Purchasing power: business and health policy change in Massachusetts

As in many states around the country, health care costs in Massachusetts had risen to an unprecedented proportion of the state budget by the early 1980s. State health policymakers realized that dramatic changes were needed in the political process to break provider control over health policy decisions. This paper presents a case study of policy change in Massachusetts between 1982 and 1988. State officials formulated a strategy to mobilize corporate interests, which were already awakening to the problems of high health care costs, as a countervailing power to the political monopoly of provider interests. Once mobilized, business interests became organized politically and even became dominant at times, controlling both the policy agenda and its process. Ultimately, business came to be viewed as a permanent part of the coalitions and commissions that helped formulate state health policy. Although initially allied with provider interests, business eventually forged a stronger alliance with the state, an alliance that has the potential to force structural change in health care politics in Massachusetts for years to come. The paper raises questions about the consequences of such alliances between public and private power for both the content and the process of health policymaking at the state level.     

Local Venues for Change: Legal Strategies for Healthy Environments

Mounting evidence documents the extraordinary toll on human health resulting from the consumption of unhealthy food products and physical inactivity. In response to America's growing obesity problem, local policymakers have been looking for legal strategies that can be adopted in their communities to encourage healthful behaviors. In order to provide practical tools to policymakers, this article examines four possible venues for local policy change to improve the health of a community: (1) the school environment (2) the built environment (3) community facilities and (4) the point of sale environment. Finally, the article examines the use of taxes or fees as a means of paying for nutrition policy work as well as potentially reducing the consumption of unhealthy products. This article illustrates that local laws and policies can be a valuable tool in changing a community's environment in order to improve nutritional options and increase opportunities for physical activity.     

Looking Ahead: Addressing Ethical Challenges in Public Health Practice

Ethical challenges in public health can have a significant impact on the health of communities if they impede efficiencies and best practices. Competing needs for resources and a plurality of values can challenge public health policymakers and practitioners to make fair and effective decisions for their communities. In this paper, the authors offer an analytic framework designed to assist policymakers and practitioners in managing the ethical tensions they face in daily practice. Their framework is built upon the following set of six considerations: determining population-level utility of the proposed action; demonstrating evidence of need and effectiveness of actions; establishing fairness of goals and proposed implementation strategies; ensuring accountability; and, assessing expected efficiencies and costs associated with the proposed action. Together, these considerations create a structured guide to assist decision-makers in identifying potential ethical challenges and in assessing the moral considerations that underlie public health practice - and possibly even, if the conditions are met, reduce the creation of ethical tension. Although the authors'empirical experiences provide the basis for the framework advanced here, their approach remains to be tested and evaluated by public health practitioners.     

More tax evasion research required in new millennium

Scholarly communication across disciplines is much harder than within disciplines. This article highlights the pervasive phenomenon of tax evasion and discusses the different theoretical models and research approaches that have been used to study the problem in the last two decades. Much of this research has been conducted in the U.S. Policy approaches suggested by this research may therefore have limited applicability in other countries. With theoretical models from a variety of disciplines available to use, and many unanswered questions remaining, international comparisons and multi-method approaches should be useful to the many policymakers and academic researchers interested in understanding the puzzle of tax compliance. This revised version was published online in July 2006 with corrections to the Cover Date.     

Trust in the information society

Trust is an important feature for all users of the Internet who rely on the safety and security of network technologies and systems for their daily lives. Trust, or the lack of it, has also been identified by the European Commission’s Digital Agenda as a major barrier to further development of the information society in Europe. One of the areas in which concerns have been raised is in relation to children’s safety online. As a result, substantial efforts have been made by policymakers and by the industry to build greater trust and confidence in online digital safety. This paper examines what trust means in the context of children’s use of the Internet. Should policy on trust enhancement, for instance, include children’s own trust in the technologies or services they use or is it sufficient to seek to reinforce parental and adult confidence that children can be adequately protected? What is required to build that trust from either perspective? Does it need, or should it include a relationship of trust between parents and children? To tease out these questions further, the paper examines current European Union policy frameworks on digital safety, particularly industry responses to the call for a more trusted Internet environment for children, and argues that technical solutions to be effective need to carefully balance a number of competing objectives and to be sufficiently grounded in evidence of parental and child experience of the Internet.     

