The Ombudsman Revisited: Thirty Years of Hawaiian Experience

This article examines the classical, or real, ombudsman. Unlike quasi ombudsmen, which are bureaucratic control mechanisms subject to executive leaders or agency administrators, real ombudsmen are operationally independent officials of the legislative branch. In 1969, the state of Hawaii was the first to create a real ombudsman. Although Iowa, Nebraska, Alaska, and Arizona have since followed Hawaii's lead, no intensive, long-term study of American ombudsmen has yet been published. This article examines the ombudsman as a monitor of Hawaii's bureaucracies and considers the extent to which the office has become institutionalized over the past 30 years. Nearly 75,000 citizens have had their complaints investigated by the ombudsman, and more than one-fifth of them were rectified, that is, the agency reversed its original action. This study indicates that the classical ombudsman can become institutionalized in the United States. The findings have policy implications as jurisdictions at the federal, state, and local levels consider the creation of ombudsmen or quasi ombudsmen.     

Stewardship of quality of care in health systems: Core functions,common pitfalls,and potential solutions

National Ministries of Health in low‐ and middle‐income countries (LMICs) have a key role to play as stewards of the quality agenda in their health systems. This paper uses a previously developed six‐point framework for stewardship (strategy formulation, intersectoral collaboration, governance and accountability, health system design, policy and regulation, and intelligence generation) and identifies specific examples of activities in LMICs in each of these domains, pitfalls to avoid, and possible solutions to these pitfalls. Many LMICs now have quality strategies with clear vision statements. There are good examples of quality agencies and donor collaboration councils to coordinate activities across different sectors. There are multiple options for accountability, including public reporting, community accountability structures, results‐based payment, accreditation, and inspection. To improve health system design, available tools include decision support tools, task‐shifting models, supply chain management, and programs to train quality improvement staff. Policy options include legislation on disclosure of adverse events, and regulations to ensure skills of health care providers. Lastly, health information tools include patient registries, facility surveys, hospital discharge abstracts, standardized population and patient surveys, and dedicated agencies for reporting on quality. Policy‐makers can use this article to identify options for driving the quality agenda and address anticipated implementation barriers.     

公共健康获益权的法理探源与权利建构

人内在的发展天性总希冀于更美好的发展与自由的获得,而现代国家的要义之一亦在于追求人民福祉与社会进步,一定社会经济条件下内外相生的发展动因将为人权的确立和发展提供物质基础,并通过进一步的法律权利构建,为其提供真实有效的保障。随着我国社会经济的发展,有必要将公民在公共健康领域的各种权利、特权、权力和豁免以霍菲尔德式的展开加以梳理,厘清现行主要公共卫生法律中公民法律利益的诸多形态,并对其中有关公民法律权利的规范和内容进行梳理、重构,以构建法律权利意义上的公共健康获益权,最终促进公民健康水平的提高和全面发展的实现。     

Brunei's strategic dilemmas

Abstract

This paper compares health policy trends in Indonesia, Malaysia, the Philippines and Thailand with the purpose of drawing usable lessons in reform. The study finds that governments in the region are rapidly privatizing the provision of healthcare at the same time as they are expanding the government's role in financing. The paper argues that expansion of public financing at the same time as private provision is misconceived as the combination would aggravate instances and severity of market failures peculiar to the sector. The dysfunctional trend is particularly evident in Indonesia and the Philippines. In Thailand, in contrast, the expansion of public financing has occurred in the context of a health system dominated by public providers, which has had the effect of restraining healthcare costs. Malaysia occupies a mid position between Indonesia and the Philippines on the one hand and Thailand on the other. All four cases underline the value of state capacity in designing optimal policies and implementing them effectively.     

