Action research in mental health: acute care teams

Action research applies knowledge and research findings to practical problems in order to strengthen the capability of the work unit, to contribute to the personal growth and satisfaction of organization members, and to improve theory. An action research project studying acute care teams at a state residential psychiatric facility found that foreign-born physicians chair high-performing teams. This unexpected result strengthens theories of diversity, status inconsistency, and project team effectiveness.     

Deliberative democracy in local governance: the impact of institutional design on legitimacy

Deliberative democracy is expected to increase legitimacy and effectiveness of democratic governance. In recent years, a growing body of research has reported on different instances of participatory innovations across the globe. Nevertheless, quantitative evidence on the determinants of legitimate and effective deliberative procedures is still scarce. Examining parents’ participation in school governance in Switzerland, this article explores the effect of the design of deliberative institutions on perceptions of legitimacy and effectiveness. Based on an original survey of 312 parent councils of public primary schools in Switzerland, the results of our analysis corroborate theoretical expectations about the impact of institutional design on legitimacy and effectiveness of deliberative procedures: More authority granted to parent councils clearly enhances the output-legitimacy of these bodies.     

The health care state in the information age

The computerization of the medical record has important implications for the governance of health care, and the importance of health care means that changes wrought there are indicative of changes in government as a whole. This paper draws on work in public policy, medical sociology and studies of science and technology, as well as on cross–national empirical research in Britain and France. It describes the recent development of information policy in health care as an exercise in state–building, realized specifically in the governance of the health professions. The paper concludes with a discussion of what is both new and not so new in the form and extent of state power which emerges.     

The institutional dimensions of financial crisis management

This paper seeks to contribute to the political economy literature on the US subprime financial crisis by concentrating on the string of major financial bailouts that occurred between September 2007 and December 2008. Part of what is missing from the extant scholarship on the financial crisis is a strong analysis of the financial bailout that contemplates the changing nature of the government's response to the crisis and anchors the intervention in the key organizing rules of the post-Bretton Woods financial order. The central underlying claim is that the understanding of the crisis' impact on the US state may be enhanced if more attention is paid to the institutional-level learning processes and capacity building experiences that occurred during the worst period of turmoil as the financial system lay on the brink of complete collapse.     

The joint demand for health care,leisure, and commodities: Implications for health care finance and access in Vietnam

This paper explores linkages between the demand for health care providers and the consumption of food, non-food goods, and leisure in Vietnam, using a mixed continuous/discrete dependent variable model. Cross-price elasticities calculated from the model suggest there are strong substitution effects between health care, leisure, and certain commodities. The model allows us to explore the implications of replacing user fees with alternative forms of health care finance, such as commodity taxes. In particular, the results suggest financing public health care services with a non-food sales tax rather than user fees would be more progressive and would improve access to care.     

Suicide prevention training outside the mental health service system: evaluation of a state-wide program in Australia for rehabilitation and disability staff in the field of traumatic brain injury

The training needs of staff working in mainstream (i.e., noncrisis) health settings with client groups that have moderate levels of suicide risk have not been extensively addressed. An initiative to train rehabilitation and disability staff working in the field of traumatic brain injury (TBI) is described. A program was adapted from a generic state health department training program, and disseminated by means of established training networks within the brain injury field. Program efficacy was evaluated as the training was provided across the state of Victoria in a series of 1-day workshops. Participants (n = 86) completed two evaluation measures designed for this purpose (objective knowledge test, self-rating of knowledge and skills) on three occasions (pre- and postworkshop, 6-month follow-up). Compared to a control group of rehabilitation and disability workers who did not receive the training (n = 27), the workshop participants made significant gains in objective knowledge and reported skills, and maintained these gains at the 6-month follow-up. The Suicide Interview Response Inventory-2 (Neimeyer & Pfeiffer, 1994) was administered to a subgroup of participants as a validating measure, and correlated significantly with scores from the objective knowledge test. This process may provide a template for developing more fine-grained suicide prevention strategies among other health-related at-risk groups.     

