Child health policy in the U.S.: the paradox of consensus

The U.S. spends more of its total GNP on health services than any other nation, yet it has one of the highest infant mortality rates in the industrialized world. Young American children are immunized at rates that are one-half those of Western Europe, Canada, and Israel. In the mid-1980s, a consensus among policymakers on the need for federal action to improve child health services resulted in the expansion of Medicaid eligibility for pregnant women and young children and the separation of Medicaid eligibility from eligibility for AFDC. The current phase of child health policymaking includes discussion of much broader proposals for changes in health care financing and innovation in health care delivery. This examination of child health policy begins by reviewing the politics of maternal and child health services from the early twentieth century to the Reagan administration, including the role of feminist movements, the development of pediatrics, and the expansion of federal involvement during the 1960s. Next, the politics of Medicaid expansion as a strategy for addressing child health issues are discussed. Current critiques of child health services in the U.S. are examined, along with proposals to restructure health care financing and delivery. Central to the politics of child health policy during the 1980s and into the 1990s is the way in which child health has been defined. Infant mortality and childhood illness are presented as preventable problems. Investment in young children is discussed as a prudent as well as a compassionate policy, one which will reduce future health care costs and enhance our position in the international economy. Unlike other "disadvantaged groups," children are universally viewed as innocent and deserving of societal support. Framing child health issues in these terms helped to produce consensus on the expansion of Medicaid eligibility. Yet the issues beyond the expansion of Medicaid eligibility involve the restructuring of health care financing and delivery, and, on these issues, conflict is far more likely than consensus.     

No conflict, no interest: on the economics of conflicts of interest faced by analysts

This paper outlines evolution of the policy response to conflicts of interest analysts face in offering investment advice to investors when the company they follow may also buy merchant banking services from their employer. Both in the US and the UK on a both statutory and common law basis the response has been one of to disclose and let market participants price the implied conflict or simply rebut the advice given. An efficient market can price conflicts and by implication unravel any potential damage to shareholder wealth induced by analysts’ conflicts of interests in this view. I consider the impact the presence of “noise traders” in financial markets may have on the welfare implications of this sort of policy stance. The presence of noise traders casts doubt on the benign impact of conflicts of interest in financial markets. In particular the presence of noise induced variance in analyst’s forecasts implies disclosure based remedies may be ineffective in mitigating the harm of analyst’s conflicts of interest.     

Gambling on compliance with the new 2005 Act: Do organisations fulfil new regulations?

Gambling is not a new phenomenon. Indeed gambling has been seen to be omnipresent throughout history and culture. However gambling has taken a new path. Online gambling is fast becoming a major pastime for many of society. The ease of access and convenience of play has led to an increase in the numbers of people gambling, and not just online. Within the increase of online gambling there has also been an increase in the regulation surrounding this industry. This paper explores the regulatory approach to online gambling within the UK. The researchers explore the Gambling Act 2005 (UK) and provide an empirical analysis of the UK major gambling organisation to determine what regulatory aspects they adopt and what safety measures they have in place to protect minors and to protect against financial crime. The researchers finally looks at policy implications for UK governments when regulating future online gambling.     

The third way in mental health policy: negative rights, positive rights, and the Convention

Mentally disordered patients may be said to have rights in two senses: negative rights to freedom from arbitrary detention or interference with their person; and positive rights to expect a certain minimum standard of service, be that in terms of treatment as an in-patient, or as a patient in the community. The Labour government has appointed a 'scoping group' to carry out a root-and-branch review of the Mental Health Act 1983. The 1983 Act was mainly concerned with in-patient treatment. The group is to look at the scope for introducing further compulsory powers in the community, enhancing the rights of carers and relatives, and is to take account of recent British and Strasbourg case law. The primary impact of the Convention on psychiatric patients has been in relation to protection against arbitrary detention under Article 5, unsoundness of mind being one of the permitted grounds of deprivation of liberty under Article 5(1)(e). This article explores the potential impact of Convention rights in developing what Gostin referred to in the early 1980s as a 'new legalism'. The new legalism linked concern for traditional rights to due process and review by the courts or other external bodies with the 'ideology of entitlement' to adequate treatment and services. The article outlines the current policy context of mental health services and looks at the development by the European Court of Human Rights of positive Convention rights to services out of Article 5, whose purpose seems at first sight to be the protection of due process rights. It examines the relevance of Convention rights to community powers.     