The weakness of strong policies and the strength of weak policies: Law,experimentalist governance,and supporting coalitions in European Union health care policy

The experience of European Union (EU) health care services policy shows the importance of supporting coalitions in any effort to effect policy change and the extent to which the presence or absence of such coalitions can qualify generalizations about policymaking. EU health care services law is substantively liberalizing and procedurally driven by the courts, with little legislative input. But the European Court of Justice (ECJ) has been much better at establishing an EU competency in law than in causing policy development in the EU or member states. Literature on courts helps to explain why: courts are most effective when they enjoy supporting coalitions and the ECJ does not have a significant supporting coalition for its liberalizing health care services policy. Based on interview data, this article argues that the hard law of health care services deregulation and the newer forms of health care governance, such as the Open Method of Coordination and the networks on rare diseases, depend on supporting coalitions in member states that are willing to litigate, lobby, budget, decide cases, and otherwise implement EU law and policy. Given the resistance that the Court has met in health care sectors, its overarching deregulatory approach might produce smaller effects than expected, and forms of experimentalist governance that are easy to deride might turn out to have supporting coalitions that make them unexpectedly effective.     

State Abortion Policies,Targeted Regulation of Abortion Provider Laws,and Abortion Demand

Targeted Regulation of Abortion Provider laws (or TRAP laws) are state laws that apply only to abortion providers and impose on them licensing fees, physical plant/personnel regulations, and requirements that exceed those imposed on other comparable health‐care providers or medical facilities. According to prochoice supporters, the explicit or implicit goal of TRAP laws is to drive abortion providers from the market and reduce the supply of abortion services. This paper examines whether a state TRAP licensing fee or a TRAP plant/personnel law also has an independent impact on women's demand for abortion over the period 1982–2005. The empirical results find that neither state TRAP law has a statistically significant independent effect on women's abortion demand. The empirical results remain robust even after controlling for time‐varying factors or the time period after the Supreme Court's landmark 1992 Planned Parenthood of Southeastern Pennsylvania v. Casey decision.     

Health‐Care Data Protection and Biometric Authentication Policies: Comparative Culture and Technology Acceptance in China and in the United States

A proliferation of health information technology (HIT) policies to implement dimensions of e‐health, including electronic medical records, electronic health records, personal health records, and e‐prescribing—along with expanding initiatives on mobile health in developed countries and emerging technologies—has sparked academic inquiry into the protection of privacy and data and the technology to protect privacy and data. This article examines HIT policies in the United States and in China and the use of authentication technologies to assess biometrics as privacy's friend or foe in different political frameworks with varying conceptions of privacy. An analysis of privacy in the context of health data protection, challenging relations of trust between patients and providers, the increasing perspective of health data integrity as a cyber‐security issue, and the growing rate of medical fraud and medical identity theft may yield findings of a convergence of views of privacy and biometrics unexpected of contrasting political cultures.     

Health and Health Services Access Among Adults With Disabilities Who Receive Federal Housing Assistance

Using newly available U.S. Department of Housing and Urban Development (HUD) administrative data linked with National Health Interview Survey data, this study estimates the prevalence of disability among HUD-assisted adults and examines health disparities for this population. The linked data suggest a much higher prevalence of disability among HUD-assisted adults than previously suggested by HUD administrative data. Controlling for individual characteristics and HUD program type, assisted-housing residents who have disabilities experienced higher rates of self-reported fair or poor health, asthma, diabetes, hypertension, obesity, and cigarette smoking. Adults with disabilities had more frequent use of emergency rooms and increased concerns with affording the necessary health care. HUD-assisted adult residents with disabilities were more likely than residents without disabilities to be connected to the health-care system, having higher rates of insurance coverage and more frequent contact with specialists, general doctors, and mental health-care providers. Policy implications are discussed.     

The Gradual Defederalization of Canadian Health Policy

Health policy is an important facet of territorial politics,drawing the contours of the sharing community. Changes in themanagement of the division of powers in health policy pointto shifting understandings of the federal political community.This article adopts this approach in the Canadian case, whereobservers disagree about whether values of federal diversityremain robust or are eroding. It considers three Commissions(Rowell-Sirois, Hall, and Romanow) reporting over a 60-yeartime span. The Commissions adopt different understandings ofthe division of powers and of the proper forms of intergovernmentalhealth governance, moving from a robust understanding of federaldiversity and the division of powers in the 1940s, to an afederalemphasis on efficiency and pan-Canadian citizenship in the early2000s.     

