Assessing Medicaid managed care in eastern state.

This case examines the expanding role of managed care programs in improving health care for the poor while controlling runaway health care costs. The case asks what the commissioner of health in a large eastern state should do to effectively monitor Medicaid managed care programs in her state. The commissioner faces intense pressures for cost containment and strong, but not universal, support for the managed care solution to health care cost problems. The commissioner is herself concerned that the cost savings attributed to managed care may not be real and that the unintended effects on health care may be adverse. Her immediate challenge is to determine what kinds of data she should require service providers to submit to her agency so that she may effectively monitor managed care programs for health care quality, provide positive feedback to health care providers, and establish politically credible program oversight.     

Assessing medicaid managed care in eastern state

This case examined the expanding role of so-called managed care programs in improving health care for the poor while controlling runaway health care costs. The case asked what the commissioner of health, Dr. Lorna Hill, in a large eastern state should do to effectively monitor Medicaid managed care programs in her state. The commissioner faced intense pressures for cost containment and strong, but not universal, support for the managed care solution to health care cost problems. The commissioner was herself concerned that the cost savings attributed to managed care might not be real and the unintended effects on health care might be adverse. Her immediate challenge was to determine what kinds of data she should require service providers to submit to her agency so that she could effectively monitor managed care programs for health care quality, provide positive feedback to health care providers, and establish politically credible program oversight.     

Has the Shift to Managed Care Reduced Medicaid Expenditures? Evidence from State and Local‐Level Mandates

From 1991 to 2009, the fraction of Medicaid recipients enrolled in HMOs and other forms of Medicaid managed care (MMC) increased from 11 percent to 71 percent. This increase was largely driven by state and local mandates that required most Medicaid recipients to enroll in an MMC plan. Theoretically, it is ambiguous whether the shift from fee‐for‐service into managed care would lead to an increase or a reduction in Medicaid spending. This paper investigates this effect using a data set on state‐ and local‐level MMC mandates and detailed data from the Centers for Medicare and Medicaid Services (CMS) on state Medicaid expenditures. The findings suggest that shifting Medicaid recipients from fee‐for‐service into MMC did not on average reduce Medicaid spending. If anything, our results suggest that the shift to MMC increased Medicaid spending and that this effect was especially present for risk‐based HMOs. However, the effects of the shift to MMC on Medicaid spending varied significantly across states as a function of the generosity of the state's baseline Medicaid provider reimbursement rates.     

Attitude Responsiveness and Partisan Bias: Direct Experience with the Affordable Care Act

This study evaluates the competing influences of motivated reasoning and personal experience on policy preferences toward the Affordable Care Act. Using cross-sectional and panel survey data, the findings reveal that healthcare attitudes are responsive to information that individuals receive through personal experience. Individuals who experienced a positive change in their insurance situation are found to express more positive views toward the health reform law, while individuals who lost their insurance or experienced an otherwise negative personal impact on their insurance situations express more negative views. The results point to personal experience as a source of information that can influence individuals’ preferences. However, although attitudes are responsive to the quality of one’s personal interactions with the healthcare system, the results also suggest that partisan bias is still at work. Republicans are more likely to blame the health reform law for negative changes in their health insurance situations, while Democrats are more likely to credit the law for positive changes in their situations. These motivated attributions for their personal situations temper how responsive partisans’ attitudes are to information acquired through personal experience.     

Medicaid Managed Care for Children with Special Health Care Needs: Examining Legislative and Judicial Constraints on Privatization

Over the past decade, much has been written about the results of reinventing government. Most research has examined the effects of executive or managerial perspectives. Using David Rosenbloom's competing perspectives model, we examine Medicaid managed care programs for children with special health care needs to illustrate the influence of legislative and judicial institutional perspectives on the reinvention movement. Legislative and judicial responses to the reinvention of Medicaid managed care reveal the outer limits of what managed care and related executive reforms can accomplish in a Constitutional system that is based on checks and balances among competing institutional perspectives. Furthermore, relative to Medicaid managed care, legislative and judicial responses conserve public responsibility to society's most vulnerable populations. In the long run, the balance of institutional perspectives and values—not managerial innovation per se—will influence public administration.     

