Competitive bidding and states' purchase of services: the case of mental health care in Massachusetts.

Over the past two decades states have significantly increased their use of competitive bidding to purchase health and social services from private agencies. Competitive contracting is thought to facilitate program administration, to reduce costs, and to increase the quality of delivered services. We evaluate these claims in light of Massachusetts' experience with competitive contracting for mental health care. We find that few of the expected benefits are achieved. In practice, supposedly competitive bidding systems often degenerate into administratively complicated negotiations between the state and private monopolies. This results in higher costs and lower quality of services. In light of this negative assessment, three strategies for reform are proposed and evaluated.     

Spontaneous bacterial peritonitis in the non-cirrhotic individual

A case of spontaneous bacterial peritonitis is reported. A methodical postmortem examination failed to disclose cirrhosis or other liver pathology; nor, was any anatomic alteration of the immune system noted. Acquired immunodeficiency syndrome was likewise discounted. A discussion ensues concerning recognition of this entity.     

Psychopathy and Female Gender: Phenotypic Expression and Comorbidity; A Study Comparing a Sample of Women Hospitalized in Italy's Maximum Security Facility with Women Who were Criminally Sentenced and Imprisoned,

Various studies have shown that women with psychopathy tend to commit crimes that are less violent than those of psychopathic men. The present study was designed to address the influence of psychopathy on the crimes committed by female offenders. A national sample of female offenders found NGRI or of diminished responsibility and at risk for criminal recidivism (OPG patients) was compared with a sample of female offenders who were convicted and imprisoned. Results of this comparison between the two groups of female offenders indicate that psychopathy is a transversal psychopathological dimension which may or may not be associated with other mental disorders. In both samples, the most commonly reported offenses among women with high PCL‐R scores were minor offenses, not particularly violent, but they appear to be related to typical psychopathic features such as superficial charm, pathological lying, and manipulation.     

The Equal Chance To Have One's Vote Count

Law and Philosophy -