Handicapped by old and new traps: Hungary's health care reform

Since the early 1980s, grave challenges have faced Hungarian health policy. The health status of the population stagnated between the mid-1960s and mid-1970s, and has dramatically deteriorated since then. In the 1980s the multidimensional crisis of the health care system deepened. Its overhaul must embrace every component: policy-making, ownership, financing, management, service structure, patient rights, medical education, etc. The main purpose of this paper is to describe how health policy has (or has not) responded to these challenges. First it summarizes the inheritance of the state-socialist regime, then it outlines the recent changes in social insurance legislation, and finally it compares official goals with the way the reform is actually proceeding. The paper is intended to discuss the connection between health care reform and the historic transformation of the political regime and the economy.     

Social Security in Australia and New Zealand: Means-tested or Just Mean?

The social security systems of Australia and New Zealand have traditionally rejected social insurance in favour of a means-tested categorical safety net approach that provides considerable scope for targeting. The experience of both countries provides many examples of how targeting can be used to constrain social security spending, and these have attracted interest in other countries keen to contain the growth in their social security budgets. However, although there are many similarities between the two systems, there are also many differences and these have become greater as targeting has gathered momentum over the last two decades. This paper analyses how targeting has been used in each country as a way of illustrating the different approaches adopted. Attention is focused on how the retirement income systems of the two countries illustrate an increasing policy divergence, with the planned Australian transition to a "multi-pillar" approach in contrast to the constant (and continuing) reform of New Zealand superannuation. Household data on the pattern of receipt of transfer incomes and their impact on the distribution of income are then used to explore the impact of targeting since the early 1980s. This analysis suggests that, in practice, targeting has had a far smaller impact on income inequality in both countries than is often claimed.     

Beyond New Zealand's Dual Health Reforms

The New Zealand health system was substantially reformed in 1993 with the introduction of a purchaser–provider split, competitive contracting and managerialism. The new system failed to deliver the desired gains and, in 1996, the reforms were "reformed". While there has been widespread study of the 1993 reforms, there has been little discussion to date of the 1996 changes and the emerging directions for New Zealand health policy and service delivery, which remain unclear. This paper discusses the New Zealand health reforms of the 1990s. It briefly outlines the 1993 reforms and their results. Next, it details the 1996 "reforms". Third, it discusses developments since 1996, some of which have emerged out of the 1993 reforms, but which have gathered momentum only since the 1996 changes were announced. In the conclusion, the paper lists some of the directions in which the New Zealand health sector appears to be heading, noting that there is a need for coordination of the sector, and for permanence.     

Ageing in “Poor Household” or Ageing into Poverty? Tackling the Policy Dilemma of Redistribution

The policy issue of how to target poor households rather than provide universal coverage takes the primary place in the question of redistribution where resources are limited. The Government of India's social protection programs, particularly the old age pension for the informal sector of the economy, has taken a targeting approach. In this article we show that there is a case for universal coverage since ageing households experience greater exclusion from market-based protection as well as from informal (household-based) protection. We make the argument for universal coverage on two grounds: first, a targeted approach has resulted in leakage, indicating that non-poor elderly individuals in the unorganized sector also require some sort of support. Though they are valid, we do not resort to traditional arguments against targeting, such as that it creates institutional lock-in mechanisms and stigmatizes the recipients. Second, the loss of income on age-related matters (e.g. hospitalization) or the ability of elderly individuals to gain credit is not particularly class-specific, although the targeting policy implies it is. The article is based on the secondary data source of the National Sample Survey, primary data sources, particularly those conducted by the authors in Kerala and Maharashtra and specifically designed for the ageing population, and ethnographic observations from fieldwork.     

Redefining Welfare: Australian Social Policy and Practice

The present paper outlines and analyzes Australia's welfare reform policies as they have been implemented over the past decade. While there have been numerous social policy initiatives over this period, welfare reform provides an interesting site for analysis and review. This suite of policies and programs is of particular importance from several standpoints. First, its target groups – those needing income security assistance, including the unemployed, people with disabilities, and single parents – are historically and traditionally of concern to social work and social welfare. Second, welfare reform policies have had significant impact on social welfare agencies, and the social workers and welfare workers employed in them. Finally, welfare reform has had a wider impact on inequality in Australia and our attitudes to those in need. This paper first provides a brief overview of the context of Australian social policy and welfare, its origins and current situation. It then outlines the key operational elements of welfare reform and how it has been implemented. The third section of the paper offers a critical analysis of these policies and programs and finally poses some questions and issues requiring further discussion and research.     

