The influence of institutions and culture on health policies: different approaches to integrated care in England and The Netherlands

The concept of integrated care has assumed growing importance on the policy agendas both in England and The Netherlands and elsewhere. It is characterized as health and health care-related social care needed by patients with multi-faceted needs. This article compares policy approaches to integrated care in England and The Netherlands. Differing political strategies and conditions for integrated care correspond to the dissimilarities in the institutional structure and culture of their health care systems. Health care systems are understood as specific national and historical configurations. We review the last decade's relevant policy processes, using the concepts of hierarchy, market and network. The state health care system in England relies mainly on hierarchical steering, thus creating tight network structures for integrated care on the local level. The Netherlands, with its health care system in a public-private mix, has set incentives for voluntary, loosely coupled and partly market-driven cooperation on the local level. Implications for success or failure are mixed in both configurations. Policy recommendations have to be tailored to each systems' characteristics.     

Problem solving as reinforcement in adolescent drug use: Implications for theory and policy

The problem of adolescent drug use received a great deal of attention both in criminological theory and public policy. Predominant among theories was Akers' social learning theory which examined the role of learning through a process of imitation, modeling, and reinforcement. Public policy led to the development of programs such as Drug Abuse Resistance Education (DARE) that aimed to warn youths of the dangers of drug use. In line with research findings, both theory and policy gave a central role to peers in understanding adolescent drug use. Less attention was given to another important finding in the literature, that those who used drugs often perceived the drugs as solutions to problems. Using social learning theory, the role of perceptions of drug use as an effective problem solver was examined. Results indicated that a more explicit recognition of the use of drugs to deal with problems might inform both theory and policy.     

Partisanship as information

Intuitively, we associate different political parties with different types of policy. In contrast, this paper shows that in the absence of differential costs of membership among parties (that is, if party membership ischeap talk), party labels cannot perfectly signal the ideologies of candidates. However, under certain conditions parties can signal candidate types imperfectly. The paper therefore also provides an example of how costless communication can be effective in games of partial conflict.     

Determining the Optimal Size of Local Government: The Case of Tasmanian Councils

We estimated the optimal size of the most significant functions performed by Tasmanian councils between 1999 and 2008 using a non‐parametric technique based on the shared input data envelopment analysis model. The principal advantage of this technique is that it not only provides an overall estimate of efficiency but it also allows for the estimation of ‘partial efficiencies’ and ‘cost shares’ when one input is shared among multiple outputs. Our results indicate that water supply and sewerage services, on average, were more efficient, whereas activities related to community health and safety and information systems warrant improvement. However, because the costs associated with water supply and sewerage services are considerably higher than the costs related to community health and safety and information systems, the elimination of these inefficiencies would result in greater cost savings for the Tasmanian local government sector.