Modeling budgetary strategies in health policy, East and West

This essay has sought to develop a rationale for new approach to the formal modeling of intergovernmental budgetary relations. The focus has been on health care budgeting, and on evidence from centrally-planned systems in Eastern Europe. But it has been argued that the modeling strategy advanced here will have applicability across policy areas, and across types of political and economic systems. The description of developments in human service provision emphasized the growing complexity of policy activity along both vertical and horizontal dimensions, and the accompanying increase in competition and in strategic thinking as central elements of policy activity generally, and of intergovernmental budgetary relations specifically. It has been argued that these developments are observable not only in Western pluralist systems--where the adumbration of evidence makes it increasingly difficult to take exception to these generalizations--but also in highly-structured systems such as the communist-governed systems of Eastern Europe. The possibility that certain elements of human service policy activity are becoming increasingly similar across ideologically and structurally different system types has numerous significant implications worth exploring. The next step will be the testing of the full set of linear systems theory models with data from Eastern Europe. If these tests are encouraging, important methodological implications for the modeling of budgetary activity would seem to follow.