Regime transformation from below: Decentralization,local governance,and democratic reform in Nigeria

How realistic are democratic-governance strategies that emphasize local governance as a key component? Using Nigeria’s experience in local government and primary health care in the 1980s and 1990s as a case example, the article finds there were substantial shortfalls in local participation and program performance. These were caused by problems in the local political environment and local institutional design, in the national policy environment (particularly in the funding system), and by the stresses of structural adjustment, resource shortfalls, the natural physical environment, and weak leadership. These combined to create poor and inappropriate reward structures and lack of accountability. However, even though the Nigerian case was not successful, most of the specific problems that hurt it are remediable through policy changes at the national level. Several of these were under consideration at the time of the coups of 1992 and 1993.     

Do Śrāvakas understand emptiness?

Conclusions The present study has attempted to artriculate a central issue of Mahäyäna soteriology through an examination of the writings of two Mädhyamika masters, Bhävaviveka and Candrakïrti. The purpose here has been to demonstrate a further criterion for the retrospective designation of their respective philosophies with the terms Svtantrika and Prasangika an exhaustive study of the nature of the Hinayäna wisdom according to the Mädhyamika school would entail an analysis of the writings of many other masters, especially those who produced what has been called the Yogäcära-Mädhyamika synthesis. To attempt to determine the position of Maitreyanätha, for example, on this issue would entail an analysis of the famous Five Treatises (the Dharmadharmatävibhaa, the Madhyäntavibhaga, the Mahayanasutrlamkara, the Uttratantra, and the Abhisamayälamkära) as well as the myriad commentaries on these works. It is possible to speculate briefly here on what the position of Nägärjuna may have been on this issue and then go on to discuss the implications and possible motivations of the views of Bhävaviveka and Candrakïrti.     

PPS waivers: implications for Medicare, Medicaid, and commercial insurers

This paper compares the Medicare prospective payment system (PPS) to four all-payer rate-setting systems that operated under HCFA waiver authority. The study examines the experience of Medicare, Medicaid, and commercial insurers under the two approaches. Data from several American Hospital Association surveys and from Medicaid 2082 report forms are analyzed. The paper concludes that the all-payer waiver programs have been as successful as PPS in controlling the rate of growth in Medicare costs. In addition, Medicaid programs are more successful in controlling their outlays in all-payer rate-setting environments than when they "go alone." Finally, there is no evidence to suggest that hospitals can increase charges in response to greater financial need under either PPS or the state waivers. Nevertheless, it appears that commercial insurers are better able to compete with Blue Cross plans in all-payer rate-setting states than elsewhere.     

The state action doctrine and the Local Government Antitrust Act: the restructured public hospital model

This Article analyzes the development and complexities of the antitrust state action doctrine and the Local Government Antitrust Act as these doctrines apply to both "municipalities" and private entities. The restructuring of a public hospital is used as a model to facilitate the antitrust analysis. The restructuring model, which typically involves the leasing of a hospital facility by a public entity to a private nonprofit corporation, offers the unique opportunity to compare the different standards employed under the state action doctrine and the Local Government Antitrust Act. As a practical matter, the Article provides a framework for a public hospital to evaluate the impact of corporate restructuring on its antitrust liability exposure and to develop strategies to minimize antitrust risks.