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This paper examines the question of whether there is any correlation between the prevalence of nonprofit organizations with property, plant, and equipment exempt from property taxation and the property tax burden for homeowners. Data from the Tax Foundation and Internal Revenue Service was used to analyze general-purpose local governments within larger counties (populations greater than 65,000) in the United States for years 2005 and 2006. Several econometric specifications were used to estimate homeowner property tax burden as a function of the value of nonprofit fixed assets, government tax structure characteristics, and a series of control variables. Our estimates suggest that county geographies with greater presence of nonprofits tend to have higher homeowner tax burdens on average. Specifically, the value of nonprofit tax-exempt fixed assets within a county geography that is 10% above the mean of $15.4 million is generally associated with a median property tax paid by homeowners as a % of household income that is between 0.0009% and 0.0154% above the mean or between $2 and $24 higher on average. The median property tax paid as a % of homeowner’s home value would be between 0.0006% and 0.0069% above the mean or between $3 and $12 higher on average. Overall, we find a strong, positive correlation between nonprofit fixed assets and property tax burden for homeowners at the local level.

There has been a significant amount of work done on the private funding of nonprofits. Yet, despite the enormous size of the nonprofit sector as a whole, the importance of private donations to the sector, and the significance of the sector to public finances, there has been very little empirical research done on the capital structure of nonprofit organizations, and none has examined the potential effects of borrowing on individual contributions. Debt might affect donations because programmatic expansion might “crowd-in” additional donors, the use of debt might “crowd-out” current donors since expansion is undertaken at the behest of the organization (and not due to donor demand for increased output), donors might have a preference for funding current output rather than past output, or because of concerns that the nonprofit will be unable to maintain future programmatic output. These potential effects of debt on giving by individuals have not been the focus of research to date. The primary data for this paper come from the “The National Center on Charitable Statistics (NCCS)-GuideStar National Nonprofit Research Database” that covers fiscal years 1998 through 2003. The digitized data cover all public charities required to file the Form 990. The final sample contains 460,577 observations for 105,273 nonprofit entities. The results for the full sample support a “crowding-out” effect. The analysis is repeated on a subsample of nonprofits more dependent upon donations, following Tinkelman and Mankaney (2007). The restricted sample contains 121,507 observations for 36,595 nonprofit organizations. The results for the subsample are more ambiguous: secured debt has little or no effect, while unsecured debt has a positive effect. The empirical analysis is then expanded to test whether nonprofits with higher than average debt levels have different results than nonprofits with below average debt levels. The results suggest that donors do remove future donations when a nonprofit is more highly leveraged compared to similar organizations.
Nonprofits may fear that the use of debt signals mismanagement or bad governance, worrying that donors will punish the organization by removing future donations. The results presented here suggest a more complicated relationship between nonprofit leverage and donations from individuals than this simple calculus. On the one hand, increases in secured debt ratios (from mortgages and bonds) seems to reduce future contributions, possibly because donors are wary of government or lender intervention in the nonprofit’s management, or possibly because of the lack of flexibility inherent in repaying such rigid debt. On the other hand, unsecured debt, while more expensive, seems to crowd-in donations, even at increasingly higher levels when compared to similar organizations. There are at least two important conclusions from this analysis. First, during times of fiscal stress, nonprofits are often tempted to use restricted funds in ways inconsistent with donor intent simply to ensure organizational survival. Rather than violate the trust of certain donors, the results here suggest that nonprofits would be better off utilizing unsecured (possibly short-term) borrowing to smooth out cash flow needs. This option, however, assumes that nonprofits have access to some type of borrowing which is not true for many organizations. A second conclusion one might draw, therefore, is that policy considerations should be made to expand access to debt for nonprofits. The results here suggest that certain types of unsecured debt might in fact draw in additional resources, allowing nonprofits to leverage these borrowings for additional resources. By encouraging this type of policy option, nonprofits would not only gain access to increased revenue sources, but might be able to maintain programmatic output during times of fiscal stress.

Evidence on the relationship between political contributions and legislators’ voting behavior is marred by concerns about endogeneity in the estimation process. Using a legislator’s offspring sex mix as a truly exogenous variable, we employ an instrumental variable estimation procedure to predict the effect of voting behavior on political contributions. Following previous research, we find that a legislator’s proportion daughters has a significant effect on voting behavior for women’s issues, as measured by score in the “Congressional Record on Choice” issued by NARAL Pro-Choice America. In the second stage, we make a unique contribution by demonstrating a significant impact of exogenous voting behavior on PAC contributions, lending further credibility to the hypothesis that Political Action Committees respond to legislators’ voting patterns by “rewarding” political candidates that vote in line with the positions of the PAC, rather than affecting those same votes – at least in this high-profile policy domain.

We cannot understand Manhattan in the 21st century by relying on conventional measures of urban activity. Simply put, Manhattan consists of much more than its residential population and daily workforce. This island, measuring just 22.96 square miles, serves approximately 4 million people on a typical weekday, 2.9 million on a weekend day, and a weekday night population of 2.05 million. Manhattan, with a residential population of 1.6 million more than doubles its daytime population as a result of the complex network of tunnels, bridges, railroad lines, subways, commuter rail, ferry systems, bicycle lanes, and pedestrian walkways that link Manhattan to the surrounding counties, cities and towns.

This transportation infrastructure, largely built during the twentieth century, is operated by the City of New York, Metropolitan Transportation Authority, and Port Authority of New York & New Jersey. The infrastructure network generates a constant flow of people who are responsible for Manhattan's emergence as a world capital for finance, media, fashion, and the arts.

The residential population count does not include the 1.6 million commuters who enter Manhattan every weekday, or the hundreds of thousands of visitors who use Manhattan's tourist attractions, hospitals, universities, and nightclubs. This report analyzes the volume of people flowing in and out of Manhattan during a 24-hour period; we provide an upper estimate of the actual number of people in Manhattan during a typical work day.

