Medicaid Spending Dynamics: Implications for Cost Control Strategies

Because of the Medicaid program's high cost and rapid growth, state governments see it as an attractive target for cost-control strategies. The usual ways that budgeters contain spending do not work well on the Medicaid program. Cutting the Medicaid budget is likely to have unintended consequences for state revenues and spending. States can best cope with Medicaid's cost by developing a system-wide strategy of meeting their citizens' health and human-service needs.     

Policy Expansion in Local Government Environmental Policy Making

Relatively little is known about when, why, and how some jurisdictions “double down” on policy priorities, rapidly adopting multiple measures tackling the same issue. Rapid policy expansion can emerge in fast‐evolving, uncertain, and contested policy arenas in which pressures for policy making are not satisfied, and even may be strengthened, by initial policy innovation. This article analyzes local government policy making on high‐volume hydraulic fracturing by New York State municipalities from 2008 to 2012. Policy path dependence, peer influence, and policy design appear to play a critical role in determining whether public officials respond to these pressures with policy expansion. Initial policy innovations can open windows for policy participants to secure additional measures that strengthen or enlarge the scope of action. Public officials and stakeholders seeking particular policy outcomes should take a long view of the policy process while simultaneously remaining alert for opportunities afforded by pressurized policy dilemmas.     

A threat-centered theory of policy entrepreneurship

Policy Sciences - We know relatively little about the conditions that encourage people to jump into the political fray as policy entrepreneurs, advocates who devote substantial time, energy, and...     

The Future of the Public Service Workforce: A Dialogue

It has been widely suggested that public service delivery of the future will be different to that of today. Added to this, we are currently witnessing significant changes in terms of the nature of work. Taken together these developments signal that we will see transformation in terms of the role of public servants and the public service workforce. Against this background, this paper presents a dialogue on the future of the public service workforce between Helen Dickinson and Helen Sullivan of the Melbourne School of Government, University of Melbourne and Graeme Head, New South Wales Public Service Commissioner. This paper offers insights from academics actively engaged in teaching the future public service workforce and a public service commissioner actively working to make a reality of a vision of the future.     

Three faces of justice: Competing ethical paradigms in forensic psychiatry

Respect for justice has traditionally been an essential principle of health care ethics. However, many bioethical accounts of justice focus only on distributive justice, and how resources for health care should be allocated. In this article, I will argue that the practice of forensic mental health care requires clinicians to engage with justice in three additional and different ways: justice as liberty and fairness; retributive justice and protection of the vulnerable; and justice as the promotion of virtue. I will argue that British forensic psychiatry favours retributive and protective justice; in contrast to a libertarian approach to forensic practice in the United States. I discuss how respect for justice as support for virtue complements therapeutic work with offenders, which aims at the development of pro‐social character. I will conclude that without respect for justice as virtue, there is a danger that clinical forensic psychiatry risks doing harm to patients and bringing the profession into disrepute.     

Toward More “Evidence‐Informed” Policy Making?

The quality of public decision making depends significantly on the quality of analysis and advice provided through public organizations. Champions of “evidence‐informed” policy making claim that rigorous evaluation practices can significantly improve attainment of cost‐effective outcomes. After decades of experience, performance information is more sophisticated, but evaluation practices and capabilities vary enormously. Public agencies gather and process vast amounts of information, but there has been little analysis of how this information is actually utilized for policy and program improvement. This article examines how government agencies use evidence about policy and program effectiveness, with attention to four themes: (1) the prospects for improving “evidence‐informed” policy making, (2) the diversity of practices concerning evidence utilization and evaluation across types of public agencies and policy arenas, (3) recent attempts to “institutionalize” evaluation as a core feature of policy development and budget approval, and (4) the relationships between public agencies and nongovernmental sources of expertise.