Management

Recent Changes in Dutch Health Insurance: Individual Mandate or Social Insurance

Recent Changes in Dutch Health Insurance: Individual Mandate or Social Insurance
Expanding Access to Health Care. T.F. Buss and P. Van de Water (eds.) National Academy of Public Administration. New York: M.E. Sharpe.

Okma, K.
01/01/2009

The U.S. health care system faces well-known problems: 47 million people without health insurance, rapidly rising costs that consume 16 percent of the country'e economic output, and widely uneven quality of care. Even many people with coverage are experiencing serious problems paying for the rapidly rising costs of health care and insurance.

This book--a joint product of the National Academy of Public Administration and the National Academy of Social Insurance--undertakes a sweeping analysis of the management and administrative issues that arise in expanding health care coverage. The book identifies the core administrative functions that need to be performed in assuring access to health coverage, describes how these functions are performed at present and under proposed alternatives, draws lessons from experience in the U.S. and abroad, and assesses suggested administrative approaches designed to facilitate the improvement and expansion of health care coverage.

Adequate health care is one of today's most crucial domestic policy concerns. Expanding Access to Health Care is designed to bring together in one place some of the best thinking on the subject, not as an exercise in advocacy, but rather to lay out the issues in a balanced way so that policymakers, researchers, and citizens can better understand the complex details of health care reform.

Seeing Power in Action: The Roles of Deliberation, Implementation, and Action in Inferences of Power

Seeing Power in Action: The Roles of Deliberation, Implementation, and Action in Inferences of Power
Journal of Experimental Social Psychology, 45, 1-14.

Magee, J.C.
01/01/2009

Six experiments investigate the hypothesis that social targets who display a greater action orientation are perceived as having more power (i.e., more control, less dependence, and more influence) than less action-oriented targets. I find evidence that this inference pattern is based on the pervasive belief that individuals with more power experience less constraint and have a greater capacity to act according to their own volition. Observers infer that targets have more power and influence when they exhibit more implementation than deliberation in the process of making decisions in their personal lives (Study 1a), in a public policy context (Study 1b), and in small groups (Study 2). In an organizational context, observers infer that a target who votes for a policy to change from the status quo has more power than a target who votes not to change from the status quo (Study 3). People also infer greater intra-organizational power and higher hierarchical rank in targets who take physical action toward a personal goal than in those who do not (Studies 4–5).

Spending, Size, and Grade Span in K-8 Schools

Spending, Size, and Grade Span in K-8 Schools
Education Finance and Policy, 4(1): 60-88

Rubenstein, R. & Schwartz, A.E., Stiefel, L., Zabel, J.
01/01/2009

Reorganizing primary school grade spans is a tractable and relatively inexpensive school reform. However, assessing the effects of reorganization requires also examining other organizational changes that may accompany grade span reforms. Using data on New York City public schools from 1996 to 2002 and exploiting within-school variations, we examine relationships among grade span, spending, and size. We find that school grade span is associated with differences in school size, class size, and grade size, though generally not with spending and other resources. In addition, we find class size and grade size differences in the same grade level at schools with different configurations, suggesting that school grade span affects not only school size but also class size and grade size. We find few relationships, though, between grade span and school-level performance, pointing to the need to augment these analyses with pupil-level data. We conclude with implications for research and practice.

The leadership task of prompting cognitive shifts: Shaping perceptions of issues and constituencies to achieve public service goals.

The leadership task of prompting cognitive shifts: Shaping perceptions of issues and constituencies to achieve public service goals.
Public 18. (Published by ESADE Business School.)

Foldy, E.G., Goldman, L. & Ospina, S.
01/01/2009

In summary, these exemplary non-profit organizations were often very strategic in how they framed problems, solutions and the people they served. This suggests that public organizations could also be more deliberate in their framing processes. Organizational leaders might want to talk explicitly about the shifts they are trying to create, and whether these fit together or act at cross purposes, in addition to how well they match the organization’s goals and mission. Prompting cognitive shifts is at the heart of public leadership.

