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.     

'Far too dangerous a gamble'?1 British intelligence and policy during the Chanak crisis, September-October 1922

In considering the role of intelligence in the events that culminated in the 1922 Chanak crisis, particular attention is given to the extent to which intelligence assessments of Turkish Nationalist troop strengths influenced British decisions. Key political figures included Lloyd George, Lord Curzon, Winston Chuchill, and Austen Chamberlain, as well as military officers such as General Harington and Admiral Brock, and the diplomat Sir Horace Rumbold. It concludes that the final armistice, signed at Mudania, met British objectives, but only after running too high a risk.¹Harington to Maurice, 8 Jan. 1923, 23 April 1923, Maurice 3/2.     

On the Nature of Harms Reported by those Identifying a Problematic Drinker in the Family,an Exploratory Study

A national telephone survey on alcohol-related harms experienced by others consisted of 2,649 randomly selected adults and 415 (15 %) commented on the family member whose heavy drinking most negatively affected them. Relationships comprised close family (child, parent, sibling; 47 %), partner (22 %), extended family (e.g., aunt/uncle, cousin, grandparent; 19 %), and ex-partner (12 %). Common harms were being emotionally hurt and having a serious argument. An average of 3.4 harms was reported and multiple harms meant a higher likelihood of significant impact. Harms were classified into four domains which accounted for approximately 60 % of the explained variance: psychological (26.1 %), physical (11.4 %), social (10.9 %), and practical (9.6 %). Psychological and practical domains were associated with significant harm as were being female and sharing a home with the drinker. Perceived harms from a problematic drinking family member are broad ranging and have significant impact. Advice, information, and directions for family members dealing with a problematic drinker need development.     

The promise of humanistic policing: Is higher education living up to societal expectation?

More police agencies require incoming personnel to have a college education background. The hope is that collegeeducated officers will be more rounded thinkers and exhibit a greater humanistic bent. This study attempts to evaluate the efficacy of that line of reasoning. Students from three southern colleges read vignettes and sentenced a murder defendant and an automobile theft defendant to a term of imprisonment. Three hypotheses are tested. First, it is expected that policeoriented criminal justice majors will not issue more severe sentences. Second, it is anticipated that greater exposure to college from the freshman to the senior years will be accompanied by less severe sentences. Third, sentencing will be independent of social characteristics. The results provide little evidence supporting a more authoritarian and more punitive stereotype of criminal justice majors interested in pursuing police careers. A draft of this paper was presented at the annual meeting of the Southern Criminal Justice Association, Chattanooga, TN, 1999     

For the Want of Certainty: Vnuk,Juliana and Andrade and the Obligation to Insure

In 2014, the Court of Justice of the European Union in Damijan Vnuk v Zavarovalnica Triglav extended the requirement for the owner of a motor vehicle to possess insurance cover where the vehicle is used on a road or other public place to vehicles on private land. Beyond disquiet as to this extension, there remains uncertainty at statutory and jurisprudential levels. According to Fundo de Garantia Automóvel v Juliana, immobilised vehicles stored on private land but which are capable of being driven are subject to compulsory motor vehicle insurance whereas in Andrade v Crédito Agrícola Seguros, insurance is required only where the vehicle is used as a means of transport. Andrade appears overly restrictive and may operate to defeat the protections of the Motor Vehicle Insurance Directives. Clarification is needed, through a seventh MVID or direction from the CJEU, as to the authority of Andrade and the circumstances in which motor vehicles must be insured.     

Synthesis, characterisation and detection of γ-hydroxybutyrate salts

Sodium, potassium, magnesium and calcium salts of gamma-hydroxybutyrate have been synthesised from gamma-butyrolactone and the corresponding group 1 or 2 hydroxide. Although the group 2 salts are non-hygroscopic, FT-IR spectroscopy and elemental analysis revealed them to be hydrated. X-ray powder diffraction was found to be a quick, non-destructive method of discriminating between the four salts. The Smith and the chlorophenol red/modified Schweppes reagent presumptive colour tests gave positive results regardless of the salt tested. Microcrystalline tests for NaGHB were in accordance with previous literature reports, but results for the other three salts were not reliable.     

The cost disease and government growth: Qualifications to Baumol

Changes in real world wage movements across sectors account for about a third of the rise in the cost of U.S. government services between 1959 and 1989, while relatively slower productivity in the public sector accounts for the remaining two-thirds. Even though it is slower, however, the productivity record still is positive even in the labor intensive government sector. Consequently Baumol argues that the public's likely future objection to necessary increases in the share of expenditures over the next 50 years will betray a fiscal illusion unless policymakers take pains to dissolve it. But slower productivity may be equally due to the structural organization. Removing public monopolies, reducing bureaucracies, and undertaking privatization in education for example, are other policy options that could radically change the productivity record. Meanwhile in his recent calculations of dramatic government expenditure increases expected in the next half century, Baumol omits reference to the marginal welfare cost of public funds, which on our estimates, will increase at least ten times to reach 1.71 by the year 2040.