The role of substitutes in policy analysis: acute care services in state Medicaid programs

Using four acute care equations (inpatient, physician, outpatient, and clinic) from a larger model of Medicaid, this research examines the "contents" of policy outcomes. This closer examination of outcomes brings to light the interactions between redistributive programs and services and the role of substitutes and complements in state-level policy analysis. (A substitute is a benefit or service that can be used instead of another to produce a similar outcome; a complement is a benefit or service that is likely to result in the use of another benefit or service.) Support is found for the inclusion of these theoretical constructs in policy analysis. Regarding Medicaid, the author concludes that physician, outpatient, and clinic services all complement hospital services; that physician and outpatient services substitute for one another; that state AFDC and SSI policy decisions have a greater impact on utilization than Medicaid-specific eligibility and service decisions do; and that the factors driving utilization (supply, demand, etc.) vary dramatically across acute care settings. The implications for Medicaid policymaking are also discussed.     

Doctors in the executive suite: should the U.S. and U.K. be putting M.D. licensure at risk for shortfalls in institutional quality of care?

As our healthcare system becomes further managed, delivery organizations are reincreasingly relying upon physician executives to administer the delivery of care by other individual providers. In both the United States and the United Kingdom, this has led to instances in which physician disciplinary procedures have been invoked with respect to physicians who are perceived to be responsible for institutional defiiciencies. The author examines and analyzes the contrasting approaches taken in the two countries, and recommends an activist approach for disciplinary agencies faced with these circumstances.     

The gender base of institutional support in Lithuania,Ukraine and Russia

This literature review pertains to women's status in Soviet society. This study examined the degree to which attitudes toward established institutions, support for the reform process, and generalized political orientations significantly reflect gender differences. Regression models were tested among Russians, Ukrainians, and Orthodox believers in Russia. Gender differences were apparent in the evaluations of the Communist Party. Ukrainian women were more supportive of the Communist Party. Age was the only significant factor in Russia; increased age was associated with more positive attitudes toward the Communists. More Ukrainian and Russian women than Orthodox women believed that political reform is moving too rapidly. Less educated and higher income women were more likely to believe that reform is proceeding too rapidly. Russian men were more likely to have participated in a political rally than Russian women in the model which includes socioeconomic controls. Russians with higher education were more frequent participants in political demonstrations than Russians with less education. Ukrainian women were more likely than men to be pacifists. Over 20% of the variance in pacifism scores was explained by sex and sociodemographic factors. The author concluded that gender differences are apparent in the strength of pacifism, the frequency of participation in demonstrations, attitudes toward reform, and evaluations of the Communist Party. Russian women compared to US women did not necessarily support liberal, democratic reforms. Lithuanian women and urban women were less supportive of the status quo and established economic and political institutions compared to Russian, Ukrainian, or rural women. Women and men responded similarly at the same educational levels. Women had a more humanitarian view of the environment and peace. A four-stage stratified sample of 2336 individuals (796 in Russia, 826 in the Ukraine, and 714 in Lithuania) was used. The survey instrument was designed by a team from the University of Iowa working with Soviet scholars.     

Reviews

Anders Aslund & Richard Layard, eds, Changing the Economic System. London, Pinter Publishers: 1993, xviii + 237pp., £35.00.

János Mátyás Kova?s & Marton Tardos, eds, Reform and Transformation in Eastern Europe: Soviet‐type Economics on the Threshold of Change. London: Routledge, 1992, xix + 345 pp.

Peter J. Boettke, Why Perestroika Failed: The Politics and Economics of Socialist Transition. London: Routledge, 1993, viii + 199 pp., £35.00

John Flemming & J. M. C. Rollo, eds, Trade, Payments and Adjustment in Central and Eastern Europe. London: Royal Institute of International Affairs and EBRD, 1992, vii + 242 pp., £11.95 p/b.

Zoltan J. Acs & David B. Audretsch, eds, Small Firms and Entrepreneurship. An East‐West Perspective. Cambridge: CUP, 1993, 240 pp., £30.00, $49.95.

Alex Pravda, ed., The End of the Outer Empire: Soviet‐East European Relations in Transition, 1985–90. London: The Royal Institute of International Affairs, 1992, x + 238 pp., £35.00 h/b

Leonid Gozman & Alexander Etkind, The Psychology of Post‐Totalitarianism in Russia Trans. Roger Clarke. London: Centre for Research into Communist Economies, 1992, 121 pp., p/b £6.50.

F. J. M. Feldbrugge, ed., The Emancipation of Soviet Law. Dordrecht, Boston, London: Martinus Nijhoff Publishers, 1992, xvii + 272 pp., £76.00. $146.00

John Massey Stewart, ed. The Soviet Environment: Problems, Policies and Politics. Cambridge: CUP, 1992, xv + 246 pp., £40.00, $64.95.

I. Kon & J. Riordan, eds, Sex and Russian Society. Bloomington, IN: Indiana University Press, 1993, viii + 168 pp., £35.00 h/b, £12.95 p/b.

Kenneth C. Farmer, The Soviet Administrative Elite. New York: Praeger, 1992, xii + 296 pp., £39.95.

Robert Service, ed. Society and Politics in the Russian Revolution. New York: St Martin's Press, Basingstoke and London: Macmillan, 1992. Published in association with the School of Slavonic and East European Studies, University of London, in their series Studies in Russia and East Europe. 199 pp., + index. £40.00 h/b, £14.99 p/b.     

Crooked Timber or Bent Twig? Isaiah Berlin's Nationalism

Isaiah Berlin is often regarded as one of the sources of contemporary liberal nationalism. Yet his own attitude to nationalism, and its relation to his liberalism, remains unexplored. He gave conflicting definitions of nationalism in different places, and although he frequently contrasts more benign with more malign forms of nationalism, the terms in which he draws the contrast also vary. In Berlin's most explicit account, nationalist doctrine is presented as political, unitary, morally unrestricted and particularist, but these four dimensions are separate, and on each of them alternative nationalist positions are available. Berlin's account of the sources of nationalism is also ambiguous: his analysis of the Jewish condition in European societies and his support for Zionism contrasts with his diagnosis of the origins of German nationalism. Comparing Berlin with later liberal nationalists, we see that his liberalism prevented him from presenting a normative political theory in which liberal and nationalist commitments were successfully combined. Such a theory can indeed be developed, but the challenge that emerges from Berlin's writing is to explain how real-world nationalism can be kept within liberal limits.     

Some Evidence of a Pluralistic Discipline: A Narrative Analysis of Public Administration Symposia

This article investigates the discipline of public administration as it is manifested in symposium articles published during the period 1985–99. What was the field trying to accomplish? The method of investigation is narrative analysis. Using specific discourse markers (method, substantive contents, and authorial intentions), the authors found a wide variety of purposes and projects in the symposia investigated. The condition of public administration, they conclude, is distinguished by a radical pluralism—a striking absence of any singular conception of public administration scholarship.