Developing economics expertise for the evaluation of primary health care

Given that government budgets are increasingly stretched in the face of competing demands, there is a pressing need for evidence on the costs and benefits of public sector investments. Nowhere is this need greater than in the health field, where the benefits of programmes are typically difficult to measure. Within the health sector a key area of interest is primary health care, which is generally regarded as a central function and the most important means by which the health of the population can be improved. This paper reports the results of a recent survey of Commonwealth countries which sought to establish the extent of economic evaluation of PHC programmes, the impact on decision-making and the level of health economics expertise available in Third World countries. Based on the results of the survey, suggestions are made for improving the commissioning and conduct of economic evaluations, for interpreting and implementing evaluation results, and for developing government expertise in economic evaluation.     

Sustainability and local government: The case of the British Columbia Islands Trust

Abstract: In recent years environmental values have undergone a popular and political resurgence, one of the central components of which is a demand for greater public participation, especially enhanced local control. This development has important implications for theoretical thinking in public administration. The present article examines the experience of the British Columbia Islands Trust, an innovative example of local administration which is most relevant to the quest for new environmentally sustainable forms of administration as a result of its unusual mandate (“to preserve and protect”) and its locally based planning approach. The article describes the Trust area, reviews the genesis of the Trust in the 1960s and its history to the present, describes its structure, and assesses public attitudes to it. The article draws practical lessons from the Trust experience, noting in particular the powerful effect of merging a conservationist mandate with locally based planning even in the absence of more formal indicators of institutional authority (such as budget, scope of immunity). The article concludes with a consideration of the theoretical implications for public administration of the Trust experience, noting especially the potential role for greater decentralization and democratic participation in planning processes. Sommaire: Depuis quelques années, les problématiques environnementales ont connu un regain d'intérêt auprès du public et des gouvernements. L'une des principales composantes de ce phènomène, qui a d'importantes implications sur la réflexion théorique en matière d'administration publique, est une demande de plus grande participation du public, en particulier au niveau local. Cet article étudie le cas du British Columbia Islands Trust, exemple d'innovation dans l'administration décentraliée, mettant en cause un organisme qui s'efforce d'appliquer de nouvelles formes de gestion favorables à l'environnement dans le cadre d'un mandat particulier (“préserver et protéger”) et d'une approche locale de la planification. L'article décrit la structure et le cadre d'intervention de la société de fiducie, explique son évolution depuis les années 1960 jusqu‘à aujourd'hui, et évalue les attitudes du public à son égard. L'article tire des leçons pratiques de l'expérience de cette société, en particulier concernant l'impact important résultant de la rencontre d'un mandat de conservation de l'environnement avec une activité de planification décentralisée, même en l'absence d'indicateurs d'autorité institutionnelle très formels (budget et immunité entre autres). L'article conclut en étudiant les implications théoriques pour l'administration publique de l'expérience de la société de fiducie, notamment en ce qui touche le rôle possible d'une décentralisation plus poussée et d'une participation démocratique dans un processus de planification.     

Diffusion within Marcia's identity-status paradigm: Does it foreshadow academic problems?

The present investigation attempted to ascertain longitudinally whether diffuseness about academic goals and plans would predict subsequent underachievement. Identity-status interviews were administered to 98 firstsemester college students. Their grade point averages (GPA) were obtained for their first six semesters in college. SAT and conceptual-level scores were used to generate predicted GPAs. Underachievement was operationally defined as a positive discrepancy between predicted-minus-observed GPA: underachievement=predicted observed GPA. Evidence for the hypothesized relationship between diffusion and academic underachievement was not found. To the contrary, Diffusions during their freshman year showed a tendency for relativeoverachievement (predicted observed GPA). The possibility of heterogeneity within Marcia's diffusion status was considered. Some diffuselike individuals may see their current lack of commitment and concern as a hiatus, whereas others may be truly unconcerned and myopic about their lives. A significant association between foreclosure and underachievement was found when the subjects were freshmen. This relationship was not replicated with an independent sample of 90 high school students. A post hoc interpretation focused on differences between transient and long-term Foreclosures and the role that the college environment may potentially play in instigating personal identity crises. The need for longitudinal tests on this account is underscored.     

The Crisis of Central-local government relations: The British experience

The Case for Local Government. By G. Jones and J. Stewart eds. The Politics of Local Spending. By A. Midwinter . Edinburgh: Mainstream Publishing. Abolition or Reform? The GLC and the Metropolitan Counties. By N. Flynn , S. Leach and C. Vielba .     

A new typology for R&D laboratories: Implications for policy analysts

Science policy analysts have traditionally classified R&D laboratories as government, private, or university. The authors argue that this view is outmoded and provides little help in understanding the rapidly changing environment of R&D laboratories. They provide and test an alternative scheme designed to cope with “sector blurring” and the intermingling of market and political influences on R&D laboratories. The authors also discuss implications of their scheme for a variety of contemporary science policy issues.     

Expenditures and receipts in state and local government finances: Reply

It is worth repeating that causality testing is a very complex task. The diversity of views on interpreting the definition of causality and on the methods for testing causality highlight this issue. In our study, we cite an excellent article which provides a detailed critique of various problems associated with causality tests (see Conway, et al., 1984). It would appear that Chowdhury's comment draws very strong conclusions and fails to consider some of the complex theoretical issues regarding causality tests as well as important data problems pertaining to state and local governments. Moreover, we find it somewhat curious that, given the strong similarities in our two studies, Chowdhury prefers to dwell on the mechanics of an alternative technique rather than concentrate on the fact that his alternative technique yields supporting results to our 1987 paper on the tax-spend hypothesis.The views expressed are those of the authors alone and do not necessarily represent those of the U.S. Department of Treasury.