Macroeconomic performance of inflation targeting in European and Asian emerging economies

The macroeconomic performance resulting from adopting an inflation targeting policy in emerging economies of Europe and Central Asia are examined. The research includes 26 countries in the period 1997–2019, with a special focus on the period 2008–2019. Our econometric analysis consists of two approaches: dynamic panel modeling and propensity score matching. The results suggest that macroeconomic performance has improved due to the inflation targeting monetary framework. We find that a policy of inflation targeting has been effective in reducing the inflation rate, inflation volatility, and GDP volatility. The results are particularly robust for the subperiod that started in 2008. Econometric results suggest that inflation targeting policy did not affect inflation persistence or GDP growth. Our results suggest that inflation targeting improves the macroeconomic performance of developing countries even when they only partially meet the standard requirements for its implementation.     

Attributing Outcomes to Social Policy Interventions – ‘Gold Standard’ or ‘Fool's Gold’ in Public Policy and Management?

In recent years there has been increased interest in outcome‐based social policy‐making and management. The UK has been in the forefront of this movement but similar movements have been identified internationally. This interest in outcome‐based decision‐making has been given particular impetus through the ‘results’‐based movement in evaluation and performance management since the 1980s, which has increased in scope over time, slowly changing its emphasis from cost reduction and measuring outputs to measuring outcomes. This change has been widely welcomed by policymakers, practitioners and academics. However, there is evidence that the reality is often rather less than the rhetoric. Moreover, the ‘attribution problem’ of attributing changes in outcomes to specific social policies has remained a major issue. The conceptual solution of constructing ‘cause‐and‐effect’ models, imported from the policy evaluation field, has only recently become common for operationalising these models. This article outlines the evolution of interest in outcome‐based social policy‐making up to recent times and the growing realization of the importance of the attribution problem. It then outlines both how the ‘cause‐and‐effect’ policy modelling approach can partially tackle the attribution problem, but also its inherent limitations. Lastly, the article uses several case studies in current UK social policy‐making to demonstrate the potential importance of the reasoning embedded within cause‐and‐effect models but also the dangers in policy‐making which adopts this approach without understanding its conceptual basis or in fields where it is inappropriate, given the current state of our knowledge of social policy systems.     

Neoliberalism,Inequality and Politics: The Changing Face of Australia

Since the early 1980s Australian public policy has undergone the most major transformation since Federation. This transformation has been underwritten by two key principles: liberalism – the view that citizens are autonomous individual actors whose interests are best served when they are free from coercive government interventions into individual action; and marketisation – the belief that free markets are arenas which best enable individual autonomy and produce efficient economic outcomes. These principles define ‘neoliberalism’ or ‘hard liberalism‘. After summarising the major policy changes identified with neoliberalism in Australia, the paper introduces a new research project that examines its impact on socioeconomic inequality, gender inequality and politics and culture. Inspection of relevant data indicates that there are important trends in inequality, public opinion and political behaviour that warrant this investigation.     

Adoption and permanence planning in Scotland: Impact of the Adoption and Children (Scotland) Act 2007 on key processes and timescales

Adoption and permanence planning has been a key feature of Scotland's policy in relation to children and young people who are “looked after.” Although policy and law has significantly developed in recent years, there has been comparatively little research on permanence processes in Scotland. This paper outlines key findings from the first comprehensive study of permanence planning in Scotland. It examines the process for two cohorts of children where adoption or other types of permanence orders were made. The children were selected under the long standing Adoption (Scotland) Act 1978 and the more recent Adoption and Children (Scotland) Act 2007. In total, 300 cases were examined, analysing data from the children's first contact with services through to the order made by the Scottish Courts. This paper pays particular attention to the timescales found at key stages under the two sets of legislation and asks what difference the change in legislation has made.     

