Health‐care reform and the dimensions of professional autonomy

Abstract: A “managed competition” model was introduced in the Canadian province of Ontario as part of the government's reform of home care. With this model, it was assumed that competitive forces would encourage quality while driving down costs. While such reforms often achieve cost controls by constraining the incomes and practices of health‐care workers, there has been relatively little analysis of the extent to which self‐governing health‐care professionals, particularly those outside of medicine and nursing, may experience a decline in their ability to control the content and context of their professional work. In this article, the authors analyse the results of thirty‐six in‐depth interviews with representatives of Community Care Access Centres (CCACs), the organizations that purchase and coordinate the delivery of home‐care services, and rehabilitation provider agencies to examine the impact of Ontario's managed competition reform on rehabilitation professionals. Findings suggest that the impact of the reform varied across the economic, political, and clinical dimensions of professional autonomy and that, despite a general loss of autonomy under the managed competition model, market forces also served to mitigate the loss of autonomy, thus contributing to a remarkable resilience of professional autonomy. Sommaire: Un modèle de « concurrence dirigée » a été introduit récemment dans la province canadienne de l'Ontario dans le cadre de la réforme gouvernementale des soins à domicile. Avec ce modèle, il était présumé que les forces de la concurrence encourageraient la qualité tout en faisant baisser les coûts. Alors que de telles réformes parviennent souvent à maîtriser les coûts en réduisant les revenus et les pratiques des travailleurs de la santé, il y a eu relativement peu d'analyses de faites sur la mesure dans laquelle les professionnels de la santé autonomes, particulièrement ceux qui exercent en dehors de la médecine et de la profession infirmière, connaissent une perte de contrôle sur le contenu et le contexte de leur travail professionnel. Dans le présent article, les auteurs analysent les résultats de trente‐six entrevues en profondeur menées auprès de représentants des Centres d'accès aux soins communautaires (CASC), organismes qui achètent et coordonnent la prestation des services de soins à domicile, et organismes de prestation de soins de réadaptation, afin d'examiner les conséquences de la réforme de la concurrence dirigée de l'Ontario sur les professionnels de la réadaptation. Les résultats laissent entendre que l'effet de la réforme a varié en fonction des dimensions économiques, politiques et cliniques de l'autonomie professionnelle et que, malgré une perte d'autonomie générale liée au modèle de concurrence dirigée, les forces du marché ont également permis d'atténuer la perte d'autonomie, contribuant ainsi à la remarquable résilience dont font preuve ces professionnels en la matiére.     

Learning the Limits of Power: Privatization and State-Labor Interactions in Mexico

Despite repeated conflict with organized labor, the government of Carlos Salinas de Gortari (1988–94) pushed an aggressive divestment agenda that transformed Mexico into Latin America's leading privatizer. Explanations of Salinas's achievements typically emphasize centralized presidential power (including control over the ruling party) and autonomy; technocratic and political savvy; and weak labor opposition. This article questions such a pure "capacity-outcome" approach. Of equal importance are the learning effects of repeated interaction between the state and labor, which changed the course of divestment struggles and thereby influenced their outcomes. Lessons learned in successive confrontations led to patterns of interaction conducive to widescale privatization. The article develops this argument through comparative analysis of major divestment episodes in the aviation, mining, steel, and telecommunications sectors.     

Productivity growth and funding of public service broadcasting

In this paper we demonstrate how standard techniques for measuring productivity growth can be applied to the broadcasting sector to provide a benchmark for reasonable efficiency savings which public finance officials might expect public service broadcasting (PSB) to achieve. Using establishment level data from the UK, we produce estimates of productivity growth amongst commercial broadcasters between 1999 and 2003, which provide some evidence that improvements to PSB can reasonably be expected to be funded by efficiency savings rather than solely by increases in public funding.     

