Policy Analysis

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
09/23/2013

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.

Scientific Publications on Firearms in Youth Before and After Congressional Action Prohibiting Federal Research Funding

Scientific Publications on Firearms in Youth Before and After Congressional Action Prohibiting Federal Research Funding
Journal of the American Medical Association [JAMA];310(5): 532-533.

Ladapo, Joseph, Benjamin Rodwin, Andrew M. Ryan, Leonardo Trasande, Jan Blustein
09/04/2013

In January 1996, Congress passed an appropriations bill amendment prohibiting the US Centers for Disease Control and Prevention (CDC) from using “funds made available for injury prevention … to advocate or promote gun control.” This provision was triggered by evidence linking gun ownership to health harms, created uncertainty among CDC officials and researchers about what could be studied, and led to significant declines in funding. We evaluated the change in the number of publications on firearms in youth compared with research on other leading causes of death before and after the Congressional action. We focused on children and adolescents because they disproportionately experience gun violence and injury.

Medicaid's Next Metamorphosis

Medicaid's Next Metamorphosis
Public Administration Review, Vol 73, no. 4

Charles Brecher and Shanna Rose
08/20/2013

Medicaid’s transformation since its inception rivals the biological changes of metamorphosis, and that process is not yet over. Past metamorphoses are the change from a small program with eligibility linked to the states’ cash welfare benefits to one with national eligibility standards covering many not receiving cash benefits, from a traditional fee-for-service payment program to one dominated by capitated managed care arrangements, and under the ACA to a widely accepted component of a national system for near universal insurance coverage. An analysis of the forces behind these significant changes suggests that future transformations are likely, and four potential scenarios are presented and assessed.

How New York Housing Policies Are Different -- and Maybe Why

How New York Housing Policies Are Different -- and Maybe Why
In Andrew Beveridge and David Halle, New York City-Los Angeles: The Uncertain Future. Oxford University Press, 2013.

Ellen, I.G. & O'Flaherty, B.
05/07/2013

Almost everyone says New York City is exceptional, and many people think that housing is one of the most exceptional aspects of New York life. But New York’s housing conditions are not so different from those in other large US cities, or at least not in the ways that are commonly believed. Policies, not conditions, are what truly set New York’s housing market apart.  Our aim in this chapter is to describe New York City’s policies, to explore how and why they differ from those in Los Angeles and other large cities, and whether they have shaped how New York City’s housing market has weathered the recent downturn. The policies we consider are public housing, in rem properties, other subsidized housing, rent regulation, housing allowances, city capital subsidies for construction and rehabilitation, special needs housing, local tax structures, and building codes. Do unusual housing market conditions lead to these unusual policies? Do some common factors cause both unusual policies and conditions? Naturally, we cannot answer these questions definitively. But we can offer some alternative explanations.

Balanced Budget Requirements and State Spending: A Long-Panel Study

Balanced Budget Requirements and State Spending: A Long-Panel Study
Public Budgeting & Finance 33(2): 1-18.

Smith, Daniel L., and Yilin Hou.
01/01/2013

This study tests the effects of balanced budget requirements on three measures of state expenditure using data on 48 states for the years 1950 to 2004. We find that the following rules are effective in constraining expenditures: 1) requiring that the governor submit a balanced budget; 2) placing controls on supplemental appropriations; and 3) prohibiting the carry-over of a deficit from one fiscal year or biennium into the next. The latter two rules exert larger individual effects than the first. All else equal, states can best improve their prospects of reigning in spending by instituting technical rules that govern budgetary outcomes, as opposed to political rules that dictate how the budget is assembled and approved. 

State Unemployment Insurance Trust Solvency and Benefit Generosity

State Unemployment Insurance Trust Solvency and Benefit Generosity
Journal of Policy Analysis and Management 32(3): 536-53.

Smith, Daniel L., and Jeffrey B. Wenger.
01/01/2013

This paper employs panel estimators with data on the 50 American states for the years 1963 to 2006 to test the relationship between Unemployment Insurance (UI) trust fund solvency and UI benefit generosity. We find that both average and maximum weekly UI benefit amounts, as ratios to the average weekly wage, are higher in states and in years with more highly solvent trust funds. This result holds after controlling for state-level unemployment rate, Gross Domestic Product (GDP), population growth, legislative political ideology, partisan control of the executive and legislative branches, and gubernatorial election year across multiple specifications, including fixed-effects and dynamic panel estimators. We propose a theory of moderate coupling as the causal mechanism, whereby UI program benefits and financing are directly related but are not as tightly linked as in other social insurance programs, such as Medicaid. The findings have important policy implications for the funding of states’ UI systems. As a consequence of moderate coupling, the countercyclicality of the UI program is dampened. 

From Endeavor to Achievement and Back Again: Government's Greatest Hits in Peril

From Endeavor to Achievement and Back Again: Government's Greatest Hits in Peril
In To Promote the General Welfare: The Case for Big Government. Steven Conn, Ed., Oxford Univeristy Press

Paul C. Light
07/01/2012

"These 10 articles from leading scholars address federal government activism in such areas as health, education, transportation, and the arts. In some areas, federal involvement has been direct; for example, while school public systems are governed locally, Washington provides about 10% of k–12 funding. Similarly, antipoverty programs, such as the New Deal’s Social Security Act and Aid for Dependent Children, have played a major role in reducing the poverty rate from around 40% in 1900 to 11.2% in 1974. At other times, Washington has exerted influence more subtly, through regulations and research. Examples include the 1933 Glass-Steagall Act, which mandated the separation of investment and commercial banking and the WWII-era research that yielded compounds to prevent and cure malaria, syphilis, and tuberculosis. Further, as public policy scholar Paul C. Light points out in a fascinating concluding piece, more than two-thirds of leading governmental initiatives have been supported by both Democratic and Republican administrations. However, Light adds, the massive tax cut in 2001 “continue[s] to constrain federal investment in problem solving.” The scholars brought together by Ohio State historian Conn (History’s Shadow) persuasively demonstrate how the growth of “big government” throughout the 20th century has benefited ordinary Americans so comprehensively and unobtrusively that they have often taken it for granted."

Publishers Weekly

http://www.publishersweekly.com/978-0-19-985855-2

Performance Measurement and Evaluation Systems: Institutionalizing Accountability for Governmental Results in Latin America

Performance Measurement and Evaluation Systems: Institutionalizing Accountability for Governmental Results in Latin America
In S. Kushner & E. Rotondo (Eds.), Evaluation voices from Latin America. New Directions for Evaluation, 134, 77–91.

Cunill-Grau, N., & Ospina, S. M.
06/08/2012

Results-based performance measurement and evaluation (PME) systems are part of a global current in public administration. In the Latin American context, this trend is also a reflection of the broader processes of reform of the latter half of the 20th century, including the modernization of public administration, as well as broad processes of decentralization and democratization, both of which are dimensions of development in Latin America, regardless of the political and ideological orientation of specific governments. This chapter documents the development of such evaluative approaches to organizational quality and raises some issues for further discussion.

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