Health care policymakers have cited transportation
barriers as key obstacles to providing health care to
low-income suburbanites, particularly because suburbs have
become home to a growing number of recent immigrants
who are less likely to own cars than their neighbors. In a
suburb of New York City,we conducted a pilot survey of low
income, largely immigrant clients in four public clinics, to
find out how much transportation difficulties limit their
access to primary care. Clients were receptive to the opportunity
to participate in the survey (response rate = 94%).
Nearly one-quarter reported having transportation problems
that had caused them to miss or reschedule a clinic
appointment in the past. Difficulties included limited and
unreliable local bus service, and a tenuous connection to a
car. Our pilot work suggests that this population is willing to
participate in a survey on this topic. Further, since even
among those attending clinic there was significant evidence
of past transportation problems, it suggests that a populationbased
survey would yield information about substantial
transportation barriers to health care.

Effective means of transport are critical under both normal and extreme conditions, but modern transport systems are subject to many diverse demands. This path-breaking book uniquely draws together the typically conflicting arenas of transport, the environment and security, and provides collective solutions to their respective issues and challenges.

From a primarily urban perspective, the author illustrates that the fields of transportation, environment (with an emphasis on climate change) and security (for both natural hazards and terrorism) and their interconnections remain robust areas for policy and planning. Synthesizing existing data, new analyses, and a rich set of case studies, the book uses transportation networks as a framework to explore transportation in conjunction with environment, security, and interdependencies with other infrastructure sectors. The US rail transit system, ecological corridors, cyber security, planning mechanisms and the effectiveness of technologies are among the topics explored in detail. Case studies of severe and potential impacts of natural hazards, accidents, and security breaches on transportation are presented. These cases support the analyses of the forces on transportation, land use and patterns of population change that connect, disconnect and reconnect people from their environment and security.

The book will prove a fascinating and insightful read for academics, students, and practitioners across a wide range of fields including: transport, environmental economics, environmental management, urban planning, public policy, and terrorism and security.

Prior researchers have deployed the Vietnam-era draft lottery as an instrument to estimate causal effects of military service on health and earnings. However, household and residential outcomes may be more sensitive to the psychological effects of military service. Using 2SLS analyses of the 2000 Census and the 2005 American Community Survey, we find mixed results for residential stability, housing tenure, and extended family residence. While in the ACS white veterans are less mobile, veteran status has no effect on homeownership. Veteran status reduces extended family living for whites in the Census but increases it for ACS veterans of "other" races.

Public and private decision-makers continue to seek risk-based approaches to allocate funds to help communities respond to disasters, accidents, and terrorist attacks involving critical infrastructure facilities. The requirements for emergency response capability depend both upon risks within a region's jurisdiction and mutual aid agreements that have been made with other regions. In general, regions in close proximity to infrastructure would benefit more from resources to improve preparedness because there is a greater potential for an event requiring emergency response to occur if there are more facilities at which such events could occur. Thus, a potentially important input into decisions about allocating funds for security is the proximity of a community to high concentrations of infrastructure systems that potentially could be at risk to an industrial accident, natural disaster, or terrorist attack. In this paper, we describe a methodology for measuring a region's exposure to infrastructure-related risks that captures both a community's concentration of facilities or sites considered to be vulnerable and of the proximity of these facilities to surrounding infrastructure systems. These measures are based on smoothing-based nonparametric probability density estimators, which are then used to estimate the probability of the entire infrastructure occurring within any specified distance of facilities in a county. The set of facilities used in the paper to illustrate the use of this methodology consists of facilities identified as vulnerable through the California Buffer Zone Protection Program. For infrastructure in surrounding areas we use dams judged to be high hazards, and BART tracks. The results show that the methodology provides information about patterns of critical infrastructure in regions that is relevant for decisions about how to allocate terrorism security and emergency preparedness resources.

Public administration and management (PAM) scholars have long recognized that financial resources are the lifeblood of public organizations. Less appreciated is how the study of public financial management (PFM) can inform the theory, research, and practice of PAM broadly. In this article, we argue that PFM research brings a variety of conceptual, analytical, and empirical insights to bear on some of public administration and management's timeless questions. To illustrate this claim, we synthesize findings from a variety of research across the PFM subfield.

Public administration scholars answer the question: What might Alexander Hamilton, John Jay and James Madison, who between October 1787 and August 1788 penned the Federalist Papers promoting ratification of the U.S. Constitution, add now to the pamphlets, in view of changes in the administration of our government over the past two and a quarter centuries? Are these foundational essays still relevant? How might key pamphlets be updated to reflect new realities?

Federalist No. 85 offers a synopsis of the overall case for the Constitution. Describing the dangers of a nation without a national government as an "awful spectacle," the paper provides a rebuttal to the active opposition to ratification. Focusing entirely on the operations of government, this essay examines contemporary challenges to faithfully executing the laws and offers an analysis of comprehensive reforms for creating greater accountability, efficiency, and productivity.

Faulty and dysfunctional incentive systems have long interested, and frustrated, managers and organizational scholars alike. In this analysis, we pick up where Kerr (1975) left off and advance an explanation for why bad incentive systems are so prevalent in organizations. We propose that one contributing factor lies in the psychology of people who occupy managerial roles. Although designing effective incentive systems is a challenge wrought with perils for anyone, we believe the psychological consequences and correlates of higher rank within organizations make the challenge more severe for managers. Patterns of promotion and hiring typically yield managers that are more competent than their employees, and ascending to management positions increases individuals' workload and power. In turn, these factors make managers more egocentrically anchored and cognitively abstract, while also reducing their available cognitive capacity for any given task, all of which we argue limits their ability to design effective incentives for employees. Thus, ironically, those with the power to design incentives may be those least able to effectively do so. We discuss four specific types of bad incentive systems that can arise from these psychological tendencies in managers: those that over-emphasize compensation, generate weak motivation, offer perverse motivation, or are misaligned with organizational culture.

This report demonstrates that New York City has successfully achieved almost all of the key elements in the NYC2012 Olympic Plan, despite the fact that it was not chosen to host the 2012 Games. For New York City, planning for the 2012 Olympics provided the framework to shape the future of the city, through new mass transit, rezoning, and investment in parks, recreational facilities, and housing throughout the city. Long neglected and underused industrial areas have been transformed as a result of the NYC2012 Plan, including the far west side of Manhattan, which will soon be linked to the rest of the city through an extension of the #7 subway line. This report describes how many projects, long the subject of public discussion and civic debate, were able to be carried out as a result of the NYC2012 Olympic Plan.

