公众参与理念在美国土地规划票决中的实践及启示

美国的投票式分区管制将票决制度运用于土地规划,是一种最强程度的公众参与。实践表明,土地规划领域有适用票决制度的必要,票决制度体现的公众参与特征包括决策者与参与者之间的双向沟通关系,决策结果对公众参与具有高度的依赖性。在信息公开制度健全、议题限制、平等保护审查等条件下,居民投票不会沦为"愚众政治",与专业机构判断的对立也会缓解,而且也不会"压迫少数人的意见"。我国应在涉及健康、生命安全的公共项目选址决策中引入票决制度,并同时完善信息公开配套机制,以及加强对居民投票决策不违反公益要求的程序管控。     

Convergence Criteria for Participation in the Flexible Mechanisms of the Kyoto Protocol

We suggest a multi-layered system of three convergence criteria – similar to those used in the run-up to the European monetary union – that define the notion of "demonstrable progress" towards reaching the emission commitments under the Kyoto Protocol. These are the existence of an independently evaluated national emissions inventory, the level of domestic policies and measures, and the quantitative convergence of emissions towards the Kyoto target. While the first of these criteria constitutes a necessary condition for use of the Kyoto Mechanisms, the other two should determine the degree of participation allowed for any given Annex I country.     

HMO promotion and the privatization of health care in Chile

Since 1973 the Chilean junta has privatized sectors of the national economy. This paper analyzes the country's policy process of promoting private medical programs through HMO-like plans (ISAPREs, or Institutes of Provisional Health). These plans have captured less than half of their originally anticipated market share. It is argued that the future performance of ISAPREs will be undermined by their limited maternal benefits, their targeting to a small upper-income group which cannot sustain many private medical programs, and competition with less expensive yet equally competent public medical programs. The paper briefly compares privatization in Chile with the experiences of other countries, and specifically contrasts the restructuring of health services under military rule in Chile with those of Argentina and Uruguay. The paper concludes that the Chilean experience with HMOs epitomizes the perils of planning health care during short-term periods of economic prosperity as well as failing to consult medical care providers and consumers.     

National planning for locally controlled health systems: the Finnish experience

The World Health Organization considers Finland's health planning system to be among the most successful in the developed world. Despite tight resource constraints--symbolized by total health expenditures held consistently to less than 7 percent of gross domestic product--the Finns have built up a strong primary care sector and dramatically improved the overall availability and accessibility of needed services. This article compares the official health planning system with the actual planning process as experienced within one Finnish central hospital district. The official planning system seeks to integrate national strategic goals with local municipal ownership, administration, and funding of service delivery. The actual planning process within the studied district suggests that technically oriented civil servants at the regional level may be at least as important in the overall decisionmaking structure. The article concludes with a brief exploration of this finding's potential consequences for the long-term development of the Finnish health care system and for national health planning efforts generally.     

Physicians' decisions to limit Medicaid participation: determinants and policy implications

Although most primary care physicians participate in state Medicaid programs, they may accept all Medicaid patients, or they may choose to limit their participation. This decision allows physicians to adjust their Medicaid caseloads to a desired level, and it has important implications for the access of low-income patients to health care. Surveys of pediatricians in 1978 and 1983 indicate that the proportion of pediatricians limiting their Medicaid participation increased significantly from 26 percent to 35 percent (p less than .001). In addition, in both 1978 and 1983, limited participants saw significantly fewer Medicaid patients than full participants. This paper describes a number of strategies available to federal and state policymakers for fostering full Medicaid participation. Multivariate analyses indicate that increasing reimbursement levels is an important strategy for encouraging full Medicaid participation. In addition, full participants will increase their Medicaid caseloads in response to a variety of Medicaid policy incentives, while limited participants are found to respond to fewer policy incentives. The authors conclude that caution will be needed to ensure that health care cost-containment strategies such as capitation or selective contracting do not inadvertently discourage participation among both full and limited Medicaid participants.     

The politics of health care regulation: the case of the National Health Planning and Resources Development Act

This paper examines the political and bureautic dynamics of health regulation under the National Health Planning and Resources Development Act and, to a lesser extent, the Carter Cost Proposal now before Congress. A number of underlying issues that affect the day-to-day exercise of health planning are considered, including the contest between state and local and federal government for program control, jurisdictional conflict between state and local planning agencies, and the unsettled roles to be played by professional planners, consumers, and providers. When we assess regulatory policy in health, these complicating factors must be added to the long list of handicaps that already exist. One important finding is that local planning agencies have embraced the task of health regulation somewhat more fully than had generally been expected. A number of explanations for this are offered. In short, the controlling factors in health planning are political, not technical, and there is more occurring at the state and local levels than many had predicted, although any impact is not likely to be dramatic.     

