Medicaid,the States and Health Care Reform

Health care reform in the US is relying extensively on Medicaid for achieving universal health coverage. This article addresses the question of whether Medicaid is an appropriate foundation for reducing the ranks of the uninsured, given its dependence on economic conditions and the vulnerability of state budgets, along with the ever-changing preferences of governors and legislators. This article assesses the effects of the ebb and flow of Medicaid policy-making on at‐risk populations and what this implies for the Affordable Care Act. By establishing a nationwide income floor at 133% of the Federal Poverty Level, the legislation eliminates eligibility inequities across the states. However, it is argued that when state budgets are strained, as they undoubtedly will be when the reform bill is fully implemented, local officials will downsize benefit packages, raise co-payments, mandate more managed care, and reduce provider payments, negatively affecting the availability, scope, and quality of services.     

Area Poverty Effects on Local Health Care Costs: An Analysis of Mississippi

This article examines the relationship of area medical costs and poverty in Mississippi. Using a fixed‐effects model and Medicare expenditures, the results indicate that an addition of one percentage point in area poverty increases expected per enrollee expenditures by 0.90%. These figures imply that successful poverty amelioration efforts could yield substantial reductions in medical costs over time. The estimates suggest that a one‐percentage‐point reduction in poverty could accrue to a statewide savings of $510 million in medical costs over a 5‐year time period.     

Examining Policy Implementation in Health Care: Rule Abidance and Deviation in Emergency Medical Services

Passage of the Patient Protection and Affordable Care Act (ACA) has served to refocus attention on the complexity of health care delivery in the United States, with particular attention to concepts of quality, access, and outcomes. This article argues that our understanding of the ACA must be informed by an examination of policy implementation in health care, including the core public function of emergency medical services (EMS). Key concepts of implementation in frontline service—notably, rule abidance and deviation—are examined from the perspective of street‐level EMS workers. Results indicate that the intersection of rules, patient needs, and professional culture creates instances of both rule abidance and deviation, both of which contribute substantively to concepts of quality in a health care setting.     

北京市城镇医药卫生体制改革研究报告

现行医药卫生体制存在卫生资源不合理,医疗费用增长过快,公立医疗机构缺乏活力,卫生资源利用效率不高,药品监管工作亟待加强等问题,针对以上问题,本提出了我市城镇医药卫生体制改革的主要内容与原则建议。     

Medicaid Section 1115 Waivers: Shifting Health Care Reform to the States

This article focuses on recent developments in state Medicaidprograms and the role ojSection 1115 waivers in this process.The evidence presented here demonstrates quite clearly thatthe states are using Section 1115 waivers to experiment witha broad range of innovative health-care service delivery, reimbursement,and eligibility concepts. This has allowed the states to reconfiguretheir Medicaid systems. More important, perhaps, the use ofSection 1115 waivers has also increased the role ofof the statesin the American health-care policy process.     

Health Care Reform in Britain and Germany: Recasting the Political Bargain with the Medical Profession

Health care systems in the postwar period have been governed by political bargains between the state and the medical profession that have delinzated their respective powers and jurisdictions. Recent health care cost containment reforms in Britain and Germany are altering these bargains, and thereby challenge the prerogatives and autonomy of the medical profession in health policy formulation and in administration of the health care systems. But these challenges to doctors' power and autonomy vary between the two countries. Britain's 1989 “internal market” reforms attack the corporatist bargain with physicians by introducing market mechanisms into the National Health Service and, at the same time, strengthening central state control of the health care system. In Germany, on the other hand, the government's 1992 reforms only partially breached the corporatist bargain with doctors in order to strengthen rather than destroy this governance arrangement. The government has tried to curb what it views as excessive power of doctors while still allowing them a significant degree of corporatist self-governance. The reform efforts in both countries highlight some of the problems with different governance arrangements in health care systems and, more specifically, the difficulties associated with a market in health care.     

