American medical policy and the "crisis" of the welfare state: a comparative perspective

Health policy debates rarely include broad review of cross-national experiences with related social policies. This article addresses the connection between medical policy concerns and the development of welfare states in the advanced industrial democracies following the oil crisis of 1973-74. After examining the evidence about what actually occurred during the "crisis" years of the welfare state, the article relates the debates about the welfare state's crisis to American concerns about medical care in the 1980s. The distinctive American response to the fiscal strains of stagflation-more severe cuts in social spending than necessary based on the country's economic strength, threats of bankruptcy to produce small adjustments to large programs, and inability to address the problems of medical care as anything other than budgetary strain--is linked to American dissensus about the purposes of the welfare state.     

School crime policy changes: The impact of recent highly-publicized school crimes

Highly-publicized school shootings have heightened concern over school safety. This study examines the impact of school crimes on campus policy. The administrators of 336 Texas middle and high schools were surveyed. Policy changes were related to parental complaints about school crime policies and administrator perceptions that students felt less safe. School administrators should base safety policies on strategies that have been evaluated for their effectiveness in reducing school crime and fear. The authors wish to thank the anonymous reviewers for their helpful comments.     

Monitoring the uninsured: a state policy perspective

Because states have primary responsibility for the implementation of public health insurance programs, states need timely, good quality data to evaluate programs, monitor trends in the number and characteristics of the uninsured, and better understand the dynamics of health insurance coverage. This article provides a synthesis of the data sources available to states for monitoring rates of health insurance coverage. Information was collected through a comprehensive review of state and national health surveys and in-depth interviews with state analysts in all fifty states. Our findings suggest that national surveys do not meet states' needs for data, and in response, states have initiated their own household surveys. We provide information on thirty-six household surveys that are used to estimate state levels of health insurance coverage. We recommend that national and state efforts be better coordinated to facilitate efficient use of resources to achieve good state-level date.     

The political development of the Hill-Burton program: a case study in distributive policy

The Hill-Burton program offers a rare opportunity to study a distributive health policy from its adoption to its elimination. This study reveals that the political dynamics of the policy changed over time. It concludes by observing that interest group influence on distributive health policies may only be decisive when circumstances permit. Those circumstances include the involvement of powerful elected officials and the degree of consensus among policy experts about the need for the policy and the appropriateness of its objectives.     

Muslims in prison: a case study from Ohio state prisons

The present study explores core issues related to the understudied population of Muslim inmates. Mail questionnaires were sent to the full-time chaplains employed by religious services in thirty Ohio state male prisons. The survey examines: (1) characteristics of Muslim inmates, (2) patterns of identification with Islam, (3) religious behavior inside the prisons, and (4) relations between conversion to Islam and crime committed. Our findings indicate that while the vast majority of Muslim inmates are African-American, they are otherwise similar to the incarcerated population in terms of age, education, and marital status. Most of the Muslims in our sample converted while incarcerated. The devotion of Muslim prisoners in the sample tends to be high as demonstrated by adherence to central religious practices. Finally, we found no relationship between crime and conversion to Islam inside prison. Although our data must be understood as tentative, it offers a basis for further investigation of this population of inmates.     

Schizophrenia and sudden death: a medical examiner case study.

This study reviews the causes of sudden death of 66 schizophrenic patients who presented to the Office of the Chief Medical Examiner (OCME) for the State of Maryland over a 3-year period from 1994 through 1996. We identified an increased incidence of suicide compared with the general population of OCME cases. This observation is consistent with reports by other investigators. The majority of the deaths were the result of natural diseases, mostly atherosclerotic cardiovascular disease. Accidents, suicides, and 1 homicide were also present in this group.     

Regulating hospital labor costs: a case study in the politics of state rate commissions

With the advent of various attempts to control hospital costs by direct state regulation, labor input costs have become a target of particular attention. This focus is due in part to the unique discretion administrators can exercise over labor factors, and in part to the large absolute part of hospital resources devoted to labor costs, conservatively estimated to be about 55 percent of total budget. This paper examines the impact of state efforts in prospectively setting rates on collective bargaining outcomes in the hospital sector. Specifically, bargaining in New York, Maryland and Connecticut is examined. The paper concludes that government attempts at controlling costs have, in all cases, required the regulatory bodies to consciously exert influence on the collective bargaining process. Further, while such attempts seem to be within the paradigm of multilateral bargaining, there are significant distinguishing features in the role hospital regulatory bodies play in the bargaining process. These variations from the multilateral paradigm may impede the long run ability of rate review efforts to control bargaining outcomes with respect to wages.     

