Rationing care in the community: engaging citizens in health care decision making

This article examines the theoretical and practical logics of community engagement exercises in health care rationing. To evaluate such exercises in Canada, it is necessary to compare suspected rationing exercises (such as those in Nova Scotia and Saskatchewan) with clear examples of rationing. The Oregon Medicaid reform process is considered an important example of transparent and community-level rationing from which Canadian executive-driven governments can learn a few valuable lessons. While the Oregon experiment seems to have been a (qualified) success, in the Canadian context, formal citizen participation in decision making might be incompatible with social rights and present an incongruous and antagonistic pairing of executive and popular sources of authority.     

Our quest to be perfect

You don't have to be wrinkled or rich to go under the knife. New techniques are luring more and younger patients, while doctors hurry to set up shop. But there are risks as well as options in cosmetic surgery's new age.     

The European parliament and environmental legislation: The case of chemicals

The paper studies the impact of the EP on legislation on chemical pollutants introduced under the Cooperation procedure. A series of formal and informal analyses have predicted from significant impact of the EP, to limited impact (only in the second round) to no impact at all. Through the analysis of Parliamentary debates as well as Commission and Parliamentary committee documents, we are able to assess the significance of different amendments, as well as the degree to which they were introduced in the final decision of the Council. Our analysis indicates first that less than 30% of EP amendments are insignificant, while 15% are important or very important; second, that the probability of acceptance of an amendment is the same regardless of its significance. Further analysis indicates two sources of bias of aggregate EP statistics: several amendments are complementary (deal with the same issue in different places of the legal document), and a series of amendments that are rejected as inadmissible (because they violate the legal basis of the document or the germainess requirement) are included in subsequent pieces of legislation. We calculate the effect of these biases in our sample, and find that official statistics under estimate Parliamentary influence by more than 6 percentage points (49% instead of 56% in our sample). Finally, we compare a series of observed strategic behaviors of different actors (rapporteurs, committees, floor, Commission) to different expectations generated by the literature.