The failure of local government modernization in Britain: a critique of functionalism

Abstract. Modernizing local government systems to meet changing needs and urbanization is common to most Western democracies. This article examines the British local government modernization which, it argues, placed far too much emphasis on improving the system's functional capacity and too little to improving its democratic quality. The overemphasis on functionalism has been most decisive in relation to creating wider areas for planning and transportation and creating more populous local units so as to exploit economies of scale. The result is a system with some of the largest local units among Western democracies. The new system is also very unpopular. Yet, even when judged in functional terms it has serious weaknesses especially in regard to its failure to recognize the different functional needs of urban and rural areas. The article makes a strong plea for the restoration of democratic as opposed to functional criteria in the design of local government systems and notes the contribution that public choice theory can make to local government reorganization by its insistence on distribution efficiency as opposed to production efficiency. Sommaire. La modemisation des systèmes de gouvemement local pour répondre à de nouveaux besoins et aux exignences de l'urbanisation est commune à la plupart des démocraties occidentales. L'auteur de cet article étudie la modemisation du gouvernement local britannique qui, à son avis, a trop porté sur l'amélioration de la capacité fonctionnelle du système et pas assez sur sa qualité démocratique. La trop grande importance accordée au fonctionnel a joué un rôle particulièrement décisif en créant de grandes régions pour la planification et le transport et des unités locales à très forte densité de population de façon à profiter des économies d'échelle. Le résultat, c'est un système qui compte certaines des unités démographiques les plus fortes dans les démocraties occidentales. Ce nouveau système est aussi très impopulaire. Etmême lorsqu'on le juge du point de vue fonctionnel, il accuse une très grave faiblesse en ne distinguant pas entre les besoins fonctionnels différents des régions urbaines et rurales. L'auteur plaide en faveur de la restauration de critères démocratiques plutôt que fonctionnels pour la conception de systèmes de gouvemement local et il indique la contribution que pourrait apporter la théorie du choix public à la réorganisation du gouvernement local grâce à son insistance sur l'efficacité de la distribution plutôt que sur l'efficacité de la production.     

Health care in Canada: patterns of funding and regulation

During the 1970s the share of health care expenditure in Canadian GNP remained roughly stable, in the range of 7-71/2 percent of GNP, in marked contrast to its escalation in most other countries (the U.S. in particular) and to previous Canadian experience. The shift to a stable pattern coincided with the completion of the Canadian system of universal comprehensive public hospital and medical care insurance. This paper explores how and why the public insurance system served to contain cost escalation. It then discusses the inadequacy of expenditure experience per se as a basis for health system evaluation--the same data will support claims of both "underfunding" and "spiralling costs." More serious questions involve the influence of alternative patterns of health care funding and delivery on the effectiveness and efficiency of care provision, and the resulting distributional patterns of care and income. A brief sketch is given of the present situation and future possibilities of Canadian health care under these heads.     

Refining the definition of death for Australian legislation

In the article Mr. Smith considers the need for reform in the area of defining when death occurs and the various approaches that exist to define death. He then analyses the stages of the developments in the various Australian jurisdictions and discusses the substantive content of the basic definition adopted and the practical implications of any enactment. The author suggests that the concept of death should be legislatively enacted in relevant pieces of legislation which call for a resolution of the question at the present time and a more general separate statement defining death should be avoided at the moment. Conceptually death should be defined as the permanent and irreversible loss of consciousness of the individual as determined by irreversible cessation of the brain stem function. The actual operational criteria of death should form the subject of a circular published by the relevant statutory health authority for the guidance of medical practitioners in relation to the specific problems they face.