What determines public health expenditures in Pakistan? Role of income, urbanization and unemployment

What determines public health care expenditures at the national level is an important policy question. Since the pioneering work of Newhouse (J Hum Resour 12(1):115–125, 1977) on the relationship between health expenditures and national income, this area of economic inquiry has received much attention. This paper seeks an answer to this question by estimating the factors affecting public health expenditures at the national level in Pakistan. This paper uses annual time series data from 1972 to 2009 and employing unit root and Johansen cointegration methods estimated the determinants of public health expenditures. It is estimated that all variables are integrated of order one and are cointegrated hence in a long run relationship. The income elasticity of public health care expenditures is estimated below unity (at 0.26) indicating health care is a necessity in Pakistan contrary to most of the industrialized countries. Furthermore, it is imperative that government have a larger role in allocating and directing public resources to health care in Pakistan. Urbanization and unemployment variables have elasticity values of ?1.33 and ?0.37 respectively, implying that it is costly to provide health care to residents of remote rural areas of Pakistan.     

American health policy: cracks in the foundation

Much American health policy over the past thirty-five years has focused on reducing the additional health care that is consumed when a person becomes insured, that is, reducing moral hazard. According to conventional theory, all of moral hazard represents a welfare loss to society because its cost exceeds its value. Empirical support for this theory has been provided by the RAND Health Insurance Experiment, which found that moral hazard--even moral hazard in the form of effective and appropriate hospital procedures--could be reduced substantially using cost-sharing policies with little or no measurable effect on health. This article critically analyzes these two cornerstones of American health policy. It holds that a large portion of moral hazard actually represents health care that ill consumers would not otherwise have access to without the income that is transferred to them through insurance. This portion of moral hazard is efficient and generates a welfare gain. Further, it holds that the RAND experiment's finding (that health care could be reduced substantially with little or no effect on health) may actually be caused by the large number of participants who voluntarily dropped out of the cost-sharing arms of the experiment. Indeed, almost all of the reduction in hospital use in the cost-sharing plans could be attributed to this voluntary attrition. If so, the RAND finding that cost sharing could reduce health care utilization, especially utilization in the form of effective and appropriate hospital procedures, with no appreciable effect on health is spurious. The article concludes by observing that the preoccupation with moral hazard is misplaced and has worked to obscure policies that would better reduce health care expenditures. It has also led us away from policies that would extend insurance coverage to the uninsured.     

Charter rights & health care funding: a typology of Canadian health rights litigation

Canadian health consumers have increasingly relied on the Charter of Rights and Freedoms to demand certain therapies and reasonably timely access to care. Organizing these cases into a 5-part typology, we examine how a rights-based discourse affects allocation of health care resources. First, successful Charter challenges can, in theory, lead to courts granting and enforcing positive rights to therapies or to timely care. Second, courts may grant a right to certain health services; however, subsequently government fails to deliver on this right. Third, successful litigation may create negative rights, i.e. rights to access care or private health insurance without government interference. Fourth, consumers can fail in their legal pursuit of a right but galvanize public support in the process, ultimately effecting the desired policy changes. Lastly, a failed lawsuit can stifle an entire advocacy campaign for the sought-after therapies. The typology illustrates the need to examine both legal and policy outcomes of health right litigation. This broader analysis reveals that the pursuit of health rights seems to have caused largely a regressive rather than progressive impact on Canadian Medicare.     

Special report on reimbursement. The safe harbor for small investment interests: where do joint ventures go from here?

There is no specific federal self-referral legislation presently proposed or in effect that statutorily prohibits providers from referring Medicare or other patients to entities in which the referrers have an investment interest, except for existing "Stark" legislation, which applies only to clinical laboratory services, effective January 1, 1992. (See Newsletter, Vol. 6, No. 1, January 1991, at 3.) Thus, health care joint ventures are not per se illegal. The publication of the Safe Harbor Regulations does nothing to change this fundamental fact, and it should not cause providers to abandon existing joint ventures, or planned ones, in a "knee-jerk" fashion, without careful analysis. Of course, there is no guarantee that expanded "Stark" legislation, or some other new self-referral legislation, will not be enacted in the future to prohibit providers from referring patients to entities in which they have an investment interest. Because of this uncertainty, all health care joint ventures should contain "unwinding" provisions to govern the rights and obligations of investors in the event that the venture is required to, or the participants voluntarily elect to, dissolve. Any new venture being contemplated should plan for dissolution, and existing ventures should undertake an internal review of their charter documents to assess whether the rights and duties of all participants upon dissolution are properly spelled out. If not, amendments should be made now, while all participants are on good terms. A failure to agree in advance upon such important issues is an invitation to discord, and possibly even litigation.     