Propensity to Negotiate and Career Advancement: Evidence from an Investment Bank that Women Are on a "Slow Elevator"

Women are underrepresented at senior levels in most companies. This article examines whether gender differences in the propensity to negotiate contribute to this pattern. Based on a behavioral experiment run in a major investment bank in the United States, I found that fewer women than men are willing to negotiate, but employees who have a propensity to negotiate are promoted on average seventeen months more quickly than those who do not. Women advance more slowly than men, which accounts for the underrepresentation of women in senior positions. I conclude that gender differences in the propensity to negotiate partially explains why women are on a "slow elevator" to the top.     

Mediation as an alternative to criminal prosecution

In several American communities, paraprofessional mediation has become a substitute for criminal prosecution when defendant and victim have been engaged in a prior relationship. This article describes such a mediation project and its training program. It present a detailed account of two actual mediation sessions. An analysis of these sessions highlights some of the problems in mediating interpersonal disputes, particularly questions about underlying cause and the effects of different perceptions about the role of conflict in human interaction. The article also suggests a series of hypotheses to be investigated in further research on mediation.The research on which this paper is based was partially supported by grant No. 77-NI-99-0019 from the National Institute for Law Enforcement and Criminal Justice, U.S. Department of Justice. The views expressed are those of the authors only. We appreciate the cooperation received from George Nicolau and Ann Weisbrod of the Institute for Mediation and Conflict Resolution and from the staff of the Fosterton mediation project.     

Testing repeatability and error of coordinate landmark data acquired from crania

This study evaluates issues of precision, repeatability, and validation in three-dimensional (3D) landmark coordinates. Two observers collected 19 homologous cranial landmarks from three skulls during three separate digitizing sessions. Statistical analysis was conducted on the 171 interlandmark distances (ILDs) derived from the original coordinate data. A mixed model ANOVA detected significant within-subject error in 54 of the 171 ILDs (i.e., 32%). A GLM procedure revealed significant between-observer variation in 14 ILDs and significant observer-by-session differences in 13 ILDs. The majority of these differences involved ILDs with type 3 landmarks as endpoints, such as euryon and alare. Unlike type 1 and 2 landmarks which are biologically informative in all directions, type 3 landmarks contain a substantial arbitrary component. Thus, it is not surprising type 3 landmarks displayed significant digitizing error. Given these results, we caution researchers to be mindful of type 3 landmarks measurement discrepancies when selecting landmarks for coordinate data evaluation.     

“I Had a Confidence Epiphany!”: Obstacles to Combating Post-Identification Confidence Inflation

Research shows that eyewitnesses often become more confident with their selections from a lineup over time, a problem labeled "confidence inflation." Wells et al. (1998) Law and Human Behavior, 22, 603-647 suggested that eyewitnesses provide a confidence statement immediately following their selection to capture an unadulterated measure of confidence. Three experiments tested the effectiveness of introducing such a statement to combat the effects of confidence inflation on mock-juror judgments. All experiments provided evidence that the attributions participants formed about the eyewitness' confidence inflation differentially impacted their judgments. Although mock-jurors generally discredited eyewitnesses who showed confidence inflation and sometimes lowered probability of guilt ratings for the defendant, a clear exception occurred when mock-jurors attributed the inflation to an epiphany. Use of post-identification confidence statements to decrease the impact of confidence inflation in the courtroom may be insufficient.     

Human Rights in the Council of Europe and the EU: Towards ‘Individual’, ‘Constitutional’ or ‘Institutional’ Justice?

Abstract: The European Convention on Human Rights, promulgated by the Council of Europe in 1950, is widely regarded as the world's most successful experiment in the trans‐national judicial protection of human rights. The EU's much more recent judicial and political interest in human rights has also been widely welcomed. Yet, while the crisis currently afflicting the Convention system has not gone unnoticed, the same cannot equally be said of the difficulties presented by the increasing interpenetration of the two systems. Amongst the few who have shown some interest in these problems, the dominant view is that good will and common sense will provide adequate solutions. We disagree. Instead, we detect a gathering crisis which, unless properly analysed and effectively tackled, will only deepen as the EU's interest in human rights develops further. In our view, the problem is essentially conceptual and that, ultimately, it boils down to a much‐neglected question, simple to state but not so easy to answer: is the trans‐national protection of human rights in Europe a matter of ‘individual’, ‘constitutional’ or ‘institutional’ justice?