Metadata Retention as a Means of Combatting Terrorism and Organised Crime: A Perspective from Australia

On October 13, 2015, new laws came into force in Australia requiring telecommunications service providers to retain and store their ‘metadata’ for 2 years so that it remains available for analysis by anti-terrorism strategists and organised crime fighters. But there are ongoing issues associated with this legislative approach, including the threats to privacy thereby, and concerns that the retention system can be circumvented entirely. This paper will outline the legal and criminological questions that need to be explored in order to help policymakers work through these issues so that an appropriate balance can be struck between forestalling crime and terrorism using all available electronic means, and not unduly curtailing the legitimate rights to privacy that citizens in modern democracies currently expect to enjoy.     

Validation issues around DNA typing of low level DNA

A recent ruling in the Crown Court of Northern Ireland, R v. Hoey, [R v Sean Hoey. 2007, Crown Court of Northern Ireland] has raised questions about the validity of one variant of DNA analysis, often termed LCN. The ruling and subsequent discussion also raises questions about what constitutes validation of a technique.This paper examines what can be achieved in a laboratory based validation study against the Daubert standard and against guidance given in the UK. There is a significant discrepancy between what can be achieved and the Daubert standard but much less of a discrepancy against the UK guidance. Much of the difference relates to differences in word usage, definitional difficulties, and a lack of mutual understanding and communication between the judiciary and forensic scientists. This highlights a gap that needs attention.     

Moving Beyond Command-and-Control: Reflexivity in the Regulation of Occupational Safety and Health and the Environment

Direct or "command-and-control" regulation has had limited success in dealing with occupational health and safety and with environmental regulation. This lack of success has led policymakers to experiment with self-regulation as an alternative means of achieving the goals of social regulation. The economic subsystem fails to acknowledge its social identity and, therefore, appears to be blind to its negative performance regarding the environment and the workplace. The authors of this paper argue that moving beyond command-and-control can be feasible and desirable, at least to a certain extent, but that pitfalls are omnipresent. "Regulatory dilemmas" need to be solved, sound empirical studies need to be conducted, and a guiding theory needs to be drafted. To achieve these goals, the authors suggest use of the key concept of "reflexivity," which refers to the economic organization's relationship with itself. The practical usefulness of this theoretical concept is explored against the background of regulatory practice in the areas of occupational safety and health and the environment. It is concluded that a mode of reflexive administrative law requires a "negotiating government," which adopts a mixture of strategies and learns to cope with issues like third-party interests, access to information, and enforcement.     

Police use of TASER devices in mental health emergencies: A review

The proliferation of TASER devices among police forces internationally has been accompanied by concerns about injuries and health effects, and about the use of TASER devices on vulnerable populations such as people with mental illness. TASER devices have generated a flood of research studies, although there remain unanswered questions about some of the key issues. This paper outlines the introduction of TASER devices to policing and their subsequent widespread adoption. The paper considers the role of police in mental health emergencies with a particular focus on use of TASER devices. Some factors contribute to the special vulnerability of people with mental illness to the effects of TASER devices. The paper also reviews research into use of TASER devices and raises issues about conflict of interest in research into TASER devices. We conclude that TASER devices look set to play a significant role in policing in the future. We make suggestions for a future research programme, and suggest guidelines for publication of papers in which there may be a conflict of interest.     

