Strategies for controlling health care costs. National Governors' Association

Putting a lid on health costs is a job that states can and must tackle. There are many options available and many states are already testing them. But success in this arena will require strong leadership and cooperation among key state officials.     

Expanding access to health care for Social Security Disability Insurance beneficiaries: early findings from the accelerated benefits demonstration

Most Social Security Disability Insurance (DI) beneficiaries must complete a 5-month waiting period before they become entitled to DI cash benefits and an additional 24-month waiting period before Medicare benefits begin. The Accelerated Benefits (AB) demonstration is a randomized experiment designed to test the effects of providing newly entitled DI beneficiaries who do not have health insurance with a generous health benefits package during the Medicare waiting period. This article presents early findings on the prevalence of health insurance coverage among newly entitled beneficiaries and the characteristics of those without health insurance. It also examines the effects of AB on health care utilization, the extent to which AB reduces unmet medical needs, and the costs of providing the AB health benefits package.     

A shrinking state? Politics,economics and private health care in Thailand

This article explores the political and economic forces involved in the development of privatization policies within the health care sector in Thailand. It is suggested that many of the motivating factors behind private sector growth are outside of the health sector; the general macroeconomic environment and tax incentives have stimulated private sector expansion. Within the Ministry of Public Health a preoccupation with improving care in rural areas and an unclear policy line on the private sector has facilitated this expansion. Only recently has private sector growth come to the policy agenda. During this lag period a number of interest groups have developed. It will be difficult to overcome these entrenched interests in order to change policy direction. Meanwhile, problems of rapid cost inflation and inequity face the Thai health care system. Although this case study focuses upon the health care sector in Thailand it would appear relevant both to other sectors and to other countries. The relationship between development models based upon pro-private, pro-market tenets and the establishment of a satisfactory social policy is questioned.     

The Punjab National Bank scam: Ethics versus robust processes

With the rising incidents of corporate scams, it has become imperative to lift the corporate veil to unearth the reasons behind them. As a result, it is of paramount importance to examine the formation of the companies entering into the contract—the executives, directors, and top management. A large‐scale scam hit the Punjab National Bank (PNB) in India recently with huge implications on its financial position and credibility. It is inferred through this work that violation of checks and balances led to the huge scam. Following this scam, several banks have initiated measures to prevent and early detect such manipulative practices. Banks have incorporated stringent verification of all stakeholders involved in any transaction and do not completely rely anymore on the Society for Worldwide Interbank Financial Telecommunications system. The Reserve Bank of India, as the apex governing body of all banking agencies in India, has also started taking measures to ensure that monitoring and control mechanisms are strong and robust. Finally, we present the way forward to prevent malpractices in the corporate world and the ethical implications in the society. Although any organization, especially, a public service organization does not allow any perpetrators into its systems, loopholes might exist that its internal or external stakeholders take advantage of. While emphasizing the needs for robust monitoring and audit processes to prevent violation by perpetrators, it is interesting to note that the same monitoring processes have brought out the scam to open for legal scrutiny, specifically at PNB.     

Centralisation versus regionalisation: Designing the Sixth National Mental Health Plan

In response to the recent Productivity Commission report into mental health, the previous Federal Government announced its intention to produce a new national agreement that lays the platform for Australia's sixth national mental health plan. It has been recommended mental health move to a more regional model of governance and planning, away from a centralised, top-down approach, partly in response to broader reforms affecting health care, and partly in direct response to consistent inquiry evidence that the mental health system remains in crisis. The past 30 years of mental health planning have been centralised. Successive national plans set a broad framework, with real decisions about mental health funding and service allocation made in the health departments of our capital cities. Will the next plan sponsor or inhibit regionality in mental health planning? This paper assesses Australia's historical approach to health planning particularly as it affected mental health and the costs arising. In learning these lessons, we propose the necessary ingredients to facilitate a regional, innovative, and effective approach to decentralised planning, for better mental health outcomes. We cannot afford to replicate the failed planning approaches of the past.     

Voluntarism and health care

The writers are co-authors of Unhealthy Charities; Health Research Charities II: The Politics of Fear;and Health Research Charites: Image and Reality.     

National styles of regulation: Child care in three countries

An analysis of child care regulations in Germany, Sweden, and the United States reveals distinctive national policy styles. A ‘social constructionist’ perspective, with its emphasis on variable problem definitions, helps to explain such differences. However, a full understanding of regulatory differences requires attention to regulatory solutions as well. By disaggregating the concept of regulation, we are able to demonstrate rather different rank-orderings of our three countries in their regulatory solutions. We attribute these differences to cultural, institutional, and political characteristics of the three countries.