摘要:

Abstract:President Clinton's proposals to reform health‐care in the United States have stimulated unprecedented levels of discussion amongst stakeholders, commentators, policy analysts and the media. It seems obvious that there is a need to reform a system that consumes 14% of gross domestic product, yields only OECD‐average morbidity and mortality rates and fails to provide coverage to millions of people. Nevertheless, forces against change are marshalling considerable resources in opposition to Clinton's proposals, and now that the November 1994 mid‐term elections have routed the democrats in both the House of Representatives and the Senate, the belief is that his reforms will never be adopted in their original format. Some of the issues and ideas emanating from the American debate parallel trends in Australian health‐care. Elements in transition include the switch from an input‐to an outcomes‐orientation, improving the quality of care, focusing on the customer and securing greater value‐for‐money. Unlike America, Australia has a limit on national health‐care spending and this poses different challenges. However, the American debate is of vital interest to Australia. Australian and American hospitals are increasingly in competition to export services to South‐East Asia. Of particular importance to Australia are: the extremely public nature of the American debate, which should be emulated, the fact that explicit rationing is now clearly on the international health‐care agenda, the need to reconceptualise western culture's preoccupation with immortality, the need to alter economic incentives to health‐care providers and the shift to outcomes measurement and effectiveness. Despite the comparatively healthy state of the Australian system, complacency should not be allowed to set in. Lessons for Australia from America are numerous, and it behoves us to monitor closely developments, trends and options arising from the

ISSN:0313-6647    

DOI:10.1111/j.1467-8500.1995.tb01115.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:Over recent years the American states have re‐emerged as centres of policy innovation and reasserted themselves within the federal system. In contrast, at least until Bill Clinton's accession to the presidency, the federal government has lost the initiative. Indeed, Clinton's accession from what in the past would have been regarded as an obscure southern governorship symbolises the shift of the states to the centre stage of American politics.This article considers the reasons for this shift, stressing the generational change among the governors, the new economic and social challenges faced by the states and the increasing withdrawal of the federal government from the state sphere. In terms of the prospects for the future of American federalism, federal government is likely to withdraw further under Clinton, reversing the trend of earlier Democratic presidencies. Indeed, thanks to the efforts of governors like Clinton, state governments are now better equipped than ever before to shoulder new responsibilities. Their tax base has widened, though many states have faced difficult budgetary situations in the early 1990s. The organisation and structure of most state governments have been modernised, if slowly given the obstacles inherent in the separation of powers. The new breed of governor has a more managerial approach than earlier generations, and contemporary governors have sought to centralise their power within the executive branch. As state legislatures have also asserted their influence over the executive branch, gubernatorial influence has usually been enhanced at the expense of other power centres within the executiv

ISSN:0313-6647    

DOI:10.1111/j.1467-8500.1995.tb01116.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0313-6647    

DOI:10.1111/j.1467-8500.1995.tb01117.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0313-6647    

DOI:10.1111/j.1467-8500.1995.tb01118.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Book reviewed in this article:Keeping the Peace: Police Accountability and Oversight.Edited by DavidMooreand RogerWettenhallWhat's Right? Free Enterprise versus Government Control: Getting the Balance RightBy GeorgeMcFarlaneThe Australian Public Sector: Pathways to Change.Edited by JamesGuthrieCan Governments Learn? Comparative Perspectives on Evaluation and Organizational Learning.Edited by FransL Leeuw, RayC Rist andRichardC Sonnichsen

ISSN:0313-6647    

DOI:10.1111/j.1467-8500.1995.tb01119.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY