COMBATING HEALTHCARE COST INFLATION WITH CONCERTED ADMINISTRATIVE ACTIONS IN A CHINESE PROVINCE

This article defies the traditional notion that cost inflation in healthcare could hardly be curbed without the significant revision of economic incentive scheme, but demonstrates the possibility of containing cost inflation with concerted administrative actions in the Chinese context. It examines the case of Fujian Province that embarked on a health bureaucracy‐led policy reform without an alteration of economic levers but mainly using administrative tools to combat cost escalation. Through clearly defined, well designed, targeted and concerted administrative measures, effective cost containment is attainable in China's healthcare sector, at least in the short run. If combined well with the powerful economic instruments, administrative tools would be able to augment their effects in cost containment, provided with the government's possession of hospital ownership. At the heart of Fujian's case are the reassertion of the government stewardship, the reconstruction of the collapsed accountability mechanisms, the reconfiguration of policy instruments, and the revision of administrative incentives, rather than the decreased costs per se. Copyright © 2011 John Wiley & Sons, Ltd.     

Space–Time Modeling of Insurgency and Counterinsurgency in Iraq

The US and its Coalition partners concluded combat operations in Iraq in August 2010. Rather surprisingly, little empirical evidence exists as to the factors that contributed to the ebb and flow in levels of violence and the emergence and disappearance of hot spots of hostilities during the campaign. Building upon a tradition of criminology scholarship, recent work demonstrates that Improvised Explosive Device (IED) attacks are clustered in space and time and that these trends decay in a manner similar to that observed in the spread of disease and crime. The current study extends this work by addressing a key potential correlate of these observed patterns across Iraq—namely, the timing and location of a variety of Coalition counterinsurgency (COIN) operations. This is achieved by assessing the co-evolving space–time distributions of insurgency and counterinsurgency in the first 6 months of 2005. To do so, we employ a novel analytic technique that helps us to assess the sequential relationship between these two event types. Our analyses suggest that the number of COIN operations that follow insurgent IED attacks (moderately) exceeds expectation (assuming that events are independent) for localities in the vicinity of an attack. This pattern is more consistent than is observed for the relationship in the opposite direction. The findings also suggest that less discriminatory COIN operations are associated with an elevated occurrence of subsequent insurgency in the vicinity of COIN operations in the medium to long term, whilst for more discriminatory and capacity-reducing COIN operations the reverse appears to be true.     

Assessing the impact of imprisonment on recidivism

Objectives  

There is debate about the extent to which imprisonment deters reoffending. Further, while there is a large literature on the effects of imprisonment, methodologically sound and rigorous studies are the exception due to problematic sample characteristics and study designs. This paper assesses the effect of imprisonment on reoffending relative to a prison diversion program, Community Control, for over 79,000 felons sentenced to state prison and 65,000 offenders sentenced to Community Control between 1994 and 2002 in Florida.     

Cardiopulmonary resuscitation-related injuries and homicidal blunt abdominal trauma in children

Defendants accused of inflicting fatal abdominal injuries to children occasionally raise the defense that the injuries were caused by cardiopulmonary resuscitation (CPR). The purpose of this study is to answer the question: Does closed chest CPR result in fatal blunt abdominal injuries that can be mistaken for homicidal assault? To that end, a retrospective study was conducted of all homicidal blunt abdominal injuries in children 10 years and younger from the Dade, Broward, and Palm Beach Medical Examiner's Offices from 1981 through 1997. These were compared to cases of children who died of natural causes during the same time period in Broward County who had CPR (control group 1) and to children who died of nonvehicular accidental blunt abdominal trauma (control group 2). Children with life-threatening head injuries were excluded. Medical examiner records, autopsy reports, documenting photographs, and clinical records were reviewed. The data analyzed included subject demographics, whether CPR was performed and by whom, and autopsy findings. Thirty-three child homicides with fatal abdominal injuries were reviewed. Twenty-four (73%) of the homicides received CPR. There was no difference in the nature and severity of injuries between the 24 children who received CPR and the 9 who did not. Three hundred and twenty-four cases of pediatric natural deaths were reviewed, all of which had CPR. No traumatic abdominal injuries were found in any of the children who died of natural causes. Only four children who died of natural causes had evidence of extraabdominal trauma related to CPR. No cases of nonvehicular accidental blunt abdominal trauma were identified during the 17-year period, although there were nonvehicular accidental fatalities due to extraabdominal injuries. The likelihood of CPR-related primary abdominal trauma in child homicides is very low.