Locating the Issue Public: The Multi-Dimensional Nature of Engagement with Health Care Reform

This research examines in detail the structure of the issue public for health care reform, drawing from extensive, nationally representative survey data tapping general attentiveness to news and public affairs, specific interests in health care issues, and motivations (e.g., personal health and financial conditions) to follow health care reform issues. We furthermore adopt a multi-dimensional approach to defining the contours of the issue public for health care policy, separately studying its cognitive, affective, and behavioral underpinnings. Results indicate only weak interconnections across these dimensions—measured through health care knowledge, holding strong opinions on health care issues, and participation in health-related political activities, respectively—and somewhat different structural and motivational patterns underlying each. Theoretical, conceptual and methodological implications of these findings are discussed.Vincent Price and Joseph N. Cappella are Professors in the Annenberg School for Communication at the University of Pennsylvania, where Clarissa David, Brian Goldthorpe, and Marci McCoy Roth are doctoral students. Gathering of the data reported here was supported by grants to Vincent Price and Joseph N. Cappella from The National Science Foundation (Grant EIA-0306801) and the Annenberg Public Policy Center of the University of Pennsylvania. Views expressed are those of the authors alone and do not necessarily reflect opinions of the sponsoring agencies.     

Federalism,Physicians, and Public Policy: A Comparison of Health Care Reform in Canada and Brazil

Abstract

This article uses comparative historical analysis to explore physicians’ involvement in health care reform in Canada and Brazil. Drawing on historical institutionalism, the analysis stresses how, beyond partisanship, physicians build consensus around and promote specific policy ideas, and how federal institutions shape physicians’ mobilization. In both countries, physicians’ mobilization shaped the emergence of universal health care coverage, but in quite different ways, because of the differing federal institutions. Although the Brazilian medical lobby was far more heterogeneous than the Canadian profession, one faction was able to mobilize at the local level to pursue policy ideas favorable to universal health coverage.     

'Designing Better Health Care in the South': A Case Study of Unsuccessful Transformational Change in Public Sector Health Service Reform

This article presents a case study of a project known as 'Designing Better Health Care in the South' that attempted to transform four separately incorporated health services in southern Adelaide into a single regional health service. The project's efforts are examined using Kotter's (1996) model of the preconditions for transformational change in organisations and the areas in which it met or failed to meet these preconditions are analysed, using results from an evaluation that was commenced during the course of the attempted reform. The article provides valuable insights into an attempted major change by four public sector health organisations and the facilitators and barriers to such change. It also examines the way in which forces beyond the control of individual public sector agencies can significantly impact on attempts to implement organisational change in response to an identified need. This case study offers a rare glimpse into the micro detail of health care reform processes that are so widespread in contemporary health services but which are rarely systematically evaluated.     

Cutting Oneself on Too Sharp an Administrative Knife: Problems of Implementation in Finnish Health Care Planning

Finnish public health care planning is a multi-level five year planning system which is heavily bureaucratized. The planning process is formalized and is supposed to work according to fixed time-tables. Here the system is seen to display a conflict between technical planning assumptions and the political and pluralistic setting of the system. This conflict is seen to generate bureaucratic inertia. Empirical evidence indicates that the system does not work according to the a priori set schedules and it is doubtful whether it will keep up to schedule even after the reforms that have been made.     

社会稳定：中国改革和发展的必要前提

改革和发展需要有一个也必须有一个好的社会环境。如果没有社会的稳定,那就意味着改革和发展进程的中断;意味着已有的改革和发展成果的丧失;意味着人民的生活要陷入苦难的状态之中;意味着综合国力的削弱。复杂的时代条件,不可避免地会引发了一系列的社会问题,并进而对中国的社会稳定造成许多不利的影响。这主要表现在:就业的压力;贫困问题;贫富差距明显拉大;社会安全网的薄弱;社会焦虑现象的存在。为了有效地维护社会稳定,应当做:确立起基本立足点;大力推进社会经济的发展;保证民众基本生活需求的满足和基本生活水平的持续提高;尽可能地实现充分就业;形成一个公正的社会分配结构。     

我国改革开放以来的行政发展论析

改革开放以来的五次行政改革,经历了组织调整、职能转变、能力建设和价值诉求的逻辑路径,下一步行政发展面临治理主体独大与社会基础脆弱、制度化与市场化、外部性与内部性、工具理性与价值理性等四重基本矛盾,有三个方面的基本对策。     

