Policy analysis最新文献

In recent years the most popular strategy of reform in the human services arena has been to foster coordination among agencies serving the same populations. The certainty of difficulties in implementing coordination programs and the uncertainty of achieving improvements in service delivery have not dimmed the enthusiasm among policymakers for these programs. This persistent popularity seems to be rooted in the strong symbolic appeal of "coordination," which has overridden attention to evidence about performance.

The author proposes a national health insurance plan that would encourage the use of preventive medicine and involve a graduated voucher arrangement. The program would provide a limited amount of free care, copayment beyond the amount covered by vouchers, and catastrophic coverage beyond the copayment level. The maximum price of medical procedures would be set by the government, and would be varied to encourage provider relocation and innovative provider arrangements such as health maintenance organizations.

Demographic change bears directly on the formulation of social policy because it determines in large part whose wealth or income is redistributed to whom. Where demographic events modify the recipients and donors in such redistribution, they may sharply alter the consequences of existing legislation or create constituencies for new laws. This article considers how current and emerging demographic changes are affecting the redistribution of wealth across generations, across income groups, and across geographic regions.

Physicians make the majority of decisions about the type and quantity of medical care, but cost-sharing mechanisms intended to control costs place the burden upon the patient. This article proposes a variety of mechanisms for placing this burden upon the small group of physicians identified as being excessively costly.

Although most studies of policy implementation have been very pessimistic about the ability of important statutes actually to achieve their objectives, there have been a few success stories. The authors first identify five conditions conducive to effective implementation and then suggest a number of strategies available to legislative and other policy formulators for overcoming deficiencies in one or more of these conditions.

The authors compare two policy studies of the federally implemented Community Mental Health Centers program--one by a Ralph Nader study group and one by the U.S. General Accounting Office--in order to develop and illustrate two corresponding concepts or "ideal types" of policy research methodology, termed "advocacy research" and management review". They give special attention to two analytic dimensions: the balance of "extrinsic" to "intrinsic" critisms, and the structural relationship between policy researchers and policymakers.

A central purpose of proposed "major-risk" ("catastrophic") national health insurance would be to provide an incentive to economize by requiring most households to pay, out of pocket, at least a fraction of the cost of all medical care they use. To help ensure the success of this cost-conscious strategy, the author asserts, a cash-equivalent option for workplace supplementary private health insurance should be legally required.

This study applies time-series experimentation methods in estimating costs and benefits of measles eradication efforts conducted by the Center for Disease Control beginning in 1966. Application of an integrated moving average model, explicated by Box and Tiao, in an interrupted-time-series design, facilitates estimation of reductions in measles cases attributable to federally sponsored eradication efforts and provides a basis for applying cost-benefit standards to this public policy.