Creating stability in the New Europe: The OSCE high commissioner on national minorities and the socialization of risky states

In “Protecting ‘The Prize': Oil and the U.S. National Interest,” Eugene Gholz and Daryl G. Press present an important counterargument to many common but overwrought worries about energy security. Yet they themselves go too far in the opposite direction. Gholz and Press argue that only three types of potential oil market disruptions could induce “particularly painful” adjustments and hence rise to the highest level: consolidation of a large fraction of Persian Gulf reserves under a single power, domestic instability in Saudi Arabia, and blockage of the Strait of Hormuz. I argue in this response that Gholz and Press confine the second and third scenarios too narrowly, and hence understate the security risks stemming from U.S. dependence on oil.     

One perspective on “democracy vs. efficiency”: Testing mutuality via the laboratory approach

Much social commentary has fixated on the theme of “democracy vs. efficiency,” but observers have directed attention at modes of decision-making alternative to the usual bipolar foci. Gaenslen takes the latter tack in suggesting a third mode, and this note at once shares in his intent while seeing problems with his approach. Specifically, this note outlines a fourth mode for decision-making, based on the “laboratory approach to organization development”; it sketches some of its underlying theory and practice; and the narrative details a number of ways in which the demands of economic efficiency and political democracy can be met with substantial mutuality by learning designs consistent with the laboratory approach.     

Diversity and structure: exploring a neglected but critical interface

Most public organizations can anticipate serious structurallyrelated impediments to efforts to “value” or “manage” diversity. Many public organizations maintain bureaucratic structures which provide, at best, awkward foundations for responding to changing workforce demographics. This article details management practices and techniques that may accommodate the needs of diverse employees.     

Case-mix nursing home reimbursement: a technical “fix” for a policy inadequacy?

Most state Medicaid programs, in many cases the largest fundors of long term care, reimburse nursing homes or home health agencies on negotiated flat rates. However, several states have implemented or are planning to use reimbursement methods using case-mix indices to adjust for the different variable costs (e.g., resource utilization groups, RUGs) incurred in caring for different types of patients. Advocates contend that such methods can simultaneously help contain costs and enhance access by motivating the nursing home to keep costs below predetermined rates and mitigating providers’ reluctance to admit “heavy care” residents. The numbers of such residents putatively have increased as a result of incentives in the Prospective Payment System for hospitals to more quickly discharge sicker patients. However, the potentially negative effects of case-mix reimbursement (CMR) on quality of care have not gone unnoticed, and the costs (as yet undetermined) of mechanisms to avert these effects likely are nontrivial.

This paper examines the effects of CMR on cost (to states and nursing homes), access and quality. A preliminary review of the available evidence seems to indicate mixed results; yet, CMR obviously appeals to some Medicaid programs and representatives of the nursing home industry. We suggest that the allure of CMR may be due to a mistaken belief that, to borrow from Brandon (1990), such “tech fixes” obviate irksome negotiation on the part of policy elites.

An alternate reimbursement policy is proposed: a negotiated prepayment, based on a facility's global budget, with periodic allocations and an end of period adjustment to compensate the provider for unanticipated costs.     

Governmental Corruption and Social Change in New Zealand: Using Scenarios, 1950–2020

New Zealand has long enjoyed a reputation as a country with a corruption-free state sector, and ranks very highly on the Transparency International's Corruption Perceptions Index (meaning its corruption levels are perceived to be extremely low). However, there is prima facie evidence to suggest that this situation may be changing, not dramatically but significantly. While the state sector changes of the 1980s and early 1990s may be having some impact on this shift, it also has to be understood in the context of wider societal changes, which are probably more decisive. After some brief conceptual clarification, the article presents three scenarios sketching past (1950s/1960s), present (1990s–2006) and future (2006–2020) social and governmental conditions thought to be relevant to corruption levels.