Unmanaged care: towards moral fairness in health care coverage

Health insurers are generally guided by the principle of "actuarial fairness," according to which they distinguish among various risks on the basis of cost-related factors. Thus, insurers often limit or deny coverage for vision care, hearing aids, mental health care, and even AIDS treatment based on actuarial justifications. Furthermore, approximately forty-two million Americans have no health insurance at all, because most of these individuals cannot afford the cost of insurance. This Article argues that Americans have come to demand more than actuarial fairness from health insurers and are increasingly concerned by what I call "moral fairness." This is evidenced by the hundreds of laws that have been passed to constrain insurers' discretion with respect to particular coverage decisions. Legislative mandates are frequent, but seemingly haphazard, following no systematic methodology. This Article suggests an analytical framework that can be utilized to determine which interventions are appropriate and evaluates a variety of means by which moral fairness could be promoted in the arena of health care coverage.     

Changing Forms of Accountability in Education? A Case Study of LEAs in Wales

Political mechanisms of accountability were marginalized by Conservative government reforms during the 1980s and 1990s which sought a more market-oriented approach within the public sector in order to enhance ‘consumerism’. In education, parents were given more choice between schools and were provided with more information on school performance. The promotion of market accountability has involved a reduction in the powers of local education authorities (LEAs) which had been central to the operation of political accountability. However, whilst market-based forms of accountability were firmly enhanced in principle by the legislation, to what extent have the forms of accountability operating within LEAs changed in practice? Interviews with Chief Officers and the Chair of the Education Committee are used to identify changing perceptions and practices of accountability in LEAs in Wales. The findings indicate that although local politicians and officials have been forced to operate within the legislative framework of market accountability, they have sought to impede its successful implementation. The policy community in Wales facilitated the LEAs’ capacity to respond in this way. The market-based reforms conflicted with fundamental values held in Wales, which remain those of professional accountability.     

Reporting under International Human Rights Treaties: Perspectives from Timor Leste's Experience of the Reformed Process

This article explores Timor Leste's experience of reportingunder the reformed international human rights treaties reportingsystem during the period 2004–2007. Whilst consciousnesshas grown of the difficulties faced by states by the duplicationof treaty reporting processes and the resource burden representedby reporting, the reforms instituted to date have been comparativelyminor. Timor's experience with the new Common Core Document(CCD)/treaty-specificdocument format affirms that reporting serves useful purposes,particularly in stimulating human rights education initiatives,government/NGO collaboration and awareness of human rights gapsin practice. The reformed process highlights cross-cutting humanrights matters. Yet, significant challenges remain, particularlyfor developing, post-conflict states, before reporting willattain its desired potential of support for improved human rightspromotion and protection at the national level. The CCD itselfraises complex conceptual difficulties needing resolution. Thereremains a paucity of appropriate methodological tools to supportthe reporting process and facilitate the integration of humanrights and development goals. Further work is thus needed toshape a sustainable process for reporting.     

Stressors, coping resources and strategies, and police stress in South Korea

The present article extends prior research to identify the predictors of police stress from work place problems, the resources available through social support, different strategies for coping with stress, and conditions unique to policing in South Korea. The unique conditions are perceived public perception of police and attitudes towards women working outside of the home. Seven hundred officers were asked to participate in the research, and 686 did participate (96 percent response rate). Almost half of the variance in stress could be explained. Reports of being ridiculed and “set up” in dangerous situations, and to a lesser extent, lack of support from superiors and perceived disrespect from the public, were salient predictors of stress. Coping strategies did not moderate the associations between stressors and stress. Findings were interpreted in relation to collectivist culture and possible points of intervention.