This study examines the role of mobile communications in urban transportation systems and analyzes American metropolitan regions best positioned to capitalize on the growth of mobile technologies. This paper identifies three critical factors—data accessibility, mobile network strength, and mobile tech user/developer demographics—and uses data from several public resources in an analysis of major Metropolitan Statistical Areas (MSAs). The authors explore trends and public policy implications for furthering the use of mobile communications in the transportation systems of metropolitan regions.

The rankings revealed that metropolitan regions each have areas of strength and weakness. In fact, no MSA ranked in the top five for each category, suggesting that though several cities were very strong (top five) in two categories (San Jose, San Francisco, Washington DC, San Diego), every MSA has substantial room for improvement.

This paper examines the impact of institutional change on patient care. Using panel data on obstetric deliveries from the state of California in the United States between 1983 and 2001, it develops and tests hypotheses predicting impacts of three features of institutional change-managed care insurance, changing professional controls and public attention to cost-control practices-on cesarean use and geographic variation in cesarean deliveries. It finds that managed care insurance promotes the diffusion of cost-effective patient care practices, reducing cesarean use and increasing variation. I found that over time, managed care patients experience continued lower use and reduced geographic variation as new practices become established. The combined effects of changing professional controls-the growing importance of clinical guidelines-and public attention to cost-control practices also diffuses cost-effective practices, increasing variation and decreasing cesarean use. Cesarean use increases and geographic variation declines in a period of managed care retreat in the late 1990s. The analysis extends prior research by documenting the impact of institutional change on health services use and variation and by suggesting that geographic variation is caused, in part, by the diffusion of new patient care practices

The purpose of this effort has been to foster a dialogue among peers at transportation and planning agencies about their experiences with promoting public transit and, in particular, the challenges they face related to bus rapid transit (BRT) projects, as well as the solutions that they have developed in response. Agencies from dozens of large cities around the United States participated at three (3) peer-to-peer exchanges in New York City, Los Angeles, and Cleveland. The facilitated discussions were structure to address the unique barriers to BRT implementation on the streets of dense and/or highly congested large urban centers. Three major themes were the focus of the workshops: Network, Route and Street Design, Traffic Operations, and BRT as a Driver of Economic Development; Building Political, Interagency and Stakeholder Support. The results of the workshops make clear that better public transportation in general and BRT in particular can be cost-effective and useful tools for improving transportation, the environment and for restoring the livability of America‘s large cities.

The present study examines the model of freight consolidation platforms, and urban distribution centers (UDCs) in particular, as a means to solve the last mile problem of urban freight while reducing vehicle miles traveled and associated environmental impacts. This paper attempts to identify the key characteristics that make UDCs successful and discuss under what contextual settings (e.g., institutional, policy) they work best. After an extensive review of UDC cases already implemented in other countries, the study examined three UDCs cases with potential applicability to the New York metropolitan region, discussing models and relevant features and elements that may be transferred to the New York context.

Substance use (SU) disorders adversely impact health status and contribute to inappropriate health services use. This qualitative study sought to determine SU-related factors contributing to repeated hospitalizations and to identify opportunities for preventive interventions. Fifty Medicaid-insured inpatients identified by a validated statistical algorithm as being at high-risk for frequent hospitalizations were interviewed at an urban public hospital. Patient drug/alcohol history, experiences with medical, psychiatric and addiction treatment, and social factors contributing to readmission were evaluated. Three themes related to SU and frequent hospitalizations emerged: (a) barriers during hospitalization to planning long-term treatment and follow-up, (b) use of the hospital as a temporary solution to housing/family problems, and (c) unsuccessful SU aftercare following discharge. These data indicate that homelessness, brief lengths of stay complicating discharge planning, patient ambivalence regarding long-term treatment, and inadequate detox-to-rehab transfer resources compromise substance-using patients' likelihood of avoiding repeat hospitalization. Intervention targets included supportive housing, detox-to-rehab transportation, and postdischarge patient support.

Abstract

Background: Pay-for-performance is an increasingly popular approach to improving health care quality, and the US government will soon implement pay-for-performance in hospitals nationwide. Yet hospital capacity to perform (and

improve performance) likely depends on local resources. In this study, we quantify the association between hospital performance and local economic and human resources, and describe possible implications of pay-for-performance for socioeconomic equity.

Methods and Findings: We applied county-level measures of local economic and workforce resources to a national sample of US hospitals (n = 2,705), during the period 2004–2007. We analyzed performance for two common cardiac conditions (acute myocardial infarction [AMI] and heart failure [HF]), using process-of-care measures from the Hospital Quality Alliance [HQA], and isolated temporal trends and the contributions of individual resource dimensions on performance, using multivariable mixed models. Performance scores were translated into net scores for hospitals using the Performance Assessment Model, which has been suggested as a basis for reimbursement under Medicare’s ‘‘Value-Based Purchasing’’ program. Our analyses showed that hospital performance is substantially associated with local economic and workforce resources. For example, for HF in 2004, hospitals located in counties with longstanding poverty had mean HQA composite scores of 73.0, compared with a mean of 84.1 for hospitals in counties without longstanding poverty (p,0.001). Hospitals located in counties in the lowest quartile with respect to college graduates in the workforce had mean HQA composite scores of 76.7, compared with a mean of 86.2 for hospitals in the highest quartile (p,0.001). Performance on AMI measures showed similar patterns. Performance improved generally over the study period. Nevertheless, by 2007—4 years after public reporting began—hospitals in locationally disadvantaged areas still lagged behind their locationally advantaged counterparts. This lag translated into substantially lower net scores under the Performance Assessment Model for hospital reimbursement.

Conclusions: Hospital performance on clinical process measures is associated with the quantity and quality of local economic and human resources. Medicare’s hospital pay-for-performance program may exacerbate inequalities across regions, if implemented as currently proposed. Policymakers in the US and beyond may need to take into consideration the balance between greater efficiency through pay-for-performance and socioeconomic equity.

Please see later in the article for the Editors’ Summary.

