Any-Willing-Provider laws: their financial effect on HMOs

Any-Willing-Provider (AWP) legislation requires that health plans accept any health care provider who agrees to conform to the plan's conditions, terms, and reimbursement rates. Many states have adopted such legislation, raising questions about its effect on the managed care market. Those favoring this legislation argue that it will reduce restrictions on choice of provider, while opponents argue that it will reduce competition by increasing administrative and medical costs for managed care plans. Using cross-sectional time-series data for the period 1992-1995 (the period during which many of these laws were enacted), this study investigates the effect that these laws have on HMO financial performance. Our results show that "all-provider" AWP laws have a very limited effect on the financial performance measures we examine. "Pharmacy" AWP laws have a more significant effect, but neither type of law appears to affect the overall profitability of HMOs.     

Grassroots support organisations in Peru

Private developmental organisations have emerged rapidly and forcefully in Peru, amid a turbulent national context of change and acute social and economic instability over the last two decades. While no official statistics exist on the number of such organisations (there is no single entity that oversees or registers their activity), independent studies and surveys indicate that almost 350 groups, of diverse objectives and coverage, are currently operating throughout the country. The forces and influences that have shaped this sector are complex, and this article does not attempt to address each individually. Rather, it focuses on those deemed most relevant: the factors that have left their mark on the sector of private development institutions as a whole.     

Policy‐making and administrative discretion: The case of immigration in Canada

Abstract: Decisions in complex and controversial policy areas are often left to civil servants. As a result, civil servants use their discretionary power to make decisions that will likely have important consequences for society. This is the case with immigration. Partially based on interviews conducted with Canadian and Quebecois immigration agents, the authors note that the use of the judgement of civil servants is an important factor in the selection process of newcomers. The authors recognize also that discretion can take different forms: procedural discretion, selection grid discretion, and final decision discretion. This case study enables a better understanding of both the use of judgement in the decision‐making process and the role of street‐level civil servants in the policy implementation process. Sommaire: Les décisions se rapportant à des domaines de politiques complexes et prêtant à controverse sont souvent laissées aux mains des fondionnaires. Ainsi, les fonctionnaires usent de leur pouvoir discrétiormaire pour prendre des décisions qui auront vraisemblablement des conséquences importantes pour la sociéte. C'est précisément le cas de l'immigration. Se fondant partiellement sur des entrevues effectuées par des agents d'immigration canadiens et québécois, les auteurs remarquent que dans le processus de sélection des nouveaux arrivants, le jugement de ces agents est un facteur important. Les auteurs reconnaissent également que la discrétion peut prendre différentes formes: la discrétion procédurale, la discrétion relative à la grille de sélection et la discrétion en matière de décision définitive. La présente étude de cas permet de mieux comprendre à la fois le recours au jugement dans le processus décisionnel et le rôle des fonctionnaires de la base dans le processus de mise en æeuvre des politiques.     

Is there empirical evidence of a David E. carkut trend towards “managerialism”? A longitudinal study of six countries

Abstract: In the past decade, there has been a considerable amount written about the development of “managerialism” and the “new public management” (NPM) in the Western, primarily Westminster-type, democracies. There has even been some concern expressed that the trend towards managerialism, with its lack of emphasis on the acquisition of technical competence, may be undermining policy capacity and the career public service itself. This paper addresses the question of whether there has been a trend towards managerialism over time. Specifically, this paper looks at whether changes in three objective measures of “managerialism” - mobility, education, and management type - indicate a shift towards managerialism in the senior levels of selected departments in Australia, Britain, Canada, New Zealand, the United States and Mauritius, during the period between 1971 and 1991. There is little evidence of such a trend. There has been, however, a slight shift in the “management type” of senior bureaucrats towards administrative rather than towards technical expertise and an increase in the number of administratively managed departments. If there is a large scale shift towards managerialism, it must be manifested in improved management skills on the part of technical managers or in improved technical knowledge and skills on the part of administrative managers. Sommaire: Au cours de la dernière décennie, de nombreux auteurs ont examiné la montée du nouveau management public et des préoccupations de gestion dans les démocracies occidentales, surtout celles du type Westminster. Certains se sont dit inquiétés par la possibilité que cette tendance, qui met moins l'accent sur l'acquisition de compétences techniques, risque de miner la capacité de formuler des politiques et la Fonction publique de carrière. Dans cet article, on se demande si effectivement cette tendance s'est matérialisée au fil des années. Plus précisément, on y examine si l'évolution des trois mesures objectives du nouveau management public que sont la mobilité, la formation et le type de gestion, indique un changementaux niveaux supérieurs de certains ministères choisis, de 1971 à 1991, dans les pays suivants: Australie, Grande-Bretagne, Canada, Nouvelle-Zélande, États-Unis et l'lle Maurice. Selon l'auteur, une telle tendance ne semble pas avoir eu lieu. Cependant, il y a eu un léger glissement du «type de gestionnaire» supérieur vers la compétence administrative plutôt que technique, ainsi qu'une augmentation du nombre de ministères gérés suivant les principes du nouveau management public. Un déplacement massif vers ce dernier doit se manifester soit par de meilleures capacités de management chez les gestionnaires techniques, soit par de meilleures connaissances et aptitudes techniques chez les gestionnaires administratifs.