Repealing Federal Oversight of State Health Policy: Lessons from the Boren Amendment

The Boren Amendment is frequently cited as an example where judicial involvement markedly shaped the implementation of federal legislation. Unlike other controversial health policies, Boren was eventually rescinded by Congress. Results indicate that the Amendment was repealed because changing socioeconomic, political, and programmatic conditions combined with policy‐oriented learning to facilitate a shift in policy venue away from the judiciary toward the President and Congress. This is because during the devolutionary climate of the mid‐to‐late 1990s, both the executive and legislature proved more conducive to the policy image promulgated by state officials that the Amendment unnecessarily restricted state discretion, than the policy image promulgated by providers that without the Amendment, low reimbursement levels would compromise access and quality. Data for this analysis derive from archival documents, secondary sources, and 101 interviews with state and federal experts.     

The message on the street corner: alchemy,public health and the Brussels Manneken Pis urinating statue

Manneken Pis, a Renaissance fountain in Brussels depicting a urinating boy, is a “floating signifier”, attracting multiple symbolic meanings from its earliest appearance. There is a surprising degree of overlap between meanings attached to the statue by hermetic alchemists and those used in health promotion campaigns. Approaches to alchemy could be scientific or spiritual but shared symbolic modes of expression. Both alchemists and public health promoters see the statue as capable of inspiring practical changes in behavior in an individual. From the starting point of an account of an eighteenth-century search for the philosopher’s stone which is said to have ended in a tragic death, this article examines how alchemists and proponents of public health have used the image of the urinating boy.     

Health,Conflict, Stability and Statebuilding: A House Built on Sand?

Abstract

Increasingly, the purpose of third party health interventions in fragile states has become linked to statebuilding agendas in order to build government through health programmes. However, there is only limited data to support the efficacy of such an assumption. Indeed, this approach may instead invert the desired outcome of social legitimacy and undermine the rationale for which it is intended. This paper examines the strategic response from donors vis-à-vis the objective of statebuilding, and concludes that new research is required. It concludes that until there is empirically based evidence of the benefits of health interventions for statebuilding, the goals of health interventions should remain fixed primarily on improving health indicators instead.     

Parallel Systems and Human Resource Management in India's Public Health Services: A View from the Front Lines

There is building evidence in India that the delivery of health services suffers both from an actual shortfall in trained health professionals and from unsatisfactory results of existing service providers working in the public and private sectors. This study focuses on the public sector and examines de facto institutional and governance arrangements that may give rise to well‐documented provider behaviors such as absenteeism that can adversely affect service delivery processes and outcomes. We analyze four human resource management (HRM) subsystems: postings, transfers, promotions and disciplinary practices from the perspective of front‐line workers—physicians working in rural healthcare facilities operated by two state governments. We sampled physicians in one “post‐reform” state that has instituted HRM reforms and one “pre‐reform” state that has not. The findings are based on both quantitative and qualitative measurements. The results show that formal rules are undermined by a parallel modus operandi in which desirable posts are often determined by political connections and side payments. The evidence suggests an institutional environment in which formal rules of accountability are trumped by a parallel set of accountabilities. These systems appear so entrenched that reforms have borne no significant effect. Copyright © 2015 John Wiley & Sons, Ltd.     

Towards a Model Public Sector Integrity Commission

This article examines the current debate in Australia about public sector integrity and the idea of a standing anticorruption commission. From this debate the article outlines a specific type of ‘public sector integrity commission’ that in principle should have the necessary powers and techniques at its disposal to minimise corruption while ensuring efficiency and fairness. The debate has been most active in jurisdictions that have not had an anticorruption commission – mainly in Victoria, South Australia and Tasmania – but debate about integrity commissions has occurred in all jurisdictions. The authors argue that anticorruption commissions are essential to ensure the integrity of the public sector and that a model commission should: cover all elements of the public sector; independently investigate serious and mid‐level complaints; have own motion powers to investigate any matter; have summary authority to apply administrative sanctions; make use of a range of investigative tools; not be tasked with combating major and organised crime; and be held accountable to citizens through a parliamentary committee and a parliamentary inspector.     