R&;D productivity and the organization of cluster policy: an empirical evaluation of the Industrial Cluster Project in Japan

Industrial clusters have attracted increasing attention as important locations of innovation. Therefore, several countries have started promotion policies for industrial clusters. However, there are few empirical studies on cluster policies. This paper examines the effects of the “Industrial Cluster Project” (ICP) in Japan on the R&D productivity of participants, using a unique dataset of 229 small firms, and discusses the conditions necessary for the effective organization of cluster policies. Different from former policy approaches, the ICP aims at building collaborative networks between universities and industries and supports the autonomous development of existing regional industries without direct intervention in the clustering process. Thus far, the ICP is similar to indirect support systems adopted by successful European clusters. Our estimation results suggest that participation in the cluster project alone does not affect R&D productivity. Moreover, research collaboration with a partner in the same cluster region decreases R&D productivity both in terms of the quantity and quality of patents. Therefore, in order to improve the R&D efficiency of local firms, it is also important to construct wide-range collaborative networks within and beyond the clusters, although most clusters focus on the network at a narrowly defined local level. However, cluster participants apply for more patents than others without reducing patent quality when they collaborate with national universities in the same cluster region.     

中国与欧洲公众环境参与权的比较研究

公众参与权的保障与实现程度直接关系着民主决策的科学性和有效性,关系着全面建设社会主义现代化国家的进程。针对环境问题而言,如何从法律理论与实践两个层面更有效地回应公众的“参与权”,值得深入研究。相较而言,欧洲的相关法律制度走在世界前列,从纵向发展的视角来看,中国和欧洲在保障公众环境参与权的进程以及所面临的挑战方面有着相似之处,欧洲经验对我国有着极其重要的借鉴作用。中国和欧洲公众环境参与权有着不同的理论基础、历史发展进程、参与范围、参与层次、参与阶段以及支持者。基于这些相似性和不同点,立足于中国的具体国情和实际,欧洲公众环境参与权保障法律机制能为我国解决类似挑战提供一些可能路径。     

HMOs for Medicaid: the road to financial independence is often poorly paved.

During the 1980s both the federal government and the private sector articulated policies to encourage the development and participation of health maintenance organizations (HMOs) in the Medicaid program. However, the policies, intended to save costs, limited the ability of new HMOs to achieve financial independence. New plans that emphasize Medicaid participation have few, if any, options on benefit design or in setting capitation rates. Relative to fee-for-service Medicaid programs, their costs to provide services may be quite high, as they have neither the buying power not the ability to impose discounts. As a consequence, plans must focus their financial planning efforts on targeting and attaining a stable enrollment base and on controlling the amount of services provided, tasks that are difficult for all HMOs. Achieving a stable enrollment base is particularly hard because Medicaid eligibles have few incentives to enroll and once enrolled often lose their Medicaid eligibility. Traditional HMOs control the amount of services provided through physician selection, financial incentives on physicians, and monitoring and utilization review. Lack of information and the difficulty inherent in attracting sufficient provider participation limit the first two strategies, so new plans often adopt organization structures that rely heavily on monitoring activities. Unfortunately, management information systems for HMOs are often the weakest link. We discuss the tasks and present data on financial planning, on putting financial plans into operation, and on monitoring progress toward financial independence for a set of ten demonstration projects sponsored by the Robert Wood Johnson Foundation.     

The Health Care Quality Improvement Act of 1986: its history, provisions, applications and implications

Congress granted qualified immunity from liability for peer review participation to physicians, osteopaths and dentists, created a national practitioner data bank to track inept, incompetent or unprofessional physicians, and enacted procedural rules for due process, privilege restrictions, and reporting and disbursement of information. The Health Care Quality Improvement Act of 1986 is now in full force, and peer review participants are anxious to cloak themselves with immunity from actions brought by health care professionals. Although its goals are worthy, HCQIA's effects remain to be seen. Serious loopholes appear to exist, warranting close monitoring and possibly early amendment of the Act. Cautious judicial assessment is needed, in order to prevent not only circumvention of the Act's requirements by artful litigants, but also use of the national data bank by health care entities as a pretext for denying privileges and escaping antitrust liability.     

