"Europe of the Regions" and the Federalization of Europe

There is a close connection between regionalism, federalism,and the movement to create a united federal Europe. The recentmovement to create a "Europe of the Regions" is one expressionof these connections. However, there are many kinds of regions,and certain forms of regional policy that may not necessarilybe an expression of either regionalism or European federalism.It might be said, nevertheless, that a "Europe of the Regions"is emerging in the weaker sense that, in today s Europe, significantchanges are taking place in the nature and functions of thenation-state. These changes are providing new opportunitiesfor regions to become more important policy actors in a widerEuropean context. The nation-state, however, is unlikely todisappear.     

Setting limits through global budgeting: hospital cost containment in Rhode Island

In 1974, hospitals in Rhode Island have participated in annual negotiations with state officials and representatives from Blue Cross to determine the allowed increase in statewide hospital costs (the "Maxicap") for the next fiscal year, based on projected increases in hospitals' revenues, changes in patient volume and operating expenses. Individual hospital budgets may be above or below the Maxicap as long as the total increase in hospital costs for all hospitals in the state does not exceed the negotiated amount. At a time when regulatory solutions are increasingly under fire, continued support for Rhode Island's approach to hospital cost containment from third party payers, providers and public officials stands in stark contrast to other states where rate setting was either dismantled or discredited as a cost control strategy. A negotiated global cap on hospital expenditures offers an alternative to formula-based state rate-setting methodologies which could be incorporated as part of an all-payer reimbursement methodology or as an incremental step towards more comprehensive reform.