Community Safety and Social Policy

This article examines community safety policy. In many countries community safety has become a replacement discourse for situational crime prevention, although in some countries such as the UK, it too is threatened with replacement by the narrower concerns of crime reduction. Community safety represents the apparent merging of the concerns of criminal justice and social policy, specifically over questions of social inclusion and exclusion. Focusing in the main upon UK policy, but also drawing upon experience elsewhere, this article scrutinises the policy of community safety, arguing that while it offers an inclusionary vision of crime control, its practice may be something rather different. More specifically, and in common with the trajectory of much advanced liberal social policy, in practice community safety may have an exclusionary effect. Thus, while community safety may represent the convergence of social and criminal justice policies, it does so on neoliberal rather than welfare liberal terms. It also means that community safety has a closer connection to policies of punitive sovereignty – particularly sentencing policies of mass incarceration – than might often be assumed.     

Public hospitals in China: privatisation, the demise of universal health care and the rise of patient-doctor violence

Ensuring the safety of staff and patients has become a major problem for hospitals in China. This article examines whether one of the reasons for this violence may be the emerging injustice and inequality that have manifested in the Chinese health care system as a result of privatisation reforms since the early 1980s. It considers approaches to these issues that may assist the Chinese Government, and other nations contemplating similar policy changes, to create efficient but equity-based health care systems that minimise collateral trauma to patients and their families.     

Rehabilitation in the Punitive Era: The Gap Between Rhetoric and Reality in U.S. Prison Programs

Scholars of mass incarceration point to the 1970s as a pivotal turning point in U.S. penal history, marked by a shift toward more punitive policies and a consensus that “nothing works” in rehabilitating inmates. However, while there has been extensive research on changes in policy makers' rhetoric, sentencing policy, and incarceration rates, scholars know very little about changes in the actual practices of punishment and prisoner rehabilitation. Using nationally representative data for U.S. state prisons, this article demonstrates that there were no major changes in investments in specialized facilities, funding for inmate services–related staff, or program participation rates throughout the late 1970s and the 1980s. Not until the 1990s, more than a decade after the start of the punitive era, did patterns of inmate services change, as investments in programming switched from academic to reentry‐related programs. These findings suggest that there is a large gap between rhetoric and reality in the case of inmate services and that since the 1990s, inmate “rehabilitation” has increasingly become equated with reentry‐related life skills programs.     

In silico toxicity as a tool for harm reduction: A study of new psychoactive amphetamines and cathinones in the context of criminal science

The emergence of new psychoactive substances (NPS) has raised many issues in the context of law enforcement and public drug policies. In this scenario, interdisciplinary studies are crucial to the decision-making process in the field of criminal science. Unfortunately, information about how NPS affect people's health is lacking even though knowledge about the toxic potential of these substances is essential: the more information about these drugs, the greater the possibility of avoiding damage within the scope of a harm reduction policy. Traditional analytical methods may be inaccessible in the field of forensic science because they are relatively expensive and time-consuming. In this sense, less costly and faster in silico methodologies can be useful strategies. In this work, we submitted computer-calculated toxicity values of various amphetamines and cathinones to an unsupervised multivariate analysis, namely Principal Component Analysis (PCA), and to the supervised techniques Soft Independent Modeling of Class Analogy and Partial Least Square-Discriminant Analysis (SIMCA and PLS-DA) to evaluate how these two NPS groups behave. We studied how theoretical and experimental values are correlated by PLS regression. Although experimental data was available for a small amount of molecules, correlation values reproduced literature values. The in silico method efficiently provided information about the drugs. On the basis of our findings, the technical information presented here can be used in decision-making regarding harm reduction policies and help to fulfill the objectives of criminal science.     