Uneven Development, Territorial Politics and the British Health Care Reforms

The paper considers the relationships between the uneven development of the British economy, the political strategies pursued by the Conservative government, and the changes to the character of the NHS in the 1980s which culminated in the NHS reforms. It describes the context in which spatial resource allocation policies in the NHS were operating—one of heightened uneven development, with particularly rapid growth taking place in South East England with harmful effects on the NHS. It shows that one response was pressure by backbench MPs on government for a more equitable distribution of funds. Developments within the NHS are interpreted as strategic attempts to prioritize the interests of key geographical locations within a broader 'two nations' political strategy. Three issues are raised: the usefulness of the idea of 'spatial coalitions' in understanding pressures for change in health care policy; the extent to which spatially-uneven development and the 'two-nations' political strategy influenced the character and timing of changes in health care policy; and the possibility that the politics of the welfare state will increasingly be shaped by territorially-based conflicts.     

我国事业单位改革政策发展研究

事业单位改革政策是事业单位改革的方向标和行动指南.目前我国事业单位改革政策主要呈现了重视厘清政府与事业单位的关系、重视扩大事业单位的自主权、重视事业单位的分类改革、重视加强事业单位的公益性、重视创新公共服务提供方式等特征.改革开放以来事业单位改革政策的发展为我国事业单位改革提供了切实的法律和制度保障,但我国事业单位改革政策也还存在着政策制定的系统性较为缺乏、政策执行不到位、政策绩效评估机制不够健全和法治体系建设相对滞后等方面的问题.因此,未来我国应从强化事业单位改革政策的顶层设计、加强改革政策执行的监管力度、重点推动事业单位公共服务清单的建设、健全改革政策的绩效评估机制、重视改革政策的法律保障等方面来完善事业单位改革政策.     

城市社区老年群体就医行为影响因素分析

日益增长的老年人健康需求是老龄化带来的诸多挑战中的一个重要方面。新一轮医药卫生体制改革突出强调基本医疗服务供给和基层卫生服务体系建设,在缓解老年人健康压力方面有一定的积极作用。老年人在身体条件、经济能力、思想观念等方面的特点,使得其就医行为受到机构服务能力、距离、费用、就医过程等多方面因素影响。在新医改背景下,需要结合这些影响因素继续完善基层医疗服务体系,以更好地满足老年群体健康需求。     

改革开放:推进当代中国经济发展的国家战略——纪念改革开放三十周年

30年前开启的改革开放是推进当代中国经济发展的国家战略.改革开放的战略起点是突破中国发展面临的发展困境,改革开放的战略目标是以实现国家利益为归宿的发展目标的动态演进,战略途径是渐进式地探索适合中国国情的'间接路线",战略手段是多力井举提升发展效应.改革开放战略的经验在于:战略目标的制定上,坚持阶段性与长远性相统一;战略路径的选择上,坚持重点性与系统性相统一;战略手段的选择上,坚持自主性与特色性相统一.在新阶段,中国改革开放应顺应形势发展要求实现战略升级.     

中国医疗卫生体制改革的政策议程分析

公共政策议程研究是西方政策研究领域中一个新兴的研究热点。20世纪70年代以来,西方学者基于西方政治体系中的政策实践总结归纳出了政策议程的很多准入条件和模型。而中国学者在议程问题的研究上还处于萌芽阶段,基于本国实践的同类研究不仅数量稀少,而且解释的力度和系统性都欠缺。约翰·金顿（John·Kingdon）的多源流分析框架为基础对我国医疗卫生体制改革的政策议程有现实的指导意义。     

科学发展观与我国行政体制改革的深化

许多人理解科学发展观，往往注重其“依靠科学发展”方面，而忽略其“按科学规律发展”方面。更缺少对其“核心”的关注。现在我们必须全面理解“以人为本”的深刻内涵，并从其“发展为了人民，发展依靠人民，发展成果由人民共享”三个方面研究对我国行政体制改革提出的要求，找到差距，并规划出我们今后行政体制改革的基本方向。