Race,Medicine, and Social Justice: Pharmacogenetics,Diversity, and the Case of BiDil

In this article, I probe an example of high‐technology medicine as a case study in the problems of the regulation of advancing technology. Specifically, I address the implications of pharmacogenomics—an emerging form of population‐based health care intervention—for public policies designed to eliminate racial disparities in health. Using the case of BiDil, a historical precursor to pharmacogenetic technology, I offer a framework for further studies of high‐technology medicine in which policy analysis is part of a social review based on the justice standard of ex ante mutual advantage. It is the contention in this article that the most just and reasonable deployment of pharmacogenomics is as a compensatory tool to alleviate health disparities.     

Strategic Implications of the Ambush in Niger

The October jihadist ambush in Niger that left four American soldiers on a combined patrol with Nigerien forces dead has raised questions about the extent to which US military personnel should advise and assist local military operations overseas. It has also produced controversy about civil-military relations in the Trump administration. As a result, Congress's post-9/11 Authorization of the Use of Military Force, delegating broad powers to the president to initiate counter-terrorism efforts, may be curtailed.     

Proximity to service providers and service utilization among welfare recipients: the interaction of place and race.

Currently, welfare programs coordinate a range of services to support work among welfare recipients and help them overcome barriers to employment. This paper considers the relationship between spatial proximity to and utilization of support services among welfare recipients. Accessibility of mental health and substance abuse service providers among welfare recipients is examined in the three-county Detroit metropolitan area and the relationship between mental health service accessibility and mental health service utilization among welfare recipients considered. Not only does access to service providers vary significantly across the metropolitan area by race and place, but these analyses reveal that greater spatial proximity to service providers increases the probability that welfare recipients will receive services. When controlling for access to providers and individual-level characteristics, we also find that African American welfare recipients are about half as likely to use mental health services as white recipients.     

Healthy Country, Healthy People: Policy Implications of Links between Indigenous Human Health and Environmental Condition in Tropical Australia

Investment in programs that help Indigenous people undertake work maintaining the environmental health of their country has benefits for the environment as well as the physical, mental and cultural health of the Indigenous people involved. For health these findings have direct implications for some national health policies, service provision to homelands, health promotion and Indigenous health research. There are also direct implications for environmental investment in northern Australia and the design and regulation of markets in resource entitlements. Indirectly the findings should be important for economic, employment and education policies as well as those promoting social harmony. Given the range of benefits there is a strong argument for cross-agency investment in working on country by Indigenous people.     

论审判权运行机制改革

审判权运行机制改革主要是为了贯彻中央关于深化司法体制和工作机制改革的总体部署，适应公正司法的要求，建立符合司法规律的审判权运行模式，优化配置审判资源，加强独任法官、合议庭办案责任制，维护独立审判原则，最大程度地满足人民群众对公平正义的需求，提高司法公信，树立司法权威。人民法院将着重设计具体的审理工作程序，使合议庭、审委会回归其审判组织的属性，强化审判责任，切实做到“让审理者裁判，由裁判者负责”。     

Civil Rights,Federalism, and the Administrative Process: Favorable Outcomes by Federal,State, and Local Agencies in Housing Discrimination Complaints

Some theorists argue that cooperative intergovernmental relations are critical to policy implementation in the United States. This assertion is explored in the context of fair housing enforcement by comparing favorable administrative outcomes in fair housing complaints at the federal, state, and local levels from 1989 to 2004. What conclusions can be drawn from this systematic comparison of intergovernmental enforcement in one policy area over an extended period of time? First, cooperative federalism works well in fair housing enforcement. Second, of special significance, state civil rights agencies resolve complaints in favor of complainants nearly as often as the Department of Housing and Urban Development, and localities sometimes do so even more frequently.