Why Medicare cannot promulgate a national coverage rule: a case of regula mortis

For over twenty-five years, Medicare has tried to promulgate a rule to implement the broad congressional directive to pay only for items and services that are "reasonable and necessary." A rule would clarify legal authority and describe specific criteria for evaluation of new technology in Medicare. This case study is an intractable example of a larger issue of regula mortis or dead rule. Regula mortis occurs when a mobilized interest group blocks legitimate administrative agency action, causing a regulatory stalemate. In this case, the medical device industry has prevented the implementation of a rule. The article diagnoses the condition of regula mortis, explains its effects in the Medicare case, and draws on principles of administrative law to propose remedies to break the logjam. While the case of coverage criteria is important in its own right, it has wider relevance. All health systems must grapple with the challenge of evaluating new technologies. Medicare efforts provide a starting point for the policy discussion. In our current political environment, regula mortis may be an increasingly common phenomenon and the proposed cures for it broadly applicable.     

Identity orientation and stakeholder engagement—the corporatisation of elite schools

Identity orientation provides a means to understand the social motivations of organisational relationships and organisational policy and practices. This study uses identity orientation to understand the highly marketised context of independent ‘elite’ schools in Australia and how they relate to stakeholders to straddle their roles as social institutions that are increasingly required to operate in a corporate manner. Interviews with managers in quite new school roles such as marketing communication and business management were conducted in non‐government schools to understand the schools' external orientations, coveted internal member traits, and frames of reference. The study shows that, in contrast to existing literature on the rhetoric of schools as focusing on ‘the child’, there was a strong emphasis on individualistic orientations in schools that saw stakeholders in instrumental terms of resources and connections, saw teachers as providing an innovative and leading edge, and used other prestigious schools as their frame of reference. To a lesser extent, schools would also be interested in the relationships with families, teachers, and the community for their own means. There were very few instances where the identity orientation was contributing to society, instead, focusing on university and network outcomes for pupils. Using identity orientation provides a theoretical lens to connect organisational governance to stakeholder engagement by providing insights into an organisation's identity including practices and behaviours, in relation to others. Copyright © 2014 John Wiley & Sons, Ltd.     

The Political Enforcement of Liberalism: Bargaining, Institutions, and Auto Multinationals in Hungary

The demise of communism triggered large flows of foreign direct investment into Eastern Europe. This article examines the impact of recent changes in the international environment—the transformation of world production systems and the rise of neoliberalism—on bargaining between multinational corporations and post-communist governments. It focuses on the Hungarian automobile industry, one of the region's largest recipients of FDI. The Hungarian case illustrates the ability of small, open, and geopolitically weak states to parlay shifts in the global environment into a bargaining asset. The ascent of lean production heightened pressure on auto MNCs to develop local supplier systems capable of fast delivery of components to East European subsidiaries. The pull of backward integration was particularly strong for Japanese producers, whose non-European status enabled Hungarian state authorities to secure commitments to raising domestic content. Transplanting Japanese-style production in Eastern Europe proved less vexing for European MNCs, whose status as EU-based companies freed them of local-content requirements and whose preexisting supplier networks obviated heavy investments in the Hungarian components industry. But while Western auto producers enjoyed highly favorable terms of entry into Eastern Europe, even they could not elude the paradoxical effects of global changes on MNC/host state relations. The very eastward extension of the European Union's nondiscriminatory rules that facilitated EU-based firms' entry into Hungary also permitted host state authorities to parry efforts by MNCs to obtain particularistic concessions after entry. The Hungarian case thus demonstrates that MNC/host state bargaining in the post–Cold War period hinges more on the global positions of multinationals than on the structural vulnerabilities of capital-importing states ( per dependency theory) or the internal capacity of host states ( per statist theories).     

Planning for incapacity by people with bipolar disorder under the Mental Capacity Act 2005

The Mental Capacity Act 2005 provides a variety of legal mechanisms for people to plan for periods of incapacity for decisions relating to personal care, medical treatment, and financial matters. Little research has however been done to determine the degree to which these are actually implemented, and the approach to such advance planning by service users and professionals. This paper looks at the use of advance planning by people with bipolar disorder, using qualitative and quantitative surveys both of people with bipolar disorder and psychiatrists. The study finds that the mechanisms are under-used in this group, despite official policy in support of them, largely because of a lack of knowledge about them among service users, and there is considerable confusion among service users and professionals alike as to how the mechanisms operate. Recording is at best inconsistent, raising questions as to whether the mechanisms will be followed.     

Introducing Social Media Intelligence (SOCMINT)

Abstract

We introduce the latest member of the intelligence family. Joining IMINT, HUMINT, SIGINT and others is ‘SOCMINT’ – social media intelligence. In an age of ubiquitous social media it is the responsibility of the security community to admit SOCMINT into the national intelligence framework, but only when two important tests are passed. First, that it rests on solid methodological bedrock of collection, evidence, verification, understanding and application. Second, that the moral hazard it entails can be legitimately managed. This article offers a framework for how this can be done.     

Sex,Dementia, Capacity and Care Homes

This paper addresses the appropriate legal and policy approach to sexual conduct involving people with dementia in care homes, where the mental capacity of one or both partners is compromised. Such conduct is prohibited by sections 34–42 of the Sexual Offences Act 2003, but this article asks whether this blanket prohibition is necessarily the appropriate response. The article considers a variety of alternative responses, eventually arguing that clearer guidance regarding prosecution should be issued.