The Stafford Act and Priorities for Reform

The Stafford Act and Priorities for Reform
Journal of Homeland Security and Emergency Management. Berkeley Electronic Press, Vol. 6, issue 1: Article 13 

Moss, M., Schellhamer, C. & David A Berman.
01/01/2009

During the past fifty years, federal disaster policy in the United States has been shaped by an ongoing conflict between proponents who favor federal intervention following a disaster and those who believe disaster response should be the responsibility of state and local governments and charity. This article explores the existing federal disaster policy landscape within the United States with a focus on the Stafford Act, the cultural and political forces that produced it, and how the current system is ill equipped to aid in the response and recovery from major catastrophes. The Stafford Act defines how federal disasters are declared, determines the types of assistance to be provided by the federal government, and establishes cost sharing arrangements among federal, state, and local governments. The Federal Emergency Management Agency (FEMA) carries out the provisions of the Stafford Act and distributes much of the assistance provided by the Act. With the establishment of the U.S. Department of Homeland Security, the threat of domestic terrorism, and large-scale natural disasters like Hurricane Katrina, the limits of the Stafford Act and FEMA have been shown. We look at several areas where the shortcomings of the Stafford Act have emerged and propose directions for reform.

A Government Ill Executed: The Decline of the Federal Service and How to Reverse It

A Government Ill Executed: The Decline of the Federal Service and How to Reverse It
Harvard University Press,

Light, P.C.
05/01/2008

The federal government is having increasing difficulty faithfully executing the laws, which is what Alexander Hamilton called "the true test" of a good government. This book diagnoses the symptoms, explains their general causes, and proposes ways to improve the effectiveness of the federal government. Employing Hamilton's seven measures of an energetic federal service, Paul Light shows how the government is wanting in each measure.

After assessing the federal report card, Light offers a comprehensive agenda for reform, including new laws limiting the number of political appointees, reducing the layers of government management, reducing the size of government as its baby-boom employees retire, revitalizing the federal career, and reducing the heavy outsourcing of federal work. Although there are many ways to fix each of the seven problems with government, only a comprehensive agenda will bring the kind of reform needed to reverse the overall erosion of the capacity to faithfully execute all the laws.

 

Jump-Starting Collaboration: The ABCD Initiative and the Provision of Child Development Services through Medicaid and Collaborators

Jump-Starting Collaboration: The ABCD Initiative and the Provision of Child Development Services through Medicaid and Collaborators
Public Administration Review, May 2008, Vol. 68 Issue 3, p480-490, 11p.

Berry, C., Krutz, G.S., Langner, B. & Budetti, P.
05/01/2008

Many policy problems require governmental leaders to forge vast networks beyond their own hierarchical institutions. This essay explores the challenges of implementation in a networked institutional setting and incentives to induce coordination between agencies and promote quality implementation. It describes the national evaluation of the Assuring Better Child Health and Development program, a state-based program intended to increase and enhance the delivery of child development services for low-income children through the health care sector, using Medicaid as its primary vehicle. Using qualitative evaluation methods, the authors found that all states implemented programs that addressed their stated goals and made changes in Medicaid policies, regulations, or reimbursement mechanisms. The program catalyzed interagency cooperation and coordination. The authors conclude that even a modest level of external support and technical assistance can stimulate significant programmatic change and interorganizational linkages within public agencies to enhance provision of child development services.

Race/Ethnicity and Patient Confidence to Self-manage Cardiovascular Disease

Race/Ethnicity and Patient Confidence to Self-manage Cardiovascular Disease
Medical Care. 2008; 46(9):924-9

Blustein, J., Valentine, M., Mead, H. & Regenstein, M.
04/01/2008

Background: Minority populations bear a disproportionate burden of chronic disease, due to higher disease prevalence and greater morbidity and mortality. Recent research has shown that several factors, including confidence to self-manage care, are associated with better health behaviors and outcomes among those with chronic disease.

Objective: To examine the association between minority status and confidence to self-manage cardiovascular disease (CVD).

Study Sample: Survey respondents admitted to 10 hospitals participating in the Expecting Success program, with a diagnosis of CVD, during January-September 2006 (n = 1107).

Results: Minority race/ethnicity was substantially associated with lower confidence to self-manage CVD, with 36.5% of Hispanic patients, 30.7% of Black patients, and 16.0% of white patients reporting low confidence (P < 0.001). However, in multivariate analysis controlling for socioeconomic status and clinical severity, minority status was not predictive of low confidence.

Conclusions: Although there is an association between race/ethnicity and confidence to self-manage care, that relationship is explained by the association of race/ethnicity with socioeconomic status and clinical severity.

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