Children and Poverty Why their experience of their lives matter for policy

Children's poverty has long been a central concern for policy makers and policy researchers. The body of extant research conducted and the range of programmatic interventions undertaken by successive governments in this and other countries is extraordinary. Nevertheless, children remain in poverty. Clearly there are many reasons for this, not least of which is the maintenance and intensification of market capitalism with its attendant blatant inequalities. Even so, the moral, political, social and economic imperatives for developing workable responses to children's poverty remain. This paper argues that we, in Australia, should adopt an approach increasingly taken in the UK. Drawing on, among other things, the new sociology of childhood, this approach begins not with the expertise of adult researchers and policy makers, but with that of children. In doing so, the case is made for why children's perceptions and experiences of poverty are key concerns for policy. The paper outlines in theoretical terms why children's voices matter. Invoking the new sociology of childhood and the sociology of identity, a conceptual framework for understanding why policy scholars and makers should carefully attend to the voices of their subjects is sketched – in this case, the subjects are children. Finally, some methodological implications of this for undertaking policy research informed by this approach are outlined.     

Change and Resilience in Welfare State Policy. The Politics of Sickness Insurance in Norway and Sweden

This article compares the processes of reforming sickness insurance in Norway and Sweden. Despite the many similarities between the Norwegian and Swedish welfare states, they have taken different paths when it comes to reforming their sickness insurance systems. In the period between 1990 and 2010 Sweden changed its wage replacement levels and levels of employer financing several times, while in Norway they remain basically unchanged since 1978, notwithstanding many reform initiatives by political authorities. Why have the two cases evolved so differently? We address this question by using Peter Starke's review of the retrenchment literature which outlines four major strands of theorizing the politics of welfare reform: neo‐functionalism, conflict theories, institutionalist theories and discourse theory. Rather than treating these as providing competing explanations, the article suggests that elements from all perspectives bring insights to the case. The need for policy reform must always be communicated in a way that can be understood and approved in order to materialize as actual policy change. But discursive change and apparently seductive frames will not always be enough. This comparative analysis illustrates that the chance of success for new frames or discourses depends on the institutional, political and functional context into which they are inserted. Similar attempts at framing the need for reform and cutbacks have had different effects in the two countries depending on the character of the counter forces and extant frames reformers are up against. On the other hand, over time discourses and frames also shape institutions and political relations.     

What's in a service?

The measurement of ‘service’ in children's services is highly varied. We do not know in a meaningful sense what services children and families get. This paper sets out why it is important to measure services well. It outlines the dimensions of ‘service’, how they have been measured in research, policy and practice contexts, and the strengths and weaknesses of these approaches. It then explores implications for the field and identifies potential applications of a more nuanced and consistent approach to measuring services.     

Inflation targeting and its spillover effects on financial stability in emerging market economies

In this paper, we study whether adoption of inflation targeting monetary policy framework has spillover effects on financial stability in emerging market economies. Working with data for 64 emerging market economies, we develop financial stability and sector specific stability indices and identify the effect using dynamic panel data models in difference-in-difference framework. We find significant positive spillover effects of inflation targeting adoption on banking system resilience and external capital inflows arising from improved transparency and accountability of the central banks. Based on the results, the paper recommends to emerging market economies which are currently under inflation targeting lite regime, to adopt full-fledged inflation targeting monetary policy.     

Compulsory Income Management in the Northern Territory – evaluating its impact

Australia has been experimenting with constraining the ways in which welfare recipients can spend their income support payments, limiting their ability to access cash and purchase some products. The policy objectives include to reduce spending on alcohol, gambling, pornography and tobacco in favour of meeting ‘basic’ family needs, especially for children, to limit the scope for financial harassment, encourage pro‐social behaviours, and build financial capabilities. In the logic of the programs these outcomes are expected to be manifest at the individual, family and community levels. The policy has primarily impacted on Indigenous Australians as a result of its geographic targeting, although a recent report has recommended a more stringent version of the program be introduced universally to all welfare recipients other than the aged. The largest of these experiments is ‘New Income Management’ in the Northern Territory, which has had more than 35,000 participants since its introduction in 2010. This article reports on the key findings of the major independent evaluation of New Income Management commissioned by the Australian Government.     

