Medical malpractice reform and insurer claims defense: unintended effects?

In response to recent and past medical malpractice insurance crises, most states have implemented reforms meant to stabilize premiums and coverage availability. The importance of understanding whether these reforms implicitly affect the behavior and incentives of plaintiffs, attorneys, medical providers, and malpractice insurers in the intended way is crucial to policy makers, if they are to achieve their goal. This study specifically examines the effect of reforms on the claims defense efforts of insurers, given that defense expenses account for approximately 30 percent of malpractice premiums. Using state data for the period 1998-2002, we regress claims defense expenses against a variety of reform variables. These include seven tort reforms (noneconomic damage caps, punitive damage limits, attorney fee limits, modified collateral source rule, modified joint and several liability doctrine, mandatory pretrial screening, and statute of limitations) and two government-sponsored insurance mechanisms (joint underwriting associations and patient compensation funds). Claims defense expenses are found to be higher in the presence of noneconomic damage caps, punitive damage limits, and attorney fee limits--an unintended and counterproductive effect of reform--but are lower with mandatory pretrial screening and patient compensation funds.     

Administrative devolution and accountability: the case of the non-profit housing program

Abstract: The problem of bureaucratic accountability has received considerable attention in the literature of public administration, but few studies have considered the extent to which extra-governmental agencies are held accountable to governments or legislatures. This paper examines administrative devolution and the problem of accountability, using the non-profit housing program as an example. It argues that devolution of programs, without adjusting for the resulting loss of bureaucratic control, leaves governments with little information about, or control over, the people who make decisions about large expenditures of public funds. It concludes that if the advantages of using the voluntary sector for social service delivery are to outweigh the problems of reduced accountability, forms of control -such as incentives for compliance and internal professional standards - which do not limit the autonomy of these groups, but which can enhance pre-audit accountability, need to be developed. Sommaire: Si le problème de la responsabilité bureaucratique a fait I'objet de nombreuses études dans les textes de I'administration publique, peu d'entre elles, en revanche, ont pris en considération la mesure dans laquelle les organismes paragouvernementaux sont tenus de rendre des comptes aux gouvernements ou législatures. Cet article examine la décentralisation administrative et les problèmes de responsabilités, en utilisant comme exemple le programme de logement à but non lucratif. Il suggere que la décentralisation des programmes, sans ajustement qui tienne compte de la perte de contrôle bureaucratique en résultant, laisse les gouvernements avec peu de renseignements ou de contrôle sur les personnes qui prennent des décisions concernant d'importantes dépenses de fonds public. En conclusion, I'auteure dit que, si les avantages résultant de I'utilisation du secteur bénévole pour fournir les services sociaux doivent I'emporter sur les problèmes de diminution de la responsabilité, il faut mettre en place certaines mesures de contrôle (tels les encouragements à se conformer à des normes professionnelles internes), qui ne restreindraient par I'autonomie de ces groupes, mais pourraient accroître la responsabilité avant le contrôle.     

Safeguarding adults and mass marketing fraud – Perspectives from the police,trading standards and the voluntary sector

Despite the growing awareness of mass marketing fraud (MMF) in the financial abuse of vulnerable older people, little empirical research has been undertaken in this area. This paper is one of the first to consider the perspectives of a range of professionals who work with victims of mass marketing fraud and financial crime. MMF is a growing threat in the financial abuse of older people, and is increasingly recognised as a concern for professionals involved in supporting and safeguarding vulnerable older people. This paper considers the themes emerging from a small exploratory qualitative study into the perspectives of professionals working to safeguard those at risk of MMF and considers some of the complexities involved in tackling MMF. This involves consideration of the techniques used to groom and lure victims in plausible looking frauds, and the factors that serve to reinforce their sustained involvement in such activity.     