Explaining Attitudes toward Immigration: The Role of Regional Context and Individual Predispositions

Existing research makes competing predictions and yields contradictory findings about the relationships between natives’ exposure to immigrants and their attitudes toward immigration. Engaging this disjuncture, this article argues that individual predispositions moderate the impact of exposure to immigrants on negative attitudes toward immigrants. Negative attitudes toward immigration are more likely among individuals who are most sensitive to such threats. Because country-level studies are generally unable to appropriately measure the immigration context in which individuals form their attitudes, this article uses a newly collected dataset on regional immigration patterns in Austria, Germany, and Switzerland to test the argument. The data show that increasing and visible diversity is associated with negative attitudes toward immigrants, but only among natives on the political right. This finding improves the understanding of attitudes toward immigrants and immigration and has implications for the study of attitudes toward other policies and for immigration policy itself.     

Political Partisanship and Welfare Service Privatization: Ideological Attitudes among Local Politicians in Sweden

This article ties in with a growing international literature examining the link between party politics and welfare service privatization in modern welfare states. In recent decades, a central aspect of policy change in Sweden is that private actors have come to produce publicly financed welfare services on a more regular basis. This overall privatization trend is furthermore characterized by substantial geographical variation across Sweden's 290 municipalities. The ideological attitudes of local politicians have been recognized as particularly important for understanding this development. This article examines the extent to which local politicians’ ideological attitudes regarding welfare service privatization are best explained with a partisan approach emphasizing between‐party polarization as opposed to a critical perspective that points to the proclaimed significance of ideological consensus between left and right parties in certain municipal contexts. Using multilevel modelling and survey data collected from elected politicians in municipal governments, the empirical findings show substantial differences in attitudes between Conservatives and Social Democrats, irrespective of municipal characteristics – most notably the degree of welfare service privatization. Hence, the results strongly indicate that the partisan approach is much more fruitful compared to the consensus approach as a general explanation for local politicians’ attitudes towards welfare service privatization in Sweden. Accordingly, a conclusion is that comparisons at the subnational level within countries are important as a complement to country‐comparative studies when attempting to understand the link between political partisanship and welfare service privatization in modern welfare states.     

MENTAL HEALTH CARE FOR OLDER PERSONS: NETWORKING AS A RESPONSE TO ORGANIZATIONAL CHALLENGES1

We use case study methodology to examine the degree of cooperation and coordination among organizations providing mental health care to older persons. Mail surveys and in‐depth interviews were employed to gather data from human service organizations in one relatively rural county of Upstate New York. We find that organizations that are older and provide larger numbers of services tend to have a higher degree of integration with other organizations. There is little evidence of formal coordination of services. Informal cooperation, at least on an ad hoc basis, is common, though. Older persons with chronic mental health problems are relatively well served by the system. Older persons whose mental health problems are associated with the aging process are not well served by the system. The growth of mental health managed care has increased competition among many organizations, further fragmenting a weakly integrated system.     

Corruption, Political Allegiances, and Attitudes Toward Government in Contemporary Democracies

Using surveys conducted in sixteen mature and newly established democracies around the globe, this study examines the effect of corruption on people's attitudes toward government. The analysis demonstrates that citizens in countries with higher levels of corruption express more negative evaluations of the performance of the political system and exhibit lower levels of trust in civil servants. However, the results also show that the negative effect of corruption on evaluations of the political system is significantly attenuated among supporters of the incumbent political authorities. These findings provide strong and systematic evidence that informal political practices, especially those that compromise important democratic principles, should be considered important indicators of political system performance. Moreover, they imply that, while corruption is a powerful determinant of political support across widely varying political, cultural, and economic contexts, it does not uniformly diminish support for political institutions across all segments of the electorate.     

Spirituality and Public Service

The common pronouncement of a career in public service as a "calling" echoes with a decidedly spiritual chord. However, the spiritual roots of public service have been ignored in much of the public administration scholarship. This essay examines the empirical connection between individual spirituality and participation in public service occupations. Data from the 1998 General Social Survey are analyzed to determine whether those in public service occupations are more spiritual than persons in non–public service occupations. The findings indicate that individuals in public service occupations, especially government-related ones, are in fact more spiritual in their attitudes than others. Moreover, belief in the notions of transcendence and compassion for others are more pronounced in public service employees. Finally, the experience of interconnectedness and life meaning is greater for those in the public service.     

