Antitrust, health care quality, and the courts

Antitrust law represents the principal legal tool that the United States employs to police private markets, yet it often relegates quality and nonprice considerations to a secondary position. While antitrust law espouses the belief that vigorous competition will enhance quality as well as price, little evidence exists of the practical ability of courts to deliver on that promise. In this Article, Professors Hammer and Sage examine American health care as a vehicle for advancing understanding of the nexus among competition, quality, and antitrust law. The Article reports results of a comprehensive empirical review of judicial opinions in health care antitrust litigation between 1985 and 1999, with specific attention to courts' handling of quality and other nonprice concerns. Professors Hammer and Sage conclude that, although antitrust law cannot be expected to serve as the sole oversight mechanism for industries as complex and quality dependent as health care, courts have been successful incorporating some nonprice factors into antitrust analysis.     

A kinetic model describing the pharmacokinetics of ethyl glucuronide in humans

The glucuronide conjugation is a minor pathway of ethanol metabolism. The determination of ethyl glucuronide (EG) in serum and urine has gained importance in forensic and other legal decisions. To prospectively calculate the serum concentration of this non-oxidative ethanol metabolite, the computer program developed includes a parameter fitting routine. Multiple ethanol doses can be handled.The mathematical modeling was based on the following assumptions and simplifications, respectively. A single enzyme system is responsible for ethanol conjugation at one distinct site; the distribution of EG into the systemic circulation is delayed; the elimination of EG follows first-order kinetics.The concentration of EG was calculated using three kinetic parameters: a rate constant for the first-order formation of EG from serum ethanol, a transfer constant for an obstructed transfer of EG from the formation site (FS) into the central compartment (CC) and an exponential elimination constant.The program was applied to the data collected from 21 drinking experiments. The fitting algorithm optimized the three kinetic parameters, until the sum of concentration error squares of the data points was minimized. The means+/-standard deviation of the rate constant for the first-order formation of EG from serum ethanol was 0.0011+/-0.0006 h(-1), the transfer constant for an obstructed transfer of EG from the FS into the CC was 0.43+/-0.1996 h(-1) and the exponential elimination constant was 3.0+/-1.45 h(-1).Using the range of these parameters, it is now possible to calculate minimum and maximum serum concentrations of EG based on ethanol doses and drinking times. The comparison of calculated and measured concentrations can prove the plausibility of an alleged ethanol consumption. This can be crucial when the serum ethanol concentration (SEC) itself is not meaningful.     

Government's response to Hurricane Katrina: A public choice analysis

We use public choice theory to explain the failure of FEMA and other governmental agencies to carry out effective disaster relief in the wake of Hurricane Katrina. The areas in which we focus are: (1) the tragedy of the anti-commons resulting from layered bureaucracy, (2) a type-two error policy bias causing over cautiousness in decision making, (3) the political manipulation of disaster declarations and relief aid to win votes, (4) the problem of acquiring timely and accurate preference revelations, (5) glory seeking by government officials, and (6) the shortsightedness effect causing a bias in governmental decision making.     

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Ohne Zusammenfassung     

Newspapers and Budgeting: The Effects of Media Coverage on Local Expenditure Decisions

The media play an important role for the political agenda. It is less clear, however, how strong the media impact is on political decisions. This article pursues a different approach from the one commonly used in the media–policy research tradition. Instead of focusing on the relationship between the content of the media agenda and the political agenda, it is argued here that from a broader policy perspective, media pressure on the incumbents is a more relevant variable. Media pressure is measured as media competition and media coverage. Furthermore, the article investigates the effect of media variables on budgetary decisions in different spending areas, and compares the relationships between media pressure and policy under various economic, political and institutional conditions. This allows the authors to investigate which factors hinder and promote media influence on policy. The units of analysis are the Danish municipalities, which are similar political units with different newspaper coverage. Coverage by local newspapers is intense in some municipalities, but absent in others. As expected, the authors find that in municipalities with intensive coverage from local newspapers, local politicians do feel a stronger media pressure. However, when it comes to budgetary decisions, almost no observable effects of media pressure are found, either generally or in favourable political, economic or institutional settings.     

Designing a merit‐based process for appointing boards of abcs: Lessons from the Nova Scotia reform experience

Abstract: Efforts to design merit‐based appointment systems for the boards of government agencies, boards and commissions (abcs) have gained greater priority over the past decade in order to enhance public confidence in the integrity of the political process, improve the governance of organizations operating at arm's length from ministers, and reduce the risks to the public interest and public purse that come with incompetent boards. The Nova Scotia reform experience in this regard is instructive because this province's appointment regime not only encompasses a legislative committee veto over ministerial appointments, a power unique to this province in the Canadian and comparative Westminster systems, but also uniquely sets the merit standard as relative‐merit, that is, the appointment of the most qualified of all applicants, and not merely a qualified candidate. This article reviews this provincial experience and concludes that a merit‐based appointment system that pursues relative merit can be created but only by restricting the authority of ministers to a veto over the appointment of candidates nominated by the abcs themselves. Sommaire: Ces dix demières années, les efforts déployés pour concevoir des systemes de nomination au mérite pour les conseils d'administration d'organismes, des régies et des commissions du gouvernement ont obtenu une priorité beaucoup plus grande, et cela, afin de rehausser la confiance du public envers I'intégrite du processus politique, d'ameliorer la gouvernance d'organismes fonctionnant sans contrôle ministériel direct et de réduire les risques que représentent les conseils incompétents pour le bien et les deniers publics. L'expérience de la réforme entreprise en NouvelleÉcosse est à cet égard instructive pour les partisans de la réforme. Le régime de nomination de cette province comporte non seulement un droit de veto de la part d'un comité législatif sur les nominations ministéielles, pouvoir unique à cette province dans le systéme canadien et le systéme comparatif de Westminster, mais il établit également la norme de mérite comme un mérite relatif, c'est‐à‐dire la nomination de la personne la mieux qualifiée parmi tous les candidats et non simplement la nomination d'une personne qualifiée. Le présent article examine I'expérience de cette province et conclut qu'un système de nomination au mérite visant le mérite relatif peut être mis en place, mais seulernent à condition de limiter le pouvoir des ministres à opposer leur veto à la nomination de candidats par les organismes, régies et commissions gouvernementaux.     

Accountability and Joined‐up Government

The Coombs Royal Commission identified a range of issues relating to the coordination of services. While there has been renewed interest over the last five years in the UK, Canada and Australia in initiatives that support joined‐up and cross‐cutting government, there has been only limited work to address the potential recognised by the Commission for these initiatives to result in unclear accountabilities. This paper reviews accountability approaches to joined‐up government and identifies that while the sharing of accountability for outcomes has emerged quietly over the past 25 years, joining‐up initiatives are demanding a clearer articulation of causal relationships regarding the sharing of outcomes and a fuller consideration of the multiple relationships in the partnership arrangements involved.