Effectiveness of state mandates to maintain local government health services for the poor

State governments have used several types of mandates to assure that local governments fulfill state-defined responsibilities, including public health care for the poor. This article reports the findings of a study of procedural public-participation mandates and financial sanctions imposed by California to hold counties to their obligations to provide indigent health care. An inventory of the laws' implementation in all California counties found noncompliance by some counties, although all counties complied after a state Health Services Department unit was established to monitor the counties and provide them with state aid. Case studies in eight counties identified factors that influenced the effectiveness of the laws in modifying or reversing county proposals to close county hospitals or reduce other health services. Policy guidelines are suggested for states that want to develop mandates to enforce indigent-care responsibilities of local governments.     

Contract–Management Capacity in Municipal and County Governments

Under pressure to do more with less, governments across the country have moved from direct service provision to providing services by contract. Proponents argue that contracting can reduce costs and improve flexibility and customer satisfaction. Critics point to a growing number of failed contracts, arguing there are numerous pitfalls associated with contracting. Missing from these debates is a discussion of how governments' managerial capacity can improve contract performance. In this article, we identify specific capacities that governments can use to harness the promise of contracting while avoiding its pitfalls. We present analyses of data on municipal and county government contracting activities that show how governments invest in contract– management capacity in response to several internal and external threats to effective contract performance. Because government investment in contract–management capacity is uneven—that is, some governments invest in less capacity even when circumstances would call for more—our analyses may help to explain why some contract arrangements are more successful than others.     

Understanding Women in Scotland

This article explores obstacles to understanding the history and contemporary experiences of women in Scotland, and to the development of feminist research in Scotland. It is argued that explanations which invoke Scottish male chauvinism and misogyny alone are insufficient, and that the marginalization of women in Scotland is produced both by male domination within Scotland, and by English cultural and political hegemony within the UK. The article comments on the relationship of the concept of ‘Britishness’ to that of ‘Scottishness’ (and other identities within the UK) and illustrates how the frequent confusion of ‘British’ with ‘English’ serves to obscure Scottish experience. It is also argued that the place of Scotland within the British state has led to the creation of an institutional framework that disadvantages women, and a system of government that excludes women. This implies that feminist debates on the state in Britain require a specific focus on the form of the British state, and in the context of constitutional change in particular this is important for the development of future strategies. It is argued that the double marginalization of women in Scotland is not just a problem in relation to the development of feminist research, but is also a political problem in that it contributes to a degree of alienation from feminism in England. The article concludes by arguing for the necessity of recognition of difference, but also for dialogue, as the basis for feminist alliances in different parts of the UK.