Policy Analysis

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 Île-de-France: A view from across the Atlantic

Hospitalization for ambulatory-care sensitive conditions (ACSC) in Île-de-France: A view from across the Atlantic
Revue française des affaires sociales; 3(3): 108-125.

Rodwin, VG., Gusmano, MK., 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?

The Price of Liquor is Too Damn High: Alcohol Taxation and Market Structure

The Price of Liquor is Too Damn High: Alcohol Taxation and Market Structure
Under Review

Rao, Nirupama S. (with Chris Conlon)

We study the relative benefits of taxation versus market structure regulations for distilled spirits. One popular regulation, called post and hold, helps wholesalers set collusive prices as the competitive equilibrium of a single period game. Assembling new datasets of wholesale and retail prices, and sales, we show PH leads to average wholesale markups of 30-40%, with higher markups on expensive products. Taxes distort relative prices less than PH. We show Connecticut could increase tax revenue by 350% and improve consumer welfare while holding alcohol consumption fixed. However, we also show our counterfactual policy may be slightly regressive compared to PH. 

Public Policy Investment: Priority-Setting and Conditional Representation In British Statecraft

Public Policy Investment: Priority-Setting and Conditional Representation In British Statecraft
Oxford University Press 2013. ISBN 978-0-19-966397-2.

Anthony Bertelli and Peter C. John

This book addresses one of the enduring questions of democratic government: why do governments choose some public policies but not others? Political executives focus on a range of policy issues, such as the economy, social policy, and foreign policy, but they shift their priorities over time. Despite an extensive literature, it has proven surprisingly hard to explain policy prioritisation. To remedy this gap, this book offers a new approach called public policy investment: governments enhance their chances of getting re-elected by managing a portfolio of public policies and paying attention to the risks involved. In this way, government is like an investor making choices about risk to yield returns on its investments of political capital. The public provides signals about expected political capital returns for government policies, or policy assets, that can be captured through expressed opinion in public polls. Governments can anticipate these signals in the choices they make. Statecraft is the ability political leaders have to consider risk and return in their policy portfolios and do so amidst uncertainty in the public's policy valuation. Such actions represent the public's views conditionally because not every opinion change is a price signal. It then outlines a quantitative method for measuring risk and return, applying it to the case of Britain between 1971 and 2000 and offers case studies illustrating statecraft by prime ministers, such as Edward Heath or Margaret Thatcher. The book challenges comparative scholars to apply public policy investment to countries that have separation of powers, multiparty government, and decentralization.

Pension Obligation Bonds and Government Spending

Pension Obligation Bonds and Government Spending
Public Budgeting and Finance, 33(4):43-65

Thad Calabrese and Todd Ely

We examine the use of pension obligation bonds (POBs) as a financing strategy to address the effects of unfunded pension liabilities on government operating budgets. POBs are publicly marketed as money-saving mechanisms that reduce pension system payments while allowing for increased spending on other government priorities. We review general POB usage and examine whether POBs altered school district spending patterns in Oregon and Indiana. Our results indicate that districts issuing POBs have not increased educational spending relative to other districts. Because POBs cost money to issue and manage, decision makers are encouraged to consider annual budgetary effects prior to issuance.

Calorie Labeling, Fast Food Purchasing and Restaurant Visits

Calorie Labeling, Fast Food Purchasing and Restaurant Visits
Obesity, 21: 2172–2179. doi: 10.1002/oby.20550

Elbel, B., Mijanovich, T., Dixon, L. B., Abrams, C., Weitzman, B., Kersh, R., Auchincloss, A. H. and Ogedegbe, G.

Obesity is a pressing public health problem without proven population-wide solutions. Researchers sought to determine whether a city-mandated policy requiring calorie labeling at fast food restaurants was associated with consumer awareness of labels, calories purchased and fast food restaurant visits.

Design and Methods
Difference-in-differences design, with data collected from consumers outside fast food restaurants and via a random digit dial telephone survey, before (December 2009) and after (June 2010) labeling in Philadelphia (which implemented mandatory labeling) and Baltimore (matched comparison city). Measures included: self-reported use of calorie information, calories purchased determined via fast food receipts, and self-reported weekly fast-food visits.

The consumer sample was predominantly Black (71%), and high school educated (62%). Postlabeling, 38% of Philadelphia consumers noticed the calorie labels for a 33% point (P < 0.001) increase relative to Baltimore. Calories purchased and number of fast food visits did not change in either city over time.

While some consumers report noticing and using calorie information, no population level changes were noted in calories purchased or fast food visits. Other controlled studies are needed to examine the longer term impact of labeling as it becomes national law.

Public Policy Investment: Risk and Return in British Politics

Public Policy Investment: Risk and Return in British Politics
British Journal of Political Science, 43, pp 741-773. doi:10.1017/S0007123412000567.

Anthony M. Bertelli and Peter John

This article sets out and tests a theory of public policy investment – how democratic governments seek to enhance their chances of re-election by managing a portfolio of policy priorities for the public, analogous to the relationship between investment manager and client. Governments choose policies that yield returns the public values; and rebalance their policy priorities later to adjust risk and stabilize return. Do the public reward returns to policy capital or punish risky policy investments? The article investigates whether returns to policy investment guide political management and statecraft. Time-series analyses of risk and return in Britain 1971–2000 reveal that risk and return on government policy portfolios predict election outcomes, and that returns, risk profiles and the uncertainty in public signals influence the prioritization of policies.

Democratization and Universal Health Coverage: A comparison of the experiences of Ghana, Kenya, and Senegal

Democratization and Universal Health Coverage: A comparison of the experiences of Ghana, Kenya, and Senegal
Global Health Governance, 6(2): 1-27.

Grépin, Karen and Kim Yi Dionne

This article identifies conditions under which newly established democracies adopt Universal Health Coverage. Drawing on the literature examining democracy and health, we argue that more democratic regimes – where citizens have positive opinions on democracy and where competitive, free and fair elections put pressure on incumbents – will choose health policies targeting a broader proportion of the population. We compare Ghana to Kenya and Senegal, two other countries which have also undergone democratization, but where there have been important differences in the extent to which these democratic changes have been perceived by regular citizens and have translated into electoral competition. We find that Ghana has adopted the most ambitious health reform strategy by designing and implementing the National Health Insurance Scheme (NHIS). We also find that Ghana experienced greater improvements in skilled attendance at birth, childhood immunizations, and improvements in the proportion of children with diarrhea treated by oral rehydration therapy than the other countries since this policy was adopted. These changes also appear to be associated with important changes in health outcomes: both infant and under-five mortality rates declined rapidly since the introduction of the NHIS in Ghana. These improvements in health and health service delivery have also been observed by citizens with a greater proportion of Ghanaians reporting satisfaction with government handling of health service delivery relative to either Kenya or Senegal. We argue that the democratization process can promote the adoption of particular health policies and that this is an important mechanism through which democracy can improve health.


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