Control versus consent in long-term care case management programs: implications for public policy

Case management programs for long-term care include the dual public policy goals of providing access to services and ensuring the efficient and effective application of public funds. We will use a paradigm for social policy development that proposes a conflict between control and consent motives of social policy makers. Illustrations of the limitations and positive elements of control versus consent as applied to case management will be presented.

We will discuss how the tension between these approaches can be used to develop policy that balances the goals of access and cost-effectiveness.     

Evaluation of the south carolina comr/cunity long-term care medicaid waiver for the elderly and disabled

Medicaid waivers play an important role in the health policy process. Various health care policy initiatives have encouraged states to experiment ith their Medicaid programs by expanding coverage to populations not traditionally covered by Medicaid, or by delivering Medicaid services in non traditional ways. Lessons learned by individual states' Medicaid waivers could be an important part of the health care reform debate. This paper presents an evaluation of a Medicaid waiver operating in South I Carolina. The South Carolina Community Long-term Care Waiver for the Elderly and Disabled is evaluated for cost effectiveness, quality of care, and client satisfaction. This evaluation shows that the waiver is highly effective in offering individuals who are medically and financially eligible for Medicaid supported nursing home care a viable, cost effective, high quality alternate to institutionalization.     

Returning to the record: Originalism and the evolution of public assistance policy

This article clearly demonstrates that qualitative techniques are indispensable for gaining a more comprehensive understanding of public assistance policy's evolution. Rather than reinforcing the generally accepted view that Southern Members of Congress were steadfastly opposed to an expansion of central government power and influence, an analysis of the Congressional Record reveals that representatives from the South often were ardent advocates of an expanded federal role. Qualitative analysis also challenges the prevailing view that the national government is the primary instigator of policies which enhance federal power. During the period under study, all increases in federal match rates for public assistance, except one, emanated from Members of Congress who were attempting to increase the flow of federal funds to their states. In view of the divergence between generally accepted views and the findings produced by qualitative analysis, it is clear that qualitative methods are an invaluable tool in theory construction and highlighting promising avenues of inquiry.     

Housing trends of the elderly: emerging policy and implications

Housing and living environment options are both one of the most pressing problem are as for the elderly and an unavoidable policy subject for public administrators. This article analyzes the topic of housing and the elderly so as to high light selected dimensions that might have implications for decision - makers in resource considerations and allocations. An opening section gives the status of how and where the elderly are now living. Six events, or environmental and policy changes, that affect the housing options of the elderly are analyzed. These events are: high mortgage rates; rent controls; condominium conversions; tax relief measures; weatherization programs; and reverse annuity mortgages. The two dominant trends that appear to shape the future housing options of the elderly are examined. The first trend is the provision of a range of alternatives in living arrangements. The creation of alternatives, also known as a continuum of living environments, includes congregate housing, share - a - home, life care or continuing care, geriatric foster care, and single room occupancy hotels. The second major trend is the increasing provision of services in the home setting. The final portion draws together the evident implications about the housing problems of the elderly for policy makers in the public management field. Implications that have community-wide ramifications are clustered as they relate to: increasing the housing supply; regulatory mechanisms; and budgetary references.     

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.     

Purpose and practice in public administration education: The place of substantive public policy areas

Public administration's early identification with the concept of a strong executive has resulted in an emphasis on staff functions in its graduate education programs. In the practicing world, staff functions are viewed as tools employed in the actual practice of public administrators, namely the delivery of substantive public services. Although public administration is characterized as an applied field, it does not focus its theory building and educative efforts on that which practicing public administrators actually do. The field necessarily imports other disciplines, but it does not provide the unique focus that would justify this borrowing; its current research agenda and training curricula are available in other disciplines. Public administration graduate students should concentrate in individual substantive policy areas, and the field should focus on optimizing organizational arrangments for delivering societal knowledge as public services. Interorganizational theory can provide the common theoretical framework necessary to mitigate the centrifugal effects of a variety of “administrations” within the field. The approach developed by J. Kenneth Benson is outlined; it provides a unique theoretical niche for public administration, yields a framework for comparative analysis, and defines the field's relationship to political science.     