Ample research documents the ubiquity of routines in street-level practice. Some individual-level and organizational-level research has explored how to break street-level routines, but little has looked at the work group level. Our study observed teams of state child welfare workers over 2.5 years, documenting whether they discarded old routines and learned new ones. Results suggest that team characteristics such as clear direction and reflective behaviors had greater influence on team learning than individual characteristics such as stress level, tenure, and educational level. We suggest that group-level factors be included in future models of what enables the re-creation of street-level practice.

New York. London. Paris. Although these cities have similar sociodemographic characteristics, including income inequalities and ethic diversity, they have vastly different health systems and services. This book compares the three and considers lessons that can be applied to current and future debates about urban health care.

Highlighting the importance of a national policy for city health systems, the authors use well-established indicators and comparable data sources to shed light on urban health policy and practice. Their detailed comparison of the three city health systems and the national policy regimes in which they function provides information about access to health care in the developed world's largest cities.

The authors first review the current literature on comparative analysis of health systems and offer a brief overview of the public health infrastructure in each city. Later chapters illustrate how timely and appropriate disease prevention, primary care, and specialty health care services can help cities control such problems as premature mortality and heart disease.

In providing empirical comparisons of access to care in these three health systems, the authors refute inaccurate claims about health care outside of the United States.

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Questions of how public organizations control and manage resources have been relegated to an insular subfield of contemporary public management. This is both unfortunate and unnatural because insights from the study of budgeting and financial management have traditionally been a driving force of public management's conceptual and empirical development. In this paper we seek to address this problem by reconnecting contemporary findings from the budgeting and financial management subfield to broader concerns in public management. We focus our discussion on the centrality of management technique in contemporary public management, and we argue that research in select areas of contemporary public budgeting and financial management has and will continue to illuminate the implications of reform and innovation in management technique, particularly in our current environment of amorphous institutional arrangements and diffuse, shared power.

We explore attention to Clinton's health care reform proposal, ongoing debates, and its political demise to develop theory that explains how events create opportunities for cognitive realignment and transformation in institutional logics. Our case analysis illustrates how a bottom-up process of environmental sensemaking led to the emergence and adoption of a logic of managed care, which provided new organizing principles in the hospitals' organizational field. In addition to theorization, highlighted by prior research, we propose a second mechanism of environmental sensemaking: representation of change through exemplars and environmental features. The interplay between theorization, representation, and ongoing event attention can lead to change in institutional logics over an event's life course. We found that the managed care logic did not emerge in a fully formed fashion, but that actors theorized individual dimensions of the logic consistent with changing representations of hospitals' relationships with other actors in the field. As the event unfolded, the individual dimensions came to be theorized as part of an overall managed care logic. The label "managed care," previously understood as a specific organizational form, took on a new meaning to symbolize the organizing principles for hospitals' relationships with a variety of institutional actors as alternative models not congruent with the changing organizational field were abandoned.

Victor Rodwin, professor of health policy and management at NYU Wagner, and his colleague Didier Tabuteau, counselor of state and professor of health policy at the Institut d'Etudes Politiques and the University of Paris Descartes, have published a new book (published by Editions Jacob Duvernet) in which they challenge the conventional wisdom that the French health care system is a government-managed, public and collective enterprise and the American system a private, market-oriented and individualist system. Based on six months of debates in Paris while Professor Rodwin held the Fulbright-Toqueville Chair (spring semester, 2010), this book compares public health, health insurance, the power of physicians, health care reform, and the silent revolution that is transforming health care organization in both France and the United States.

Collaborations between nonprofit and public sector organizations have become an increasingly important phenomenon in state and local public service delivery since the publication of the Winter Commission report in 1993. This article focuses on one of the less studied types of public–nonprofit collaborations, those in which philanthropic support from nonprofit organizations supplements the resources and activities of public agencies. Drawing on the case of "nonprofit-as-supplement collaborations" that support park services in New York City, this article documents the benefits and drawbacks associated with such collaborations. While they can provide increased resources and encourage management innovations, they also can lead to inequities in the availability and quality of services, the preponderance of particularistic goals over the broader public interest, and the politicization of previously bureaucratic decision making. The authors offer two strategies for public managers to realize more effectively the benefits yet mitigate the shortcomings of these collaborations.

In this paper the causes and consequences of accidents in US hazardous liquid pipelines that result in the unplanned release of hazardous liquids are examined. Understanding how different causes of accidents are associated with consequence measures can provide important inputs into risk management for this (and other) critical infrastructure systems. Data on 1582 accidents related to hazardous liquid pipelines for the period 2002–2005 are analyzed. The data were obtained from the US Department of Transportation’s Office of Pipeline Safety (OPS). Of the 25 different causes of accidents included in the data the most common ones are equipment malfunction, corrosion, material and weld failures, and incorrect operation. This paper focuses on one type of consequence–various costs associated with these pipeline accidents–and causes associated with them. The following economic consequence measures related to accident cost are examined: the value of the product lost; public, private, and operator property damage; and cleanup, recovery, and other costs. Logistic regression modeling is used to determine what factors are associated with nonzero product loss cost, nonzero property damage cost and nonzero cleanup and recovery costs. The factors examined include the system part involved in the accident, location characteristics (offshore versus onshore location, occurrence in a high consequence area), and whether there was liquid ignition, an explosion, and/or a liquid spill. For the accidents associated with nonzero values for these consequence measures (weighted) least squares regression is used to understand the factors related to them, as well as how the different initiating causes of the accidents are associated with the consequence measures. The results of these models are then used to construct illustrative scenarios for hazardous liquid pipeline accidents. These scenarios suggest that the magnitude of consequence measures such as value of product lost, property damage and cleanup and recovery costs are highly dependent on accident cause and other accident characteristics. The regression models used to construct these scenarios constitute an analytical tool that industry decision-makers can use to estimate the possible consequences of accidents in these pipeline systems by cause (and other characteristics) and to allocate resources for maintenance and to reduce risk factors in these systems.

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.

