Hospital selective contracting without consumer choice: What can we learn from Medi‐Cal?

In the selective contracting era, consumer choice has generally been absent in most state Medicaid programs, including California's (called Medi-Cal). In a setting where beneficiary exit is not a threat, a large payer may have both the incentives and the ability to exercise undue market power, potentially exposing an already vulnerable population to further harm. The analyses presented here of Medi-Cal contracting data, however, do not yield compelling evidence in favor of the undue market power hypothesis. Instead, hospital competition appears to explain with greater consistency why certain hospitals choose to contract with Medi-Cal while others do not, the trends in inpatient prices paid by Medi-Cal over time, and the effect of price competition on service cutbacks, such as emergency room closures. Copyright 2003 by the Association for Public Policy Analysis and Management.     

International Cooperation to Manage High‐Skill Migration: The Case of India–U.S. Relations

Highly skilled people are among the most valuable factors of production in the contemporary world economy. Some have characterized the competition among nations for these people as a “brain drain” or “war for talent,” which imposes significant costs on the countries of emigration. However, the distribution of costs and benefits that results from high‐skill migration is not necessarily zero‐sum or fixed. It may be altered through international cooperation, producing a self‐reinforcing “win–win” scenario for sending and receiving countries. Bilateral cooperation, focused on specific sectors affected by migration, is the most promising approach for realizing such a scenario. This paper explores the prospects and potential for such cooperation between India and the United States, which comprise what is probably the world's largest high‐skill mobility relationship. After sketching the broad contours of the relationship, we explore the prospects for mutually beneficial cooperation in three specific fields of high‐skill migration: information technology services, medicine and nursing, and graduate education.     

Positional Asphyxia in Opioid-Related Deaths: Is It Being Overlooked?

The contribution of positional asphyxia in opioid-related deaths is currently unknown. Diagnostic criteria for positional asphyxia include finding the decedent in a position that does not allow for adequate respiration and an inability to extricate themselves from the position due to various conditions. Our primary objective was to assess whether positional asphyxia and the resulting airway compromise were a contributing factor to death due to the toxic effects of opioids. We evaluated 225 deaths where the death scene investigation contained adequate information to evaluate for positional asphyxia and performed a Pearson chi-square test to determine if the proportion of deaths found in an airway compromising position was higher when opioid(s) caused the death. The proportion of decedents found in a potential airway compromising position was greater when the death was related to opioid use (p < 0.0001). Further, narrowing the dataset to decedents who were definitely in an airway compromising position [Yes (24.49%) vs. No (11.02%)] showed a statistically significant association between positional asphyxia and deaths related to opioid use (p = 0.0021). Carefully documenting the position in which the decedent was initially found may be a significant factor in accurate reporting and in harm reduction efforts to decrease the opioid mortality rate.     

The Complexity of Destruction in Darfur: Historical Processes and Regional Dynamics

This paper analyzes the complex historical and regional factors that contribute to the escalation of destruction from 2003 on in Darfur. Darfur is not an isolated case that suddenly erupted in violence. It is the most recent case in a long history of repeated violations by the Sudanese state against its citizens. From the use of proxy militias (the Janjaweed) to signing peace agreements that fragment and weaken the opposition, destruction in Darfur continues government strategies of divide and rule. At the same time, complex regional dynamics especially between Sudan, Chad and the Central African Republic add to violence and instability within states and across borders. The paper emphasizes the speed with which during 2003–2005 over 2.4 million were uprooted from their homes and the ongoing vulnerability of internally displaced persons to attacks, disease and malnutrition. This restructuring of the population in Darfur is part of a strategy to control the populace and redistribute land and other resources. The multicausal origin of the conflict and its increasing complexity points to the difficulty of providing security for the people in Darfur and resolving the conflict.

Gender,HipHop and Pop-Islam: the urban identities of Muslim youth in Germany

While many opponents construe the growing presence of Muslim headscarves in Germany as evidence of creeping Islamicization, religious activism can also be interpreted as an attempt on the part of migrant offspring to forge positive ‘hyphenated identities’, rooted in urban culture, material consumption, and specific mosque communities. Islam has become ‘young, chic and cool’ among ethnic minorities, often denied citizenship and opportunity in their country of birth owing to jus sanguinis and/or other complex naturalization requirements. Religiosity, in turn, is slowly giving rise to new types of civic engagement, leading more ethnic youth to pursue German citizenship. Drawing on representative surveys, inter alia, this essay argues that while not problem free, an emerging Pop-Islam movement has provided Muslimas especially with an important platform for breaking with traditional gender roles, building social capital and acquiring the participatory skills necessary to bring ‘civil society’ into their own communities. It moreover infers that national policies banning headscarves in public service professions are increasingly at odds with European Union directives addressing gender equality and religious discrimination.