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In the United States, the 1993 Government Performance and Result Act (GPRA) has increased public demand for governments not only to produce and deliver public goods and services, but also to demonstrate program effectiveness, which is the ultimate goal of a public program's existence, mission, and spending. This public management approach parallels the results-oriented management, which aims to strengthen organizational effectiveness and emphasize the need to integrate all major activities and functions, an activity that will direct them toward advancing organization-wide strategic goals or fundamental policy agendas (Kettl, 1997). Managers use program outputs and outcomes as implementation benchmarks to identify implementation means or directions (Kettl, 1997). By reporting performance measurement results to the public and policy makers, public managers are held accountable for the tax-dollars spent to produce and deliver public services in the most efficient and effective way (Aristigueta, 2007). Performance measurement results, especially those related to outcome achievement, are partially useful in budget allocation from the perspective that the tax-dollars spent are tied to desirable outcomes rather than to program input costs that may or may not correspond with public desires (DuPont-Morales & Harris, 1994).

The provision of universal health care by the Portuguese NHS depends on the allocated government budget to health. Several reforms have been implemented over the last decades to improve access while ensuring the financial sustainability of the health care system. However, a practical and useable definition of public health sustainability is hard to find. We show that under two alternative definitions – both related to fiscal space and compliance with sound public finances – public health spending increase is limited. Our analysis indicates that public health spending growth levels below 3% can be financially sustainable.

Taking into account that financial sustainability is a function of economic growth and will depend on the level of control of other public spending, our forecast for long-run health spending growth is compatible with the financial sustainability targets defined.

The environment surrounding U.S. higher education has changed substantially over the past 40 years. However, we have a limited understanding of what these changes mean for the higher education organizations (HEOs) that occupy this organizational field. In this paper, I use descriptive statistics and multilevel latent class analysis (MLCA) to analyze the financial behaviors of public four-year HEOs from 1986 to 2010 to evaluate how HEOs adapt financially to their changing environments. I advance the current conceptual and empirical understanding of public HEO behaviors by evaluating how public HEOs utilize combinations of revenue and spending streams to accomplish their mission and the extent to which the revenues and spending patterns of these institutions are related. Descriptive results confirm the shift away from state funding toward tuition revenues and the relative stability in spending patterns. MLCA results, which allow for the investigation of how combinations of revenue and spending streams work together, indicate that public HEOs are changing the combinations of revenues they rely on in different ways, revealing multiple specific pathways for how public HEOs adapt to their changing environments. The spending profiles, in contrast, remain stable with only a few HEOs changing their profile over time. I argue that the loose coupling between revenues and spending and discontinuity in their patterns of change over time suggests that public HEOs are able to establish a buffer between their environment and spending or activities that allows them to continue engaging in the same broad set of activities despite environmental changes.

Social origins theory proposes that countries cluster around different models according to how public welfare spending affects nonprofit sector scale (Anheier & Salamon, 2006; Salamon & Anheier, 1998). This article confronts these assumptions about a liberal, corporatist, and social democratic model with results from a comparative analysis of highly industrialized countries with extensive welfare arrangements. We focus on nonprofit sector employment in relation to total employment in the welfare field, including education and research, health, and social services. Explanatory factors are public welfare spending, share of income from donations, and religious homogeneity. Qualitative Comparative Analysis (QCA) (Ragin, 2000) is applied to sort countries in types. The results show that the consequences of public sector welfare spending on nonprofit welfare employment vary depending on other social conditions. In liberal countries, low public sector welfare spending results in a small nonprofit share of employment. The preconditions are low religious homogeneity and large shares of nonprofit income from donations. In other Western European countries, the size of public sector welfare spending is inversely proportional with the size of the nonprofit share of employment, depending on religious homogeneity. The Nordic countries have the highest religious homogeneity, and largest public welfare costs, and accordingly, the smallest share of nonprofit welfare services. However, a similar “crowding out” pattern can be found in the presumably corporatist countries such as France, Austria, and also to some extent in Germany and Italy. In the other end of the line, we find the Netherlands, which is the clearest example of the presumed corporatist pattern in this sample. Religious homogeneity comes into play in both the liberal and the Western European causal constellation in accordance with Weisbrod's theory of government failure/market failure (Weisbrod, 1977), which indicates that this factor is more important for nonprofit welfare regimes than previously thought.

