Competitive pricing and the challenge of cost control in medicare

The Medicare program faces a serious challenge: it must find ways to control costs but must do so through a system of congressional oversight that necessarily limits its choices. We look at one approach to prudent purchasing - competitive pricing - that Medicare has attempted many times and in various ways since the beginning of the program, and in all but one case unsuccessfully due to the politics of provider opposition working through Congress and the courts. We look at some related efforts to change Medicare pricing to explore when the program has been successful in making dramatic changes in how it pays for health care. A set of recommendations emerges for ways to respond to the impediments of law and politics that have obstructed change to more efficient payment methods. Except in unusual cases, competitive pricing threatens too many stakeholders in too many ways for key political actors to support it. But an unusual case may arise in the coming Medicare fiscal crisis, a crisis related in part to the prices Medicare pays. At that point, competitive pricing may look less like a problem and more like a solution coming at a time when the system badly needs one.     

OxyContin and a Regulation Deficiency of the Pharmaceutical Industry: Rethinking State-Corporate Crime

On May 10, 2007, three executives of the pharmaceutical company Purdue Pharma pled guilty in federal court to misleading doctors and patients about the risk of addiction and potential for abuse of OxyContin. Additionally, Purdue Pharma paid over $600 million in fines and other payments to the United States government and the Commonwealth of Virginia. The drug OxyContin was first introduced to the market in December of 1995. Warning signs of the drug’s potential for abuse were almost immediate, and there were reports of copious amounts of the drug being diverted into the black market for recreational use. In some cases, criminologists have argued that if the government fails to protect its citizens from the harm of a corporation then such behavior should be considered state-corporate crime. We critically evaluate the case of OxyContin to see if it falls under the state-corporate crime paradigm. Further, we argue the state-corporate crime paradigm can benefit from an increased focus on the organizational structures of regulation agencies.     

Measuring Puberty and Understanding Its Impact: A Longitudinal Study of Adolescent Twins

Pubertal development is an important focus of current biopsychosocial research. The Pubertal Development Scale or PDS (Petersen, Crockett, Richards, and Boxer, J. Youth Adolesc. (1988) 17: 117–133) has become a widely used measure in school-based and longitudinal research, because it incorporates several indices of pubertal development. This study reports normative data on the PDS for two population-based birth cohorts of Finnish twin boys and girls, assessed at ages 11–12 and 14. Additionally, we report longitudinal analyses of the associations between pubertal development and substance use, suggesting that the impact of pubertal timing is more complex than previously reported; associations commonly assumed between pubertal development and substance use held only for those whose developmental level, relative to peers, remained stable across follow-up. Finally, we report twin correlations for the PDS which suggest that sibling similarity for pubertal development arises from both shared genes and shared environments and that the patterns of these influences vary between sexes and across time.     

The recovery of latent fingermarks and DNA using a silicone-based casting material

There are many techniques available for the recovery of fingermarks at scenes of crime including the possibility of taking casts of the marks. Casts can be advantageous in cases where other destructive recovery techniques might not be suitable, such as when recovering finger marks deposited on valued or immobile items. In this research, Isomark (a silicone-based casting material) was used to recover casts of finger marks placed on a variety of substrates. Casts were enhanced using cyanoacrylate fuming. Good quality marks were successfully recovered from a range of smooth, non-porous surfaces. Recovery from semi-porous surfaces was shown to be inefficient. DNA was subsequently extracted from the casts using QIAamp Mini extraction kits, amplified and profiled. Full DNA profiles were obtained 34% of samples extracted.     

An insight into forensic document examiner expertise for discriminating between forged and disguised signatures

It has previously been shown that forensic document examiners (FDEs) have expertise in providing opinions about whether questioned signatures are genuine or simulated. This study extends the exploration of FDE expertise by evaluating the performance of eight FDEs and 12 control subjects at identifying signatures as either forgeries or the disguised writing of a specimen provider. Subject eye movements and response times were recorded with a Tobii 1750 eye tracker during the signature evaluations. Using a penalty scoring system, FDEs performed significantly better than control subjects (t = 2.465, p = 0.024), with one FDE able to correctly call 13 of the 16 test stimuli (and three inconclusive calls). An analysis of eye movement search patterns by the subjects indicated that a very similar search strategy was employed by both groups, suggesting that visual inspection of signatures is mediated by a bottom up search strategy. However, FDEs spent greater than 50% longer to make a decision than the control group. The findings are suggestive that for some stimuli FDEs can discriminate between forgeries and disguises, and that this ability is due to a careful inspection and consideration of multiple features within a signature.     

