Policy Analysis

Using Comparative Analysis to Address Health System Caricatures

Using Comparative Analysis to Address Health System Caricatures
International Journal of Health Services, Volume 44, Number 3, Pages 547–559, 2014. Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/HS.44.3.g

Michael K. Gusmano, Victor G. Rodwin, and Daniel Weisz

To learn from health care systems abroad, we must move beyond simplistic characterizations and compare different systems with respect to salient performance measures. Despite findings from recent cross-national studies suggesting that many health care systems outperform the United States, claims by U.S. public officials often fail to acknowledge the actual accomplishments of health care systems abroad. We document significant variation among the United States and France, Germany, and England, which provide universal coverage, albeit in different ways. As previously documented, the United States has the highest rate of mortality amenable to health care. We extend this work by adding two indicators: (a) access to timely and effective primary care as measured by hospital discharges for avoidable hospital conditions; and (b) use of specialty services as indicated by coronary revascularization (bypass surgery and angioplasty), adjusted for the burden of coronary artery disease. Our findings indicate that: (a) the United States suffers the gravest consequences of financial barriers to primary care; (b) in all four countries, older people (65+) receive fewer revascularizations than their younger counterparts once we account for disease burden; and (c) in France, patients receive the most revascularizations, after adjusting for the burden of disease.

What Passes and Fails as Health Policy and Management

What Passes and Fails as Health Policy and Management
Journal of Health Politics, Policy and Law, Vol. 39, No. 5, October 2014 DOI 10.1215/03616878-2813719

Rodwin, Victor G. and David Chinitz

The field of health policy and management (HPAM) faces a gap between theory, policy and practice. Despite decades of efforts at reforming health policy and health care systems, prominent analysts state that the health system is ‘‘stuck’’ and that models for change remain ‘‘aspirational.’’ We discuss four reasons for the failure of current ideas and models for redesigning health care: (1) the dominance of microeconomic thinking; (2) the lack of comparative studies of health care organizations and the limits of health management theory in recognizing the importance of local contexts; (3) the separation of HPAM from the rank and file of health care, particularly physicians; and (4) the failure to expose medical students to issues of HPAM. We conclude with suggestions for rethinking how the field of HPAM might generate more promising policies for health care providers and managers by abandoning the illusion of context-free theories and, instead, seeking to facilitate the processes by which organizations can learn to improve their own performance.

Can Democracy Survive Democracy

Can Democracy Survive Democracy
Public Administration Review Vol 74 Issue 4

David Elcott

A review of Cornell W. Clayton and Richard Elgar, eds, Civility and Democracy in America: A Reasonable Understanding (Pullman, Washington: Washington State University Press, 2012).The focus is on the historical activist role of religion in policy formulation and implementation in the U.S. and the implications for present day faith communities' engagement in the public arena.

The State of New York City’s Housing and Neighborhoods in 2013

The State of New York City’s Housing and Neighborhoods in 2013
Furman Center for Real Estate and Urban Policy, New York University

I.G. Ellen et al.

The State of New York City’s Housing and Neighborhoods in 2013 report , published annually by the NYU Furman Center, provides a compendium of data and analysis about New York City’s housing, land use, demographics, and quality of life indicators for each borough and the city’s 59 community districts.

The report combines timely and expert analysis of NYU Furman Center researchers with data transparency. It is presented in three parts:

Part 1: Focus on Economic Inequality

Each year, the State of New York City’s Housing and Neighborhoods describes, contextualizes, and provides analysis on a pressing and policy-relevant issue affecting New York City. In 2013, the report focuses on economic inequality in New York City, analyzing changes over time in the distribution of the city’s income, economic segregation of city residents, and the neighborhood environments experienced by people of different incomes.

Part 2: City-Wide Analysis

The City-Wide Analysis provides a broad, longitudinal analysis of the New York City's housing and neighborhoods. The chapter is divided into five parts: land use and the built environment; homeowners and their homes; renters and their homes; income and workers; and neighborhood services and conditions.

Part 3: City, Borough, and Community District Data

The data section provides current and historical statistics for over 50 housing, neighborhood, and socioeconomic indicators at the city, borough, and community district levels. It also includes indicator definitions and rankings; methods; and an index of New York City’s Community Districts and Sub-Borough Areas.

‘‘Do Something’’ Politics and Double-Peaked Policy Preferences

‘‘Do Something’’ Politics and Double-Peaked Policy Preferences
Journal of Politics 76(2): 333-349.

Egan, Patrick J.

When a public problem is perceived to be poorly addressed by current policy, it is often the case that credible alternative policies are proposed to both the status quo’s left and right. Specially designed national surveys show that in circumstances like these, many Americans’ preferences are not single-peaked on the standard left-right dimension. Rather, they simply want the government to ‘‘do something’’ about the problem and therefore prefer both liberal and conservative policies to the moderate status quo. This produces individual and collective preferences that are double-peaked with respect to the left-right dimension. Double-peakedness is less prevalent on issues where no consensus exists regarding policy goals, and it increases when exogenous events raise the public’s concern about the seriousness of a policy problem.