Patients with frequent hospitalizations generate a disproportionate share of hospital visits and costs. Accurate determination of patients who might benefit from interventions is challenging: most patients with frequent admissions in 1 year would not continue to have them in the next. Our objective was to employ a validated regression algorithm to case-find Medicaid patients at high-risk for hospitalization in the next 12 months and identify intervention-amenable characteristics to reduce hospitalization risk. We obtained encounter data for 36,457 Medicaid patients with any visit to an urban public hospital from 2001 to 2006 and generated an algorithm-based score for hospitalization risk in the subsequent 12 months for each patient (0 = lowest, 100 = highest). To determine medical and social contributors to the current admission, we conducted in-depth interviews with high-risk hospitalized patients (scores >50) and analyzed associated Medicaid claims data. An algorithm-based risk score >50 was attained in 2,618 (7.2%) patients. The algorithm’s positive predictive value was equal to 0.67. During the study period, 139 high-risk patients were admitted: 60 met inclusion criteria and 50 were interviewed. Fifty-six percent cited the Emergency Department as their usual source of care or had none. Sixty-eight percent had >1 chronic medical conditions, and 42% were admitted for conditions related to substance use. Sixty percent were homeless or precariously housed. Mean Medicaid expenditures for the interviewed patients were $39,188 and $84,040 per patient for the years immediately prior to and following study participation, respectively. Findings including high rates of substance use, homelessness, social isolation, and lack of a medical home will inform the design of interventions to improve community-based care and reduce hospitalizations and associated costs.

The continuing rise in obesity rates across the United States has proved impervious to clinical treatment or public health exhortation, necessitating policy responses. Nearly a decade’s worth of political debates may be hardening into an obesity issue regime, comprising established sets of cognitive frames, stakeholders, and policy options.

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).

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.

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.

How do we understand and also assess the health care of America? Where is health care provided? What are the characteristics of those institutions which provide it? Over the short term, how are changes in health care provisions affecting the health of the population, the cost of care, and access to care? Health Care Delivery in the United States, 8 th Edition discusses these and other core issues in the field. Under the editorship of Dr. Kovner and with the addition of Dr. James Knickman, Senior VP of Evaluation, Robert Wood Johnson Foundation, leading thinkers and practitioners in the field examine how medical knowledge creates new healthcare services. Emerging and recurrent issues from wide perspectives of health policy and public health are also discussed. With an easy to understand format and a focus on the major core challenges of the delivery of health care, this is the textbook of choice for course work in health care, the handbook for administrators and policy makers, and the standard for in-service training programs.

Developing community capacity to improve health is a cornerstone of community-based public health. The concept of community capacity reflects numerous facets and dimensions of community life and can have different meanings in different contexts. This paper explores how members of one community identify and interpret key aspects of their community's capacity to limit the availability and use of tobacco products. Particular attention is given to examining the interrelationship between various dimensions of community capacity in order to better understand the processes by which communities are able to mobilize for social change. The study is based on qualitative analysis of 19 in-depth interviews with key informants representing a variety of community sectors in Harlem, New York City. Findings indicate that the community is viewed as rich in human and social resources. A strong sense of community identity and connectedness underlies this reserve and serves as a catalyst for action.

This paper's first goal is to evaluate the evolution and state of scholarship in public administration. It begins with a question: How far have public administration theory and research advanced since 1940, when the self-aware study of public administration, as a field if not a discipline, took root in the United States? This paper argues that scholars of public administration in the U.S. and abroad continuously advance the scientific rigor of research and are cognizant of the real-world challenges faced by policymakers and public servants of all sorts. Nonetheless, it is further argued, there remains room for improving our scientific understanding of the public service in the twenty-first century. Turning to practice, the second section identifies how we might better link our scientific findings to the lessons we provide in the classroom. Finally, the paper concludes with a discussion on preparing the public service of the twenty-first century and beyond to manage some of the considerable challenges it will encounter.

There is little doubt that globalization, however defined, has hit the field of
professional policy education in the twenty years since APPAM’s Hiltonhead conference on the future of policy education first took stock of a largely American landscape. Despite the title of this session, the relevant development is not merely the accretion of public policy schools and programs around the world. It is the recognition of international dimensions of the policy education enterprise that, if taken seriously (and participants in this discussion argued that it must), promises to change the way we conduct business on multiple levels. This report of the lively discussion generated in the wake of Iris Geva-May and her coauthors’ stimulating conference paper1 explores why and how.

Purpose – The paper explores an emerging challenge for large public-sector bureaucracies: developing information and performance measurement systems that support anti-corruption efforts.
Design – An analytical framework linking functions and contexts of performance measurement to anti-corruption requirements is presented. The framework is used to explore a case study of the World Bank’s ongoing efforts to strengthen anti-corruption information systems in Indonesia.
Findings – A range of organizations are increasingly turning to performance measurement systems to fulfill several functions related to organizational integrity: to hold organization’s accountable for reaching publicly stated standards of fiduciary responsibility and corruption control; to identify vulnerable operational points in multi-faceted public enterprises; and to facilitate organizational learning regarding ‘what works’. Yet corruption is difficult to measure, and corruption vulnerabilities often arise from informal practices, insufficient incentives for enforcement or adherence to standards, and managerial blindspots. Enhanced information systems need to be coupled with effective and multi-directional accountability arrangements in order for performance measurement to contribute effectively to corruption control.
Practical implications – Improved information systems and a reassessment of managerial incentives and attitudes are both essential in order to reduce organizational vulnerability to corruption and to the public backlash that follows in the wake of corruption scandals.
Originality/value – Focus on an emerging area of performance management likely to gain increasing visibility as large bureaucracies attempt to institutionalize public commitments to high anti-corruption standards

Developing countries that were early, enthusiastic adopters of Primary Health Care often developed an extensive – but eventually dilapidated and under-utilized – network of public clinics at the grassroots. As paradigms and investment patterns of health sector reform have shifted, the question of what role these public clinics can meaningfully play, and how best to revitalize them, has become important in a number of countries. This paper evaluates the strategy taken by, and outcomes of, a major attempt in Vietnam to revitalize the grassroots infrastructure of primary health care against the backdrop of the country’s economic transition. The project’s substantial supply-side investments in infrastructure led to marginal increases in utilization and the quality of preventive health services  provided by the centers. But because the project failed to take adequate stock of broader, public sector-wide trends and reforms over the transition, the investments had little impact on the incentives, accountability patterns and capacities of clinic staff and the local authorities. Such institutional factors are heavily implicated, in Vietnam as elsewhere, in the substantial and often increasing disparities in service access and quality that continue to afflict transitional health sectors.

