Understanding Local Service Delivery Arrangements: Are the ICMA ASD Data Reliable?

The authors utilize the two latest ICMA Profile of Local Government Service Delivery Choices surveys to investigate whether the service provision and delivery arrangement information reported in the surveys accurately represents reality and, if not, what factors contribute to generating incorrect or unreliable survey responses. Interviews with practitioners are used to better understand both the accuracy of the survey responses and improvements that could be made to the survey instrument. Results suggest that the ICMA ASD survey data are highly erratic, with more than 70 percent of the cases (N = 70) investigated containing some inaccuracies. A qualitative analysis shows that the majority of the errors appear to be caused by the lack of a clear definition of service provision or by the service titles being too vague or too broad, both of which likely lead to discretion in interpreting survey questions and thus inconsistent answers by individual respondents over time.     

Aleksandr Solzhenitsyn, <Emphasis Type="Italic">March 1917, Node III,The Red Wheel</Emphasis>. Trans. Marian Schwartz

A review of Aleksandr Solzhenitsyn's March 1917, translated by Marian Schwartz     

Rehumanizing Birth and Death in America

THESIS: Despite spending more on medical care than any other country in the world, the United States still boasts some of the worst patient outcomes of any developed nation. This disparity is especially true of how Americans give birth and die.  These natural human transitions have become catastrophically expensive and leave patients and their families traumatized from unnecessary interventions. This article examines the costs and outcomes associated with the medicalization of birth and death and argues that alternatives exist that improve patient outcomes while lowering costs. Access to these alternatives will require changing current regulatory and reimbursement structures and providing trained support staff to help families navigate beginning- and end-of life decisions.