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  • Author or Editor: B. Guy Peters x
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Administrative reforms have received a great deal of scholarly attention but substantive reform has been proceeding at the same time as their implementation system is being changed. These two strands of reform often have very different assumptions about public policy and about the politics that lie behind the policies. This article examines administrative reform in the United States in light of several substantive policy changes such as the ‘welfare to work’ changes in social policy and increased federal involvement in criminal justice.

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The principal roots for policy analysis were in the United States, and the ideas and structures associated with studying public policy have been diffused to much of the world. This chapter analyses the types of influences that the American tradition has had, and the extent to which this tradition has had a pervasive influence. It does, however, point to certain areas in which American scholarship and practice have lagged behind other areas of the world.

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To understand contemporary governance one needs to be cognisant of the manner in which media, and perhaps more generally, information, is used as a component of the process. The fundamental contention of the mediatisation literature is that institutions and organisations adapt to the pervasive role of the media, and this paper argues that the same is true for processes of governance. Thus, contemporary governance reflects the extent to which the formal and informal actors in governance have adapted their behaviours to the media environment within which they function. Whatever the goals of a government, they must pursue those goals within the environment shaped (in part) by mediatisation.

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Coordination has been a continuing challenge to governments. This paper examines the nature of those challenges, and proceeds to consider the possibilities for a theory of coordination. In particular the paper considers means of overcoming the collective action problems involved in coordination through means other than hierarchy. Several alternative mechanisms for producing greater coordination in policy are examined, and then situated in their broader political and organisational contexts.

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Policy design has returned to the centre of discussions of public policy, both for academics and practitioners. With that interest in policy design has come an interest in organisations and institutions that will do the designing, with much of the interest being in structures such as policy laboratories that attempt to foster innovation. These organisations tend to exist outside government hierarchies and support collaborative designing with stakeholders and citizens. This paper examines the potential of these structures from an organisational perspective. Although they do offer great promise as sources of innovation they also confront a number of institutional barriers and dilemmas. This paper focuses on those barriers and dilemmas, as well as some possible means of overcoming them.

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Coordination has been a continuing challenge to governments. This paper examines the nature of those challenges, and proceeds to consider the possibilities for a theory of coordination. In particular the paper considers means of overcoming the collective action problems involved in coordination through means other than hierarchy. Several alternative mechanisms for producing greater coordination in policy are examined, and then situated in their broader political and organisational contexts.

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To understand contemporary governance, one needs to be cognisant of the manner in which media, and perhaps more generally, information, is used as a component of the process. The fundamental contention of the mediatisation literature is that institutions and organisations adapt to the pervasive role of the media, and this paper argues that the same is true for processes of governance. Thus, contemporary governance reflects the extent to which the formal and informal actors in governance have adapted their behaviours to the media environment within which they function. Whatever the goals of a government, they must pursue those goals within the environment shaped (in part) by mediatisation.

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As well as intervening in healthcare through insurance, the federal government is also heavily involved in regulatory activities. The most important of these is regulation of drugs, and the licensing of new drugs. Although the Food and Drug Administration has been successful over an extended period in protecting the American public from dangerous pharmaceuticals, it currently faces several challenges. The most important of these is the close connection between the agency and pharmaceutical firms, and difficulties in licensing drugs for rare diseases.

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The Affordable Care Act, passed in 2010, represented a major move in the direction of public, universal health insurance. At the same time, it depends heavily on private insurance companies and leaves a significant portion of the population uninsured. There are also important policy problems within the program, including relatively high prices and variations across states. The ACA has been challenged a number of times in court, but most of its provisions have been upheld.

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This chapter introduces the American healthcare system and the policy issues that confront it. Healthcare costs much more than in other countries and the outcomes are not as good. These negative facts about the system lead to questions about the organization and management of healthcare. On the one hand the system is a jungle that makes it difficult for patients to get the access they need. On the other hand, the system can be seen as a hierarchy, controlled by insurance companies and/or government.

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