The influence of institutions and culture on health policies: different approaches to integrated care in England and The Netherlands

The concept of integrated care has assumed growing importance on the policy agendas both in England and The Netherlands and elsewhere. It is characterized as health and health care-related social care needed by patients with multi-faceted needs. This article compares policy approaches to integrated care in England and The Netherlands. Differing political strategies and conditions for integrated care correspond to the dissimilarities in the institutional structure and culture of their health care systems. Health care systems are understood as specific national and historical configurations. We review the last decade's relevant policy processes, using the concepts of hierarchy, market and network. The state health care system in England relies mainly on hierarchical steering, thus creating tight network structures for integrated care on the local level. The Netherlands, with its health care system in a public-private mix, has set incentives for voluntary, loosely coupled and partly market-driven cooperation on the local level. Implications for success or failure are mixed in both configurations. Policy recommendations have to be tailored to each systems' characteristics.     

A Model of Learned Implementation

The majority of the literature concerning the implementation of public policy assumes that public managers can carry out new policy initiatives regardless of the behavioural, cognitive or technical demands that the introduction of such policies may make upon them. There has been a tendency to assume that managers actually have the detailed technical knowledge by which to enact such new policies. The paper proposes that in effect, public managers have to learn a range of often new and detailed techniques in order to implement what are often ambiguous policy directives. Drawing on data gathered from the introduction of capital investment appraisal in the British National Health Service, a model of Learned Implementation is presented that describes one way in which public managers can learn to enact new policy initiatives. Using a mix of six organizational processes and variables, the model demonstrates how learning occurs and is used to solve the problems that are inherent in the introduction of new policy initiatives. The model further describes how the managers routinize these solutions into job tasks and procedures and hence a policy initiative is operationalized. The paper concludes with a discussion about the difficulties of predicting the operational consequences of new policy initiatives and raises questions about knowledge, ability and capability in the implementation of public policy.     

The Effect of Associative Issue Ownership on Parties’ Presence in the News Media

Some studies suggest that challenger parties push new issues onto the agenda, especially when they ‘own’ these issues. Others claim that established parties largely determine how prominent issues appear on the agenda. This article contributes to this debate by focusing on an issue on which challenger parties have most ‘ownership’: immigration. Political claims on this issue made by political parties in newspapers in seven West European countries after three events that could potentially trigger attention to immigration were studied. Large and government parties appear most prominent in the news. However, findings show a significant, positive effect of associative issue ownership on claims-making in the news, while controlling for party size and government status. So, when challengers have issue ownership they appear as claim-makers on the issue. These results paint a balanced picture of the role that challenger and established parties have in setting the agenda.     

Community rehabilitation workers as catalysts for disability: inclusive youth development through service learning

This paper explores access to health and education for disabled youth in sites with and without community rehabilitation workers (CRWs). A cross-sectional survey using a structured questionnaire was undertaken in nine sites in South Africa, and a snowball sample of 523 disabled youths of both sexes, aged between 18 and 35 years, was selected. The survey found that a significantly larger proportion of disabled youth living in sites with CRWs were seen by health care workers at home, and that there was a large difference in educational access between sites with and without CRWs. CRWs are well positioned to promote equal citizenship for disabled youth through service learning with occupational therapy final year students to improve access to health and education, so that barriers to their participation in economic development are removed.     

Contextual Compliance: Situational and Subjective Cost‐Benefit Decisions about Pesticides by Chinese Farmers

This article analyzes how cost‐benefit calculation influences compliance with pesticide regulation by Chinese farmers. Building on a study including 150 farmers and experts, it studies how operational costs and benefits and deterrence affect compliance. Moreover, it studies what variation in cost‐benefit perceptions there are with different types of rules, farms, and villages. It finds that, in this context, cost‐benefit calculation matters for compliance; with operational costs and benefits being more clearly related to compliant behavior than deterrence. It highlights that perceptions about costs and benefits are situational and vary along the type of legal rule and the type of regulated actor. It also shows that such perceptions are individually subjective, as even with similar rules and similar types of actors, perceptions vary. The paper concludes by stating expectations on how the situational and subjective nature of cost‐benefit calculation can inform regulators seeking to enhance compliance.     

The Legal Case File as Border Object: On Self‐reference and Other‐reference in Criminal Law

What do case files do? With help of an ethnographic study on the care, maintenance, and use of legal case files in a Dutch, inquisitorial context, we work through Latour's and Luhmann's conceptualizations of law. We understand these case files as enacting and performing both self‐reference and other‐reference. We coin the term border object to denote the way the legal case file becomes the nexus between two worlds it itself performatively produces: the world of ‘law itself’ on the one hand, and the ‘world out there’ on the other. As such, our discussion offers clues for a partial reconciliation of Latour's and Luhmann's conceptualizations of law: while Luhmann's insistence on other‐referential operations assist in showing how law forges an ‘epistemic relationship’ with the realities it seeks to judge, Latour's concentration on the materialities of epistemic practices assists in situating these other‐referential and self‐referential operations.     

Review Symposium: Interdisciplinary Readings of Ari Z. Bryen's Violence in Roman Egypt: A Study in Legal Interpretation—Introduction

Bryen, Ari Z. 2013 . Violence in Roman Egypt: A Study in Legal Interpretation . Philadelphia, PA: University of Pennsylvania Press. Pp. 376. $75.00 cloth; $75.00 eBook.