Legal Constraints on the Use of Race in Biomedical Research: Toward a Social Justice Framework

This article addresses three questions concerning the legal regulation of the use of race as a category in biomedical research: how does the law currently encourage the use of race in biomedical research?; how might the existing legal framework constrain its use?; and what should be the law's approach to race-based biomedical research? It proposes a social justice approach that aims to promote racial equality by discouraging the use of "race" as a biological category while encouraging its use as a socio-political category to understand and investigate ways to eliminate disparities in health status, access to health care, and medical treatment.     

Small area analysis: a review and analysis of the North American literature

Variations in health service use rates by geographic area have long interested researchers and policymakers. Typically, investigators comparing population-based health care utilization rates among geographic areas have demonstrated substantial variations in use among seemingly similar communities. One method of investigation is "small area analysis." Numerous areas in North America have been studied extensively using this technique. This research has attempted to document the amount of variation found in health care use rates among areas; determine whether or not there is a pattern to such use in high- versus low-use areas; and identify the variables that are associated with the variation and explain a portion of the variation. Beyond this, many researchers have attempted to ascertain whether such variables are associated with characteristics of the population, whether they reflect differences in access and need, or whether a substantial portion of the variation is associated with differences in the medical care system itself. This review discusses the methods used to define the areas, the dependent variables that have been studied and the patterns found within them, the independent variables that have been tested, the statistical methods and analysis procedures used, the results of each study, and the policy recommendations emanating from the research. More importantly, based on what has been learned, the paper provides researchers in small area analysis with a set of recommendations for both analyzing and reporting results. These recommendations are designed to facilitate the development of a common research methodology, increase the comparability across studies, and enhance the use of this technique in the health policy formulation process.     

International Conference on Harmonisation; Guidance on E7 Studies in Support of Special Populations; Geriatrics; Questions and Answers; availability. Notice

The Food and Drug Administration (FDA) is announcing the availability of a guidance entitled ``E7 Studies in Support of Special Populations: Geriatrics; Questions and Answers.' The guidance was prepared under the auspices of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The questions and answers (Q&A) guidance addresses special considerations for the design and conduct of clinical trials of drugs likely to have significant use in the elderly. The Q&As are intended to provide guidance on the use of geriatric data to adequately characterize and represent the safety and efficacy of a drug for a marketing application, including data collected postmarketing.     

The Hermann Hospital closing agreement. Is informal guidance better than no guidance at all?

Creating barriers to communications between the IRS and the tax-exempt health care community is particularly troubling in this time of fundamental change. As exempt hospitals around the country gear up to provide service in a managed care environment, they are becoming involved in new forms of integrated delivery systems for which there is an utter lack of guidance. If the IRS is to formulate effective policy on questions involving the creation of these new health care entities, it needs to be aware of the dynamics and economic incentives at work in a managed care environment and how these incentives and dynamics differ from those in a fee-for-service context. The Hermann Hospital experience seems altogether contrary to these objectives.     

Speaking Their Language: How to Communicate Better with Policymakers and Opinion Shapers – and Why Academics Should Bother in the First Place

Scholars of international environmental politics who want their work to affect policy must learn to speak and write in a slightly different language – with extreme concision, an appealing format, and ready solutions to pressing policy questions. While communicating directly with policymakers and journalists can be time-consuming and exasperating, the direct approach may be the only way to rise above the din of the increasingly noisy marketplace of ideas.     

Hospital utilization review: past experience, future directions

Utilization review (UR) programs seek to determine whether specific services are medically necessary and whether they are delivered at an appropriate level of intensity and cost. Although UR programs have been operating for more than 40 years, they have changed dramatically during the past two decades. Today, many health care providers, analysts, and policymakers view UR as a possible solution to hospital inpatient cost and quality problems. This paper addresses how UR has evolved, how UR is used today by different delivery mechanisms (i.e., Medicare, health maintenance organizations, preferred provider organizations, Blue Cross, and commercial insurers), the cost effects of various UR approaches, and how UR will be used in the future.     