The study of the health workforce has gained in prominence in recent years, as the dynamic interconnections between human resource issues and health system effectiveness have come into sharper focus. This paper reviews lessons relating to strategic management challenges emerging from the growing literature in this area. Workforce issues are strategic: they affect overall system performance as well as the feasibility and sustainability of health reforms. Viewing workforce issues strategically forces health authorities to confront the yawning gaps between policy and implementation in many developing countries.

Lessons emerge in four areas. Once concerns imbalances in workforce structure, whether from a functional specialization, geographical or facility lens. These imbalances pose a strategic challenge in that authorities must attempt to steer workforce distribution over time using a limited range of policy tools. A second group of lessons concerns the difficulties of central-level steering of the health workforce, often critically weak due to the lack of proper information systems and the complexities of public sector decentralization and service commercialization trends affecting the grassroots. A third cluster examines worker capacity and motivation, often shaped in developing countries as much by the informal norms and incentives as by formal attempts to support workers or to hold them accountable. Finally, a range of reforms centering on service contracting and improvements to human resource management are emerging. Since these have as a necessary (but not sufficient) condition some flexibility in personnel practices, recent trends towards the sharing of such functions with local authorities are promising. The paper identifies a number of current lines of productive research, focusing on the relationship between health policy reforms and the local institutional environments in which the workforce, both public and private, is deployed.

In his essay “All Community Is Local,” political scientist William Schambra urges that researchers and activists “direct our gaze away from the failed project of national community and focus once again on the churches, voluntary associations, and grass-roots groups that are rebuilding America’s civil society one family, one block, one neighborhood at a time.” Schambra’s is a rather extreme version of a view expressed by many theorists of citizenship, as well as by political figures from both right and left: that the nation is too distant from most people’s lives (or its governing officials too impersonal or corrupt) to inspire a sense of shared purposes or civic spirit. Only intense local involvement yields rightly-constituted citizens, and small communities are the likeliest realm for realizing the public good.[1]

OBJECTIVES:

We examined the mechanisms by which living in a disadvantaged minority community influences smoking and illegal cigarette sale and purchasing behaviors after a large cigarette tax increase.

METHODS:

Data were collected from 14 focus groups (n=104) that were conducted during the spring of 2003 among Blacks aged 18 years and older living in New York City.

RESULTS:

A large tax increase led to what focus group participants described as a pervasive illegal cigarette market in a low-income minority community. Perceived pro-smoking community norms, a stressful social and economic environment, and the availability of illegal cigarettes worked together to reinforce smoking and undermine cessation.

CONCLUSIONS:

Although interest in quitting was high, bootleggers created an environment in which reduced-price cigarettes were easier to access than cessation services. This activity continues to undermine the public health goals of the tax increase.

This study examines whether rules, particular participants, and executive politics in state tax revenue estimation exert measurable influences on forecast error. Fixed-effects estimation using data from states’ respective fiscal years 1994 to 2003 indicates that all impact state tax revenue forecast accuracy in varying ways, and results suggest that policy can be crafted to effectively mitigate forecast error. Further examination of the quality of participation in tax revenue forecasting as well as the mechanisms of political involvement in this arena is suggested.

The trend toward greater decentralization of governance activities, now accepted as commonplace in the West, has become a worldwide movement. Today s world demands flexibility, adaptability, and the autonomy to bring those qualities to bear. In this thought-provoking book, the first in a new series on Innovations in Governance, experts in government and public management trace the evolution and performance of decentralization concepts, from the transfer of authority within government to the sharing of power, authority, and responsibilities among broader governance institutions.

The contributors to Decentralizing Governance assess emerging concepts such as devolution and capacity building; they also detail factors driving the decentralization movement such as the ascendance of democracy, economic globalization, and technological progress. Their analyses range across many regions of the world and a variety of contexts, but each specific case explores the objectives of decentralization and the benefits and difficulties that will likely result.

We examine the size and distribution of the gap in test scores across races within New York City public schools and the factors that explain these gaps. While gaps are partially explained by differences in student characteristics, such as poverty, differences in schools attended are also important. At the same time, substantial within-school gaps remain and are only partly explained by differences in academic preparation across students from different race groups. Controlling for differences in classrooms attended explains little of the remaining gap, suggesting little role for within-school inequities in resources. There is some evidence that school characteristics matter. Race gaps are negatively correlated with school size-implying small schools may be helpful. In addition, the trade-off between the size and experience of the teaching staff in urban schools may carry unintended consequences for within-school race gaps. © 2006 by the Association for Public Policy Analysis and Management.

We examine the size and distribution of the gap in test scores across races within New York City public schools and the factors that explain these gaps. While gaps are partially explained by differences in student characteristics, such as poverty, differences in schools attended are also important. At the same time, substantial within-school gaps remain and are only partly explained by differences in academic preparation across students from different race groups. Controlling for differences in classrooms attended explains little of the remaining gap, suggesting little role for within-school inequities in resources. There is some evidence that school characteristics matter. Race gaps are negatively correlated with school size - implying small schools may be helpful. In addition, the trade-off between the size and experience of the teaching staff in urban schools may carry unintended consequences for within-school race gaps.

Background: Access to timely and effective medical services can reduce rates of premature mortality attributed to certain conditions. We investigate rates of total and avoidable mortality (AM) and the percentage of avoidable deaths in France, England and Wales and the United States, three wealthy nations with different health systems, and in the urban cores of their world cities, Paris, Inner London and Manhattan. We examine the association between AM and an income-related variable among neighbourhoods of the three cities. Methods: We obtained mortality data from vital statistics sources for each geographic area. For two time-periods, 1988–90 and 1998–2000, we assess the correlation between area of residence and age- and gender-adjusted total and AM rates. In our comparison of world cities, regression models are employed to analyse the association of a neighbourhood income-related variable with AM. Results: France has the lowest mortality rates. The US exhibits higher total, but similar AM rates compared to England and Wales. Rates of AM are lowest in Paris and highest in London. Avoidable mortality rates are higher in poor neighbourhoods of all three cities; only in Manhattan is there a correlation between the percentage of deaths that are avoidable and an income related variable. Conclusions: Beyond the well-known association of income and mortality, persistent disparities in AM exist, particularly in Manhattan and Inner London. These disparities are disturbing and should receive greater attention from policy makers.