Inside national service: AmeriCorps' impact on participants

This study examines the short‐ and long‐term impact of AmeriCorps participation on members' civic engagement, education, employment, and life skills. The analysis compares changes in the attitudes and behaviors of participants over time to those of individuals not enrolled in AmeriCorps, controlling for interest in national and community service, member and family demographics, and prior civic engagement. Results indicate that participation in AmeriCorps led to positive impacts on members, especially in the area of civic engagement, members' connection to community, knowledge about problems facing their community, and participation in community‐based activities. AmeriCorps had some positive impacts on its members' employment‐related outcomes. Few statistically significant impacts were found for measures of participants' attitude toward education or educational attainment, or for selected life skills measures. Within a subset of community service programs that incorporate a residential component for members, the study also uncovered a short‐term negative impact of participation on members' appreciation for ethnic and cultural diversity, which disappeared over time. The implications of these findings for future research on national service are discussed. © 2009 by the Association for Public Policy Analysis and Management.     

Terrorist attacks and Europeans’ attitudes towards immigrants: An experimental approach

Over the past several years an increasing number of terrorist attacks committed in the name of Islam and targeting civilians have taken place in many Western democracies, calling for more research on the impact of these exogenous events on citizens’ attitudes towards immigrants. Using a quasi-experimental design, this study examines the short-term effect of the Paris attacks of the night of 13 November 2015 on the attitudes towards European Union (EU) and non-EU immigrants across 28 EU countries. Employing Eurobarometer 84.3 survey data collected in 28 European countries between 7 and 17 November 2015, the design allows the testing of individual attitudes before and after the Paris attacks and the spillover effects of this event in all European countries. It is found that the Paris attacks had a significant negative effect on attitudes towards immigrants, especially among educated and left-wing individuals. Moreover, the negative effect was stronger in countries where the national political-ideological climate was more positive towards immigrants. These findings are explained by theorising that first emotional reactions to the attack are the results of coping mechanisms whereby individuals are confronted with disconfirmation/confirmation of their previous beliefs: individuals who experience stronger stereotype disconfirmation are the most negatively affected by the terrorist attack. Overall, the study holds important implications for understanding the short-term impact of terrorist attacks on public attitudes towards immigrants.     

Does Person‐Organization Fit Matter in the Public ‐Sector? Testing the Mediating Effect of Person‐Organization Fit in the Relationship between Public Service Motivation and Work Attitudes

Public service motivation theory suggests that public service motivation is positively related to work attitudes, but person‐organization fit theory assumes that person‐organization fit completely mediates the relationship between public service motivation and work attitudes of public employees. This article investigates which theory better predicts attitudes toward work, such as job satisfaction and organizational commitment of public employees, by testing hypotheses on (1) whether public service motivation directly influences work attitudes, or (2) whether person‐organization fit mediates the relationship between public service motivation and work attitudes, or (3) whether both hypotheses are true. Using survey data on civil servants in Korea, this article shows that public service motivation has not only a direct effect on but also an indirect effect on job satisfaction and ‐organizational commitment through its influence on person‐‐organization fit.     

Implications of Occupational Locus and Focus for Public Service Motivation: Attitudes Toward Work Motives across Nations

Is occupational locus or focus important for public service motivation? Does national context influence public service motivation? To answer both questions, the author examines attitudes toward work motives from national samples in 11 North American and Western European nations using multilevel binary logistic regression analysis. The findings demonstrate that the locus of an occupation in government and its focus on a public service activity both are important in shaping preferences for work motives related to public service motivation. Also, the preference for work motives held by citizens is correlated with the type of welfare regime in a nation. Although it is less pronounced, some evidence suggests that the type of welfare regime influences preferences toward work motives among government employees.     

