Download pdf - Canada: Getting Government Right

Canada: Getting Government RightGetting Government Right: Governing for Canadians by Treasury Board of CanadaReview by: Kuno SchedlerPublic Administration Review, Vol. 58, No. 1 (Jan. - Feb., 1998), pp. 92-93Published by: Wiley on behalf of the American Society for Public AdministrationStable URL: http://www.jstor.org/stable/976897 .

Accessed: 15/06/2014 00:52

Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .http://www.jstor.org/page/info/about/policies/terms.jsp

.JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range ofcontent in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new formsof scholarship. For more information about JSTOR, please contact [email protected].

.

Wiley and American Society for Public Administration are collaborating with JSTOR to digitize, preserve andextend access to Public Administration Review.

http://www.jstor.org

This content downloaded from 194.29.185.162 on Sun, 15 Jun 2014 00:52:51 AMAll use subject to JSTOR Terms and Conditions

http://www.jstor.org/action/showPublisher?publisherCode=black

http://www.jstor.org/action/showPublisher?publisherCode=aspa

http://www.jstor.org/stable/976897?origin=JSTOR-pdf

http://www.jstor.org/page/info/about/policies/terms.jsp


ficiaries must rely on private supplemental insurance for stop loss protections. Adding stop loss to Medicare-perhaps in conjunc- tion with other changes-offers yet another option for restructuring. However, stop loss would be expensive, particularly if it is set low enough to protect a substantial number of beneficiaries in any one year. For example, only 3.2 percent of the noninstitution- alized elderly would be helped by a $5,000 stop loss, but this provision would raise Medicare spending by about $4.5 billion.

Various approaches could be simultane- ously adopted, including both increases and decreases in cost-sharing requirements. Such restructuring could help to "modern- ize" the basic fee-for-service benefit in Medicare, and savings from various options outlined in the paper would range from $0.9 billion to $6.1 billion if fully imple- mented in 1996.

Gary Claxton and Larry Lexitt (1996). Reform of the Individual Health Insurance Market. New York: The Commonwealth Fund.

The Kennedy-Kassebaum Bill (the Health Insurance Portability and Account- ability Act of 1996) assures that people changing jobs or losing their group coverage cannot be excluded from joining a new plan because of pre-existing health conditions. However, the new law does lite to assure that sicker individuals can afford new policies because it does not set limits on the premiums that insurance companies can charge them.

The authors of this report write that people seeking new coverage on their own, outside of group plans, can generally find it, but paying for it is another matter. The individual insurance market contains 10 to 15 million beneficiaries, who are likely to be younger, poorer, and more often self-employed than those with group coverage.

Individual insurance can be prohibitive- ly expensive for people who are not healthy, who leave the Medicaid program, or who leave their jobs. The last group is often eli- gible for extended group coverage through their employer (through COBRA plans- Consolidated Omnibus Budget Reconcilia- tion Act of 1985) but only one-fifth of them elect to purchase it, usually because they feel the premiums are too expensive. The authors describe several reform

options, which have varying costs and effects, for increasing access to coverage and making it more affordable for a broader share of the population. Included are the model laws adopted by the National Asso- ciation of Insurance Commissioners, which subsidize the costs of high-risk enrollees to insurers.

The report also reviews the experiences of states that have gone beyond the new federal reforms and taken their own measures to increase access to coverage. More than 25 states, for example, have attempted to provide coverage for individuals by cre- ating "high-risk pools" for those who have been unable to get insurance on their own because of pre-existing conditions. Several states have also enacted reforms that require carriers to accept nongroup appli- cants regardless of their health status. To keep rates affordable for moderate income families, these states generally limit the premiums that carriers can charge through community rating, or by capping rates for various groups of policyholders.

A particularly contentious issue for states has been how to adjust for the added costs of providing coverage to people with pre-existing health conditions, who, by def- inition, have higher than average medical costs, and how to determine who will bear the cost of expanded coverage.

The federal law leaves these issues to the states. Unless they act to set their own pre- mium limits or otherwise subsidize premiums for sicker individuals seeking nongroup insurance, the new legislation may not have its intended effect of increasing access to coverage.

Budgeting: A Guide for Local Governments Keon S. Chi

Robert L. Bland and Irene S. Rubin (1997). Budgeting: A Guide for Local Governments. Washington, DC: International City/County Management Association. 241 pp., $34 paper, ISBN: 0-87325-151-8.

Budgeting: A Guide for Local Governments by Bob Bland of the University of North Texas and Irene Rubin of Northern Illinois University explains budgeting from the ini-

tial conception, and pressures on decision makers to the final audit. With abundant examples from different cities, the book gives a detailed account of how budgets are put together, what budget manuals look like and what they need to contain, how to lay out the budget in a clear fashion, and how to organize the budget office and the budgeting process. The book offers a range of options at nearly every point, explaining how each option develops and what each option accomplishes.

The 241-page book contains eight chapters: (1) The Context of Local Gov- ernment Finance, (2) Designing the Budget Process, (3) Budget Preparation and Adop- tion, (4) Budgeting as Policy making, (5) The Budget as a Management Tool, (6) Budgeting and Financial Control, (7) Plan- ning and Budgeting for Capital Improve- ments, and (8) The Budget Document. In addition, it also includes a glossary of more than 130 terms.

This book is written by two close observers of budgeting who attempt to address realistic concerns. They describe the obstacles as well as the ideals, and out- line in detail how the obstacles have been dealt with in various cities. Regardless of the specific context of each local government, this book offers general and practi- cal guidance for improving on budgeting. It can be used as a reference, read a chapter at a time, or read whole, and is equally suitable for the classroom or the budget office.

Canada: Getting Government Right Kuno Schedler

Treasury Board of Canada (1997). Getting Gov- ernmentRight: Governingfor Canadians. Ottawa, Canada: Canada Communication Group Publishing. ISBN 0-660-60191-5. 40 pages.

Since 1993, the Canadian federal government has been active in a multidimen- sional project to redesign the structures, processes, and results of government institutions. This report is a status report as well as a summary of all planned activities and programs that will have to take place in Canada within the next few years if the

92 Public Administration Review * January/February 1998, Vol. 58, No. 1



Canadian government is to introduce a comprehensive and modern management system.

Starting with a focus on the fiscal crisis of the years 1993-94 and the measures that have been taken to overcome the dramatic situation, the short report gives an impression that most of the reforming energy went into cost-cutting. Here, the results are obvious and impressive. By implement- ing new program review methods, the Canadians seem to have successfully

increased a certain sensitivity within the public sector for alternative structures of service provision. It is therefore not sur- prising that the second major focus of the report lies on developing a culture of change, including steps to reinstall collec- tive bargaining with the public sector unions, modernization of program delivery by a strategic use of information technology, service clustering, regulatory reform, user charges, and partnering with public and private institutions.

This report is a short and easily readable collection of all the measures that have been taken-with some success stories- and will have to be taken in the future of the Canadian public sector. It is useful to get an impression of how broad a reform like the Canadian one will have to be when trying to be comprehensive. Unfortunately, the report is not detailed enough, to provide in-depth coverage of the Canadian reform. The report contains both an English and a French version of the text.

Reports and Documents 93

