794 resultados para Healthcare Decision Making


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The multiple crises the European Union (EU) has experienced in recent years have fundamentally altered decision-making and, more broadly, governance in the EU. Pre-crisis systems and processes were not adequate to react to such critical and systemic challenges, but the speed of the crisis meant that new governance mechanisms have been superimposed on existing processes and structures rather than seeing a fundamental reform of decision-making. Consequently, not all changes have been fully successful. Given the institutional changes this year and the ongoing development of the EMU governance framework, now presents a good opportunity to reform EU decision-making.

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This paper will outline and analyze the decision-making process in WTO matters. First, the players of the decision-making process -- the Council of the European Union (Council), the Trade Policy Committee, the Commission, and the European Parliament -- will be examined. Then the distinction will be made between decision-making in initiating WTO disputes and decision-making conducting trade agreement negotiations in the WTO. Then, decision-making practices in WTO matters will be assessed against constitutional principles of transparency, accountability, and legitimacy. After this assessment, conclusions will be drawn.

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This research forecasts the implications of Turkish membership for decision-making effectiveness and dynamics within the Council of Ministers of the European Union (EU). Effectiveness is determined in this research by 'passage probability': the chance that a random proposal as put forth by the European Commission (EC) is accepted by the Council of Ministers. Dynamics are determined by means of the Shapley-Shubik Index (SSI), which plots power values of individual member states by forecasting a number of possible EU enlargement scenarios. This study falsifies earlier research by Baldwin and Widgrén.1 It finds that the implications of Turkish EU-membership for EU decision-making efficiency are ambiguous and depend on the number of other candidate states entering the EU alongside Turkey, as well as the timeslot - 2014 or 2020 - at which the accession would take place. Moreover, this study asserts that Turkish EU-accession would result in unequal- but generally negative - power changes among other EU member states, although member states with similar demographic weight will experience comparable changes. Finally, it appears that the larger a EU member state is, the more power it loses if Turkey would join the EU.

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Since the beginning of its existence in the form of communities, the European Union’s decision-making process underwent constant evolution. There were continuous adjustments that transformed a pure intergovernmental process into one having rather federal features. Based on the hypothesis that changes have occurred at the decision level in regards to the actors, procedures, influence and ways of taking decisions in order for the new realities, needs and will at the European level to be properly addressed, this paper aims to present the reforms performed through the adoption of new treaties and the modification of the existing ones. The reality is that in order for the European dream and integration to go on and also for further development of the European Union, finally becoming an entity far beyond the founders expectations, decision makers had to constantly and carefully adapt the decision-making process. The purpose of this paper will be achieved by conducting a research based on the qualitative method, analyzing the related researches on this topic and the consolidated versions of the treaties. Thus, we will finally validate our research hypothesis that there was an evolution in what the EU’s decision-making process and decision procedures are concerned.

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The previous chapter uncovered important differences between decision-making structures across the 11 processes investigated by this study. As we have noted, both historically and in much contemporary literature, the Swiss political system has been described as highly consensual. And yet, when we focus on differences between decision-making structures across different policy domains, important elements appear that point toward a more conflictual style of decision-making. Both when there is a power balance between coalitions and in the presence of a dominant coalition, coalition interactions are conflictual in the majority of cases. Based on the descriptive account of these differences in Chapter 4, the present chapter studies the conditions under which given decision-making structures emerge. Under which circumstances are actors able to form a dominant coalition, and which conditions lead to a situation where power is more evenly balanced between coalitions? Which conditions lead actors to develop a conflictual rather than a consensual type of interaction? Answering these questions can give us some indication of the factors responsible for different types of decision-making structures.

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In most Western countries, the media are said to exert an increasing influence on the political game. This development, which has been described variably as a shift towards an 'audience democracy' (Manin 1995) or the 'mediatization of politics' (Mazzoleni and Schulz 1999), emphasizes the increasing importance of the media for political actors and political decision-making. In such a context, political actors need to communicate with both the media and the public in order to gain support for their policy plans and to influence decision-making. The media were noticeably absent from Kriesi's (1980) in-depth analysis of political decision-making in Switzerland. This suggests that in the early 1970s, the media did not matter or mattered far less than they do today.

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The previous chapter presented the overall decision-making structure in Swiss politics at the beginning of the 21st century. This provides us with a general picture and allows for a comparison over time with the decision-making structure in the 1970s. However, the analysis of the overall decision-making structure potentially neglects important differences between policy domains (Atkinson and Coleman 1989; Knoke et al. 1996; Kriesi et al. 2006a; Sabatier 1987). Policy issues vary across policy domains, as do the political actors involved. In addition, actors may hold different policy preferences from one policy domain to the next, and they may also collaborate with other partners depending on the policy domain at stake. Examining differences between policy domains is particularly appropriate in Switzerland. Because no fixed coalitions of government and opposition exist, actors create different coalitions in each policy domain (Linder and Schwarz 2008). Whereas important parts of the institutional setting are similar across policy domains, decision-making structures might still vary. As was the case with the cross-time analysis conducted in the two previous chapters, a stability of 'rules-in-form' might hide important variations in 'rules-in-use' also across different policy domains.

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This in-depth study of the decision-making processes of the early 2000s shows that the Swiss consensus democracy has changed considerably. Power relations have transformed, conflict has increased, coalitions have become more unstable and outputs less predictable. Yet these challenges to consensus politics provide opportunities for innovation.

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Consensus democracies like Switzerland are generally known to have a low innovation capacity (Lijphart 1999). This is due to the high number of veto points such as perfect bicameralism or the popular referendum. These institutions provide actors opposing a policy with several opportunities to block potential policy change (Immergut 1990; Tsebelis 2002). In order to avoid a failure of a process because opposing actors activate veto points, decision-making processes in Switzerland tend to integrate a large number of actors with different - and often diverging - preferences (Kriesi and Trechsel 2008). Including a variety of actors in a decision-making process and taking into account their preferences implies important trade-offs. Integrating a large number of actors and accommodating their preferences takes time and carries the risk of resulting in lowest common denominator solutions. On the contrary, major innovative reforms usually fail or come only as a result of strong external pressures from either the international environment, economic turmoil or the public (Kriesi 1980: 635f.; Kriesi and Trechsel 2008; Sciarini 1994). Standard decision-making processes are therefore characterized as reactive, slow and capable of only marginal adjustments (Kriesi 1980; Kriesi and Trechsel 2008; Linder 2009; Sciarini 2006). This, in turn, may be at odds with the rapid developments of international politics, the flexibility of the private sector, or the speed of technological development.

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Federal Highway Administration, Washington, D.C.

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Research supported by U.S. Dept. of Housing and Urban Development, Office of Policy Development and Research.