When health policy is the problem: a report from the field

We often think of health policy and health services research as offering solutions to cost, quality, and access problems. Many of us see health policy as simply ineffective. But any activity that has the power to cure can also do harm. Is it possible that the health policy enterprise has contributed to the very problems it has been attempting to eliminate? We argue that it has. Reasonable assumptions have led to a series of solutions that have provided political cover for those vested in the status quo. This process is nonpartisan, with those of us on the left and the right unintentionally and inadvertently contributing to the problems we are so committed to solving.     

Developing Countries and the Implementation of CITES: The Mexican Experience

A key issue for the success of international conventions regulating biodiversity conservation is to understand the different philosophical positions of each party for initially acceding to that convention, and for the measures each party takes to implement that convention. This paper documents policies for wildlife trade regulation in Mexico from the early 1980s to the early 2000s, with emphasis on the process of CITES implementation. Mexico was slow to adopt environmental policies, but when Mexico did recognize wider environmental concerns, the prospect of acceding to CITES was not considered because of existing bans on all wildlife trade in native species. However, Mexico could not control the illegal trade of wild species during the 1980s. Mexico acceded to CITES in 1991 mainly in response to international pressure and to bilateral pressure while seeking to join a free trade agreement. The step of joining CITES was taken without clear analysis about the consequences of being a party to the Convention. Between 1992 and 1996, Mexico had no clear policy about its role within CITES. The period from 1997 to 2001 witnessed an improved legal and administrative structure and a greater internal coordination between the institutions involved with CITES. Mexico has now improved its policy toward international wildlife trade.     

论医疗机构对原因不明伤害或死亡病例的报警义务

在涉及刑事犯罪的案件中,警方尽早介入并利用其自身专业技能进行侦查对于案件的早日侦破具有举足轻重的作用。但在法律实践中,有许多案件因为没有及时报警,致使被害者遭受了不应有的损失,同时也会放纵犯罪分子的犯罪行为,加大了其给社会带来的危害性。医疗机构为社会特殊主体,明确其在诊疗过程中对于原因不明伤害或死亡患者是否具有报警义务对于减少医疗纠纷、减轻患者损失、降低社会危险性具有重要意义。在目前我国立法尚未对报警义务的主体加以普遍规定的情形下,本文立足于法律所保护和追求的社会利益,在现行立法的基础上对医疗机构是否具有报警义务进行了分析。     

Emergent authority and expert knowledge: Psychiatry and criminal responsibility in the UK

In the UK context, the rise of the discipline and practice of forensic psychiatry is intimately connected with the concurrent development of principles and practices relating to criminal responsibility. In this article, we seek to chart the relationship between psychiatry and the principles and practices of criminal responsibility in the UK over the early modern, modern and late modern periods. With a focus on claims about authority and expert knowledge around criminal responsibility, we suggest that these claims have been in a state of perpetual negotiation and that, as a result, claims to authority over and knowledge about criminal non-responsibility on the part of psychiatrists and psychiatry are most accurately understood as emergent and contingent. The apparent formalism of legal discourse has tended to conceal the extent to which legal policy has been preoccupied with maintaining the primacy of lay judgments in criminal processes of evaluation and adjudication. While this policy has been somewhat successful in the context of the trial – particularly the murder trial – it has been undermined by administrative procedures surrounding the trial, including those that substitute treatment for punishment without, or in spite of, a formal determination of criminal responsibility.     

Re-Evaluating ‘Best Interests’ in the Wake of Raqeeb v Barts NHS Foundation Trust & Anors

In Raqeeb v Barts NHS Foundation Trust, the latest of a number of cases concerning whether a child can travel abroad for treatment that doctors in the UK do not consider to be in their best interests, the High Court held that the hospital had acted unlawfully by failing to consider the child's rights under EU law when refusing to allow her to travel. Although this derogation could be justified on public policy grounds, as such treatment was, on the facts, in her best interests, no further interference with her rights was justified. In making this finding, the court recognised the ‘stress’ that such a case placed on the best interests test, lending weight to the argument for moving instead to a risk of significant harm threshold for judicial intervention in parental decisions, which better accounts for legitimate differences of value and strikes a better balance under Article 8 ECHR.     