Context The Centers for Medicare & Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) measure and report quality process measures for acute myocardial infarction (AMI), but little is known about how these measures are correlated with each other and the degree to which inferences about a hospital's outcomes can be made from its performance on publicly reported processes.

Objective To determine correlations among AMI core process measures and the degree to which they explain the variation in hospital-specific, risk-standardized, 30-day mortality rates.

Design, Setting, and Participants We assessed hospital performance in the CMS/JCAHO AMI core process measures using 2002-2003 data from 962 hospitals participating in the National Registry of Myocardial Infarction (NRMI) and correlated these measures with each other and with hospital-level, risk-standardized, 30-day mortality rates derived from Medicare claims data.

Main Outcome Measures Hospital performance on AMI core measures; hospital-specific, risk-standardized, 30-day mortality rates for AMI patients aged 66 years or older.

Results We found moderately strong correlations (correlation coefficients ≥0.40; P values <.001) for all pairwise comparisons between beta-blocker use at admission and discharge, aspirin use at admission and discharge, and angiotensin-converting enzyme inhibitor use, and weaker, but statistically significant, correlations between these medication measures and smoking cessation counseling and time to reperfusion therapy measures (correlation coefficients <0.40; P values <.001). Some process measures were significantly correlated with risk-standardized, 30-day mortality rates (P values <.001) but together explained only 6.0% of hospital-level variation in risk-standardized, 30-day mortality rates for patients with AMI.

Conclusions The publicly reported AMI process measures capture a small proportion of the variation in hospitals' risk-standardized short-term mortality rates. Multiple measures that reflect a variety of processes and also outcomes, such as risk-standardized mortality rates, are needed to more fully characterize hospital performance.

Substantial national attention is being directed at enhancing the competency levels of early careerists in healthcare management. In this study, we examined preceptors' ratings of administrative resident/fellow competencies in multiple domains, and we compared those to our previous results of self-rated competency by residents/fellows. In this national sample of preceptors (n=61) of administrative residency/fellowship program listed with the American College of Healthcare Executives, competency in the information management domain was ranked highest, with more than half of preceptors (55.7%) giving their residents/fellows an "A" rating. Fewer preceptors (between 30.0% and 39.2%) gave their residents/fellows an "A" rating in domains of interpersonal and emotional intelligence, analytic and conceptual reasoning, and clinical operations. Less than 20% of preceptors rated competencies as "A" level in the domains of human resources/marketing/public affairs, financial management, fund raising, and facilities management. There were significant differences in preceptor ratings compared with resident/fellow self-ratings, with preceptors often providing lower ratings than provided by resident/fellows. The findings highlight the need not only to enhance competency levels of graduates but also to address the potential mismatch in early careerists' and preceptors' views about required and attained competency levels.

Objective: To use publicly available secondary data to assess the impact of Brazil's Family Health Program on state level infant mortality rates (IMR) during the 1990s.

Design: Longitudinal ecological analysis using panel data from secondary sources. Analyses controlled for state level measures of access to clean water and sanitation, average income, women's literacy and fertility, physicians and nurses per 10 000 population, and hospital beds per 1000 population. Additional analyses controlled for immunisation coverage and tested interactions between Family Health Program and proportionate mortality from diarrhoea and acute respiratory infections.

Setting: 13 years (1990-2002) of data from 27 Brazilian states.

Main results: From 1990 to 2002 IMR declined from 49.7 to 28.9 per 1000 live births. During the same period average Family Health Program coverage increased from 0% to 36%. A 10% increase in Family Health Program coverage was associated with a 4.5% decrease in IMR, controlling for all other health determinants (p<0.01). Access to clean water and hospital beds per 1000 were negatively associated with IMR, while female illiteracy, fertility rates, and mean income were positively associated with IMR. Examination of interactions between Family Health Program coverage and diarrhoea deaths suggests the programme may reduce IMR at least partly through reductions in diarrhoea deaths. Interactions with deaths from acute respiratory infections were ambiguous.

Conclusions: The Family Health Program is associated with reduced IMR, suggesting it is an important, although not unique, contributor to declining infant mortality in Brazil. Existing secondary datasets provide an important tool for evaluation of the effectiveness of health services in Brazil.

In a critical examination of some of the most topical and challenging issues confronting the public sector in developing counties in an era of globalization, the contributors to this book examine the potential and limits of managerial, fiscal and decentralization reforms, and highlight cases where selective use of some of the new management reforms has delivered positive results. A common thread that runs through the book is the challenges of capacity to improve public services. Looking beyond the past and the present into the future, the book provides lessons from the experience of implementing public sector reforms in developing countries.

Federal social program evaluation has blossomed over the past quarter century. Despite this growth, there has been little accompanying public debate on research ethics. This essay explores the origins and the implications of this relative silence on ethical matters. It reviews the federal regulations that generally govern research ethics, and recounts the history whereby the evaluation of federal programs was specifically exempted from the purview of those regulations. Through a discussion of a recent evaluation that raised ethical concerns, the essay poses - but does not answer - three questions: (1) Are there good reasons to hold federal social program evaluations to different standards than those that apply to other research?; (2) If so, what ethical standards should be used to access such evaluations?; and (3) Should a formal mechanism be developed to ensure that federal social program evaluations are conducted ethically?

A traditional view of scholarly quality defines rigor as the application of method and assumes an implicit connection with relevance. But as an applied field, public administration requires explicit attention to both rigor and relevance. Interpretive scholars' notions of rigor demand an explicit inclusion of relevance as an integral aspect of quality. As one form of interpretive research, narrative inquiry illuminates how this can be done. Appreciating this contribution requires a deeper knowledge of the logic of narrative inquiry, an acknowledgement of the diversity of narrative approaches, and attention to the implications for judging its quality. We use our story about community-based leadership research to develop and illustrate this argument.

