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761.
Tim R. Miller 《政策研究评论》1985,5(2):395-412
This paper tests the popular thesis that as a result of various changes over the past decade, the subsystemliron triangle model is no longer the central dynamic in federal water policymaking. A cross section of 30 authorities were interviewed on two aspects of this key dispute: (a) the extent to which iron triangle tenets were either central (traditional viewpoint) or secondary (revisionist viewpoint) to the Carter administrationls 1977 water projects "hit list" 81 defeat, 11 and (b) perceptions of the viability of the leading water alliances in the years since the hit list events. Major findings: (1) Although the two leading water subsystems are portrayed as having been weakened by recent challenges, they are viewed by subsystem insidersll and "outsiders" alike as the most powerful of six alternative explanations for the Carter "defeat." (2) The alliances are largely pursuing a strategy aimed at adapting (Ripley and Franklinls "adapting subsystems") to the threatening political climate based on extensive funding for operations and maintenance. (3) The argument is advanced that the traditional-revisionist dispute is bridged by cyclical policy dynamics, labeled the policy pacing dimension. 相似文献
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States have implemented a number of strategies to provide services, pay providers, and control Medicaid spending. We test the effects of some differences in state Medicaid policies on program enrollees' access to and use of health care services. Logistic and OLS regression analyses of cross-sectional data indicate that these policies exert significant influences on enrollees' access to health services but have a weaker direct effect on their use of them. However, we find evidence that utilization is affected indirectly (through increased access) by state policy decisions. Somewhat surprisingly, Medicaid policies designed to contain costs by limiting utilization appear to affect neither access nor utilization. Medicaid enrollees have greater access to a private physician in states with higher physician reimbursement and additional Medicare insurance for their enrollees. Other nonpolicy variables with pronounced impacts on access to private office physicians include race and the availability of private insurance. 相似文献
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R D Miller D M Doren G Van Rybroek G J Maier 《The Bulletin of the American Academy of Psychiatry and the Law》1988,16(4):309-320
Mental health professionals have been concerned recently about their liability for the actions of patients in their outpatient practices. The history of suits against clinicians for negligent release of inpatients extends back several decades since before the Tarasoff decision. The authors suggest that the same consumerism/victims' rights trends that resulted in Tarasoff and its progeny are likely to rebound again on forensic clinicians and that such pressures are likely to add to other political and social pressures that already complicate the treatment of forensic inpatients. They present three cases to illustrate the dilemmas involved in the release of forensic patients and argue that clinicians must bear significant responsibility for their current plight because of overstated claims of capacities to predict and treat aggressive behavior. 相似文献
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The Miller Forensic Assessment of Symptoms Test (M-FAST) was developed to provide evaluators with a brief, reliable, and valid screen for malingered mental illness. This study examined the initial validity of the M-FAST in a sample of 50 criminal defendants found incompetent to stand trial because of a mental illness. The M-FAST total score and items were compared with the Structured Interview of Reported Symptoms (SIRS) and the fake-bad indicators of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Results indicated good evidence of construct and criterion validity, demonstrated by t tests, receiver operating characteristics analysis, and high correlations between the M-FAST, SIRS, and the fake-bad indices on the MMPI-2. Tentative cut scores for the M-FAST total score and scales were examined and demonstrated high utility with the sample of criminal defendants incompetent to stand trial. 相似文献