Repealing Federal Oversight of State Health Policy: Lessons from the Boren Amendment

The Boren Amendment is frequently cited as an example where judicial involvement markedly shaped the implementation of federal legislation. Unlike other controversial health policies, Boren was eventually rescinded by Congress. Results indicate that the Amendment was repealed because changing socioeconomic, political, and programmatic conditions combined with policy‐oriented learning to facilitate a shift in policy venue away from the judiciary toward the President and Congress. This is because during the devolutionary climate of the mid‐to‐late 1990s, both the executive and legislature proved more conducive to the policy image promulgated by state officials that the Amendment unnecessarily restricted state discretion, than the policy image promulgated by providers that without the Amendment, low reimbursement levels would compromise access and quality. Data for this analysis derive from archival documents, secondary sources, and 101 interviews with state and federal experts.     

Collaborative Governance in the Reform of Western Australia's Alcohol and Other Drug Sector

Collaborative governance involves processes and structures for policy development and decision making with particular relevance for health and social services. We examined collaborative governance in the reform of Western Australia's alcohol and other drug sector, applying Emerson et al.'s (2012) integrative framework. A documentary review and group interviews with government, sector, and consumer representatives were involved. Contextual factors included increased service funding, and the development of a partnership approach. Drivers for collaboration involved leadership and financial incentives for policy implementation. Key stakeholders across government and the sector reported a mutually supportive and constructive relationship and increased capacity, and they shared an agenda for change. The integrative framework was a useful structure for the explication of collaborative governance, although financial arrangements were not addressed.     

Reinventing the Governance of Public Finances in Remote Indigenous Australia

The economies of remote Indigenous settlements are dominated by public finances. The current system of governing public finance is highly saturated, fragmented and centralised, and this has a corrosive effect on local governance capability. The political accountability of leaders to their constituents is weakened in favour of an administrative accountability ‘upwards’ to higher authorities. New Public Management reforms have promoted administrative deconcentration, over political devolution, and this has been accompanied by an influx of public servants, Non‐Government Organisations (NGOs) and private contractors, and a decline in Indigenous organisations and local government. The end result in many settlements is a marked disengagement of Indigenous people in their own governance. There is evidence of considerable political capabilities existing within local government electorates. Decentralised financing arrangements can be used to catalyse these capabilities and then address deficits in administrative and technical performance.     

Upset over Air Pollution: Analyzing Upset Event Emissions at Petroleum Refineries

The Clean Air Act (CAA) controls routine emissions at petroleum refineries, by creating limits and penalties for excess emissions. The CAA offers provisions for upset events, air emissions released because of unforeseen or unavoidable circumstances, if companies report the emissions and take corrective action. States enforce upset event rules and many states provide exemptions for a variety of circumstances, which may allow upset emissions to become a substantial, yet mostly unregulated source of emissions. We catalog the quantity and type of emissions generated during upset events at 18 Texas petroleum refineries from 2003 to 2008. We find that upset events occur frequently at these facilities and are collectively large in magnitude, emitting a combined total of 75 million lbs of emissions. In a select number of cases, single upset events exceeded annual emissions reported to the Toxics Release Inventory. Future research should assess the accuracy of upset event reporting and impact of upset events on environmental health.     

Contracting for Indigenous Health Care: Towards Mutual Accountability

In Australia and other industrialised countries, governments contract with the non‐government sector for the provision of primary health care to indigenous peoples. Australian governments have developed policies and funding programs to support this health sector, but the current arrangements are unduly complex and fragmented. The results of our study show that the complex contractual environment for Aboriginal Community‐Controlled Health Services (ACCHSs) and their funders is an unintended but inevitable result of a quasi‐classical approach to contracts applied by multiple funders. The analysis in this article highlights potential policy and program changes that could improve the effectiveness of funding and accountability arrangements, based on the use of an alliance contracting model, better performance indicators and greater clarity in the relative roles of national and jurisdictional governments.