Movers and stayers: mobility patterns among senior public servants in Canadian provinces

Abstract: There has developed in Canada a well‐established literature on bureaucratic elites at the federal level. There has not, however, been a systematic study of bureaucratic elites at the provincial level. While individual scholars have studied particular provincial governments, there have been few studies that covered more than one province. This paper, which analyses a census of assistant deputy ministers and deputy ministers in every Canadian province between 1988 and 1996, considers the mobility of these top two levels of the senior public service. The findings indicate that there has only been a slight decline in the number of senior public servants as governments have downsized. The findings also show that, unlike at the federal level, there is limited mobility among these senior public servants, with roughly one‐third of them changing each year. In some provinces, mobility levels increase slightly in the year after an election. Levels of mobility and changes in the number of senior public servants also vary across provinces, but there is no pattern based on the size of the province. Finally, there are important differences in the mobility depending on the type of department. In particular, in departments where there is a core knowledge or skill, mobility levels are much lower than in departments that lack such a core. These findings throw some light on the difficulties provinces may have in solving some of their more intractable policy problems. Sommaire: Il existe au Canada une bibliographie solidement implantée concernant les elites bureaucratiques au niveau fédéral. Il n'y a pas eu, par contre, d'étude systématique concernant les élites bureaucratiques au palier provincial. Des chercheurs ont analysé un gouvemement provincial à la fois mais peu d'études ont examiné plus d'une province à la fois. Dans cet article, qui analyse un recensement de sous‐ministres adjoints et de sous‐ministres dans chaque province du Canada entre 1988 et 1996, nous examinons la mobilité des ces deux niveaux supérieurs du fonctionnariat. Face aux réductions d'effectifs gouvernementaux, le déclin du nombre de hauts fonctionnaires semble avoir été léger. On constate aussi que, à l'encontre du palier fédéral, il y a une mobilité limitée chez ces derniers, environ un tiers changeant chaque année. Dans certaines provinces, le taux de mobilité augmente légèrement l'année qui suit une élection. Les taux de mobilité et l'évolution du nombre de hauts fonctionnaires varient aussi d'une province à l'autre, mais la taille de la province ne semble pas être un facteur déterminant. Enfin, il y a des écarts de mobilité importants selon le type de ministère. Notamment, les ministères exigeant des connaissances ou des aptitudes particulières ont des taux de mobilité très inférieurs à ceux des autres. Ces constatations mettent en relief les difficultés auxquelles peuvent se heurter les provinces lorsqu'elles essaient de régler certains de leurs problèmes les plus ardus en matière de politiques.     

Goal Setting and Self-Efficacy Among Delinquent, At-Risk and Not At-Risk Adolescents

Setting clear achievable goals that enhance self-efficacy and reputational status directs the energies of adolescents into socially conforming or non-conforming activities. This present study investigates the characteristics and relationships between goal setting and self-efficacy among a matched sample of 88 delinquent (18 % female), 97 at-risk (20 % female), and 95 not at-risk adolescents (20 % female). Four hypotheses related to this were tested. Findings revealed that delinquent adolescents reported fewest goals, set fewer challenging goals, had a lower commitment to their goals, and reported lower levels of academic and self-regulatory efficacy than those in the at-risk and not at-risk groups. Discriminant function analysis indicated that adolescents who reported high delinquency goals and low educational and interpersonal goals were likely to belong to the delinquent group, while adolescents who reported high educational and interpersonal goals and low delinquency goals were likely to belong to the not at-risk group. The at-risk and not at-risk groups could not be differentiated. A multinomial logistic regression also revealed that adolescents were more likely to belong to the delinquent group if they reported lower self-regulatory efficacy and lower goal commitment. These findings have important implications for the development of prevention and intervention programs, particularly for those on a trajectory to delinquency. Specifically, programs should focus on assisting adolescents to develop clear self-set achievable goals and support them through the process of attaining them, particularly if the trajectory towards delinquency is to be addressed.     

Book Notes Resumes de livres

Ann L. Griffiths,Handbook of Federal Countries, 2002. Montreal and Kingston: McGill‐Queen's University Press for the Forum of Federations, 2002. Pp. xiv, 513. Catherine Frostis a member of fnculty, Department of Political Science and Communication Studies, McMaster University.