The effect of state regulations on the quality and sale of insurance policies to Medicare beneficiaries

This paper examines the effects of state regulations on the quality of insurance policies sold to Medicare beneficiaries and on the amount of sales abuse reported in the sale of such policies. State regulations regarding such policies relate to policy content and format, minimum rates of return, sale of these policies related to disclosure requirements, consumer information activities, and penalties for agent and company abuse. This paper examines the impact of specific regulations on the ratio of the expected policy benefits per premium dollars and on the number and kind of abusive sales practices reported by purchasers and nonpurchasers in agent and mail sales. The study finds that loss ratio floors, minimum benefit standards, and the development of states of consumer information guides for prospective policyholders have a positive impact on the quality of the policies purchased. In addition, the study finds that the amount of abuse reported is less when insurance companies routinely issue press releases concerning agent or company misrepresentation and when consumer guides are developed and available from the state.     

Choosing Healthplans All Together: a deliberative exercise for allocating limited health care resources

CHAT (Choosing Healthplans All Together) is an exercise in participatory decision making designed to engage the public in health care priority setting. Participants work individually and then in groups to distribute a limited number of pegs on a board as they select from a wide range of insurance options. Randomly distributed health events illustrate the consequences of insurance choices. In 1999-2000, the authors conducted fifty sessions of CHAT involving 592 residents of North Carolina. The exercise was rated highly regarding ease of use, informativeness, and enjoyment. Participants found the information believable and complete, thought the group decision-making process was fair, and were willing to abide by group decisions. CHAT holds promise as a tool to foster group deliberation, generate collective choices, and incorporate the preferences and values of consumers into allocation decisions. It can serve to inform and stimulate public dialogue about limited health care resources.     

Live Bureaucrats and Dead Public Servants: How People in Government Are Discussed on the Floor of the House

This article examines how members of Congress refer to individuals in government on the House floor. Using content analysis, floor speeches from the 103rd and 104th Congresses were examined to determine the way in which terms such as "bureaucrats" and "public servants" were manipulated in floor speeches, and the political gain members seek to achieve from these moves. The data show that the Republican takeover of Congress led to a marked change in the tone of debate, and a sharp increase in pejorative discussions of individuals in government. Republicans tended to use bureaucrats in legislative debate in their efforts to shape the debate over the size and role of government.     

The Human Dimensions of Pollution Policy Implementation: Air quality in rural China

The People's Republic of China is experiencing severe air pollution with very serious public health and economic consequences. Over the past decade, the Chinese government has sought to utilize bureaucratic, political, legal and educational vehicles to address these problems. This paper examines the ways in which those policy measures have been communicated to, understood by, and acted upon by the citizenry, drawing in important part on household and epidemiological surveys conducted in Anhui. Our study suggests that the central government's message has yet to be absorbed to the degree intended and then considers both why this has been the case and how the effectiveness of policy mechanisms might be enhanced.