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Refugees’ access to psychotherapeutic care is insufficient in Germany. One factor particularly contributing to hindering their access to adequate therapeutic care is a lack of provision of language mediation. This paper aims to explore the institutional system in which the financing of language mediation in the context of the medical treatment of asylum seekers in Germany is located. It examines why the language barrier problem resulting from a lack of financing is not being solved, even though it has been well known for years as a structural problem of day-patient health care to refugees and migrants in Germany.

The financing of language mediation is analysed against the background of theories of the so-called “shunting yard”, in which public responsibilities for the assumption of costs are shifted from one level and actor to the other, thus preventing sustainable solutions being achieved. A mix of qualitative methods including the evaluation of official documents, reports and secondary literature, and of 23 expert interviews was used.

The financing of language mediation is a perfect example of the “shunting yard” phenomenon, with responsibilities being shifted between federal government, health insurance bodies and the municipalities in Germany. This paper argues that the specific financing structure in the German federal system can be viewed as a reason for the non-solution of the language barrier that hinders refugees’ access to health care.

The problem of the financing of language mediation in the context of health care has been rarely treated from a social sciences perspective. This paper contributes to addressing this gap.

This chapter is aimed at contributing to the question of how institutional reforms affect multi-level governance (MLG) capacities and thus the performance of public task fulfillment with a particular focus on the local level of government in England, France, and Germany.

Drawing on concepts of institutional evaluation, we analytically distinguish six dimensions of impact assessment: vertical coordination; horizontal coordination; efficiency/savings; effectiveness/quality; political accountability/democratic control; equity of service standards. Methodologically, we rely on document analysis and expert judgments that could be gleaned from case studies in the three countries and a comprehensive evaluation of the available secondary data in the respective national and local contexts.

Institutional reforms in the intergovernmental setting have exerted a significant influence on task fulfillment and the performance of service delivery. Irrespective of whether MLG practice corresponds to type I or type II, task devolution (decentralization/de-concentration) furthers the interlocal variation and makes the equity of service delivery shrink. There is a general tendency of improved horizontal/MLG type I coordination capacities, especially after political decentralization, less in the case of administrative decentralization. However, decentralization often entails considerable additional costs which sometimes overload local governments.

The distinction between multi-purpose territorial organization/MLG I and single-purpose functional organization/MLG II provides a suitable analytical frame for institutional evaluation and impact assessment of reforms in the intergovernmental setting. Furthermore, comparative research into the relationship between MLG and institutional reforms is needed to reveal the explanatory power of intervening factors, such as the local budgetary and staff situation, local policy preferences, and political interests in conjunction with the salience of the transferred tasks.

The findings provide evidence on the causal relationship between specific types of (vertical) institutional reforms, performance, and task-related characteristics. Policy-makers and government actors may use this information when drafting institutional reform programs and determining the allocation of public tasks in the intergovernmental setting.

In general, the euphoric expectations placed upon decentralization strategies in modern societies cannot straightforwardly be justified. Our findings show that any type of task transfer to lower levels of government exacerbates existing disparities or creates new ones. However, the integration of tasks within multi-functional, politically accountable local governments may help to improve MLG type I coordination in favor of local communities and territorially based societal actors, while the opposite may be said with regard to de-concentration and the strengthening of MLG type II coordination.

The chapter addresses a missing linkage in the existing MLG literature which has hitherto predominantly been focused on the political decision-making and on the implementation of reforms in the intergovernmental settings of European countries, whereas the impact of such reforms and of their consequences for MLG has remained largely ignored.

In the performance measurement and management research field, the applicability of performance measurement systems (PMS) in nonprofit organizations (NPOs) and public administration has been considered a challenge. The diversity of these organizations makes it difficult to define proper terminology and organizational characteristics. PMS evolution has not yet been able to capture all performance dimensions of a public administration and, especially for NPO considering its dynamic and multiple goals. The purpose of this paper is to provide a conceptual framework that identifies and classifies the factors that influence the design of PMSs in NPOs and public administration.

The study was developed through a systematic literature review (SLR). A set of 29 papers were intensely studied, and the results provide a multi-disciplinary and holistic set of factors.

A set of ten factors that influence the design of PMSs in NPO and public administration were found. They were categorized into three groups: factor related to purpose, stakeholders and management.

The study synthesized the literature and provided a conceptual framework of the factors that influence the design of PMSs in NPO and public administration. No individual paper collected in the SLR shows a similar organization of the factors as the present paper. The set of factors indicates the importance of this study for NPO and public administration, and how complex a PMS in an NPO and public administration can become. The conceptual model presented can further assist practitioners in developing design process observing the role that the identified factors play.