Reportlng of performance measures for federal agencies: the initial impact of the chief financial officer act of 1990

The Chief Financial Officer Act of 1990 requires the preparation and audit of financial statements for many federal government programs and agencies. The first comprehensive set of financial statements prepared to meet the provisions of the CFO Act were for the fiscal year ended September 30, 1991 and were published in CFO Annual Reports due in August of 1992. This paper presents the results of a study of performance measurement in the fiscal year 1991 financial statements of the sixty-three reporting entities filed as part of the 1992 CFO Annual Reports. The purpose of the analysis of performance measures included in the fiscal year 1991 financial statements was to determine to what extent the financial statements of each of the reporting entities included the various types of performance measures identified in the framework developed for this project. The paper also includes an in-depth analysis of the performance measures reprted by the Social Security Administration and the Department of Labor.     

The economic impact of genetically modified cotton on South African smallholders: Yield,profit and health effects

Results of a large-scale survey of resource-poor smallholder cotton farmers in South Africa over three years conclusively show that adopters of Bt cotton have benefited in terms of higher yields, lower pesticide use, less labour for pesticide application and substantially higher gross margins per hectare. These benefits were clearly related to the technology, and not to preferential adoption by farmers who were already highly efficient. The smallest producers are shown to have benefited from adoption of the Bt variety as much as, if not more than, larger producers. Moreover, evidence from hospital records suggests a link between declining pesticide poisonings and adoption of the Bt variety.     

The influence of institutions and culture on health policies: different approaches to integrated care in England and The Netherlands

The concept of integrated care has assumed growing importance on the policy agendas both in England and The Netherlands and elsewhere. It is characterized as health and health care-related social care needed by patients with multi-faceted needs. This article compares policy approaches to integrated care in England and The Netherlands. Differing political strategies and conditions for integrated care correspond to the dissimilarities in the institutional structure and culture of their health care systems. Health care systems are understood as specific national and historical configurations. We review the last decade's relevant policy processes, using the concepts of hierarchy, market and network. The state health care system in England relies mainly on hierarchical steering, thus creating tight network structures for integrated care on the local level. The Netherlands, with its health care system in a public-private mix, has set incentives for voluntary, loosely coupled and partly market-driven cooperation on the local level. Implications for success or failure are mixed in both configurations. Policy recommendations have to be tailored to each systems' characteristics.     

Financing the health care of the aged.

The Medicare and Medicaid programs, which were enacted through the 1965 amendments to the Social Security Act, placed the federal government in the central role of assuring access of the aged and the poor to needed medical care. In this article the trends in the sources of financing medical care services for the aged are examined. The distinction in terms of insurance coverage between acute care services and long-term care services is highlighted. The effect of the programs in terms of reducing the aged's direct financial cost of medical care, increasing their access to medical services, and improving their health status is explored. The unanticipated increase in the cost of these programs has led to a change in emphasis in public policy, from assuring access to mainstream medical care to containing the cost of providing care. The direction of new federal policies is analyzed, and it is concluded that no longer will it follow the private sector's specifications of the conditions and arrangements under which health services are provided to program beneficiaries.     

The measurement of institutional characteristics of nations: Methodological considerations

A major barrier to the quantitative investigation of interactions between economic and non‐economic influences in economic development is the lack of adequate indicators of institutional traits of nations. Our purpose in this paper is to consider the methodological procedures involved in the development of qualitative sociopolitical and economic indicators.

The first sections of the paper deal with various aspects related to the subject of measurement. This is necessary because misconceptions regarding the nature of ‘qualitative measurement’ are common, and misleading contrasts between qualitative and quantitative measurement are frequently made. The last four sections illustrate the procedures for the measurement of institutional indicators by applying them to the quantification of the concept of political participation in developing countries.     

The oregon plan: Toward a model for the future of health care financing

The State of Oregon has proposed a new method of financing health care services for its citizens. Oregon proposes to fund only the most cost-effective services. But in addition to narrowing the offering of health services funded by the State, Oregon proposes to fund all of the State's poor for services, no matter the family status. This broadened number of poor (everyone at the federal poverty level and below, single or married, children or not) will provide health care for more than 200,000 additional Oregonians. The supplementary legislation, SB 534 and SB 935, combined with broadened health care coverage for the poor (SB 27) will cover an additional 478,000 Oregonians. Nearly 95 % of its citizens will have some form of health insurance in Oregon.