Bengt Jacobsson

A world of standards

In this insightful discussion of the phenomenon of standardization in organizations and society at large, the authors regard standards as a form of regulation enabling a higher degree of global o ...

Soft regulations in pharmaceutical policy making: an overview of current approaches and their consequences.

It is a challenge to improve public health within limited resources. Pharmaceutical policy making is a greater challenge due to conflicting interests between key stakeholder groups. This paper reviews current and future strategies to help improve the quality and efficiency of care, with special emphasis on demand-side controls for pharmaceutical prescribing.A large number of different educational, organizational, financial and regulatory strategies have been applied in pharmaceutical policy making. However, the effectiveness of most strategies has not been thoroughly evaluated and there is evidence that the behaviour of healthcare professionals is difficult to influence with traditional methods. During the last decades, new modes of governing and new governing constellations have also appeared in healthcare. However, relationships between those who regulate and those regulated are often unclear. New approaches have recently been introduced, including extensive dissemination strategies for guidelines and extensive quality assessment programmes where physicians’ performances are measured against agreed standards or against each other. The main components of these ’soft regulations’ are standardization, monitoring and agenda setting. However, the impact of these new modes on health provision and overall costs is often unknown, and the increased focus on monitoring may result in a higher conformity and uniformity that may not always benefit all key stakeholders. Alongside this, a substantial growth of auditing associations controlling a diminishing minority of people actually performing the tasks may be costly and counter-productive.As a result, new effective strategies are urgently needed to help maintain comprehensive healthcare without prohibitively raising taxes or insurance premiums. This is especially important where countries are faced with extreme financial problems. Healthcare researchers may benefit from researching other areas of society. However, any potential strategies initiated must be adequately researched, debated and evaluated to enhance implementation. We hope this opinion paper is the first step in the process to develop and implement new demand-side initiatives building on existing ’soft regulations’.

Dynamics of Soft Regulations

Introduction In a speech given in Uppsala on 6 September 2001, in memory of the fortieth anniversary of the death of the late UN Secretary-General, Dag Hammarskjold, UN Secretary-General Kofi Annan argued that today, in many respects, the activities of the UN follow an agenda established by Hammarskjold. However, towards the end of his speech, Annan pointed to a fundamental difference between todays world and the one in which Hammarskjold lived and worked. So if we go back to the things about todays world that we would have to explain to him, if he unexpectedly joined us now, probably the most difficult for him to adjust to would be the sheer complexity of a world in which individuals and groups of all kinds are constantly interacting – across frontiers and across oceans, economically, socially and culturally – without expecting or receiving any permission, let alone assistance, from their national governments … From this he might well conclude that we should not rely exclusively on state action to achieve our objectives on the international level, either. A great deal, he would think, is likely to depend on non-state actors in the system – private companies, voluntary agencies or pressure groups, philanthropic foundations, universities and think tanks, and of course creative individuals. And that thought would surely feed into his reflections on the role of the United Nations (Annan 2001: 10–11).

Governing the Embedded State : the Organizational Dimension of Governance

Governing the Embedded State integrates governance theory with organization theory and examines how states address social complexity and international embeddedness. Drawing upon extensive empirical research on the Swedish government system, this volume describes a strategy of governance based in a metagovernance model of steering by designing institutional structures. This strategy is supplemented by micro-steering of administrative structures within the path dependencies put in place through metagovernance. Both of these strategies of steering rely on subtle methods of providing political guidance to the public service where norms of loyalty to the government characterize the relationship between politicians and civil servants. By drawing upon this research, the volume will explain how recent developments such as globalization, Europeanization, the expansion of managerial ideas, and the fragmentation of states, have influenced the states capacity to govern. The result is an account of contemporary governance which shows the societal constraints on government but also the significance of close interaction and cooperation between the political leadership and the senior civil servants in addressing those constraints.

The European Union and the Baltic States : changing forms of governance

1: Scripted States and Changes in Governance - Bengt Jacobsson 2: Europeanization and Organization Theory - Bengt Jacobsson 3: Rituals of Inquisition. European Commission Monitoring of Accession Processes - Matilda Dahl 4: Governance Through Meditation. EU Twinning in Lithuania - Jenny Svensson 5: Opening up for Change: Modernizing Public Administration in the Baltic States - Eva Granqvist and Emma Wallin 6: Europeanization of Labor Market Policy-Making in the Baltic States - Kerstin Jacobsson and Charlotte West 7: The Choice of Parliamentary EU Scrutiny Mechanisms in the New Member States - Ann-Cathrine Jungar 8: Scripted Parties: The Case of Estonian Social Democracy - Karl Magnus Johansson 9: Soft Powers (in a Community of the Willing) - Bengt Jacobsson and Anders Nordstrom