Adding Security,but Subtracting Safety? Exploring Schools’ use of Multiple Visible Security Measures

In response to continued concerns over crime and violence, schools are increasingly employing visible security measures such as cameras, metal detectors, and security personnel. These security measures are not mutually exclusive, but few studies have considered the relationship between the use of multiple forms of security and youth’s exposure to drugs, fighting, property crime, and firearms at school. To address this issue, we analyzed nationally representative school administrator-reported data from the School Survey on Crime & Safety, using a quasi-experimental design with propensity scores to adjust for potential confounding factors. The results indicated that utilization of multiple security measures reduced the likelihood of exposure to property crime in high schools, but most other security utilization patterns were associated with poorer school safety outcomes. Our findings provide guidance to policymakers in considering whether to use – or expand – visible school security measures in schools.     

Weapon choice and American political violence

Research Summary
The criminal use of firearms presents a unique challenge to policymakers and is the subject of scientific study in fields such as criminology, public health, sociology, and law. Previous research has described firearm use by terrorists in the United States as uniformly common; however, little systematic attention has been focused on this phenomenon. Although valuable, progress in this area has been hampered by the absence of reliable quantitative information. Using data from the American Terrorism Study and the U.S. Sentencing Commission, we examine the firearm-offending characteristics of 923 federal felons and 336 terrorists.
Policy Implications
Findings indicate that many systematic differences exist between terrorists and other types of federal felons and that terrorists are more likely than other felons to be convicted of firearm-related crimes. We recommend that official efforts to monitor weapons sales—such as the Brady Act—continue to include those named on the terrorist watch list and that those named on the list be subject to additional law-enforcement scrutiny when attempting to purchase firearms. These efforts should be coordinated by federal law-enforcement agencies to facilitate the effective use of existing antiterrorism mechanisms in both blocking purchases and garnering intelligence on terrorists attempting to obtain firearms.     

Integrative Regulation: A Principle-Based Approach to Environmental Policy

This article builds on recent field research to articulate a principle-based approach to environmental regulatory design that is applicable to a wide variety of circumstances, irrespective of political and social particularities. At its core, this approach recognizes that an excessive reliance on "single-instrument" policies is misguided, because all instruments have strengths and weaknesses, and none is sufficiently flexible and resilient to successfully address all environmental problems in all contexts. A better strategy is to harness the strengths of individual mechanisms while compensating for their weaknesses by the use of additional instruments. That is, in the large majority of circumstances, a mix of regulatory instruments is required, tailored to specific policy goals. The article identifies a series of regulatory design principles that sequentially address the problems and opportunities arising from the application of multi-instrument mixes and engaging a variety of first-, second-, and third-party participants in the regulatory process. The importance of choosing inherently complementary instrument combinations is also highlighted, with practical guidance provided to policymakers. Although the focus of the article is on environmental regulation, the general principles articulated should also be applicable to other areas of social regulation.     

CHILD SUPPORT-WHOSE RESPONSIBILITY?

As family patterns change and biological parents do not necessarily remain in contact with their children, difficult questions about who should take responsibility for supporting children are challenging policymakers and legal and welfare practitioners. This article examines recent responses in the Netherlands.     

Property Rights, Theft, Amnesty, and Efficiency

In this paper we show that costs associated with infractions of property rights, such as theft, can be reduced by imposing lower penalties on individuals who admit to such infractions and make restitution. We find that the socially optimal penalty on a confessed thief may be zero (complete amnesty) or even negative—a person may be given a reward for confessing a theft. This is because a thief's valuation of a good is generally lower that its valuation by its legal owner, and an amnesty permits the trade that such a difference in valuation makes calls for. It is interesting to note that the benefits of amnesties were apparently recognized in ancient times and they constitute part of Biblical Law. Moreover, such amnesties have also been informally incorporated into modern legal systems, wherein leniency (a form of partial amnesty) is generally shown to individuals who confess their infractions.