and debates.