Getting out what we put in: productivity of the English National Health Service

Many countries are incorporating direct measures of non-market outputs in the national accounts. For any particular output to be included there has to be data about it for two adjacent periods. This is problematic because the classification of non-market outputs is often subject to wholesale revision. We outline the challenges associated with classification changes and propose a solution. To illustrate we construct output and input indices and estimate productivity growth of the English National Health Service (NHS) for the period 2003-2004 to 2007-2008. Our index of output growth incorporates all care provided to NHS patients and captures improvements in survival rates, waiting times and disease management. We find that more patients are being treated and the quality of the care they receive has been improving. We implement our approach to dealing with changes as to how health services are defined and show what effect this has on estimates of output growth. Our index of input growth captures all labour, intermediate and capital inputs into health service production and we improve on how capital has been measured in the past. Inputs have increased over time but there has also been a slowdown since 2005-2006, primarily the result of a levelling off in staff recruitment and less reliance on the use of agency staff. Productivity is assessed by comparing output growth with growth in inputs, the net effect being constant productivity growth between 2003-2004 and 2007-2008.     

The psychological effects of solitary confinement on prisoners in supermax units: reviewing what we know and recommending what should change

This article examines the psychological consequences of short- and long-term solitary confinement for prisoners in the United States subjected to administrative or disciplinary segregation. Particular attention is paid to the use of secure housing units, alternatively known as control units or supermax units. These correctional entities allow for the isolation of convicts under conditions that offer little sensory stimulation and minimal opportunities for interaction with other people. The circumstances typically found in these units and the heightened potential for the abuse of prisoners are described. The connections between internment and mental illness-as well as isolation and race, gender, and class-are explored. A set of recommendations for the reform of secure housing is presented.     

Post-traumatic stress disorder (PTSD): what we have learned and what we still have not found out

This article discusses the biomedical and the social constructionist models applied to response to trauma, presents the prevalence and the etiology of post-traumatic stress disorder (PTSD), and describes its biological and psychological correlates in children and adults. It concludes that future research might benefit from investigating factors that may protect people who have been exposed to an event likely to be traumatic from presenting with PTSD symptoms, and factors that may affect the longitudinal course of PTSD and treatment effectiveness.     

Governing budgetary commons: what can we learn from Elinor Ostrom?

This article discusses the insights that Elinor Ostrom’s work on common-pool resources and governing the commons can provide for the literature on fiscal commons. Institutional approaches to public finance often employ the metaphor of ‘budgetary commons’. Although intuitively appealing, the notion of budgetary commons faces the danger of becoming a catch-all term that is simply taken as a starting point for an inquiry, without scrutinising the fit between the metaphor and the actual setting. In addressing this shortcoming, the literature on budgetary commons can learn from Elinor Ostrom and the analytical approaches she has advocated in her research on natural commons. This article brings out insights from Ostrom’s work that would be particularly useful for institutional analysis of budgeting. It shows that institutional approaches to public finance can draw on Ostrom’s work with regard to the general approach for examining institutional configurations and their evolution over time, the analytical structures she uses for conceptualising the problems occurring on the commons, the desire to understand institutional complexity in real-life settings, and her scepticism of over-simplified models that are often used for describing and understanding the problems of common-pool resources.     

Aid-in-dying: should we decriminalize physician-assisted suicide and physician-committed euthanasia?

Recent news stories, medical journal articles, and two state voter referenda have publicized physicians' providing their patients with aid-in-dying. This Note distinguishes two components of aid-in-dying: physician-assisted suicide and physician-committed voluntary active euthanasia. The Note traces these components' distinct historical and legal treatments and critically examines arguments for and against both types of action. This Note concludes that aid-in-dying measures should limit legalization initiatives to physician-assisted suicide and should not embrace physician-committed voluntary active euthanasia.     

Euthanasia: why it doesn't matter (much) what the doctor thinks and why there is no suggestion that doctors should have a duty to kill

A major reason that The Netherlands has taken a different approach to the rest of the world on such a fundamental moral issue is that the courts and legislature in that country have accorded the interests of doctors a cardinal role in the euthanasia debate. This article argues that the interests of doctors are of only incidental and peripheral relevance in relation to the moral status of euthanasia. The moral status of euthanasia has little to do with the preparedness of doctors to administer the lethal injection or their general attitude towards the practice. Euthanasia is principally about the interests of the patient and the impact that the practice may have on the community in general, not preserving the conscience or improving the working life of doctors.