Researching Restorative Justice: Politics,Policy and Process

The purpose of this paper is to explore some questions around the process of engaging in research in restorative justice in the contemporary political and economic climate of the UK. Its key concern is to endeavour to create a framework in which it is possible to develop an understanding of the process whereby restorative justice was transformed from the ‘dead duck’ of the late 1980s to its current popularity. It takes as its example for understanding this transformation the problems and possibilities of engaging in research in restorative justice and how such research needs to be contextualised within a wider understanding of the policy and political process. This paper does not set out to offer any answers to the questions it raises, but is primarily concerned to bring to the fore some of the absences that can be detected within the contemporary embrace of restorative justice in the UK.     

Regulatory Capitalism and the UK Labour Government's Reregulation of Commissioning in the English National Health Service

Today, policy analysts and regulatory governance scholars are sceptical about the capacity of the regulatory state hypothesis to describe change at the institutional level. For many, the hypothesis is a convenient oversimplification that fails to account for the hybridity of institutional arrangements within individual policy sectors and also for the divergence of reform trajectories across different national and sector‐based policy contexts. This article assesses the influence of the key themes of the regulatory state on the UK Labour government's reregulation of National Health Service (NHS) commissioning organizations. Following the critics, it argues that these themes are only partially evident in the programme. While the government has codified previously informal relationships with policies like Patient Choice and has also subjected commissioning organizations to metaregulatory techniques, its reforms have neither displaced public ownership and the direct supply of commissioning services with markets and new mechanisms for rule making and standard setting, nor have the reforms divided labour within the state by creating an independent agency to regulate NHS commissioning organizations via technocratic means. Under the reforms, NHS commissioning continues to take place within a structure of bureaucratic relationships. However, the article suggests that the hybridity of regulatory techniques at work within the UK Labour government's reregulation of NHS commissioning lends weight to the claim that the current era is one of regulatory capitalism. It concludes with a discussion of the consequences of this finding for the public policy and regulatory governance literatures.     

IMMIGRATION POLICY,BORDER SECURITY,AND MIGRANT DEATHS: AN IMPACT EVALUATION OF LIFE‐SAVING EFFORTS UNDER THE BORDER SAFETY INITIATIVE*

Subsequent to U.S. Border Patrol (USBP) efforts to control illegal immigration throughout the 1990s, concern arose over an apparent increase in deaths of illegal migrants as they began to undertake more treacherous routes to enter the United States from Mexico. In response, the Border Safety Initiative (BSI) was created to increase safety along the southwest border. Using multiple data sources, including the USBP BSI Incident Tracking System, this study evaluated the impact of life‐saving efforts performed under the BSI program. Results indicate that there has been no overall reduction in the rate of migrant deaths since BSI has been in operation. However, an evaluation of BORSTAR search and rescue teams and the 2003 Lateral Repatriation Program (LRP), which returned apprehended migrants from Tucson sector to less hazardous places along the border, were found to be effective in preventing migrant deaths. Policy Implications: Critics of U.S. immigration policy claim that the only way reductions in migrant deaths along the U.S.‐Mexico border can be achieved is through liberalization of immigration policy and relaxing of border security. Yet, for more than a decade, U.S. policy makers have increased restrictions on immigration and have tightened security at the borders. Considering this, alternative means must be deployed in order to save migrant lives in the near term rather than waiting for a reversal of immigration policy. This study suggests that proactive life‐saving measures implemented through a harm‐reduction strategy can have some impact on saving migrant lives.     

