Medicare reimbursement,debt financing,and measures of service efforts and accomplishments in the healthcare industry

This paper investigates the relationships among selected SEA measures and Medicare reimbursement. The findings generally indicate that those hospitals most heavily reliant on Medicare reimbursement are characterized by different levels of service efforts and accomplishments than other hospitals. The empirical analysis also provides evidence of a linkage between SEA measures and market measures of the risk associated with bonds issued by the sample hospitals.     

Bridging the academic–practitioner divide

One of the poorest countries in the world, the people of Afghanistan gained a chance for peace with the collapse of the Taliban. Whether the country can find its way forward from a precarious position to a democratic and peaceful future will depend on how it responds to the challenge of globalization and constructs a viable economic system. The rate of economic growth and integration into the world capitalist economy for developing countries depends primarily upon any given country's political capacities. Afghanistan ranks low on all three indicators of political capacity: extractive capability, institutional credibility, and transparency. Globalization is a multifaceted process. In its ability to compete in the global economy, Afghanistan is beginning the contest in arrears with little political capacity and experience in capitalist, market-based economics. Often buffeted historically by external forces and actors, two global wars are intersecting in the country today: those of narcotics and terrorism.     

The Coevolution of Networks and Political Attitudes

How do attitudes and social affiliations coevolve? A long stream of research has focused on the relationship between attitudes and social affiliations. However, in most of this research the causal relationship between views and affiliations is difficult to discern definitively: Do people influence each other's views so that they converge over time or do they primarily affiliate (by choice or happenstance) with those of similar views? Here we use longitudinal attitudinal and whole network data collected at critical times (notably, at the inception of the system) to identify robustly the determinants of attitudes and affiliations. We find significant conformity tendencies: Individuals shift their political views toward the political views of their associates. This conformity is driven by social ties rather than task ties. We also find that political views are notably unimportant as a driver for the formation of relationships.     

Performing Regulation: Transcending Regulatory Ritualism in HIV Clinics

Sociolegal scholars suggest that regulatory encounters often are occasions for displaying a surface compliance decoupled from day‐to‐day practice. Yet ethnographic data from five highly regulated HIV clinics show that regulatory encounters open opportunities both for ritualism and—surprisingly—for transcending ritualism. Using a theatrical analogy, we argue that improv performance is the technology that enables regulatory inspectors and clinic staff to transcend ritualism. As regulatory encounters unfold, clinics' carefully prepared performances sometimes change into more cooperative interactions where inspectors and regulatees hash out details about how rules will be applied and even work together on reports for the regulators' supervisors. By “performing together,” regulatory inspectors gain access to the clinic's backstage where they can assess clinic workers' deeper conformity to ethical and scientific norms. But such joint performances are less likely where cultural divides and material scarcity make it difficult for clinic staff to gain inspectors' trust.     

Critical incidents in a forensic psychiatric population: an exploratory study of motivational factors

This exploratory study examined the motivations for forensic clients’ engagement in critical incidents, specifically hostage-taking, barricades and roof-top protests. Using thematic analysis, a range of themes were identified. These included engaging in such incidents to seek deliberate isolation from others, gaining control, getting their needs meet, a need to communicate and being influenced by their peers. Selection of potential hostages appeared linked to feeling of grievance towards them. Yet the distress of a hostage, along with consideration as to the longer term consequences of their actions both for themselves and morally, appeared to reduce the risk of engagement in such incidents. The results are discussed in terms of Individualism, Self-Determination Theory of Motivation and Maslow’s Hierarchy of Human Needs.     

Political strategies for hi-tech development:the case of a university-related research park

The development of a research park at The University of Connecticut has been frustrated for a decade by a series of bureaucratic and political obstacles. Problems associated with contracting out to a private developer and using a mixed implementation model, the regulatory reviews by state agencies, and the role of local authorities have been compounded by adoption of multiple objectives and the intervention of exogenous factors. Plural actors and polylateral political relationships restrict the university's ability to control and guide the project and to achieve the desired benefits. Among the many lessons drawn from the case are the need for careful design of the developmental model, realistic political assessments and economic analyses, and recognition that such projects require time measured in decades before they are likely to succeed.     

The Continuing Evolution of Medicare Hospice Policy

This case study traces the creation and evolution of Medicare hospice policy. The Medicare hospice benefit, created in 1982, emphasizes palliative rather than curative care. It focuses on quality of life for the dying patient and family and encompasses medical, psychological, and spiritual care. Because no standard hospice care practices existed before this benefit was implemented, Medicare rules almost exclusively dictated the structure and delivery of services. Despite initial concerns about low use, spending averaged 17 percent per year between 1991 and 2001, largely driven by increased enrollment, covered days, services provided, and inflation. A rich accumulation of research studies and analyses of specific aspects of the hospice program provides an opportunity for a retrospective analysis of the program's genesis, impact on health care delivery, and implications for future policy decisions.