Punctuated Equilibrium in Comparative Perspective

We explore the impact of institutional design on the distribution of changes in outputs of governmental processes in the United States, Belgium, and Denmark. Using comprehensive indicators of governmental actions over several decades, we show that in each country the level of institutional friction increases as we look at processes further along the policy cycle. Assessing multiple policymaking institutions in each country allows us to control for the nature of the policy inputs, as all the institutions we consider cover the full range of social and political issues in the country. We find that all distributions exhibit high kurtosis values, significantly higher than the Normal distribution which would be expected if changes in government attention and activities were proportionate to changes in social inputs. Further, in each country, those institutions that impose higher decision-making costs show progressively higher kurtosis values. The results suggest general patterns that we hypothesize to be related to boundedly rational behavior in a complex social environment.     

Longevity Ancient and Modern

The article examines illustrations from ancient and modern societies to consider the connections between power, social elites and knowledge of techniques to promote longevity. In pre-modern societies, knowledge of practices and substances to promote longevity were cultivated by elites such as the Chinese imperial court. In modern societies, new technologies—cryonics, cloning, stem-cell applications and nanotechnology—will offer exclusive and expensive methods for prolonging life for the rich. However one important difference between the ancient and modern world is that with secularization longevity is no longer connected with a moral life; longevity is not a reward for sanctity. We have democratized the ambition for long life but not necessarily its realization. The modern quest for longevity appears to be connected with the desire of Baby Boomer generations to hold on to their assets, but while modern medicine may help us to survive forever, it cannot tell us how to live forever.

Does Anthropology Still Exist?

In response to Roger Sandall’s critical analysis, the problematic notion of culture in modern anthropology is examined in terms of cultural resistance to globalization. The example of McDonaldization is taken to be a potent instance of cultural globalization. Three conditions for successful cultural resistance to cultural standardization are proposed. The first is cultural in the shape of a strong aesthetic tradition of (national) resistance. This dimension involves some degree of cultural conservatism. The second condition is political, namely a viable and robust civil society that provides the basis for decisive (cultural) leadership. The third element is the involvement of the state in policies that promote and sustain a national heritage. Without this state involvement, global market conditions will largely shape the erosion of local and national cultures. Without a political response to cultural globalization, global market commodities will in all likelihood oust local goods and services. Those societies that lack both a strong aesthetic and an effective political leadership can offer little effective resistance to negative globalization and their local traditions are quickly destroyed. This argument is then examined in terms of a number of societies especially Turkey, China and Japan where the erosion of national cultures is proceeding rapidly. These critical assertions against global standardization require a strong first-order notion of culture which modern anthropology appears to be unable or unwilling to provide.

The role of authentic leadership on healthcare Street-Level Bureaucrats’ well-being during the pandemic

This study uses Conservation of Resources Theory, to explain Street-Level Bureaucrats’ (SLBs) workplace behavioural responses to threats to their well-being. We examine whether authentic leadership within street-level organisations positively impacts employee well-being by increasing SLBs’ perception of personal resources, and reducing their perceptions of work harassment. The research design comprises a survey that solicited quantitative and qualitative data from 163 healthcare SLBs working in Australian hospitals during the pandemic in April 2020. Analysis of the means indicates low levels of satisfaction with leadership and low levels of well-being for SLBs. The structural equation modelling findings show that poor leadership is associated with higher levels of work harassment and lower levels of employee well-being. Qualitative data support these findings. As healthcare workers were already listed as over-represented in the stress-related workers compensation statistics, one strategy may be to improve the level of organisational support by upskilling managers in authentic leadership behaviours with the aim of increasing their perception of support so as to increase employee well-being. This will benefit employees and their families, and the community they service.

Points for practitioners

• Street-Level Bureaucrats (SLBs) have been increasingly experiencing the public sector gap (demand outstripping supply of resources) because of the dominance of the austerity-driven managerialist paradigm.
• The recent COVID-19 crisis amplified the severity and impact of the public sector gap causing increased perceptions of work harassment and reductions in SLBs’ well-being.
• However, SLBs with high levels of Psychological Capital had a natural buffer in place to protect their well-being, and as such, they perceived less work harassment and erosion of their well-being.
• The way forward is to complement the austerity-driven managerialist paradigm in management decision-making with authentic leadership behaviours focused on maximising the well-being of SLBs and the public.