Has PPS increased Medicare expenditures on physicians?

We use data from 1983 and 1985 on the volume of Medicare physician services to analyze whether Medicare's Prospective Payment System (PPS), which resulted in a significant decline in hospital spending, led to a partially offsetting increase in real expenditures for physician services. We also analyze the effect of increases in assignment rates, increasing incomes of the elderly, and other factors on real expenditures during this period. Our main conclusion is that PPS has at most a small positive effect on real physician expenditures. Because people spent less time in the hospital, Medicare physician spending declined; but because of incentives to shift radiology and other services out of the hospital, some of this decline was offset. We also conclude that the sharp increase in Medicare assignment rates over this period, along with the rising incomes of the elderly during this period, contributed to the observed growth.     

R before D: the case of post conflict reintegration in Tajikistan1

Reintegration was prioritised over demobilisation and disarmament in Tajikistan's peace process. Inadequate disarmament rates were disregarded, but integration of opposition fighters into military and law enforcement units was relatively swift. This created high levels of trust among the former fighters and commanders. The quick provision of incentives, such as comprehensive amnesties and the offer of government positions and economic assets created stakes in the peace process for a number of actors. Transitional justice was largely overlooked. In this way, the case of Tajikistan runs counter to key elements of what has been termed the ‘post-conflict reconstruction orthodoxy’. At the same time, Tajikistan is a rare example of the emergence of post-war stability. This article provides a detailed account of the DDR process and outlines the incentives that it created for the warring parties. It also assesses the emergence of spoilers and the government's counter strategies. The article concludes by highlighting the consolidation of President Rakhmonov's power since 2001, but also raises some questions regarding the viability of Tajikistan's long-term political and economic development.     

RELATIONSHIP BETWEEN THE OFFENDING FREQUENCY (λ) OF IMPRISONED AND FREE OFFENDERS*

In the public debate over incarceration policy, there is considerable disagreement about what value of individual offending frequency (λ) is appropriate to use in estimating incapacitative effects. This article provides an approach for estimating the mean values of λ for diverse subsets of the total offender population, with particular emphasis on subsets generated by filtering through various stages of the criminal justice system. Sharp differences in offending frequency are displayed between robbery and burglary inmates, across three states, and particularly between resident inmates and free, active offenders. Free offenders average 1 to 3 robberies and 2 to 4 burglaries per year, while resident inmates have λ values 10 to 50 times higher. Differences result from the underlying levels of criminal activity and the sanction Levels that offenders face. A highly heterogeneous distribution of offending frequency in the total population of offenders combines with relatively Low imprisonment levels to lead to substantial selectivity of high-λ offenders among resident inmates and a correspondingly low mean value of λ among those offenders who remain free. These results have important implications for estimating incapacitative effects of an increase in incarceration, since the additional inmates will be drawn from free offenders whose mean λ is at least an order of magnitude Lower than that of the current inmate population.     

"First pass phenomenon" of inhaled gas in the fire victims

We investigated the differences in the levels of carboxyhemoglobin (COHb), cyanide (HCN) and petroleum fuels (gasoline and kerosene) between left and right ventricular bloods from fire victims. COHb was slightly, and HCN and petroleum fuels were markedly higher levels in the left than those in the right. These effects were so called 'first pass phenomena' due to the circulation, diffusion and metabolization before the deaths of fire victims.     

Book Review International Environmental Negotiations: The Current State of Empirical and Analytic Study

Negotiation Journal -     

Economic Interdependence and the Balance of Power

To account for variance in great powers responses to threats and the implications for the peacefulness of the international system since the late nineteenth century, this article elucidates a theory which refines and synthesizes economic liberal perspectives and realist balance of power theory. I argue that different patterns and levels of economic interdependence in the great power system generate societal-based economic constraints on, or incentives for, state leaders of status quo powers hoping to mobilize economic resources and political support to oppose perceived threats. This mobilization process influences strongly the preferences of status quo powers, other states beliefs about those preferences, and the interpretation of signals in balance of power politics. In this way, economic ties influence the strategies great powers pursue. Firm balancing policies conducive to peace in the international system are most likely, I then hypothesize, when there are extensive economic ties among status quo powers and few or no such links between them and perceived threatening powers. When economic interdependence is not significant between status quo powers or if status quo powers have strong economic links with threatening powers, weaker balancing postures and conciliatory policies by status quo powers, and aggression by aspiring revisionist powers, are more likely. I then illustrate how these hypotheses explain the development of the Franco-Russian alliance of the 1890s and its effectiveness as a deterrent of Germany up to 1905, British ambivalence toward Germany from 1906 to the First World War, the weakness of British, French, Soviet, and American behavior toward Germany in the 1930s and World War II, and the American and European responses to the Soviet threat, including the NATO alliance, and the "long peace" of the post-1945 era.     

Acidic and neutral drugs screen in blood with quantitation using microbore high-performance liquid chromatography–diode array detection and capillary gas chromatography–flame ionization detection

Blood previously acidified with aqueous saturated ammonium chloride solution was extracted with ethyl acetate. The dried extract was subjected to acetonitrile–hexane partition. The acetonitrile portion was analysed for the presence of acidic and neutral drugs by HPLC–DAD (200 mm×2.1 mm I.D. microbore ODS-Hypersil column) and GC–FID (25 m narrow-bore×0.25 mm I.D. HP-5 column with 0.33 μm film thickness). The protocol was found to be suitable for both clinical toxicology (including emergency toxicology) and postmortem toxicology. At least 66 drugs of interest were unequivocally identified by RRTs (HPLC) and UV spectra (DAD) match while another 12 were unequivocally identified by double RRTs match (HPLC and GC). Quantitation was facilitated by incorporating calibration blood standards in each assay batch. The five drugs most commonly encountered in clinical blood specimens (1150 cases) were: paracetamol (47.4% of the cases); chlormezanone (6.6%), theophylline (1.74%), naproxen (1.65%) and mefenamic acid (1.56%). The following drugs were detected in toxicologically significant quantities in postmortem blood specimens (245 cases): phenobarbitone (1.22% of the cases), naproxen (0.82%), chlormezanone (0.82%), theophylline (0.82%), carbamazepine (0.41%) and paracetamol (0.41%).