The who, what, and why of risk adjustment: a technology on the cusp of adoption

Risk adjustment (RA) consists of a series of techniques that account for the health status of patients when predicting or explaining costs of health care for defined populations or for evaluating retrospectively the performance of providers who care for them. Although the federal government seems to have settled on an approach to RA for Medicare Advantage programs, adoption and implementation of RA techniques elsewhere have proceeded much more slowly than was anticipated. This article examines factors affecting the adoption and use of RA outside the Medicare program using case studies in six U.S. health care markets (Baltimore, Seattle, Denver, Cleveland, Phoenix, and Atlanta) as of 2001. We found that for purchasing decisions, RA was used exclusively by public agencies. In the private sector, use of risk adjustment was uncommon and scattered and assumed informal and unexpected forms. The most common private sector use of RA was by health plans, which occasionally employed RA in negotiations with purchasers or to allocate resources internally among providers. The article uses classic technology diffusion theory to explain the adoption and use of RA in these six markets and derives lessons for health policy generally and for the future of RA in particular. For health policy generally, the differing experiences of public and private actors with RA serve as markers of the divergent paths that public and private health care sectors are pursuing with respect to managed care and risk sharing. For the future of RA in particular, its history suggests the need for health service researchers to consider barriers to use adoption and new analytic technologies as they develop them.     

Training strategies designed to mitigate agency liability in lawsuits against the police

Journal of Police and Criminal Psychology -     

The AFSP Standard - a lesson for law enforcement agencies

Compliance with the AFSP (Association of Forensic Science Providers) Standard [1] which concerns the formulation of an evaluative opinion requires consideration of the defence case. This can be problematic for forensic scientists working with or for law enforcement agencies. Among the aims of law enforcement agencies is to secure a conviction while in many jurisdictions the forensic scientist owes an overriding duty to the Court. This casework report demonstrates that early consideration of the defence case by a forensic scientist complying with the AFSP Standard may help rather than hinder the prosecution. The dichotomy as to a conflict of interest for the scientist between supporting the police/prosecutors and being scientifically objective is shown to be a false dichotomy. Compliance with the Standard ensures that science is a better servant of justice.     

A social and political profile of Canadian legislators, 1996

This research note provides an overview and an update on the social and political backgrounds of all elected Canadian legislators at the federal and provincial/territorial levels of government in 1996. For provincial/territorial legislators data are presented by electoral jurisdiction, and for all legislators by level of government and political party. Relatively few differences in social characteristics were found between the two levels although there were some variations by province, territory and party. Business, education and law are the three most prevalent occupations, although the latter has declined among legislators over time. There is little movement of members from the provincial to the federal level. The most common political experience of both groups lies in municipal governance. Over time women have increased their share of seats at both levels. Even in a polity such as Canada with high rates of legislative turnover at both federal and provincial/territorial levels and with new parties emerging, most changes in social and political experience backgrounds proceed incrementally.     

The use of performance evaluations to mitigate agency liability in lawsuits alleging police misconduct

Conclusion Police administrators must take a proactive approach in preventing and defending vicarious liability lawsuits. Their ability to verify that adequate training and supervision has occurred is essential in this type of litigation. The proper use of performance evaluations is an excellent method of demonstrating that adequate training and supervision have occurred.