Reinvigorating publicly funded medicare in Ontario: new public policy and public administration techniques

Abstract: In the increasingly complex and “horizontal” environment of Canadian governmental decision‐making, the ability of governments to advance a major new policy initiative can be compromised or impeded by the often cumbersome systems evolved to ensure both due diligence and a comprehensive approach. In Ontario, the urgent and multi‐faceted health care reform agenda has been implemented using a new set of policy‐development and program‐implementation techniques. This paper summarizes those reforms. In doing so, it outlines the degree to which the reform agenda has been implemented using techniques and processes that have been grafted onto or even short circuited existing decision‐making systems. The paper also draws conclusions about the potential utility of the Ontario experience both for health care reform and for developing new mechanisms to implement challenging, time‐limited reform agendas within parliamentary systems of government with politically neutral civil services. Sommaire: Dans le contexte de plus en plus complexe et “horizontal” de la prise de décisions gouvernementale au Canada, l'aptitude des gouvernements à promouvoir une nouvelle initiative politique majeure peut être compromise ou entravée par la lourdeur des systèmes élaborés pour assurer une diligence raisonnable et une approche exhaustive. En Ontario, le programme de réforme des soins de santé, urgent et polyvalent, a été mis en œuvre grâce à un nouvel ensemble de techniques d‘élaboration de politiques et de mise en œuvre de programmes. Le présent article résume ces réformes. Ce faisant, il souligne comment le programme de réforme a été mis en œuvre grâce à des techniques et processus qui ont été greffés, ou qui ont même court‐circuité les systèmes de prise de décisions existants. L'article tire aussi des conclusions sur l'utilité possible de l'expérience de l'Ontario en ce qui concerne la réforme des soins de santé mais aussi la mise au point de nouveaux mécanismes pour exécuter des programmes de réforme difficiles, à délai déterminé, au sein de systèmes parlementaires de gouvernement avec des fonctions civiles politiquement neutres.     

The referral decision scale with mentally disordered inmates

Correctional facilities are increasingly burdened with mentally disordered offenders and are faced with the formidable task of effectively screening inmates for major mental disorders and suicide potential. Teplin and Swartz (1989) developed the Referral Decision Scale (RDS) as a rapid screen for schizophrenia and major mood disorders in jail populations. However, more recent research by Hart, Roesch, Corrado, and Cox (1993) has called into question the effectiveness of the RDS. In this study, we examined the convergent and discriminant validity of the RDS with the Schedule of Affective Disorders and Schizophrenia—Change Version (SADS-C) and the Personality Assessment Inventory (PAI) on a sample of 108 mentally disordered inmates. The RDS provided moderate evidence of convergent validity but failed to demonstrate acceptable discriminant validity, because of high intercorrelations on RDS subscales (heterotrait-monomethod coefficients). In comparison, the SADS-C yielded similar evidence of convergent validity and excellent discriminant validity.The authors would like to thank the Research Opportunities Program, University of North Texas for its grant support and Captain James Moore for his active cooperation.Tarrant County Mental Health and Mental Retardation Services.     

Hair analysis: a worthless tool for therapeutic compliance monitoring

Hair analysis has been presented by some authors as a possible tool of investigation for estimating patients' compliance to long-term therapies. This paper summarises the different publications that have been devoted to this topic and highlights the available statistical data presented to support this proposition. Qualitative results of such determinations may be of some interest but due to the enormous interindividual variations of quantitative data, the idea of using hair analysis to ascertain whether a patient has taken his treatment exactly as prescribed, clearly appears to be inapplicable.     

Dirty tricks of cross-examination

A mock jury study was conducted to test the hypothesis that perceptions of a witness can be biased by presumptuous cross-examination questions. A total of 105 subjects read a rape trial in which the cross-examiner asked a question that implied something negative about the reputation of either the victim or an expert. Within each condition, the question was met with either a denial, an admission, or an objection from the witness's attorney. Results indicated that although ratings of the victim's credibility were not affected by the presumptuous question, the expert's credibility was significantly diminished—even when the question had elicited a denial or a sustained objection. Conceptual and practical implications of these findings are discussed.This research was supported by funds provided to the first author by the Bronfman Science Center.     

UNDERCOVER DECEPTION CLUES: A CASE OF RESTRICTIVE DETERRENCE*

Although studies on drug dealing have examined techniques sellers use to ensure against undercover infiltrations, none has explored the use of such techniques at the interactional level. The objective here is to address this void by exploring the perceptual shorthand dealers use to determine whether buyers in question are undercover. This perceptual shorthand processes one of two types of deception clues in making this judgment: trend discontinuity and interpersonal illegitimacy. Trend discontinuity is associated with police in formants and results from situations in which (I) familiar customers suddenly introduce unfamiliar others who wish to buy drugs and (2) familiar customers suddenly and signifcantly increase quantities they themselves desire to purchase. Interpersonal illegitimacy is associated with undercover agents and results from situations in which unfamiliar buyers emit certain physical and verbal “vibes” believed to be indicative of covert law en forcement personnel. Discussion focuses on the data's presuppositional and microstructural implications for restrictive deterrence (Gibbs, 1975). Data were drawn from semi-structured interviews with 32 semi-institutionalized heroin user-dealers located in a very large western US. city.     

GENDER AND SOUTHERN PUNISHMENT AFTER THE CIVIL WAR*

Recent scholarship raises two questions about the historical relationship between gender and official responses to criminality. First, to what extent has the formal social control of women changed in the past two centuries? Second, to what extent can changes in the presence of women within the criminal justice system be traced to the same factors that account for the changing presence of men? To address these questions, I focus on women incarcerated for felonies in a southern state (Georgia) between 1870 and 1940. Along with a comparable sample of male offenders, this population forms the basis of a time-series analysis that compares, and seeks to account for, trends in admission rates. The analysis yields little evidence that women disappeared from formal system of punishment. Instead, there were gender similarities in punishment trends and in explanations for those trends. Concluding the paper is a discussion of its implications for further research on gender differences in punishment.     

PROBATION AND PAROLE: PUBLIC RISK AND THE FUTURE OF INCARCERATION ALTERNATIVES*

Jail and prison populations in the United States have continued to grow unabated during the past two decades but crime rates have not declined. Partly in response to the pressures caused by burgeoning correctional populations, the use of alternatives to incarceration has expanded. An ongoing debate centers on the effectiveness of these alternatives. Many criminal justice professionals and some researchers question whether such alternatives seriously restrict the criminal justice system 's ability to incapacitate the active offender. This study deals specifically with two alternatives to incarceration: probation and parole. We examine offender recidivism for a sample of probationers and parolees active in New Orleans, Louisiana, and offer a new approach to addressing the effectiveness issue. Past research has evaluated the effectiveness of alternatives by examining failure rates of diverted offenders. High failure rates, we argue, do not necessarily imply a significant loss of the incapacitative effects of imprisonment. We suggest that a more appropriate measure of the loss of incapacitative effect is the proportion of all offenses committed by persons on probation or parole. Our results suggest that such losses are surprisingly low. The policy implications of our findings are discussed.