When methods meet politics: how risk adjustment became part of Medicare managed care

Health-based risk adjustment has long been touted as key to the success of competitive models of health care. Because it decreases the incentive to enroll only healthy patients in insurance plans, risk adjustment was incorporated into Medicare policy via the Balanced Budget Act of 1997. However, full implementation of risk adjustment was delayed due to clashes with the managed care industry over payment policy, concerns over perverse incentives, and problems of data burden. We review the history of risk adjustment leading up to the Balanced Budget Act and examine the controversies surrounding attempts to stop or delay its implementation during the years that followed. The article provides lessons for the future of health-based risk adjustment and possible alternatives.     

The effects of judicial admonitions on hearsay evidence

Using a simulated civil case, this experiment investigated whether mock jurors: (a) are able to disregard hearsay evidence when admonished to do so, (b) experience psychological reactance and "backfire effects" in proportion to the strength of judicial admonition instructing them to disregard hearsay evidence, and (c) are able to recognize and disregard hearsay evidence without judicial instructions. Results indicate that jurors were unable to disregard inadmissible hearsay testimony in some legal decisions regardless of whether there were judicial instructions to do so. Jurors exhibited backfire effects paying more attention to inadmissible hearsay evidence when they were strongly instructed to disregard it. More specifically, juror backfire effects were evident in both their confidence in their liability verdicts and in their punitive damage awards. The legal and policy implications of these findings are discussed.     

The Course and Psychosocial Correlates of Personality Disorder Symptoms in Adolescence: Erikson's Developmental Theory Revisited

Personality disorder symptoms were investigated in a community sample of young people (n = 714) to assess their relationship over time with well-being during adolescence and the emergence of intimacy in early adulthood. Drawing on Erikson's theory of psychosocial development, changes in adolescent well-being were conceptualized as indirect indicators of identity consolidation. Cluster B personality disorder symptoms (borderline, histrionic, and narcissistic symptoms) were conceptualized to represent identity diffusion—i.e. maladaptive personality traits that usually resolve during the identity crisis of adolescence. Latent growth models were used in 2 age cohorts to assess (1) interrelationships between Cluster B symptoms, well-being, and intimacy at mean ages 13.8 and 18.6 years; and (2) associations between their developmental trajectories over the next 6 years. As expected, higher personality disorder symptoms were associated with lower well-being during adolescence, and declines in personality disorder symptoms over time were associated with corresponding gains in well-being. Consistent with Erikson's developmental theory, there was an inverse relationship between Cluster B symptoms and intimacy that increased in strength as young people entered adulthood. As an indicator of successful identity consolidation, well-being was significantly associated with intimacy in female adolescents and young adults.     

Firing Back at the Backfire Effect: The Influence of Mortality Salience and Nullification Beliefs on Reactions to Inadmissible Evidence

Two studies were conducted to explore psychological factors that contribute to the influence of inadmissible evidence (i.e., the backfire effect) on jurors' verdicts. On the basis of hypotheses derived from terror management theory, we predicted that reminders of mortality, in contrast to an aversive control topic, should lead participants to be less punitive when confronted with inadmissible (as opposed to admissible) evidence, when participants were either situationally induced or dispositionally prone to follow their personal sense of justice. In Study 1, control participants who scored high on a measure of nullification beliefs, and thus were prone to relying on their own sense of justice rather than the law, exhibited the backfire effect. However, reminding participants of their mortality reduced the damaging influence of inadmissible evidence. Study 2 extended these findings by showing parallel effects with a manipulation of nullification proneness via judicial instructions. The implications of these factors on the judicial process are discussed.     

The Role of Incubators in the Entrepreneurial Process

We outline a model that improves our understanding of the role of incubators in the entrepreneurial process. Specifically, we focus on the impact of the services offered, namely infrastructure, coaching and networks, on the graduation rates of the respective incubators tenants. The model is tested among three different types of incubators, for-profit, non-profit, university-based incubators. Based on our qualitative findings, we conclude that our initial model is ineffective, in the sense that it cannot fully explain the role of the incubators in facilitating entrepreneurship. Interviews with directors of incubator centers were also carried out simultaneously. Further analysis of the results along with interview responses from incubator directors, led us to propose a more comprehensive model to explain how incubators affect the entrepreneurial process.     

Space Matters: Designing Better Electoral Systems for Emerging Democracies

Although the holding of founding and subsequent elections is essential for any transition from authoritarian to democratic rule, the comparative literature on electoral system design is limited on the experience of "Third Wave" democratizers. This is especially true with respect to the interactive effects between the choice of electoral system and the spatial, i.e., geographic, distribution of the vote—a critical factor that shapes electoral outcomes in all societies, but particularly in emerging democracies because many are plural and agrarian societies. Political elites in these countries have also rarely considered the impact of alternative electoral systems when selecting a system for their country. This article addresses these gaps in the literature and practice by presenting a computational model known as a spatial decision support system or SDSS that both explores these interactive effects and facilitates electoral design. The utility of the model is then demonstrated with data from Kenya and South Africa—two emerging democracies where issues posed by the spatial distribution of the vote have given rise to demands for redesigning or modifying the electoral system.