Improving suicide risk assessment in a managed-care environment

This article describes the quality improvement intervention of a managed behavioral healthcare company to improve the quality of suicide risk assessments by its panel of providers. At-risk cases are identified by the patient's self-reported high frequency of suicidal ideation on a standardized outcome measure. Clinicians also assess severity of suicidal ideation based on clinical interviews. The clinician's assessment is identified as probably erroneous if the patient report indicates a high frequency of suicidal ideation and the clinicians assessment of suicidal ideation is none. The article describes the methods used to encourage clinicians to utilize information from the patient self-report measure as part of the clinical assessment. Probable suicidal ideation assessment errors were subsequently reduced by 29% over a 1-year period of administration.     

Post-war Russian economic growth: not a riddle

In a recent article Steven Rosefielde (2003) has advanced three propositions. He suggests that according to the best available statistics the post-war growth of the Russian economy under the command system was surprisingly good; in fact, he argues that it was too good. The standard for this judgement is economic theory, which holds that non-market systems must fail by comparison with market economies; Rosefielde associates specifically this view with the ‘Washington consensus’. He concludes that it is the statistics that are at fault: they ‘lied and were misconstrued’ by Western ‘statistically oriented comparativists’ in a way that was unduly favourable to the command system. In this comment I argue that Rosefielde has misread both the facts and the theory. There is no riddle in the statistics. His conclusion, therefore, must fall.     

The role of tax bases and collections costs in the determination of income tax rates,seigniorage and inflation

A growing theoretical literature on optimal taxation predicts that governments will set the tax rates on money holdings and on more traditional tax bases to minimize the deadweight losses of collecting government revenue. Under the presumption that relative collection costs and tax bases have not changed significantly over time, the empirical time-series seigniorage literature has focused on the theory's tax smoothing implication, finding only weak support. We show that changes in collections costs and tax bases played an important role in the determination of tax composition and find stronger support for tax smoothing when this is taken into account.     

Expressions of Distrust: Third-Party Voting and Cynicism in Government

Voter distrust of the national government is an ongoing theoretical concern for scholars who study voting behavior in the United States. Previous research demonstrates that distrustful voters are less likely to vote for major party candidates than their more trusting counterparts. Using the American National Election Survey, we explore the relationship between citizen distrust and voting for three major third-party challengers (Wallace, Anderson, and Perot) and the use of trust levels as predictors of third- party voting. We find citizen trust levels are significant and strong predictors of third-party voting, independent of other common explanatory variables of vote choice. We also find trust levels are stable over time, and we find little evidence to support the argument that trust levels measure trust of incumbent political figures.     

WELFARE IDEOLOGY, THE MARKET AND SOCIAL SECURITY: Towards a Typology of Market-Oriented Reform

The global shift towards the market in the provision of social security is typically associated with the values of the New Right, but we take issue with this view. An examination of the main welfare ideologies that have influenced the development of contemporary social security systems suggests that the market and individualism have a role to play in a range of approaches to reform. Whilst some approaches unreservedly endorse the market – in a way which accords with the ideas of the New Right – other approaches adopt a pragmatic orientation based on a recognition of two public policy dilemmas, “market failure” and “state failure.” This attempt to define a middle way typifies many of the recent social security reform initiatives. Drawing upon Esping‐Andersen's recent work on de‐commodification, we construct a typology of normative approaches to the provision of social security which may be used to contextualise market‐oriented social security reform initiatives. This we argue is necessary to avoid the over‐simplified dichotomy between individualism and collectivism which is typical of so much recent work on social security reform.     

Whatever happened to deconcentration? Recent initiatives in Cambodia

Contemporary decentralization discourse and recommended practice focus on political decentralization. However, experience with such devolution has often failed to produce the anticipated developmental returns. This has prompted reconsideration of managerial or administrative decentralization (deconcentration) as a vehicle for improving services and encouraging popular participation. A range of potential benefits is available from deconcentration. Cambodia has embarked on a cautious policy of decentralization involving weak devolution and deconcentration. But it is from deconcentration that the government expects the greatest developmental gains. Initial results are encouraging but difficulties confront the deconcentration experiment. These include the piecemeal nature of the initiative, unfamiliar financial management practices, deeply embedded patterns of hierarchy in society and state, and limited managerial capacity. Nevertheless, it appears that incremental deconcentration may offer a useful policy alternative for countries such as Cambodia which are engaged in slowly building the infrastructure of a modern state following debilitating internal conflict. Copyright © 2002 John Wiley & Sons, Ltd.