The competitive impact of health maintenance organizations on hospital finances: an exploratory study

In this study we explore whether HMO-induced competition has contained expenditures in Minneapolis/St. Paul hospitals. Specifically, we assessed the impact of HMOs on revenue, cost, and net income per admission in Twin Cities hospitals from 1979 to 1981. Some HMOs have obtained negotiated discounts from hospitals. We found that hospitals which gave larger discounts did not have lower costs per admission. This finding suggest that discounts do not force hospitals to operate more efficiently. In addition, hospitals with a large share of patients from HMOs or government Medicare and Medicaid programs did not have lower costs per admission than other hospitals during the years from 1979 to 1981. This finding casts doubt on the claim that discounts are justified by lower costs for HMO or government patients. Finally, neither HMO market share nor discounts had an adverse effect on hospital profits. During the three years studied, hospital profits in the Twin Cities showed an upward trend. This study concludes that if competition is to succeed it must encompass more than HMOs. HMOs may be important, but they are only one agent in the market. Thus, public policy created to induce competition must go beyond the simple stimulus of HMO growth.     

Diffusion of responsibility in crime,punishment, and other adversity

Three studies tested the hypothesis that an individual acting alone, compared with an individual group member, would be held more responsible for behavior leading to a negative consequence. In one study, 240 subjects read scenarios of an event with a negative outcome involving one, two, three, or four individuals. As predicted, there was a significant inverse relationship between the number of participants and the degree of attributed responsibility. The second study investigated subjects' attributions of responsibility for criminals committing a crime alone or with a partner. Single perpetrators were considered more responsible than those acting with a partner, although there was no difference in sentence length assigned. In the third, archival-type study, prison sentences for criminals who had actually committed a robbery alone or with others were examined. Again, there was diffusion of responsibility: criminals acting alone received significantly longer sentences than perpetrators who had committed a similar crime, but who had acted with others.     

Principles for Public Management Practice: From Dichotomies to Interdependence

In this essay we explore the relationship between management practices and a basic governance dilemma: how to manage flexibly and accountably. The challenge is both practical and theoretical. Managers must respond flexibly to the changing demands and expectations of the public and the ever-changing nature of public problems, yet they must do so in a manner that provides accountability to the public and political overseers. A dichotomous approach to the study of leadership as management action and the governance structures within which managers operate has inhibited the search for a public management theory that reconciles the dilemma. Emphasis upon managers as leaders typically focuses on the flexible actions managers might take to overcome structural "barriers," while emphasis upon governance structures typically focuses on the essential role of structure in ensuring accountability and restraining or motivating particular management efforts. The practicing manager, however, cannot deal with these aspects of the work separately. Managers must attend to demands for both flexible leadership action and structures that promise accountability. Anecdotal evidence provides illustrations of some of the ways that managers can integrate these demands. We suggest that these efforts point to an alternative theoretical framework that understands action and structure as mutually constitutive, creating a dynamic tension in which attention to one requires attention to the other.     

The class as case: “Reinventing” the classroom

New approaches to public management provide principles by which to organize the classroom as a case. In teaching public management one can enhance learning for practice by modeling, experimenting with, and reflecting upon the principles that one is teaching the students. The principles from the new ideas about public management that can be used to organize the classroom as well are strength through diversity, continuous improvement, teamwork, and empowerment. They represent changes in governing relations across the country and globe within which the new approaches to public management rest; each of these principles has a role in the “reinvented” classroom. Such practices require institutional support of various kinds as well. © 1999 by the Association for Public Policy Analysis and Management.     

Predictors of child molestation: adult attachment, cognitive distortions, and empathy

A conceptual model derived from attachment theory was tested by examining adult attachment style, cognitive distortions, and both general and victim empathy in a sample of 61 paroled child molesters and 51 community controls. Results of logistic multiple regression showed that attachment anxiety, cognitive distortions, high general empathy but low victim empathy significantly increased the odds of child molester status. Findings supported theoretically based hypotheses, suggesting that attachment theory may be useful in the conceptualization and treatment of child molesters.     

How Law Changes the Environmental Mind: An Experimental Study of the Effect of Legal Norms on Moral Perceptions and Civic Enforcement

This paper examines how different legal instruments affect people's moral intuitions and willingness to engage in social enforcement in the field of environmental law. These instruments vary in terms of their governance technique, the process through which they were enacted, and their allocation of enforcement responsibilities. Their effect on citizens' moral evaluation and emotional reaction to corporate polluting behaviour are examined, based on an experimental survey of a representative sample of 1400 individuals in Israel.
Our findings demonstrate that their design influences people's level of moral and emotional resentment when faced by environmentally problematic behaviour, as well as their motivation to engage in private enforcement. The design of the regulatory instrument could thus generate biases in social reactions to polluting behaviour, irrespective of its actual ecological adverse effect. We analyse the moral and psychological mechanisms which underlie these effects and explore their various policy implications.     

Building peace through education

ABSTRACT

Can we pave the way to world peace through education of the next generation? This paper focuses on how teaching social and emotional learning (SEL) skills in schools could promote the positive development of children and youth so that they can choose prosocial, nonviolent ways of building relationships with others. First, research on how belonging and fairness develop early in life is briefly reviewed. Then the authors introduce SEL and the research supporting its impact, and explain how it can be supported through various strategies in the classroom, including programs, teacher–student relationships, cooperative learning, approaches to discipline, and solving problems and dealing with conflict peacefully. Building peace by promoting social and emotional development through education offers hope for future generations.     

Promoting an Environmental Civil Society: Politics,Policy, and Russia's Post‐1991 Experience

In recent years the United Nations Environment Program, UN Conference on Environment and Development, and other international organizations have acknowledged the importance of civil society for engaging stakeholders in environmental change—especially at the local community level—and in promoting democracy. ¹ In Russia, efforts by nongovernmental organizations (NGOs) to promote reform since 1991 have aimed at achieving both objectives and face numerous political, legal, and attitudinal hurdles. This article examines these hurdles and the factors that facilitate development of an environmentally conscious civil society in Russia through analysis of the views of 100 representatives of environmental NGOs, news media, scientific community, corporations, and public agencies. We also investigate three abbreviated but illustrative vignettes that illuminate civil society impediments. Our thesis is that successful efforts to ensure adequate protection of Russia's environment require a strengthening of civil society.     

Motivating Environmental Action in a Pluralistic Regulatory Environment: An Experimental Study of Framing,Crowding Out,and Institutional Effects in the Context of Recycling Policies

In designing a recycling policy, the regulator must choose among multiple instruments. Our study seeks to address the linkages between the choice of regulatory instruments and institutional frameworks, people's intrinsic motivation, and various attitudinal measures. We examined the behavioral repercussions of several instruments that are used widely in recycling regulation, using an experimental survey on a representative sample of the Israeli population (N = 1,800 participants). Our findings suggest that the design of recycling policies should be sensitive to the framing effects of varied regulatory instruments and to the interplay between intrinsic and extrinsic motivation on the desirability and efficacy of the law. In particular, we point out the potential regulatory advantage of using deposit schemes over other instruments and of using private organizations as regulatory agents. Drawing on these findings, we discuss the potential value of using differentiated regulatory policies to provide incentives for recycling in societies characterized by broad heterogeneity in levels of intrinsic motivation.