Public policy最新文献

This study examines the rapid growth of hospital wage rates and employment levels over the past decade, with particular attention to the period 1971-73, when wage and price controls were in effect throughout the economy. The analysis shows that the hospital regulations under the Economic Stabilization Program reduced real hospital wages below what they would have been in the absence of controls; a similar but smaller effect of the controls on hospital employment levels is also shown. This suggests that if the current HEW proposal for hospital cost containment is enacted, its impact would be a significant decrease in the rate of growth of hospital wages and employment.

This article analyzes the recent federal experience in subsidizing health care services for low-income children. The overall equalizing effects of Medicaid are discussed, as are those of Medicaid's component that promotes preventive services for children, the Early and Periodic Screening, Diagnosis, and Treatment program (EPSDT). Both Medicaid and EPSDT have provided poor children greater access to services, but, due to their insurance-based approach, have been unable to resolve structural inequities inherent in the present health care delivery system. The Comprehensive Health Assessment Plan (CHAP), a recent Administration proposal to revise and expand EPSDT, is also discussed and characterized as providing some improvement but retaining the underlying limitations of EPSDT. Four alternatives are proposed that could complement CHAP at limited additional cost.

The recent profound transformation of the California mental health system is viewed from the perspective of policy termination--that phase in the overall policy process involving the cessation or redirection of policy. State mental hospitals have been phased out, and the responsibility for patients has been shifted to local mental health programs. This article explores the processes of policy and organizational change that occurred with mental health reform and uncovers a number of significant policy outcomes associated with that change. The consequences of the new mental health policy are found to be intimately related to the manner in which previous policy was terminated. In conceptualizing the role of termination, an experimental approach to the development of public policy is contrasted with policy innovation justified on the basis of ideology. It is argued that the numerous resistances to the termination of current policy weaken the prospect of policy innovation. Ideological commitment is the powerful force that overcomes these resistances. But this in turn produces a policy context in which important termination considerations are systematically ignored. The ideology of community mental health, emerging concurrently with changes in certain characteristics of the larger social structure, served to augment and legitimize the redirection in medical health policy. Mental health reform in California, although leading to the provision of services to an expanded population, resulted in the neglect of the more severely disabled.

In American political culture, as in much of Western political thought, the proposition that men are and ought to be treated as equal in the eyes of polity, law, and society is highly valued. Whether traditional arguments for equality can be properly extrapolated from the political and social spheres to a third sphere--the distribution of resources and services under public welfare state policies--is another question, rarely explored with care. In one of these policy areas, health care, the notion that each citizen is entitled by right to equal access to medical care has grown very popular. Federal programs that equalize access among groups by means of biomedical research, hospital construction and renovation, and financial aid for the elderly and poor have dominated federal health care policy since the end of the Second World War. Empirical consideration of the nature of medical care services, the structure of the health care system, and the consequences of programs to equalize access suggests, however, that public expectations and federal policy may have placed more weight on the principle of equality than it can properly bear. In recent years policy analysts have begun to insist that the equal access issue be viewed in the context of the national cost of medical services relative to that of other social goods, the cost effectiveness of medical services, and the degree to which health and illness result from behavior in an individual's power to pursue or avoid. Attracted by the new revisionist thinking, but unwilling to follow its arguments to their logical policy implications, federal policy makers have institutionalized their ambivalence. The mainstream equalizing programs continue to receive strong support, but they are now challenged by another set of federal programs based largely on revisionist premises. This seemingly inconsistent policy solution is probably the most rational approach to preserving the claims of equality of medical care services, while assigning the principle of equality an appropriately delimited scope.

The empirical analysis of compensating wage differentials received by 496 blue-collar workers yields the first implicit values of injuries ever obtained and the only implicit values of life that take into account compensation for other nonpecuniary characteristics. Workers behave as if they attached a dollar value of $10(4) to nonfatal injuries and $10(6) to death. This value of life estimate exceeds those found in other studies, not because these earlier estimates are wrong, but simply because there is not a unique value of life but a distribution of such values across the population. Detailed discussions indicate the pertinence of these results not only to occupational health and safety policies but also to benefit-cost analyses of other policies affecting life and limb.

Politics and policy frequently interact to affect substantially the final shape of legislation. In the case of the Child Abuse Prevention and Treatment Act, public hearings and the media focused attention on the problem of abused children, helping to create a climate favorable for action by the Congress. The shapers of the bill deliberately accepted an incremental approach, believing that adequate funding for a more comprehensive attack on child abuse was not forthcoming. This "something is better than nothing" strategy may well be appropriate at the present time for many children's programs.