Hospital selective contracting without consumer choice: What can we learn from Medi‐Cal?

In the selective contracting era, consumer choice has generally been absent in most state Medicaid programs, including California's (called Medi-Cal). In a setting where beneficiary exit is not a threat, a large payer may have both the incentives and the ability to exercise undue market power, potentially exposing an already vulnerable population to further harm. The analyses presented here of Medi-Cal contracting data, however, do not yield compelling evidence in favor of the undue market power hypothesis. Instead, hospital competition appears to explain with greater consistency why certain hospitals choose to contract with Medi-Cal while others do not, the trends in inpatient prices paid by Medi-Cal over time, and the effect of price competition on service cutbacks, such as emergency room closures. Copyright 2003 by the Association for Public Policy Analysis and Management.     

A Global Model for Forecasting Political Instability

Examining onsets of political instability in countries worldwide from 1955 to 2003, we develop a model that distinguishes countries that experienced instability from those that remained stable with a two-year lead time and over 80% accuracy. Intriguingly, the model uses few variables and a simple specification. The model is accurate in forecasting the onsets of both violent civil wars and nonviolent democratic reversals, suggesting common factors in both types of change. Whereas regime type is typically measured using linear or binary indicators of democracy/autocracy derived from the 21-point Polity scale, the model uses a nonlinear five-category measure of regime type based on the Polity components. This new measure of regime type emerges as the most powerful predictor of instability onsets, leading us to conclude that political institutions, properly specified, and not economic conditions, demography, or geography, are the most important predictors of the onset of political instability.     

Small states and the ‘throughput’ legitimacy of international organizations

Abstract

The unequal participation of member states in international organizations (IOs) undermines IOs’ legitimacy as global actors. Existing scholarship typically makes this assessment by referencing a combination of input—the interests IOs serve—and output—the decisions they take. This scholarship does not, however, pay enough attention to how IOs have responded to these concerns. We argue that IOs have used the participation of small states—whose membership most studies typically ignore—as an important means of generating what Vivian Schmidt calls ‘throughput’ legitimacy for their operations. We organize our analysis of ‘throughput’ legitimacy in IOs around four institutional mechanisms—(1) agenda setting; (2) leadership (s)election; (3) management and operation; and (4) service delivery—in which all states seek to exert influence. What emerges is an account of IOs seeking to balance ‘inputs’ and ‘outputs’ by way of ‘throughputs’. We conclude by arguing for an expanded focus on the means by which IOs generate ‘throughput’ legitimacy in future research.     

Vladimir Iowa Lenin,Part 1: A Bolshevik Studies American Agriculture

A busy year for Russian revolutionary Vladimir Ilyich Lenin, 1917 also marked the publication of his study of American agriculture. The report reads as more than a historical curiosity, offering insights, however era-bounded, on a variety of topics of substantive and epistemological interest today. Lenin writes of the history of American agriculture, its dynamic regionalism, and its sector-specific class conflicts. Along the way, despite his obvious structural tendencies, we meet an anti-foundational author who, while upbraiding bourgeois economists for their expedient technicism, often in scathing terms, also warns that sweeping conclusions about the sizes of farm and capitalization are problematic in the face of historically dependent and contradictory trends. Here, in the first of the paper’s two parts, we begin to place Lenin’s project in the broader stream of critical agrarian studies, including the classic contrast with agricultural economist Alexander Chayanov, but also the diseconomies of modern agriculture, the biological limits on industrializing food production, and Stalin’s “dekulakization” campaign. Our aims here are more than academic. The exploration is framed by the roles the structure of agriculture and its impacts on its participants play in political change, from elections to revolution.     

People and Performance: Challenges for the Future Public Service— the Report from the Wye River Conference

What are the key challenges for the public sector at present, and what will the future public service look like if it is to meet these challenges? These questions were put to public‐sector leaders at a conference at the Wye River Plantation in June 1999. The leaders agreed on aspects of a broad vision for the future and the urgent need for a detailed debate on the transition questions that arose.     

