Nondecision making and inertia in Portuguese health policy

Despite there having been a positive context for initiating health care reforms in Portugal in the past fifteen years (accompanied by political consensus on the nature of the structural problems within the health care system), there has been a lack of reform initiatives. We use a process-based framework to show how institutional arrangements have influenced Portuguese health care reform. Evidence is presented to demonstrate inertia and nondecision making in three critical areas of Portuguese health policy: clarifying the public-private mix in coverage and provision, creating financial incentives and motivation for human resources, and introducing changes in the pharmaceutical market. Several factors seem to explain these processes, namely, problems in the balance of power within the political system, which have contributed to a lack of proper policy discussion; a lack of pluralism in the formation of health care policies (with low participation from citizens and high mobilization among structural interest groups); and the low priority of health care in public sector reforms. Portuguese politicians should be aware of the pitfalls of the current political system that constrain participatory arrangements and pluralism in policy making. In order to pursue health care reform, future governments will need to counterbalance the strong influence of structural interest groups.     

Suicidal ideation and self-determination in institutionalized elderly

The right to self-determination is central to the current debate on rational suicide in old age. The goal of this exploratory study was to assess the presence of self-determination in suicidal institutionalized elderly persons. Eleven elderly persons with serious suicidal ideations were matched according to age, sex, and civil status with 11 nonsuicidal persons. The results indicated that suicidal persons did not differ from nonsuicidal persons in level of self-determination. There was, however, a significant difference between groups on the social subscale. Suicidal elderly persons did not seem to take others into account when making a decision or taking action. The results are discussed from a suicide-prevention perspective.     

From patronage politics to community deliberation: the recent experience of democratic school management in Brazil

The article discusses the limits and possibilities of school empowerment within education systems plagued by pervasive patronage politics. The analysis focuses on reform initiatives implemented by Brazilian sub‐national governments throughout the 1980s and 1990s to allow for the election of school principals by parents, teachers and students. Until the implementation of this reform, state and local authorities had relied on the school system as a source of patronage resources, and principals were nominated according to political criteria. The new system of democratic school management was expected to undermine this patronage‐based system and foster community participation in school decisions. The article relies on secondary evidence to assess the impact of school elections in what concerns the participation of parents, students and teachers in school affairs and the relationship between schools, party politicians and education administrators. It concludes that high levels of social inequality and the lack of a universalistic and effective system of welfare provision constitute serious obstacles to the empowerment of disadvantaged groups in developing societies such as Brazil. On the other hand, the article argues that school empowerment has the potential to undermine resilient patronage structures, by introducing universalistic mechanisms of decision‐making and making school administrators more accountable to their constituencies. Copyright © 2007 John Wiley & Sons, Ltd.     

The "GeneTrustee": a universal identification system that ensures privacy and confidentiality for human genetic databases

This article describes a generic model for access to samples and information in human genetic databases. The model utilises a "GeneTrustee", a third-party intermediary independent of the subjects and of the investigators or database custodians. The GeneTrustee model has been implemented successfully in various community genetics screening programs and has facilitated research access to genetic databases while protecting the privacy and confidentiality of research subjects. The GeneTrustee model could also be applied to various types of non-conventional genetic databases, including neonatal screening Guthrie card collections, and to forensic DNA samples.     

Immigration reform,the INS,and the distribution of interior and border enforcement resources

This paper investigates the Immigration and Naturalization Service (INS) interior and border enforcement effort allocation choice following the enactment of IRCA in 1986. The INS increasingly allocated a disproportionate amount of resources along the border as a result of the new law. It is contended that this behavior is consistent with that of a public agency intent on maximizing its budget and not in accord with minimizing the undocumented population in the United States. The theory developed here is then used to evaluate proposals that could potentially reconcile the INS's objectives with those of the policy makers and the public.