Why do governance reforms in developing democracies so often fail, and when might they succeed? When Democracies Deliver offers a dynamic framework for assessing the effectiveness and durability of ...policy change. Drawing on detailed analyses of public sector reforms in Brazil and Argentina, this book challenges conventional wisdom to reveal that incremental changes sequenced over time prove more effective in promoting accountability, increasing transparency, and strengthening institutions than comprehensive overhauls pushed through by political will. Developing an innovative theory that integrates cognitive-psychological insights about decision making with research on institutional change, Katherine Bersch shows how political and organizational factors can shape reform strategies and information processing. Through extensive interviews and field research, Bersch traces how two competing strategies have determined the different trajectories of institutions responsible for government contracting in health care and transportation. When Democracies Deliver offers a fresh insight on the perils of powering and the benefits of gradual reform.
Since 1978 when it embarked on sweeping agricultural and industrial reforms, Chinas economic growth has been remarkable. Its success in transforming itself within just three decades from a very poor ...low-income country to a successful middle-income country is unparalleled. During this period, however, and in contrast to the first 30 years of the Peoples Republic, progress in the health sector has been disappointing. For example, during the period 1980-2007, China increased its income per head as a percentage of the OECD average from 3 percent to 15 per cent, but infant mortality fell no faster in China than in the OECD area. Government spending on health grew in real terms, but in contrast to the pattern seen in other countries, the share of GDP allocated to government health spending stayed unchanged in China despite 30 years of economic growth of over 8 per cent per year. Household out-of-pocket spending increased to fill the gap, rising as a share of total health spending from 20 per cent in 1978 to over 60 per cent in 2000. This left many households doing without care when they needed it, and others incurring expenses so large they were driven into poverty. In 2003, as part of its program of balanced development and harmonious society, the government began launching a series of policy reforms in the rural health sector where spending and policy reform had lagged. This book examines the performance and workings of the rural health system leading up to these reforms, outlines the reforms, and presents some early evidence on their impacts. It goes on to outline ideas for building on these reforms to further strengthen Chinas rural health system, covering health financing and health insurance, service delivery, and public health. Health systems often get locked into certain reform paths. The final part of the book therefore uses the
experiences of the OECD countries to gaze into Chinas future; it asks not only what Chinas health system might look like, but also how China might get there from where it is today.
It has been more than 20 years since Brazil's 1988 Constitution formally established the Unified Health System (Sistema Unico de Saude, SUS). Building on reforms that started in the 1980s, the SUS ...represented a significant break with the past, establishing health care as a fundamental right and duty of the state and initiating a process of fundamentally transforming Brazil's health system to achieve this goal. This report aims to answer two main questions. First is have the SUS reforms transformed the health system as envisaged 20 years ago? Second, have the reforms led to improvements with regard to access to services, financial protection, and health outcomes? In addressing these questions, the report revisits ground covered in previous assessments, but also brings to bear additional or more recent data and places Brazil's health system in an international context. The report shows that the health system reforms can be credited with significant achievements. The report points to some promising directions for health system reforms that will allow Brazil to continue building on the achievements made to date. Although it is possible to reach some broad conclusions, there are many gaps and caveats in the story. A secondary aim of the report is to consider how some of these gaps can be filled through improved monitoring of health system performance and future research. The introduction presents a short review of the history of the SUS, describes the core principles that underpinned the reform, and offers a brief description of the evaluation framework used in the report. Chapter two presents findings on the extent to which the SUS reforms have transformed the health system, focusing on delivery, financing, and governance. Chapter three asks whether the reforms have resulted in improved outcomes with regard to access to services, financial protection, quality, health outcomes, and efficiency. The concluding chapter presents the main findings of the study, discusses some policy directions for addressing the current shortcomings, and identifies areas for further research.