Living in the Past? Change and Continuity in the Norwegian Central Civil Service

In this article, the authors describe the changes that have taken place in the Norwegian civil service over the past 30 years, focusing on demographic changes in education and gender and on changes in civil servants' tasks, attitudes, and contact patterns. The changes are analyzed using tenure, structural, and demographic perspectives. The unique empirical database is provided by surveys conducted every 10 years of civil servants in the ministries since 1976. The main empirical findings are that there has been a combination of robustness and change. The findings show little support for the generational version of a tenure perspective, meaning that civil servants are not living in the past. The structural perspective, illustrated by the importance of formal position, best explains the variations in civil servants' contact patterns and attitudes, followed by the career version of a tenure perspective. Demography, as represented by different educational backgrounds and gender, also has an effect.     

What is bad about clientelism? Citizen perceptions in poor communities in South Africa and Tunisia

The literature regards clientelism as a negative practice because of its particularism, informality, inequality, and inefficiency. At present, we know little about whether citizens in communities where clientelism is prevalent share this assessment. However, their evaluations are the ones that are critical for the persistence of clientelism. We explore the attitudes of citizens towards clientelism with conjoint experiments administered with respondents from two poor communities in South Africa and Tunisia, and a sample of academics that we use as benchmark. On average, Tunisian and South African respondents evaluate clientelism more favorably than academics. All groups see particularism and inequality as negative features but only academics care about informality. Clients are evaluated much more positively than patrons in the exchange. Our findings suggest that clientelism persists not only because communities fail to coordinate around a programmatic candidate but because clientelism is considered as a legitimate strategy to access resources.     

Fear as a Disposition and an Emotional State: A Genetic and Environmental Approach to Out‐Group Political Preferences

Fear is a pervasive aspect of political life and is often explored as a transient emotional state manipulated by events or exploited by elites for political purposes. The psychological and psychiatric literatures, however, have also established fear as a genetically informed trait, and people differ in their underlying fear dispositions. Here we propose these differences hold important implications for political preferences, particularly toward out‐groups. Using a large sample of related individuals, we find that individuals with a higher degree of social fear have more negative out‐group opinions, which, in this study, manifest as anti‐immigration and prosegregation attitudes. We decompose the covariation between social fear and attitudes and find the principal pathway by which the two are related is through a shared genetic foundation. Our findings present a novel mechanism explicating how fear manifests as out‐group attitudes and accounts for some portion of the genetic influences on political attitudes.     

Politics and Administration in Council-Manager Government: Differences between Newly Elected and Senior Council Members

This study examines the different attitudes of newly elected officials and senior incumbents on variables that are considered to be the building blocks of the relationship between local elected officials and professional civil service staff: council respect for the city's professional staff; a clear understanding of the roles of council and the staff; and the governing body's commitment towards working as a group and toward consensus. Governing body members who have served for eight or more years show greater respect for staff, have greater role understanding, and value teamwork among their colleagues more than their newly elected counterparts. While there are differences, the attitudes of long-term officials appear to change little while in office. They enter office with the building blocks of their own success. These findings are based on a cross-sectional and modest longitudinal survey research design, supplemented by in-depth interviews.     

美国应急志愿者管理制度及其经验借鉴

为了提高应急志愿者的组织化与专业化程度,美国建立了完善的应急志愿服务体系,实施了严格的应急志愿者认可与保护制度,并对无组织归属的志愿者进行了有效的管理。借鉴美国的经验并结合中国实际,文章提出了完善我国应急志愿者管理制度的建议。     

Technocratic attitudes: a citizens’ perspective of expert decision-making

Despite repeated appointments of technocratic governments in Europe and increasing interest in technocracy, there is little knowledge regarding citizens’ attitudes towards technocracy and the idea of governance by unelected experts. This article revisits normative debates and hypothesises that technocracy and democracy stand in a negative relationship in the eyes of European citizens. It tests this alongside a series of hypotheses on technocratic attitudes combining country-level institutional characteristics with individual survey data. While findings confirm that individual beliefs about the merits of democracy influence technocratic attitudes, two additional important factors are also identified: first, levels of trust in current representative political institutions also motivate technocratic preferences; second, historical legacies, in terms of past party-based authoritarian regime experience, can explain significant cross-national variation. The implications of the findings are discussed in the broader context of citizen orientations towards government, elitism and the mounting challenges facing representative democracy.