Competitive pricing and the challenge of cost control in medicare

The Medicare program faces a serious challenge: it must find ways to control costs but must do so through a system of congressional oversight that necessarily limits its choices. We look at one approach to prudent purchasing - competitive pricing - that Medicare has attempted many times and in various ways since the beginning of the program, and in all but one case unsuccessfully due to the politics of provider opposition working through Congress and the courts. We look at some related efforts to change Medicare pricing to explore when the program has been successful in making dramatic changes in how it pays for health care. A set of recommendations emerges for ways to respond to the impediments of law and politics that have obstructed change to more efficient payment methods. Except in unusual cases, competitive pricing threatens too many stakeholders in too many ways for key political actors to support it. But an unusual case may arise in the coming Medicare fiscal crisis, a crisis related in part to the prices Medicare pays. At that point, competitive pricing may look less like a problem and more like a solution coming at a time when the system badly needs one.     

OxyContin and a Regulation Deficiency of the Pharmaceutical Industry: Rethinking State-Corporate Crime

On May 10, 2007, three executives of the pharmaceutical company Purdue Pharma pled guilty in federal court to misleading doctors and patients about the risk of addiction and potential for abuse of OxyContin. Additionally, Purdue Pharma paid over $600 million in fines and other payments to the United States government and the Commonwealth of Virginia. The drug OxyContin was first introduced to the market in December of 1995. Warning signs of the drug’s potential for abuse were almost immediate, and there were reports of copious amounts of the drug being diverted into the black market for recreational use. In some cases, criminologists have argued that if the government fails to protect its citizens from the harm of a corporation then such behavior should be considered state-corporate crime. We critically evaluate the case of OxyContin to see if it falls under the state-corporate crime paradigm. Further, we argue the state-corporate crime paradigm can benefit from an increased focus on the organizational structures of regulation agencies.     

Sleep and Delinquency: Does the Amount of Sleep Matter?

Sleep, a key indicator of health, has been linked to a variety of indicators of well-being such that people who get an adequate amount generally experience greater well-being. Further, a lack of sleep has been linked to a wide range of negative developmental outcomes, yet sleep has been largely overlooked among researchers interested in adolescent delinquency. The purpose of this study was to explore the relationship between hours of sleep and delinquent behavior among adolescents by using data from Wave 1 of the National Longitudinal Study of Adolescent Health (n = 14,382; 50.2% female, 63.5% white). A series of negative binomial regressions showed that youth who typically sleep seven or fewer hours per night reported significantly more property delinquency than youth who sleep the recommended 8–10 h. Further, youth who reported sleeping 5 or fewer hours per night reported significantly more violent delinquency than youth who reported sleeping the recommended number of hours per night. The findings suggest that sleep is an important, and overlooked, dimension of delinquent behavior and studies that focus on adolescent health should further investigate the effects of insufficient sleep. Finally, the authors recommend that sleep and other relevant health behaviors be considered in the context of more comprehensive approaches to delinquency prevention and intervention.     

Promoting strengths, prevention, empowerment, and community change through organizational development: lessons for research, theory, and practice

SPEC Learning and Changing by Doing is a three-year, action research, and organizational change project designed to ultimately promote social justice and well-being in the community. SPEC is an acronym that stands for Strengths, Prevention, Empowerment, and Community Change. The project consists of five organizations tackling internal organizational change in order to better promote justice and well-being in their respective constituencies. In this article we present a formative evaluation of this multicase study of organizational change in human services. This article contributes to the empirical and theoretical literature on organizational change in the nonprofit human service milieu.     

Backloading to extinction: Coping with values conflict in the administration of Australia's federal biodiversity offset policy

Policy-makers are frequently required to consider and manage conflicting public values. An example of this in the environmental domain is biodiversity offset policy, which governments worldwide have adopted as a mechanism to balance environmental protection with socio-economic development. However, little work has examined administrative practices underpinning biodiversity offset policy implementation, and how the adoption of coping strategies to manage value conflicts may influence resulting policy outcomes. This study fills this research gap using a case study of Australia's federal biodiversity offset policy under the Environment Protection and Biodiversity Conservation (EPBC) Act 1999. Using data from 13 interviews of federal policy administrators, I show that the introduction of a new policy in 2012 enabled a shift from the use of precedent to a technical approach for setting offset requirements under the EPBC Act. Yet, multiple sources of policy ambiguity remain, and administrators have adopted post-approval condition-setting, or ‘backloading’—a form of cycling, facilitated by structural separation—to defer detailed assessments of offset requirements until after biodiversity losses are approved. Backloading thus undermines the effectiveness of environmental policy and will persist as coping strategy unless policy ambiguity is reduced via legislative amendments and adequate resourcing of biodiversity conservation.

Points for practitioners

• Biodiversity offset policy requires administrators to manage conflicting environmental and socioeconomic values.
• Technical decision tools reduce reliance on case-by-case decision-making, but multiple ambiguities persist.
• Backloading (post-approval condition-setting) defers values conflict, but reduces transparency, accountability, and policy effectiveness.
• Policy ambiguity must be reduced at the political level to facilitate effective biodiversity conservation.