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71.
In this article, we will further the explanation of the state's changing role in health care systems belonging to the Organisation for Economic Cooperation and Development (OECD). We build on our analysis of twenty-three OECD countries, which reveals broad trends regarding governments' role in financing, service provision, and regulation. In particular, we identified increasing similarities between the three system types we delineate as National Health Service (NHS), social health insurance, and private health insurance systems. We argue that the specific health care system type is an essential contributor to these changes. We highlight that health care systems tend to feature specific, type-related deficiencies, which cannot be solved by routine mechanisms. As a consequence, non-system-specific elements and innovative policies are implemented, which leads to the emergence of "hybrid" systems and indicates a trend toward convergence, or increasing similarities. We elaborate this hypothesis in two steps. First, we describe system-specific deficits of each health care system type and provide an overview of major adaptive responses to these deficits. The adaptive responses can be considered as non-system-specific interventions that broaden the portfolio of regulatory policies. Second, we examine diagnosis-related groups (DRGs) as a common approach for financing hospitals efficiently, which are nevertheless shaped by type-specific deficiencies and reform requirements. In the United States' private insurance system, DRGs are mainly used as a means of hierarchical cost control, while their implementation in the English NHS system is to increase productivity of hospital services. In the German social health insurance system, DRGs support competition as a means to control self-regulated providers. Thus, DRGs contribute to the hybridization of health care systems because they tend to strengthen coordination mechanisms that were less developed in the existing health care systems. 相似文献
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AbstractOver the past 15 years, Ohio’s juvenile justice system has undergone important reforms that have led to a significant decline in the number of youthful offenders committed to state correctional facilities. As such, the purpose of this paper is to describe five unique innovations carried out across the state that have led to the downsizing of juvenile confinement in Ohio. These innovations include (1) the creation of Community Corrections Facilities; (2) RECLAIM Ohio; (3) the Ohio Youth Assessment System; (4) Targeted RECLAIM; and (5) the Behavioral Health/Juvenile Justice Initiative. Lessons learned from these efforts will be identified and discussed. 相似文献
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Ignacio Correa-Velez Aleana Green Kate Murray Robert D Schweitzer Lyn Vromans Caroline Lenette 《Journal of immigrant & refugee studies》2020,18(4):498-514
AbstractLittle is known about the predictors of quality of life among refugee women. 104 refugee women-at-risk were recruited within 6 months of arriving in Australia. A structured questionnaire was administered using standardized tools to assess pre-migration trauma, post-migration living difficulties, social capital, social networks, and quality of life. Hierarchical multiple and logistic regressions assessed factors predicting quality of life. Post-migration factors such as low trust in the community, and lack of support from individuals in their social networks predicted poorer quality of life. These findings have implications for community and social programs for refugee women-at-risk. 相似文献
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Dominic Heinz 《German politics》2013,22(1):129-142
Germany recently experienced another federal reform, shortly after a previous modification to the German federal system. Has the second federal reform brought substantial change instead of the gradual change that literature on joint decision making would lead us to expect? This article analyses the reform in three stages: agenda setting, negotiation, and ratification; and suggests that at best the new restrictions upon public debt brought about by the second federal reform can be seen as a substantial change, but only if actors comply with them. Furthermore, this note argues that varieties of joint decision making can be identified in German constitutional policy, as they can in German public policy and EU policies. Patterns of joint decision making vary, depending on agenda setting and negotiations, so that the article argues for a differentiated view of joint decision making, the joint decision trap and exits from the joint decision trap. 相似文献
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Past research suggests that attitudes towards severity of punishment are affected by crime‐specific factors. The impact of such factors has usually been investigated by between‐subjects designs. The studies reported in this paper, however, are based on within‐subjects designs, using conjoint analysis for data collection and analysis. Study 1 employs a rape scenario for investigating the impact of the victim–offender relationship and of two victim characteristics – provocative behavior and intoxication. Study 2 uses a theft and an assault scenario for analyzing the influence of several offender and crime characteristics on sanctioning: offender's age, readiness to confess, previous convictions, and severity of the offense. Results from both studies are reported and discussed in terms of utility values. These values represent the importance placed on the case characteristics focused upon. In addition to the general evaluation of case characteristics, inter‐individual differences are analyzed by means of hierarchical cluster analysis. Advantages of the conjoint analytic approach over conventional research methods on sanctioning behavior are discussed. 相似文献
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