Policy analysis in the presence of distorting taxes

This article first describes the new literature in environmental economics on the so‐called “double‐dividend” and then explores its implications for a broad range of economic issues. This literature reveals that in a second‐best, general‐equilibrium setting, environmental measures raise costs and prices and thereby reduce the real wage. This rise in the cost of living reduces slightly the quantity of labor supplied in an already highly distorted labor market, giving rise to losses in social welfare that can be large relative to the basic gains from a cleaner environment. These losses can be offset to some extent by using revenues (if any) from the environmental programs to reduce existing taxes on labor. This same line of analysis applies to many programs and institutions in the economy that raise the cost of living: tariffs and quotas on imports, agricultural price‐support programs, monopoly pricing, programs of occupational licensure that limit entry, and many others. Thus, traditional, partial‐equilibrium benefit‐cost analysis appears, in many instances, to have unwittingly omitted from the calculations a potentially quite significant class of social costs. © 2000 by the Association for Public Policy and Management.     

Sensitive Method for the Confident Identification of Genetically Variant Peptides in Human Hair Keratin

Recent reports have demonstrated that genetically variant peptides derived from human hair shaft proteins can be used to differentiate individuals of different biogeographic origins. We report a method involving direct extraction of hair shaft proteins more sensitive than previously published methods regarding GVP detection. It involves one step for protein extraction and was found to provide reproducible results. A detailed proteomic analysis of this data is presented that led to the following four results: (i) A peptide spectral library was created and made available for download. It contains all identified peptides from this work, including GVPs that, when appropriately expanded with diverse hair-derived peptides, can provide a routine, reliable, and sensitive means of analyzing hair digests; (ii) an analysis of artifact peptides arising from side reactions is also made using a new method for finding unexpected modifications; (iii) detailed analysis of the gel-based method employed clearly shows the high degree of cross-linking or protein association involved in hair digestion, with major GVPs eluting over a wide range of high molecular weights while others apparently arise from distinct non-cross-linked proteins; and (v) finally, we show that some of the specific GVP identifications depend on the sample preparation method.     

Identifying Fatal Head Injuries on Postmortem Computed Tomography Using Convolutional Neural Network/Deep Learning: A Feasibility Study

Postmortem computed tomography (PMCT) is a relatively recent advancement in forensic pathology practice that has been increasingly used as an ancillary investigation and screening tool. One area of clinical CT imaging that has garnered a lot of research interest recently is the area of “artificial intelligence” (AI), such as in screening and computer-assisted diagnostics. This feasibility study investigated the application of convolutional neural network, a form of deep learning AI, to PMCT head imaging in differentiating fatal head injury from controls. PMCT images of a transverse section of the head at the level of the frontal sinus from 25 cases of fatal head injury were combined with 25 nonhead-injury controls and divided into training and testing datasets. A convolutional neural network was constructed using Keras and was trained against the training data before being assessed against the testing dataset. The results of this study demonstrated an accuracy of between 70% and 92.5%, with difficulties in recognizing subarachnoid hemorrhage and in distinguishing congested vessels and prominent falx from head injury. These results are promising for potential applications as a screening tool or in computer-assisted diagnostics in the future.     

Immigration and the Imagined Community in Europe and the United States

Both Europe and the United States are confronting the challenges of economic and cultural integration posed by immigration. This article uses the ESS and CID surveys to compare transatlantic public opinion about immigrants and immigration. We find more tolerance for cultural diversity in the United States, but we also find that Americans, like Europeans, tend to overestimate the number of immigrants in their countries and tend to favor lower levels of immigration. The underpinnings of individual attitudes are similar in all countries and immigration attitudes are surprisingly unrelated to country-level differences in GDP, unemployment and the number and composition of the foreign born. An implication of these findings is that acceptance of higher levels of immigration, deemed by many to be an economic need, will require both more selective immigration policies and an emphasis on the cultural assimilation of newcomers.     

Job burnout among narcotics investigators: An exploratory study

In exploring the relationship between narcotics investigators and job burnout in the United States, a sample of 115 East San Francisco Bay police officers from five law enforcement departments was drawn. Three subgroups (current narcotics investigators, former narcotics investigators, and patrol officers) were used in the survey. The findings indicate that current narcotics investigators had significantly higher burnout scores than the comparison groups on most dimensions of burnout. Both former narcotics officers and patrol officers had similar burnout scores. Conclusions reached were that: (1) narcotics officers experienced a greater degree of job burnout while in the assignment; (2) this burnout was directly attributed to the working environments of the narcotics officers; and (3) burnout decreased once an officer left the assignment. Administrative and managerial implications for dealing with job burnout are discussed along with suggested techniques for dealing with, and minimizing, job burnout among narcotics officers. Future research issues are identified.