John Kenneth Galbraith’s social balance theory is an important theme in many of his books, particularly The Affluent Society, The New Industrial State, and Economics and the Public Purpose. Galbraith’s social balance theory states that forces driving private consumption in an industrial society will outpace the development and provision of public goods and services with consequences on the well-being of society (Stanfield, 1996, p. 49). The theory leads to several questions: (1) What is the specific relationship between private and public goods and consumption? (2) What is optimized with social balancing? (3) Does the relationship between private and public goods change over time? and (4) How do we evaluate the types of public goods we need? This chapter explores these questions and examines the type of public goods we need today to serve our communities better. For example, police presence and activities in many minority communities are now viewed negatively, as evidenced by the “defund the police” movement. Conversely, some have advocated for greater public spending on community mental health programs and new initiatives to deal with racism in communities.

This paper offers an overview of the defining traits of the Spanish National Health Service (Sistema Nacional de Salud, in Spanish), as well as an account of its current trends in both spending and organisational changes. Beyond a thorough description of the Spanish public health-care system and its main quantitative indicators, we offer a critical review of the ongoing decentralisation process of health-care provision and its recent trends in pharmaceutical spending.

The text is organised in the following two parts. Part 1 provides an overview of the Spanish health-care system, structured in several sections. It starts by placing Spain within a classification of international health-care systems and is followed by an account of the importance of public provision in the Spanish case. A relation of the guiding principles of the Spanish public system concludes the first part. The second part focuses on two key developments that have shaped the evolution of the Spanish health-care system in the recent decades. The first is the process of decentralisation of health-care; the section explains the challenges arising with the transference of health-care provision responsibilities from the central to regional governments. The second section critically reviews the recent expansion of drug-related spending in the Spanish health-care system, and the policy responses to attempt to contain health-care costs.

The substantial resources devoted to warfare in modern times might explain the increasing relevance that military spending has acquired in social sciences. In this regard, the so-called defence economics has extensively studied the main determinants of military spending and its main consequences in terms of economic performance and institutional transformations. However, one of the main problems for comparative analysis on the causes and effects of military spending is the lack of long-term homogeneous and comparable data in international panel datasets. This paper contributes to fill in this gap by providing new military spending data on Spain from 1850 to 2009 based on NATO methodological criterion. It provides total military spending estimates as well as economic and administrative disaggregated figures for most of the period. These data allow reliable international comparisons while also providing new quantitative evidence to better understand the military history of Spain in modern times.

Spending constraints in state budgets have resulted in a need to evaluate the effects of alternative budgeting techniques. We study public school administrations, where improvements in budgetary processes could help align system goals with reduced levels of funding. A budgeting technique, called strategic budgeting (SB), emphasizing information symmetry and mutual monitoring, is investigated in a nonprofit setting by comparing it to a traditional budgeting (TB) method. The experiment finds that the effect of reduced spending previously discovered in a corporate setting are also evident in a not-for-profit setting. Results indicated an overall cost savings with SB of almost 25 percent. Public school administrators made spending decisions in a hypothetical three-year task and provided comments to justify their decisions. These comments along with anecdotal evidence from prior field research indicate that collaborative characteristics in a budget format may reduce unnecessary spending.

The purpose of this study is to examine the effect of local government spending on local government financial performance. Furthermore, this study also investigates the moderating role of re-election on the relationship between local government spending and the financial performance for all local government and dynastic local government. The hypotheses are analyzed using multiple regression with fixed effect using two groups of samples: all local governments and dynastic local governments from 2010 to 2015. The result shows that local government spending positively affects local government financial performance, but in dynastic local government, spending has negative effect on financial performance. Moreover, this study proves that re-election strengthens the positive effect of local government spending on local government financial performance in all sample and weaken the negative effect of spending on financial performance in dynastic local government. The finding of this study is very useful for the central government in terms of policy formulation and mechanisms to limit the practice of political dynasty.