Collaborative school planning and active schools: a case study of Lee County, Florida

To contribute to the understanding of the links between urban planning and school siting and, ultimately, the impact of both on physical activity, we conducted a case study of Lee County, Florida. Our study examined the extent of state-mandated collaboration between the Lee County School Board and Lee County government (e.g., the Lee County Department of Planning, the Office of Smart Growth, and the Department of Parks and Recreation). Specifically, we investigated planning processes under mandated coordination between the school board and the county and the impact of such coordination on the integration of land-use planning and school facility planning. By describing the process of mandated collaborative school planning in Florida, we illustrate the promise and pitfalls of such top-down legislation and offer insights to other state and local governments looking for ways to improve local planning and to increase physical activity among children.     

The impact of public policy and publicity on admissions to state mental health hospitals

This paper examines the impact of broadened Washington state civil commitment standards on utilization of the state's mental hospitals. Included in the analysis is an assessment of the impact of a public event (a well-publicized murder case) which was in all likelihood a precursor to the law's revision. We also examine the different ways Washington's two state hospitals managed the dramatic increase in civilly committed patients that occurred after the revision took effect. The findings indicate that the murder case, in which the defendant had been denied voluntary admission to a state hospital prior to the killing, resulted in an increase in involuntary admissions in the county where it occurred a full year before the standards were revised. The law itself had the effect of increasing commitments throughout the state, reducing the levels of voluntary admissions, and increasing the likelihood of involuntary admission for individuals previously admitted voluntarily, thus transforming a principally voluntary system into one which was primarily involuntary. Finally, it was found that the increased demand for services mandated by the broadened commitment standards was managed differently in the two state hospitals: one imposed a cap on admissions; the other phased out voluntary admissions at a rate roughly equal to the increase in commitments. These findings illustrate both the substantive impact of broadened civil commitment law and the importance, when assessing the impact of laws, of examining public events and administrative interventions which may have significant causal links with legal interventions.     

The impact of foreign and state ownership on post-transition industrial concentration: the case of Polish manufacturing

This paper reports an analysis of the determinants of the level and changes in Polish industrial concentration in the early post-transition era. In particular, the relative effects of foreign and state ownership are examined. The empirical evidence is based on a panel of 144 Polish manufacturing industries over the period 1989–1993. The results suggest that both state and foreign ownership have a significant impact on industry concentration and this relationship is U-shaped. Minimum efficient scale is found to be the only other factor to impact on industry concentration.     

The determinants of health policy, a case study: regulating safety and health at the workplace in Sweden

This article analyzes and criticizes the " technocratic " view of occupational health and safety policies, which sees the values of the personnel in "post-industrial" regulatory agencies as the most important determinant of those policies. It takes an alternate position, which explains occupational health and safety policies as primarily resulting from the different degrees of political power of the two major classes (capital and labor), and from the set of influences exerted on the regulatory agencies by the instruments (e.g., parties, unions, trade organizations) of those classes. It shows how an analysis of the historical evolution of those classes in Sweden and their conflict in both civil and political societies explains Swedish occupational health and safety policies better than a mere analysis of the regulators' views. And it concludes that the occupational health and safety policies in Sweden are not identical to those in the U.S.--as the " technocratic " theorists assume--but rather offer more protection to the workers than U.S. policies do. This situation is a result of labor having more power in Sweden than it has in the U.S. The different class formations and class behavior in the two societies are compared, and the implications of this comparison for occupational health and safety policies are discussed.     

Construction of a policy arena: the case of public health in France

In this article we examine the transformation over the past two decades of public health as a policy arena in France from a backwater of little interest to politicians, bureaucrats, the media, and the public into a central preoccupation of the state. Recent dramatic health crises (the scandal over HIV-contaminated blood, mad cow disease, etc.) have substantially raised the political profile of (and corresponding state investment in) public health in France, offering opportunities and incentives for political actors not traditionally associated with public health to enter the field and challenging more traditional actors to galvanize themselves and compete for this newly attractive policy terrain. We use the occasion of the passage of a public health law in 2004, labeled by its proponents as the "first" public health law in one hundred years, to show how, in a context of national struggle to contain both risks and costs, "public health" -- chameleonlike -- has taken on various meanings and forms to serve highly conflicting political interests.     

Trickle-up report writing: The impact of a proarrest policy for domestic disturbances

This study used police reports to examine the impact of a proarrest policy change for domestic disturbances. Insofar as the new policy reflected a “get tough” approach, the policy was expected to have a “trickle-up effect”: more official attention would be given to cases stereotyped as being less serious. Seven indicators, reflecting both legal and social definitions of seriousness, were taken from systematic samples of 96 police reports before the proarrest policy and 157 incident reports after the policy went into effect. No changes in the monthly arrests and no differences in the type of cases in which arrests were made corresponded to the policy change. We found differences, however, in the kinds of cases that were written up after the policy was instituted. The changes in report writing were consistent with a trickle-up effect.