Cause and consequence in public policy theory: Ethnic policy and system transformation in Malaysia

Considering public policy as both a dependent and an independent variable, this article undertakes a systematic assessment of the sources and systemic consequences of policy. It begins with a statement of contrasting theories of the sources of policy. One strand of comparative theory emphasizes national cultures and elite beliefs as the main sources of policy; another stresses the cross-national imperatives of particular policy programs, of international diffusion, and of common policy processes. Drawing on longitudinal data on an array of ethnic policies in Malaysia, the study highlights the limits of cultural-determinist theories of policy. It shows that elite beliefs change over time, often creating layers of policy based on varying premises; that one set of beliefs can overcome another, inconsistent set; that critical events can alter the balance of authoritative beliefs; and that, where beliefs are in conflict, organized interests have room for maneuver. Moreover, the interaction of a mix of operative beliefs can produce outcomes very much at variance with what policymakers wish or anticipate. Finally, on the systemic effects of policy, the study shows that interests created by earlier policy can be decisive actors in the shaping of later policy. Policy itself can change the entire structure of the political system - an outcome rather clearly demonstrated in the case of Malaysia.     

Medical alert: sexual harassment in the health care industry

Sexual harassment is an illegal form of sexual discrimination prohibited by Title VII of the Civil Rights Act of 1964. Although the U. S. Supreme Court has recognized that sexual harassment is illegal conduct for which an employer is liable, this transgression continues to be a major workplace problem. Although some researchers have analyzed the incident level of sexual harassment in general, little work has been conducted on particular industries.

The research described in this article is the summary of the results of a study of sexual harassment in the health care industry. A written survey was sent to 950 randomly selected members of the Kentucky Board of Nursing. Thirty-five percent of the 441 respondents to the survey indicated they had been sexually harassed in their capacity as nurses. More than 77 percent of those occurrences involved physicians as the harassers. When harassed, 51 percent of the respondents were aged 25 to 35; 25 percent, 25 or younger; 20 percent, 36 to 45; and 4 percent were 46 to 55. Fifty-three percent said they were harassed by supervisors; 32 percent said they were harassed by patients.

The survey showed that 23 percent of those harassed felt threatened in their job status if they did not go along with harassing behavior, and 24 percent reported the incidents. Only 23 percent of the nurses indicated that their employers had policies and procedures in place to address sexual harassment. Further, of the respondents that reported being sexually harassed, only 23 percent of these victims reported the incidents.

Sexual harassment complaints in the health care industry must be taken seriously. Health care institutions must adopt appropriate policies and procedures to address sexual harassment. The written policy statement on sexual harassment should show strong support from top management, specify the types of behavior perceived as sexual harassment, and be widely disseminated. Training should be provided to all staff, and effective enforcement mechanisms should be implemented.     

South Africa: The politics of racial terminology

Survey of racial terminology employed in southern Africa since 1652 is discussed     

Social Health Insurance and the Use of Formal and Informal Care in Developing Countries: Evidence from Ghana’s National Health Insurance Scheme

This paper studies the relationship between the use of formal and informal health care in a developing country setting by examining the introduction of a social health insurance scheme in Ghana. We estimate the effects of gaining coverage on changes in care seeking behaviour and show how these effects differ by age and wealth status. District-level differences in the implementation of the insurance scheme provide exogenous variation in access to insurance and allow us to address issues with selection into coverage. Results indicate that insurance access strongly increased use of formal care and reduced out-of-pocket expenditures on health services.