论我国目前公众参与的制度空间——以城市规划听证会为对象的粗略分析

听证会作为一种制度近来正不断被涉及城市规划过程的各类立法所采用。听证会作为一种行政机关听取意见的方式、同时也成为公众参与行政过程的一种保障装置。本文通过对现行的城市规划听证会的内涵、参与者及其基础以及适用范围的粗略分析,归纳出"听取-参与"、"技术-利益"和"法定-裁量"等决定该听证会实际作用的基本关系。     

公共卫生事件风险沟通中社会信任问题研究

在风险社会中,有针对性地进行风险沟通已成为应对风险不确定性的有效手段.随着我国经济的迅速发展,具有"脱域"特质的陌生人社会逐步形成,且移动智能终端进一步普及使得生活场景向虚拟化趋势发展,社会生活现状的改变对风险沟通提出了新要求.应从风险治理、立法完善、专家系统以及公众参与等方面着手完善公共卫生事件风险沟通中的社会信任机...     

Origins of the "Third psychiatric revolution": the Community Mental Health Centers Act of 1963

In recent decades the community mental health movement has achieved a dramatic reduction in the census of state and county mental hospitals in the United States, and hundreds of federally-funded community mental health centers have been established nationwide. At the same time, national controversy has arisen in response to what in places has seemed the haphazard process of implementing "deinstitutionalization" and the fate of many chronically mentally ill persons who are without needed social services and psychological care. Despite the widespread attention that this contemporary program has received, theoretical analysis of the complex social, scientific, intellectual, and political origins of America's community mental health policy remains deficient. This article examines the background and development of the Community Mental Health Centers Act of 1963, tracing how an important shift in national policy toward the mentally ill grew out of changing perceptions--among policymakers, professional groups, and the general citizenry in the post-World War II era--of the nature of the problem of mental illness.     

中国犯罪参与体系的性质及其特色——一个比较法的分析

世界各国刑法关于犯罪参与体系的立法存在着“区分制”与“单一制”的对立。区别两种犯罪参与体系的关键在于立法上是否将参与人区分为正犯与狭义的共犯两种不同的犯罪类型。因区分制具有能够深入地揭示现实生活中所存在的纷繁芜杂的共犯分工现象，适合于构筑“构成要件为中心”的法治国的刑法基础以及能够合理地限定共犯的处罚范围等诸多优点，在制度的层面上更具妥当性。在解释论上，中国的犯罪参与体系的性质可归结为区分制。不同于德、日刑法对参与人类型与参与人程度进行单层次操作的区分制模式，中国刑法采取的是区分参与人类型与参与人程度的双层次操作的模式，即在以分工为标准将参与人区分为正犯、组织犯、教唆犯、帮助犯等不同犯罪类型的基础上，进一步地以作用为标准对参与人作了主、从犯之分。两种分类方法并存不悖，且功能各异。     

Prospects for health impact assessment in the United States: new and improved environmental impact assessment or something different?

Health impact assessment (HIA) has been advanced as a means of bringing potential health impacts to the attention of policy makers, particularly in sectors where health impacts may not otherwise be considered. This article examines lessons for HIA in the United States from the related and relatively well-developed field of environmental impact assessment (EIA). We reviewed the EIA literature and conducted twenty phone interviews with EIA professionals. Successes of EIA cited by respondents included integration of environmental goals into decision making, improved planning, and greater transparency and public involvement. Reported shortcomings included the length and complexity of EIA documents, limited and adversarial public participation, and an emphasis on procedure over substance. Presently, EIAs consider few, if any, health outcomes. Respondents differed on the prospects for HIA. Most agreed that HIA could contribute to EIA in several areas, including assessment of cumulative impacts and impacts to environmental justice. Reasons given for not incorporating HIA into EIA were uncertainties about interpreting estimated health impacts, that EIA documents would become even longer and more complicated, and that HIA would gain little from the procedural and legal emphasis in EIA. We conclude that for HIA to advance, whether as part of or separate from EIA, well-formulated methodologies need to be developed and tested in real-world situations. When possible, HIA should build on the methods that have been utilized successfully in EIA. The most fruitful avenue is demonstration projects that test, refine, and demonstrate different methods and models to maximize their utility and acceptance.