The boundaries of generosity: Can administrators in charity hospitals provide “free care?”

The medical marketplace changes of the 1980's and 1990's have helped to redefine the charity care role which charity hospitals have played. How might charity hospital administrators succeed in fulfilling this responsibility, while simultaneously protecting the financial well-being of their institutions? This paper discusses how increases in charity care volume may relate to declining opportunities for cost-shifting, increased pressures for revenue-raising utilization policies, and limited support from government to subsidize uncompensated care. “Charity” and “free care” concepts are discussed, and economic and historical perspectives are introduced to provide the context for studying this issue.

The 1980's experience of charity hospitals in Massachusetts provides examples of specific policies within a state in which uncompensated care played a pivotal role in the debate over universal coverage. But there has been a quite recent refocussing upon the nonprofit hospitals' tax exemption. If such political pressures in the 1990's require a review of community benefits standards at charity hospitals, then perhaps the resolution of access questions for the poor and uninsured within forthcoming national health care reforms properly will take into account considerations of quality of care.     

Democratic Governance: A Genealogy

This essay draws on my book, Democratic Governance (Princeton University Press, 2010), to provide a genealogy of governance and to explore its implications for democracy. My arguments can be quickly stated: governance rose and spread as a consequence of new modernist theories and the public sector reforms that were inspired by these theories; policy actors respond to the challenges of governance by supplementing representative institutions with yet more modernist expertise.     

Subnational Collective Action: The Varied Patterns of Mobilisation of Local Government Associations

This article assesses differences in the way local government associations organise to influence EU legislation in different countries. EU policy outcomes have an increasing financial and administrative impact on local government. This has been increasingly recognised by both EU institutions and many national governments, and recent reforms have sought to ensure greater involvement of local authorities in the preparation of EU proposals and domestic pre-negotiations, with an emphasis on the aggregation of local government interests via European and national local government associations. Research suggests that representative organisations need to be well resourced to be able to mobilise at both European and national level to influence EU proposals. This article empirically assesses these claims by examining attempts by local government associations in England, Denmark and Ireland to influence EU environmental directives. The findings suggest that financial, staffing, and informational resources, as well as structural issues, are important factors influencing how local government representative bodies respond to EU legislative proposals.     

Unfinished business: The united states and Franco's Spain, 1944–47

‘Unfinished Business’ examines American and British postwar policy toward the regime of Francisco Franco in Spain. Although the emergence of the cold war eventually altered that policy from one of strenuous opposition to one of grudging acceptance, the continuing desire of the Western allies to alter or remove the Franco regime illustrates the persistent influence of anti‐fascism after World War II. In retrospect, the eventual alignment of Franco with the West seems a foregone conclusion, but in the fluid context of the years immediately after World War II policy makers on both sides of the Atlantic struggled to determine their interests in a world no longer defined by the war and not yet in the grip of the cold war.     

Hostage Diplomacy: Britain,China, and the Politics of Negotiation, 1967–1969

During the radical phase of the Cultural Revolution in 1967–1969, China's violation of the diplomatic norms of the international community reached an unprecedented level. Two dozen British diplomats and private citizens on the mainland became de facto hostages of their host government. In response to China's hostage-taking, the British government preferred quiet diplomacy to extreme retaliation such as a rupture of diplomatic relations and economic sanctions. It focused on negotiations through minimal publicity and reciprocal gestures. But in China, the British found a culturally different negotiating partner that was obsessed with principles rather than details. Through a step-by-step negotiating approach recommended by the Sinologists in the British Mission, London was finally successful in securing the release of its detained nationals. The lesson of Britain's quiet diplomacy was a culture-sensitive approach to negotiation and the ability to separate the hostage question from the wider political and economic relationship that would facilitate the resolution of future hostage crises.     

The common European security and defence policy and the ‘third‐country’ issue

The Common European Security and Defence Policy (CESDP) of the European Union (EU) was launched in 1999 and has been perceived as a landmark step toward European security cooperation, particularly in the field of crisis management. Still in its early stages, some difficult issues have become apparent. Of these, the so‐called ‘third‐country’ issue may prove to be among the most significant. This problem refers to the necessity of associating states outside the EU with CESDP. In this regard, three states stand out — the United States, Turkey and Russia — and this article considers their concerns and the European response in detail. This is prefaced by a general overview of how the third‐country problem emerged and what the EU has done to address it. It concludes by suggesting that third‐country considerations could well determine where and how EU‐led missions operating under the auspices of CESDP are deployed.     

Italian foreign policy in the post-cold war period: a neoclassical realist approach

Abstract

Drawing on a neoclassical realist approach, this article analyses the foreign policy conduct of different Italian governments from 1994 to 2008. Pressured by the post-cold war international system, these governments have been compelled to raise Italy's profile within the international system. However, the way in which successive governments have responded has differed markedly. By looking at variables located at the domestic level – elite perceptions of the distribution of power and government instability – it is possible to explain these differences. Neo-classical realism is seen as an advance on Waltzian neo-realism precisely because it allows room for domestic as well as international (or systemic) variables, and because it has a very specific focus on foreign policy as such.     

The Direct and Cross-Examination of Complainants and Defendants in Rape Trials: A Quantitative Analysis of Question Type

This paper is a post-hoc examination of the questioning used in six rape trials. Questions asked in the evidence-in-chief and cross-examination of six complainants and five defendants were coded into different categories. The categories comprised "open", "closed", "leading", "heavily-leading" and "yes/no" questions; questions that are known to increasingly constrain witness responses. Additionally, the frequency of "multiple questions", and questions with "negatives" and "double negatives" were recorded; questions that witnesses have difficulty understanding. Broadly speaking, results showed that questions in both evidence-in-chief and cross-examination were of a constraining nature and allowed witnesses little opportunity to provide complete accounts of alleged events, particularly during cross-examination. Multiple questions were frequent although negatives were comparatively rare, and double negatives did not occur. Similar forms of questioning were used for complainants as for defendants, although more questions were asked of complainants than defendants in cross-examination. The results are discussed in terms of the adverse influence of these questioning strategies on the completeness and accuracy of witnesses' responses, and the similarity in "combativeness" of lawyers in their examination of complainants and defendants.     

Sex offenders’ perceptions of the effectiveness and fairness of humanity,dominance, and displaying an understanding of cognitive distortions in police interviews: A vignette study

Abstract

Forty-three convicted sex offenders read each of four different offence vignettes that involved a man forcing a female victim into sex and the offender's subsequent police interview. The experimental manipulation involved giving participants each of four different scenarios concerning how the police interviewed the offender. These were interviews characterized by humanity, dominance, displaying an understanding of sex offenders’ cognitive distortions, or a neutral, control interview. Participants were required to rate the interviews on a variety of dimensions, such as the offender's likelihood of confessing, and the fairness of the interview. Where participants were told the man had been interviewed with humanity and compassion, they rated the offender as more likely to confess and rated the interview as fairer than the other conditions. In contrast, participants rated the offender interviewed with a dominant approach as less likely to confess, and for this procedure to be less fair than the other conditions. Displaying an understanding of sex offenders’ cognitive distortions appeared to have had no influence on perceived likelihood of confessions but was perceived to make the crime appear less serious.