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.     

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.     

Climate Adaptation in Canada: Governing a Complex Policy Regime

Climate adaptation is a complex policy area, in which knowledge, authority, and resources are fragmented among numerous public agencies, multiple levels of government, and a wide range of nongovernmental actors. Mobilizing and coordinating disparate public and private efforts is a key challenge in this policy domain, and this has focused research attention on the governance of adaptation, including the dynamics of interaction among interests and the institutions that facilitate collective action. This paper contributes to the study of adaptation governance by adopting the policy regimes perspective, an analytical framework designed to make sense of the loose governing arrangements surrounding complex, fragmented problems. The perspective's constructs are applied to a longitudinal case study of adaptation governance in Canada, which identifies, analyzes, and evaluates the policy ideas, institutions, and interests that comprise Canada's adaptation policy regime.     

美国对华政策对中国的启示

罗荣渠在《美国在东亚的全球战略与对华政策》一书中,对美国20世纪30年代至新中国成立这段时间对华政策进行了详细的论述,将美国对华政策分为美国绥靖政策放任日本侵华、对日宣战防止日本强大、扶持蒋介石政府防止中国加入共产主义阵营三个阶段,在对这三个阶段分析过程中得出美国对华政策的核心是追求本国利益,由于意识形态的不同,中国在经济发展过程中,应该处理好中美关系,以史为鉴,在合作中对立,在对立中合作,做到中美关系的和谐发展。     

Environmental Commitment among the States: Integrating Alternative Approaches to State Environmental Policy

This article examines variation in state commitment to protectingthe natural environment. We contribute to theoretical and empiricalresearch in this area in two primary ways. First, our dependentvariable consists of a general measure of state commitment tothe environment. Second, we develop a causal model that integratessix major explanatory approaches to state environmental policy.Our results show that stales with liberal public opinion, strongenvironmental interest groups, liberal legislatures, and professionalizedlegislatures are the most committed to environmental protection.States' manufacturing interests and economic resources playa relatively minor role, and slates' environmental conditionsand the influence of the federal government play virtually norole in explaining variation in general state commitment toenvironmental protection.     

Conceptualising the Multi-Level Party: Two Complementary Approaches

While party research has seen a number of conceptual developments in recent years, it has not kept pace with parties becoming more territorial as a result of the increasing importance of sub-national and supranational governance. This article lays down a framework for conceptualising and analysing multi-level parties (MLPs). We propose a synthesis of the formal and non-formal aspects of power; the former highlighting party rules and procedures, the latter focusing upon the ideational structures – norms and competing ideologies/discourses – within which party members operate. For empirical research on the MLP we propose to focus on autonomy and influence to measure the extent of (formal and non-formal) multi-levelness and to grasp better the strategies of regional branches vis-à-vis the centre.     

中国走向民主化：路径及现实选择

没有民主就没有社会主义,就没有社会主义现代化。发展社会主义民主政治,是我们党坚定不移、始终不渝的奋斗目标。20多年来,随着改革开放和民主政治的发展,社会主义民主已深入人心,并从抽象的民主口号、原则精神和理念走向公开的具体的制度化、法律化、程序化。以村民自治为主要内容的基层民主,成为中国民主政治的现实生长点,促进了中国政治民主化路径的探索与思考。     

Social Policy Under One Country, Two Systems: Institutional Dynamics in China and Hong Kong since 1997

Hong Kong's 1997 reversion to Chinese sovereignty brought two hitherto distinctive social policy systems into one country. As Hong Kong is gradually assimilated into China in the coming decades, the two social policy systems will need to identify elements of convergence. In this article, we argue those elements can be found in parallel efforts to curtail the reach of the state, extend the role of the market, enhance individual responsibility, and in the development of a productivist social policy orientation in both societies. The social policy systems of the two societies remain strikingly different in many ways, reflecting their diametrically opposed starting points. But their reform trajectories appear to be pointing in similar directions.     

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。     

新形势下打赢反腐正义之战的原则与路径

中国反腐败已由相持阶段转入反攻和稳固阶段。打赢反腐战既要看腐败控制的程度,又要看廉洁持续的时间长度。打赢反腐败正义之战,必须保持政治定力,坚持走中国特色反腐倡廉建设道路;必须保持"永远在路上"的心态,坚持"持久战";必须保持坚定的反腐决心,坚持"零容忍"态度不变;必须坚持全面从严治党,统筹各方力量和资源,不断提升防治腐败的科学性和有效性。     

北京防治非典型肺炎应急预案的行政学评析

为了实现对传染性非典型肺炎的可持续控制,防止今冬明春疫情反复,北京市制定了应急预案.本文从行政学的视角对该预案进行案例性质的评析,以求对其他地区、部门或系统制定和完善类似的危机管理预案,提供学理上的启发和参考.