Medicaid program; use of restraint and seclusion in psychiatric residential treatment facilities providing psychiatric services to individuals under age 21. Health Care Financing Administration (HCFA), HHS. Interim final rule with comment period

This interim final rule with comment period establishes a definition of a "psychiatric residential treatment facility" that is not a hospital and that may furnish covered Medicaid inpatient psychiatric services for individuals under age 21. This rule also sets forth a Condition of Participation (CoP) that psychiatric residential treatment facilities that are not hospitals must meet to provide, or to continue to provide, the Medicaid inpatient psychiatric services benefit to individuals under age 21. Specifically, this rule establishes standards for the use of restraint or seclusion that psychiatric residential treatment facilities must have in place to protect the health and safety of residents. This CoP acknowledges a resident's right to be free from restraint or seclusion except in emergency safety situations. We are requiring psychiatric residential treatment facilities to notify a resident (and, in the case of a minor, his or her parent(s) or legal guardian(s)) of the facility's policy regarding the use of restraint or seclusion during an emergency safety situation that occurs while the resident is in the program. We believe these added requirements will protect residents against the inappropriate use of restraint or seclusion.     

Providing health insurance in rural china: from research to policy

The focus of this case study is utilizing research to influence policy in a large developing country. Our experiences involve the lack of health insurance for China's rural populations and how our research helped shape China's recent policy attention and efforts on this issue. More than 80 percent of China's 700 million rural residents have no health insurance. This has been the case for the past thirty years, since the collapse of the once-successful Rural Cooperative Medical System after the economic reforms of the early 1980s. In 2002, the Chinese government announced a new rural health financing policy to provide health insurance for its rural populations, financed by a matching fund with contributions from central and local governments, as well as from individual households. This article documents the authors' experiences in addressing several critical questions for converting research results into policy actions, including the following: How are researchers to address policy relevant questions? How are they to acquire the attention of top policy makers to a specific problem? When is the issue at hand serious but not yet critical? And lastly, how are researchers to develop policy recommendations that stand a good chance of being accepted and enacted? Major lessons learned include the need to better understand the mandates and institutional constraints of the policy makers, the appropriateness of timing of both research result and policy efforts, how to use a country's cultural context to garner support of the government, how to enhance the policy's impact by combining formal and informal channels of communication for research dissemination, and the importance of following the policy process through the implementation phase to ensure the original objectives are achieved.     

以危险方法危害公共安全罪何以成为口袋罪

从道路交通秩序领域到市场经济秩序领域、公民个人权利领域、社会管理秩序领域,以危险方法危害公共安全罪的触角已经越伸越长。从交通肇事到生产经营非食品原料、"碰瓷"、偷窨井盖,危险方法行为犯罪行为方式可谓五花八门。以危险方法危害公共安全罪越来越显示出口袋罪的特征。产生这一结果固然有罪名本身的因素,但根本原因在于三个方面:一是对于刑事政策的不合理解读,二是对于社会效果内容的片面阐释,三是无视罪名的确定性内容。其实质是忽视了政策与规范之间的关系,过分关注结果的危害性而淡化了行为规范内容和主观心态。只有在司法中切实坚持罪刑法定原则,才不致使以危险方法危害公共安全罪成为口袋罪。     

Street justice: Some micro-moral reservations: Comment on sykes

Research on the use of incapacitation strategies to reduce crime has increased rapidly in the last decade. Estimates of the crime reduction potential are numerous and variable, reflecting different assumptions by researchers. This paper reviews and synthesizes studies of collective and selective incapacitation. Sentencing practices in the 1970s and early 1980s prevented an estimated 10 to 30 percent of potential crimes through collective incapacitation strategies. Greater use of incarceration, such as through mandatory minimum sentences, would prevent additional crimes, but prison populations would increase substantially. Selective incapacitation strategies target a small group of convicted offenders, those who are predicted to commit serious crimes at high rates, for incarceration. These high-rate serious offenders, however, are difficult to identify accurately with information currently available in official criminal history records. Preliminary research, assuming moderate accuracy, suggests that selective incapacitation may prevent some crimes, such as 5 to 10 percent of robberies by adults, but increases in prison populations would result. The future of selective incapacitation is discussed in light of current research and knowledge about serious criminal activity.