Conclusions The Dynamics of Social Service Reforms
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Conclusions The Dynamics of Social Service Reforms
159This is the semi-final DRAFT of the final chapter of Kaufman and Nelson, eds.,Crucial Needs, Weak Incentives: The Politics of Health and Education Conclusions The Dynamics of Social Service Reforms Reform inLatin America, Wilson Center Press and Johns Hopkins University Press, forthcomingautumn 2004. The book includes twelve case studies of major sector reforms, andcomparative essays examining the politics of reform in each of the two sectors.Chapter 16Conclusions; The Dynamics of Social Serv Conclusions The Dynamics of Social Service Reformsice Reforms1Robert R. Kaufman and Joan M. NelsonIn Chapters 3 and 9, we focused on the actors and institutions that shaped crossnational patterns of rConclusions The Dynamics of Social Service Reforms
eform of health and education services. One point to emerge from these chapters was the difficulty that reformers faced in maneuvering around strong o159This is the semi-final DRAFT of the final chapter of Kaufman and Nelson, eds.,Crucial Needs, Weak Incentives: The Politics of Health and Education Conclusions The Dynamics of Social Service Reformse case of the health sector, private insurers and providers. Indeed, the cases provided considerable evidence to support the conventional wisdom that there is an asymmetry of power between well-organized groups who stand to lose from the reform process, and prospective “winners” who face serious col Conclusions The Dynamics of Social Service Reformslective action problems.At the same time, however, it was also clear that changes were occurring in many countries, and that some of these involved quConclusions The Dynamics of Social Service Reforms
ite substantial reorganizations of financing and lines of accountability within the social sectors. In part, not surprisingly, these reforms tended to159This is the semi-final DRAFT of the final chapter of Kaufman and Nelson, eds.,Crucial Needs, Weak Incentives: The Politics of Health and Education Conclusions The Dynamics of Social Service Reformst group politics tells only part of (he story in any of the countries we have examined. Reforms were shaped as well by the broader international context, by links between social service reforms and broader goals and issues, and by political contingencies and strategies that sometimes opened new wind Conclusions The Dynamics of Social Service Reformsows of opportunity for policy changes.In this concluding chapter, we take a step back from the specificities of the health and education sectors and eConclusions The Dynamics of Social Service Reforms
xamine the processes through which reforms have been shaped and implemented. Reform in any aspect of public policy is never just a single event, and s159This is the semi-final DRAFT of the final chapter of Kaufman and Nelson, eds.,Crucial Needs, Weak Incentives: The Politics of Health and Education Conclusions The Dynamics of Social Service Reforms. We distinguish analytically between four phases. In the first phase, reforms become pari of a policy agenda; decision makers begin to seriously consider the need to fix perceived problems in the social sectors. The second is an initiation phase in which a concrete proposal is designed and advanced Conclusions The Dynamics of Social Service Reforms as a proposal of the executive branch. A third is formal authorization, either through legislation or decree. The fourth is an implementation phase,Conclusions The Dynamics of Social Service Reforms
which engages additional actors and interests, and may take years to unfold. The distinction among these phases, although somewhat artificial, offers 159This is the semi-final DRAFT of the final chapter of Kaufman and Nelson, eds.,Crucial Needs, Weak Incentives: The Politics of Health and Education Conclusions The Dynamics of Social Service Reformsrocess.Highlighted below are several general observations that we will elaborate morefully in the rest of this conclusion.1611.Regarding how reforms move onio government agendas: Although it is impossible to map a direct link between specific reforms and either globalization or democratization, gene Conclusions The Dynamics of Social Service Reformsral trends toward more open polities and more globalized economics created a new context in which reforms moved onto the political agenda OÍ debate inConclusions The Dynamics of Social Service Reforms
most countries OÍ the region. Sector specialists had advocated refonns for decades, but democratization and exposure to international markets tended 159This is the semi-final DRAFT of the final chapter of Kaufman and Nelson, eds.,Crucial Needs, Weak Incentives: The Politics of Health and Education Conclusions The Dynamics of Social Service Reformsed reforms, although they were seldom the primaty initiators of successful efforts.2.Top government officials, presidents and their closest associates generallyregarded social sector reforms as less urgent than other policy goals and political objectives. Yet their sustained support was often pivota Conclusions The Dynamics of Social Service Reformsl throughout the reform process. Whether or not they backed such reforms depended on whether and how they were linked to these other goals. Top-levelConclusions The Dynamics of Social Service Reforms