Performing the state: the socio-political dimensions of performance measurement in policy and public services

ABSTRACT

This opening paper outlines the rise of public sector performance measurement and performance governance from New Public Management, its trajectory from an administrative tool for organisational monitoring and management, to its insertion into service performance and accountability, to a policy tool defining policy itself. Four key conceptual ways of approaching public sector performance measurement are outlined, and the significance of understanding performance measurement as a socio-technical policy instrument is argued. The paper thematically reviews the papers that follow and how they demonstrate new points of critical analysis in policy studies, including the multiple, mixed and sometimes contradictory purposes for performance measurement, the formation of performance measurement tools, the linkages of performance numbers and governance structures from macro to micro, and the reconfigured roles of professionals in public service delivery. The paper issues a clear challenge to policy researchers to take performance measurement more seriously in understanding the dynamics of policy performance, the achievement of policy objectives, the reframing of policy and the experience of citizens.     

Does inflation targeting lower inflation and spur growth?

Over the last few decades several countries have turned to inflation targeting as a policy choice for instilling stability into their economies. Prior studies have shown that inflation targeting has reduced inflation in those countries without significantly impacting GDP. This study seeks to improve upon these results by identifying the impact of timing on the policy decision as well as its impact as related to specific regions of the world. The focus is on developing countries across six regions. We find significant regional variation in developing countries in our sample in terms of the direction of changes in inflation following a switch to the inflation targeting policy. Moreover, although the impact of inflation targeting on real GDP is minimal overall, there is a statistically significant increase in real GDP among developing countries in certain regions only, namely, Europe, Latin America, and the Middle East.     

Relationships matter: the problems and prospects for social workers' relationships with young children in care

One of the key lessons learnt in the UK from the Laming Inquiry into the death of Victoria Climbié was the importance of social workers developing consistent and long-term relationships with young children in whose lives they are involved. This issue is now informing policy developments, including the proposed Social Work Practices which, based on a similar model to General Practitioner practices, aim to provide a lead professional to act as a parental figure and an advocate for every child in care. This paper begins by confirming the importance of developing relationships between social workers and young children, but questions the ability of the new policy developments to facilitate these. Drawing upon data from research involving interviews with social workers, the paper outlines the factors which hinder social workers' relationships with young children and argues that while the new proposals address some of the more surface structural and organizational factors, they do not address the deeper factors regarding attitudes, values and emotional competence which are crucial if social workers are to successfully build relationships with young children in care.     

Changing policy,changing attitudes? Public opinion on employment relations in New Zealand, 1990–2008

Abstract

Did significant policy shifts in employment relations in the 1990s lead to equally large changes in the attitudes of New Zealanders towards employment relations? Have policy modifications made since 1999 further shaped public perceptions? This paper explores the role of policy feedback in influencing public opinion towards employers and unions and towards government responsibility for jobs and wages. Using data from New Zealand public opinion surveys, most notably the New Zealand Election Study (1990–2008), the paper finds some evidence that policy feedback has occurred in the employment relations arena, but the impact is not as strong or consistent as we might expect. As such, New Zealanders do not completely endorse the ‘there is no alternative’ arguments of neoliberalism, but they do not have an overwhelming desire to return to Keynesian demand-management employment policies.     

Social Policy in Harsh Times. Social Security Development in Denmark, Finland, Norway and Sweden during the 1980s and 1990s

For the past two decades, Nordic social policy has been subject to a range of serious challenges, among which economic problems and critiques by neo-classical economists have been most prominent. This article raises the question whether Nordic social policy has significantly changed during this period of challenges. Based on an empirical analysis of social expenditure data and three central social security programs, this article provides evidence that changes in Nordic social policy over this period have, in fact, been relatively minor. Indeed, the four welfare states of Denmark, Finland, Norway and Sweden have shown remarkable resilience considering the harsh challenges that they have been exposed to since the early 1980s.     

Turkey and the European Union: Modernizing a Traditional State?

This paper discusses the difficulties encountered when reforms are attempted to the administration of public policy in Turkey. This discussion is timely, since Turkey has recently stepped up its modernization agenda in its drive to gain membership of the European Union. The paper briefly examines the political and administrative structure of Turkey before discussing the influence of the EU on the country's modernization agenda.