Scottish devolution: identity and impact and the case of community care for the elderly

This article examines the emergent identity and impact of devolution in Scotland. Using the case of community care for the elderly, a model is set out for capturing the different interpretive perspectives evident in relation to a particular policy area in 1999–2001. The political story of the 'free personal care' issue, in which the Scottish Executive were unexpectedly forced into adopting a markedly different policy from the rest of the UK, is examined in some detail. Setting the episode in a broader context, four discursive thematics are identified in relation to the policy case. A model is demonstrated for examining different aspects of devolution including constitutional level and sub-system aspects of post-devolution governance. Conclusions are drawn as to the meaning which should be ascribed to the discourse associated with devolution and community care for the elderly.     

Targeting, residual welfare and related concepts: modes of operation in public policy

A mode of operation defines a pattern of policy-making or approach to policy. This paper attempts to deconstruct the relationship between certain modes of operation, political ideology and specific techniques, using the main example of targeting. Targeting is commonly related to a number of other concepts, including selectivity, means-testing, conditionality, residual welfare, and rationing. The inter-connectedness of the issues is often taken for granted: residualism implies selectivity, selectivity is undertaken by means-testing, selectivity and means-testing are a form of targeting, targeting and conditionality substantially overlap, and all of them have played an important role in the development of arguments for the limitations on expenditure and the restriction of welfare provision. But the methods can be used in different systems, for different purposes. Means-testing is not the same thing as selectivity; selectivity is not the same thing as conditionality or targeting; rationing can take place in any kind of service; and none of these options is necessarily residualist. Modes of operation are often compounded with political aims, the structural context of policy, discussions of implementation and the application of specific policies. When the concepts are unravelled, it becomes possible to think of the methods and approaches involved in different ways.     

Health care policy: lessons from the past and issues of the future

Liberal distributional values, the increasingly powerful capacity of medicine to provide more and better care, and concern about the health hazards of an industrial society fueled the vast expansion of the health care sector during the last 20 years. That growth was facilitated by a growing economy. The current health policy debate at one level reexamines the distributional bases of entitlement programs, and at another seeks alternative resource allocation mechanisms to reduce the cost of health care. This article has two themes. First, distributional and allocational policies are shown to be intrinsically related, so that the health policy debate is fundamentally a clash between liberal and libertarian values. Second, the inexorable social forces driving the health care system are shown to be the aging of the population and the rapid expansion of technology. The resulting dynamics imply the further growth of the health sector, now in the environment of a sluggish economy. Future policies will have to struggle with how to ration scarce health resources and how to reorient the health care sector to the problems of the aged.     

T2 Transfer of high technology from the united states to the soviet bloc: A public policy issue

The Union of Soviet Socialist Republics and the Soviet-bloc states are engaged in an extensive effort in the legal as well as illegal acquisition of United States high technology. This study examines the importance to the U. S. of such losses; the manner in which the Soviets acquire our high technology; benefits of such acquisitions to the Soviet Union; steps being taken by the U. S. to reduce its loss of high technology; and the author's recommended course of action to reduce high-technology transfer.

The transfer of U. S. high technology to the Soviet Union is recognized as one of our most serious national security problems. This problem is complicated, however, when considering our free enterprise system and the need to promote free trade. On the one hand high technology represents a substantial share of our current exports, while on the other, the United States has relied on technological superiority to offset the Soviet-bloc edge in military might. An equilibrium must be established to ensure protection of both economic and national defense interests of the United States.

The Soviet effort to acquire U. S. high technology is broad based, supported by the Military-Industrial Commission and State Committee for Science and Technology (in legal acquisitions), as well as the Soviet Intelligence Service (in illegal acquisitions). Such techniques as review of U. S. publications, U. S.-Soviet exchange programs, as well as extensive clandestine intelligence operations, are utilized by the Soviets in obtaining our high technology.