support for health or education reform was generally strongest when presidential decision-makers felt it would advance the pursuit of other objectives159This is the semi-final DRAFT of the final chapter of Kaufman and Nelson, eds.,Crucial Needs, Weak Incentives: The Politics of Health and Education Conclusions The Dynamics of Social Service Reformsthe executive bureaucracypredominated in die design phases of refonn. Specific proposals were generally designed from the top, by reform or "c hange" teams within or among the ministries. Stakeholders were consulted early in only a few cases, and broader162public debate was even more rare. In that r Conclusions The Dynamics of Social Service Reformsespect, social sector reforms resembled earlier first-generation reforms.4.Regarding authorization: Officials within the executive bureaucracy and staConclusions The Dynamics of Social Service Reforms
keholder groups were also the main actors in the authorization phases of reform. With few exceptions (most notably, both sector reforms in Colombia an159This is the semi-final DRAFT of the final chapter of Kaufman and Nelson, eds.,Crucial Needs, Weak Incentives: The Politics of Health and Education Conclusions The Dynamics of Social Service Reformsthe executive branch. The narrow array of actors reflected collective action problems faced by prospective beneficiaries of reform: as with first-generation reforms, the costs of social sector reforms were prompt, clear, and concentrated on well-organized interests, while gains were usually delayed, Conclusions The Dynamics of Social Service Reforms uncertain, and diffused across much of the public. The top-down approach may also reflect the relative lack of traditions of citizen involvement in pConclusions The Dynamics of Social Service Reforms
ublic policy-making.5.Implementation is normally by far the longest phase in the reform process, and involves the broadest set of actors. It is profou159This is the semi-final DRAFT of the final chapter of Kaufman and Nelson, eds.,Crucial Needs, Weak Incentives: The Politics of Health and Education Conclusions The Dynamics of Social Service Reforms or fundamentally distort the reformers’ intent. Sustaining the momentum of reform during this phase depended not only on the emergence of new stakeholders, a well-established point in the literature, but also on continuing support from national policy elites.6.Different kinds of reforms entail mark Conclusions The Dynamics of Social Service Reformsedly different political challenges. Not surprisingly, measures that generate prompt, visible, and widespread benefits attract support: measures thatConclusions The Dynamics of Social Service Reforms
impose costs (in terms of income, status, security, or163convenience) on providers provoke resistance; so do measures that reallocate significant reso159This is the semi-final DRAFT of the final chapter of Kaufman and Nelson, eds.,Crucial Needs, Weak Incentives: The Politics of Health and Education Conclusions The Dynamics of Social Service Reformst and inhibit opposition; measures viewed as mainly concerned with efficiency are often regarded as undesirable by providers and the public.Integrated and comprehensive reform programs usually prompt more opposition than narrower measures. These generalizations help to explain why some kinds of refo Conclusions The Dynamics of Social Service Reformsrms are much more frequently launched and carried through than other types of measures.Politically Non-controversial versus Contentious ReformsThe lasConclusions The Dynamics of Social Service Reforms
t point above cuts across all phases of reform, and we will examine it before we turn directly to each phase in the political process. In both the hea159This is the semi-final DRAFT of the final chapter of Kaufman and Nelson, eds.,Crucial Needs, Weak Incentives: The Politics of Health and Education Conclusions The Dynamics of Social Service Reformsistinctions among these programs are important, because they generate veiy different patterns of benefits and costs that affect political support and opposition. While some kinds of measures are extremely contentious, others may be relatively non-controversial or actually popular. Staled more precis Conclusions The Dynamics of Social Service Reformsely, refonns vary with respect to:• The extent, speed and transparency of benefits to users. “Transparency” means the degree to which users - parentsConclusions The Dynamics of Social Service Reforms
of school children, patients in hospitals or clinics - recognize the connection between specific reforms and improvement in the services they receive.159This is the semi-final DRAFT of the final chapter of Kaufman and Nelson, eds.,Crucial Needs, Weak Incentives: The Politics of Health and EducationGọi ngay
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