Suchergebnisse

Randomized controlled trials (RCTs) are increasingly playing a central role in shaping policy for development. By comparison, social experimentation has not driven the great transformation of welfare within the developed world. This introduces a range of issues for those interested in the nature of research evidence for making policy. In this article we will seek a greater understanding of why the RCT is increasingly seen as the 'gold standard' for policy experiments in low- and middle-income countries (LMICs), but not in the more advanced liberal democracies, and we will explore the implications of this. One objection to the use of RCTs, however can be cost, but implementing policies and programmes without good evidence or a good understanding of their effectiveness is unlikely to be a good use of resources either. Other issues arise. Trials are often complex to run and ethical concerns often arise in social 'experiments' with human subjects. However, rolling out untested policies may also be morally objectionable. This article sheds new light on the relationship between evidence and evaluation in public policy in both the global north and developing south. It also tackles emerging issues concerning the 'use' and 'misuse' of evidence and evaluation within public policy.

Abstract The aim of New Labour's health policy is to shift more of the balance of power and responsibility for services to the local level. But, while the government proclaims a new decentralized NHS, doubts exist about the extent to which the reality on the ground matches the tone of policy. This article reports empirical work examining the level of autonomy purchasers have over budgetary allocation. A case study analysis of purchasing within a single district was undertaken for the financial year 2001/2 which included semi‐structured interviews with key officers responsible for budget allocation. Purchasers approach a new financial year with a starting position that matches the previous year's allocation—the "baseline", this is adjusted for inflation and, as has happened over the last few years, increased further in real terms by "growth funds" for service modernization and government initiatives. The analysis shows a clear dissonance between policy and practice; although purchasers have complete control over their "baseline budgets", the study found that this does not "ring true" at the local level. Only about a fifth of growth funds were at the discretion of purchasers as most are taken by national priorities and pay and price inflation. Further decentralization is planned, which includes transferring more control of funds to primary care trusts by 2004, the extent to which these measures will change the perceptions of those working in the service remains to be seen—only then will the government be able to claim a truly decentred service.

AbstractThe Labor government was elected in November 2007 with a commitment to reject the labour market deregulation and other neo‐liberal policies of its predecessor, promote equality of opportunity and tackle entrenched social and economic disadvantage by implementing a new social inclusion agenda. In response to the financial crisis which had begun at the end of 2007 and had turned into a full global recession by the middle of 2008, the government introduced two substantial stimulus packages funded from the large budget surplus it had inherited from its predecessor. The fiscal stimulus has helped Australia to become the only advanced economy to avoid a technical recession (to date), although there is concern that the downturn has created a situation where social policy is being driven by political expediency rather than by the principles and commitments set out in the government's pre‐election social policy manifesto. Against this background, this article examines how the latest crisis has shaped social security policy in Australia and compares the recent policy response with the policy response to earlier crises. Analysis focuses not just on what was actually done, but also on the constraining role of prevailing economic and political circumstances and on the processes that were used to drive reform in a wage earners' welfare state.

English
The government has made nursing care in England and Wales free, while continuing to means-test personal care. This policy contrasts with the recommendation for free personal care made by the Royal Commission on Long-term Care in 1999. This article reports on a survey of attitudes towards financing care in old age from a representative sample of men and women in England aged 25 years and over. The majority of people feel that the state should finance care for older people. The article discusses the extent to which this is consistent with the government's position and the competing notions of equity that recent debate entails.

The Labour government has made it clear that it will not countenance major changes in the financing of long–term care for older people in England and Wales. One consequence is that people on modest retirement incomes will continue to have to pay for elements of their care in their own homes. The government also implicitly assumes that people of working age, on average and below–average earnings, are expected to save in order to pay for long–term care. However, evidence about individuals' willingness and ability to save and to pay for long–term care is scanty. Accordingly, an interview survey of 100 people—today's and tomorrow's pensioners—was undertaken in June and July 2000. They were asked detailed questions about their financial circumstances, and about their ability to pay more towards their own health and social care costs, now and in the future. The results suggest that today's pensioners on average and lower incomes are experiencing difficulties in paying for care services in their own homes. Tomorrow's pensioners who are currently on average and lower incomes will struggle to pay for care services in their own homes. The results also support the view that people tend to overestimate their retirement incomes and do not understand how long–term care is financed. They think that the government can and should pay for long–term care.