The Soviet acquisition of U. S. high technology has greatly benefited the USSR. This is clearly seen in U. S. Government estimates that the Soviets may have saved as much as $100 million in research and development of advanced microcircuitry. Several examples of savings to the Soviet defense industry as a result of high-technology transfer are elucidated in this work. In short, the Soviets have been able to save billions of defense dollars by utilizing proven U. S. designs with none of the risks experienced in the research and development of this technology.

Because of the paradoxical nature of this question of high-technology transfer, U. S. Congressional reaction to renewal of the Export Administration Act of 1979 has been mixed. On one side of the aisle, there has been support of looser controls on high-technology exports to promote free trade. On the other side of the aisle, tighter controls on such exports have been supported to protect critical U. S. high technology. At the same time, the U. S. Government has undertaken steps to strengthen its agreement with the COCOM nations. Another effort undertaken by the U. S. and other Western governments is the expulsion of accused Soviet spies from various Soviet diplomatic establishments (at least 67 Soviets from January to May, 1983). Additionally, the U. S. Department of State, Defense, Commerce, and Customs, as well as the American Intelligence Community, have undertaken efforts to reduce high-technology transfer to the Soviet Union. U. S. industry has attempted to increase security of high-technology; however, because of the Defense Investigative Service's workload, the quality of background investigations on individuals, working in firms handling defense contracts, has suffered.

The author recommends establishment of an ad-hoc matrix organization to integrate the resources and efforts of all of the federal agencies, as well as industry, in controlling the transfer of U. S. high technology to the Soviet Union and Soviet-bloc states. The author also includes recommendations as contained in various Congressional bills. The author's suggestions are made with a view toward creating a balance necessary to the protection of our free market system and protection of the national defense of the United States.     

Preventive veto and obstructive veto: the imposition of public policy by organizations on the margins of government

This article argues that powerful organizations at the margins of government (i. e,, contractors, franchisers, quangos, state-owned corporations, etc.) which provide vital public services are able to impose public policy on the electorate and elected officials in democratic countries. These organizations' enormous resources, including not only their tangible assets, but also freedom from accountability and dependent clientele, constitute both a source of power and vital vested interests. Illustrating with the example of the Kupat Holim Sick Fund of Israel, it shows how when these interests are significantly jeopardized, the organizations impose veto power: a preventive veto at the policy making stage or an obstructive veto at the policy implementation stage. Both types of veto enable them to appropriate the major instruments of policy making - allocation, regulation, and restructuring - from elected government. This ability undermines the traditional relationship between the electorate and elected and raises questions about the risks to democracy inherent in the proliferation of such bodies on the margins of government.     

Control versus consent in community-based long-term care services: the role of economic empowerment

Professor Kapp responds to the article in this issue by Safewright and McAuley. He discusses the use of economic empowerment as a public policy strategy that is essential to a meaningful consideration of enhancing consumer autonomy and choice within the context of publicly-funded home and community-based long term care programs.     

Interagency implementation of government policy: Strategic management of maternal and child health care in texas

Focusing on a joint effort of the Texas Department of Health and the Texas Department of Human Services, this study examined the interagency implementation of maternal and infant health policy in the state. Thompson's typology of implementation⁽¹⁾ was integrated with the Montjoy and O’Toole⁽²⁾ model of overhead influence on intraorganizational factors in public policy implementation for analysis. The findings provide some support to the Montjoy and O’Toole model.⁽³⁾ The data suggested Type A Mandate Effects and Expected Activity for both departmental programs. Reciprocal Operating Interdependence existed between the two state departments.     

Institutionalising ethics in the queensland public sector: Discussion of research into ethics education for public officials

This paper presents a case for a comprehensive approach to the institutionalisation of ethics in public sector organisational contexts. It argues that education and training have a central role in such strategies. The setting for this discussion is the State of Queensland, Australia, which is currently implementing a public sector ethics program. In particular, the author reports and analyses research conducted in the State of Queensland, Australia, in the latter half of 1993. The research explored the expectations of Queensland public sector managers as to the nature of ethics education programs. Analysis of the research supports the view that, with some reservations, public sector managers indicate significant support for the institutionalisation of public sector ethics in an educational framework.