Questions About Policy Transparency

• Published date: 01 July 2001
• DOI: http://doi.org/10.1111/0033-3352.00055
• Date: 01 July 2001
• Author: Alasdair Roberts

Book Reviews 507

Questions About Policy Transparency

Alasdair Roberts is an associate professor and director of the Campbell Public Affairs Institute at the Maxwell School, Syracuse

University. Email: asrobert@maxwell.syr.edu.

Alasdair Roberts, Syracuse University

Neal Finkelstein, ed., Transparency in Public Policy: Great Britain and the

United States (London: Macmillan Press, 2000). 200 pp.; $65.00 hardback.

This edited volume comprises eight

essays written by participants in the

Atlantic Fellowship program in 1996–

97. The program, operated since 1994

by the Commonwealth Fund on behalf

of the British government, allows

American practitioners and research-

ers an opportunity to study public

policy questions in the United King-

dom. The overarching theme of these

essays, says editor Neal Finkelstein,

is the “question of policy transpar-

ency”—or more accurately, three

questions: Is the popular predisposi-

tion towards greater transparency al-

ways justified? In what ways can al-

ternative policy designs promote or

hinder transparency? And how can

transparency be consciously employed

as an element in policy design? As one

would expect in such a volume, the

essays vary in the directness with

which they address these questions,

and the quality of their contributions.

There are, nonetheless, intriguing ob-

servations on the three questions.

The volume illustrates how alterna-

tive policy designs may incidentally

affect the degree of policy transpar-

ency—although the effects may some-

times be subtler than anticipated. In his

chapter on British educational reform,

Finkelstein observes that one side ef-

fect of a new standard curriculum is

an increase in transparency, since cen-

tral government is required to articu-

late curricular requirements before

they can be imposed on local authori-

ties. But Finkelstein also says that this

improvement in transparency may be

illusory: there is wide variation among

schools in their interpretation of the

centrally established curriculum (34–

6). Similarly, Steven Woolf argues that

Americans know “far less” about the

rationing of health care than do Brit-

ons, because of the dominant role of

private providers within the U.S.

health care system, who may assert a

proprietary interest in critical informa-

tion (30). However, this position is

partly rebutted by Paul Shekelle and

Martin Roland, who argue that private

provision may actually raise transpar-

ency. Private provision requires so-

phisticated information systems to

manage billing and auditing functions,

which incidentally serve as good

sources for data to assess health care

practices. In Britain’s publicly funded

National Health Service, there is no

need for such systems, and as a result

the system “runs almost free of infor-

mation. Virtually no data are routinely

available on individual patient encoun-

ters.” Shekelle and Roland argue that

this weakness will seriously impair

efforts to establish quality improve-

ment programs within the NHS (167–

8, 172).

Woolf and fellow author Jeffrey

Prottas share common ground in their

views about the impact of policy de-

signs that rely heavily on the exercise

of professional discretion. Woolf ar-

gues that many decisions regarding the

rationing of care within the National

Health Service “remain the preroga-

tive of the health care professions,”

who need not “spell out the detailed

rationale behind their recommenda-

tions” (23). Prottas observes the same

approach in decision making over hu-

man organ transplantation in the

United Kingdom, “[P]ublic officials

endeavor to ‘delegate’ rationing re-

sponsibility as far as down the service

delivery chain as possible—often to

individual clinicians. In this way, de-

cisions are made less visible, and the

responsibility placed on professional

caregivers. These and other techniques

avoid the need to develop and defend

explicit criteria for deciding who will

receive care and, more importantly,

who will not” (70).

In such circumstances, demands for

increased transparency represent an

assault on the autonomy of profession-

als within the health care system. (This

is equally true in other sectors, such

as education.) But Prottas says that

U.S. experience shows that attempts

to promote transparency may have

limited effect. The effort required for

laymen to have significant influence

can be underestimated, with the result

that decision-making procedures con-

form to the formalities of public con-

trol but continue to be dominated by

professional interests: “Allocation de-

cisions are now public and ‘transpar-

ent.’ These decisions are made in the

presence of outsiders and are gener-