Introduction: Special issue on housing policy in the United States

Introduction: Special issue on housing policy in the United States
J. Housing Econ. (2014), http://dx.doi.org/10.1016/j.jhe.2014.02.001

Bostic, R. and Ellen, I.G

The recent housing crisis has spawned much reflection among academics, practitioners and policy-makers regarding both the causes and the consequences of this upheaval, especially in the market for owner-occupied homes. But many questions remain. This special issue of the Journal of Housing Economics features a series of articles that seeks to answer some of these questions, with attention given to both the ownership and rental markets. We hope the nine articles in this issue help to provide some insights for both policy makers and researchers.

Child Passenger Safety Laws in the United States, 1978–2010: Policy Diffusion in the Absence of Strong Federal Intervention

Child Passenger Safety Laws in the United States, 1978–2010: Policy Diffusion in the Absence of Strong Federal Intervention
Social Science & Medicine, Vol. 100 (Jan 2014), pp. 30-37. doi:10.1016/j.socscimed.2013.10.035

Bae, J.Y., E. Anderson, D. Silver, and J. Macinko

This article examines the diffusion of U.S. state child passenger safety laws, analyzing over-time changes and inter-state differences in all identifiable features of laws that plausibly influence crash-related morbidity and mortality. The observed trend shows many states' continuing efforts to update their laws to be consistent with latest motor vehicle safety recommendations, with each state modifying their laws on average 6 times over the 30-year period. However, there has been a considerable time lag in knowledge diffusion and policy adoption. Even though empirical evidence supporting the protective effect of child restraint devices was available in the early 1970s, laws requiring their use were not adopted by all 50 states until 1986. For laws requiring minors to be seated in rear seats, the first state law adoption did not occur until two decades after the evidence became publicly available. As of 2010, only 12 states explicitly required the use of booster seats, 9 for infant seats and 6 for toddler seats. There is also great variation among states in defining the child population to be covered by the laws, the vehicle operators subject to compliance, and the penalties resulting from non-compliance. Some states cover only up to 4-year-olds while others cover children up to age 17. As of 2010, states have as many as 14 exemptions, such as those for non-residents, non-parents, commercial vehicles, large vehicles, or vehicles without seatbelts. Factors such as the complexity of the state of the science, the changing nature of guidelines (from age to height/weight-related criteria), and the absence of coordinated federal actions are potential explanations for the observed patterns. The resulting uneven policy landscape among states suggests a strong need for improved communication among state legislators, public health researchers, advocates and concerned citizen groups to promote more efficient and effective policymaking.

How States Stand to Gain or Lose Federal Funds by Opting In or Out of the Medicaid Expansion

How States Stand to Gain or Lose Federal Funds by Opting In or Out of the Medicaid Expansion
The Commonwealth Fund Vol 32, December 2013

Sherry Glied and Stephanie Ma

Following the Supreme Court's decision in 2012, state officials are now deciding whether to expand their Medicaid programs under the Affordable Care Act. While the states' costs of participating in the Medicaid expansion have been at the forefront of this discussion, the expansion has much larger implications for the flow of federal funds going to the states. This issue brief examines how participating in the Medicaid expansion will affect the movement of federal funds to each state. States that choose to participate in the expansion will experience a more positive net flow of federal funds than will states that choose not to participate. In addition to providing valuable health insurance benefits to low-income state residents, and steady sources of financing to state health care providers, the Medicaid expansion will be an important source of new federal funds for states.

Hospitalization for Ambulatory-care sensitive conditions (ACSC) in Ile de France: A view from across the Atlantic

Hospitalization for Ambulatory-care sensitive conditions (ACSC) in Ile de France: A view from across the Atlantic
Revue française des affaires sociales 2013/3 (n° 3)

Rodwin, V., Gusmano, M. and Weisz, D.

This article presents an indicator used in the United States and other OECD nations (hospitalizations for ambulatory-care sensitive conditions – ACSC) to assess access to primary care services and their capacity to handle a set of medical conditions before they require acute hospital treatment. Based on a study of Ile de France, which relies on residence-based hospital discharge data on patient diagnoses and treatments, the indicator identifies areas where hospitalizations for ACSC appear particularly high. Such hospital stays are considered potentially avoidable. Based on data from the Programme de m.dicalisation des syst.mes d’information (PMSI), disparities are measured. We rely on logistic regression analysis to identify a range of individual factors and neighborhood-level factors that explain these disparities. Access to primary care appears to be worse among residents in areas with average household income in the lowest quartile and among those hospitalized in public hospitals. This raises an important question for the future of health policy. Should areas with higher hospital discharge rates of ACSC be understood as having populations with poor health-seeking behaviors or health care systems not well enough organized to target higher-risk populations?


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