A blueprint for comprehensive, science-based health care system reform.Financial and political pressures on our health care system have negatively impacted individual care and the health system as a ...whole, an issue that has only become more acute because of the COVID-19 pandemic. In Building a Unified American Health Care System, Gilead I Lancaster, MD, lays out a blueprint for comprehensive health care reform, proposing a unified system run by health care professionals—not politicians or commercial health insurance companies—that offers universal coverage and access.Lancaster compares the current arguments for single payer versus commercial health insurance systems with arguments in the early 1900s for a central bank versus regional commercial banks. He then introduces a novel solution: the establishment of a National Medical Board similar to the Federal Reserve System that helped fix the American banking system over a century ago. Along with other innovations, a plan co-created by Lancaster dubbed EMBRACE (Expanding Medical and Behavioral Resources with Access to Care for Everyone) would involve creating a modern, evidence-based health care system, one offering universal coverage for basic needs while allowing for commercial insurance participation. Emphasizing the importance of separating health care from governmental and commercial pressures and incentives, Lancaster explains the need for comprehensive—rather than incremental—reform of the American health care system.
This indispensable guide to the Affordable Care Act, our new national health care law, lends an insider's deep understanding of policy to a lively and absorbing account of the extraordinary—and ...extraordinarily ambitious—legislative effort to reform the nation's health care system. Dr. John E. McDonough, DPH, a health policy expert who served as an advisor to the late Senator Edward Kennedy, provides a vivid picture of the intense effort required to bring this legislation into law. McDonough clearly explains the ACA's inner workings, revealing the rich landscape of the issues, policies, and controversies embedded in the law yet unknown to most Americans. In his account of these historic events, McDonough takes us through the process from the 2008 presidential campaign to the moment in 2010 when President Obama signed the bill into law. At a time when the nation is taking a second look at the ACA, Inside National Health Reform provides the essential information for Americans to make informed judgments about this landmark law.
In 2012, Cambodia—an epicenter of violent land grabbing—announced a bold new initiative to develop land redistribution efforts inside agribusiness concessions. Alice Beban's Unwritten Rule focuses on ...this land reform to understand the larger nature of democracy in Cambodia. Beban contends that the national land-titling program, the so-called leopard skin land reform, was first and foremost a political campaign orchestrated by the world's longest-serving prime minister, Hun Sen. The reform aimed to secure the loyalty of rural voters, produce modern farmers, and wrest control over land distribution from local officials. Through ambiguous legal directives and unwritten rules guiding the allocation of land, the government fostered uncertainty and fear within local communities. Unwritten Rule gives pause both to celebratory claims that land reform will enable land tenure security, and to critical claims that land reform will enmesh rural people more tightly in state bureaucracies and create a fiscally legible landscape. Instead, Beban argues that the extension of formal property rights strengthened the very patronage-based politics that Western development agencies hope to subvert.
The Amazon, the world's largest rain forest, is the last frontier in Brazil. The settlement of large and small farmers, squatters, miners, and loggers in this frontier during the past thirty years ...has given rise to violent conflicts over land as well as environmental duress. Titles, Conflict, and Land Use examines the institutional development involved in the process of land use and ownership in the Amazon and shows how this phenomenon affects the behavior of the economic actors. It explores the way in which the absence of well-defined property rights in the Amazon has led to both economic and social problems, including lost investment opportunities, high costs in protecting claims, and violence. The relationship between land reform and violence is given special attention. The book offers an important application of the New Institutional Economics by examining a rare instance where institutional change can be empirically observed. This allows the authors to study property rights as they emerge and evolve and to analyze the effects of Amazon development on the economy. In doing so they illustrate well the point that often the evolution of economic institutions will not lead to efficient outcomes. This book will be important not only to economists but also to Latin Americanists, political scientists, anthropologists, and scholars in disciplines concerned with the environment.
OECD countries have made significant reform progress in recent decades, in fields as diverse as competition policy, health care and the environment. How have they done it? And why have reforms ...advanced in some places and stalled in others? This collection of essays analyses the reform experiences of the 30 OECD countries in nine major policy domains in order to identify lessons, pitfalls and strategies that may help foster policy reform in the future. While taking full account of the tremendous differences in the political and institutional settings in which these reforms were undertaken, the authors highlight a number of common challenges and potential solutions that hold good across both countries and issue areas. They show that the scope for cross-national policy learning is enormous. The importance of such reform lessons is all the greater in the wake of the global financial and economic crisis. As OECD governments confront the challenge of trying to restore public finances to health without undermining the recovery, they will need to pursue a careful mix of fiscal policies and growth-enhancing structural reforms. Designing, adopting and implementing such a policy mix will require the crafting of effective reforms and effective strategies for implementing them.