This is one of the only books available that addresses financial and managerial accounting within the framework of the three major areas of the public sector. Clear and comprehensive, Finkler's unique and accessible text provides the fundamentals of financial management for those who lack a financial background so that readers can access and apply financial information more effectively. Details the many aspects of strategic and budgetary planning. Outlines the processes involved in implementing and controlling results. Features aspects of accounting unique for Health Care, not-for-profit organizations and state and local governments. Explains balance sheets, operating and cash flow statements. Provides basic foundation for financial analysis. For managers and policy-makers in public service organizations who want to make more efficient use of their organization's financial information.

Health services research is, by nature, multidisciplinary, for it draws on the methods,concepts and theories of social sciences, which are relevant to the study of how the organization and financing of health services can improve the delivery of health care services (Gray, et al., 2003). While medicine and public health, too, are multidisciplinary enterprises drawing on such disciplines as molecular biology, physiology, anatomy, genetics, epidemiology and more, health services research departs from these disciplines in focusing not on the nature of disease and health but rather on the financing and organization of health systems.

So it is with urban health services research albeit that this field is more narrowly focused on health services in cities. The city focus has resulted in a large body of research on vulnerable groups, barriers to service access, public health clinics and community health centers. Likewise, it has led to important investigations of safetynet institutions, e.g. public hospitals and health centers, which serve a disproportionate share of uninsured and low-income patients. In addition, urban health services research has focused on a host of specific services associated with subpopulations suffering from TB, HIV/AIDS, drug addiction and other social pathologies that are typically associated with the "inner city."

How do we understand and also assess the health care of America? Where is health care provided? What are the characteristics of those institutions which provide it? Over the short term, how are changes in health care provisions affecting the health of the population, the cost of care, and access to care?

Health Care Delivery in the United States, 8th Edition discusses these and other core issues in the field. Under the editorship of Dr. Kovner and with the addition of Dr. James Knickman, Senior VP of Evaluation, Robert Wood Johnson Foundation, leading thinkers and practitioners in the field examine how medical knowledge creates new healthcare services. Emerging and recurrent issues from wide perspectives of health policy and public health are also discussed.

Whatever his legacy as an architect of the war in Iraq, Defense Secretary Donald Rumsfeld has already earned a place in American bureaucratic history as one of its most ambitious organizational reformers. Rumsfeld is determined to complete a top to bottom overhaul of his department before he leaves office. Rumsfeld may be one of history's most ambitious reformers, but his actual impact is far from assured. He still faces intense resistance from the armed services, especially the Army, which has the most to lose in the movement to a much lighter military. And many of his proposals are either still under consideration in Congress or only in the early stages of implementation in the department. This is very much Rumsfeld's revolution to win or lose it is highly dependent upon his congressional support, which has ebbed and flowed with the fortunes of war, on the urgency of the war on terrorism, which continues to fade with memories of September 11, and on his relationship with the armed services, which has been shaken by the controversy surrounding the equipping of U.S. troops in Iraq. It also depends on his public reputation, which has dropped in the wake of the prison abuse scandals at Abu Ghraib and Guantanamo Bay. In October 2001, for example, the Harris Poll reported that 78 percent of Americans rated Rumsfeld's job performance as excellent or pretty good; by June 2005, the percentage had fallen to just 42 percent.

Four years after September 11th, public confidence in charitable organizations remains stuck at a contemporary low. According to a telephone survey of 1,820 randomly-selected Americans interviewed on behalf of NYU Wagner's Organizational Performance Initiative during the summer of 2005, confidence has held virtually constant since it bottomed out after months of controversy
surrounding disbursement of the September 11th relief funds. As of last summer, 15 percent of Americans said they had a great deal of confidence in charitable organizations, 49 percent said a fair amount, 24 percent said not too much, and 7 percent said none at all. Public views of how charitable organizations operate also remain unchanged. Only 19 percent of Americans said charitable organizations do a very good job running their programs and services, while just 11 percent said the same about spending money wisely. In addition, 66 percent of Americans said that charitable organizations waste a great deal or fair amount of money, while almost half said the leaders of charitable organizations are paid too much. If the past is prologue, these views will continue to drive higher levels of legislative and media scrutiny, which in turn, may further erode public confidence. The survey also suggests that rebuilding confidence must involve sustained investment in strengthening the capacity of charitable organizations to achieve measurable impacts toward their missions.

A summary and the reaction of ILO’s management to the report is accessible at http://www.ilo.org/public/english/standards/relm/gb/docs/gb294/pdf/pfa-8-2.pdf

Maintaining a vibrant field of public administration requires ongoing efforts to link the worlds of academic researchers and practitioners. We suggest that research itself, traditionally pursued by academics, is a promising mechanism for making this connection. In particular, researchers and practitioners in public administration can do research together in a way that enhances mutual learning, draws on the strengths of each to create useful knowledge of high quality, appreciates and tolerates of each others' worlds, styles, and contributions. Using research to promote connectedness means rethinking the roles that practitioners and academics play in generating knowledge in the field. In our project, insights from the assumptions and practices of narrative inquiry helped us to identify three research roles for practitioners: as sources of knowledge, as producers of knowledge, and as active consumers who inform the research process.

We tested the association between the availability of primary care and income inequality on several categories of mortality in US counties. Methods. We used cross-sectional analysis of data from counties (n=3081) in 1990, including analysis of variance and multivariate ordinary least squares regression. Independent variables included primary care resources, income inequality, and sociodemographics. Results. Counties with higher availability of primary care resources experienced between 2% and 3% lower mortality than counties with less primary care. Counties with high income inequality experienced between 11% and 13% higher mortality than counties with less inequality. Conclusions. Primary care resources may partially moderate the effects of income inequality on health outcomes at the county level.

To assess the cost-effectiveness of Intervention for HIV-Seropositive injection drug users-Research and Evaluation (INSPIRE), designed to reduce risky sexual and needle-sharing behaviors in research sites in four US cities (2001-2003). Methods: We collected data on program and participant costs. We used a mathematical model to estimate the number of sex partners of injection drug users expected to become infected with human immunodeficiency virus (HIV) (with and without intervention), cost of treatment for sex partners who became infected, and the effect of infection on partners' quality-adjusted life expectancy. We determined the minimum effect that INSPIRE must have on condom use among participants for the intervention to be cost-saving (intervention cost less than savings from averted HIV infections) or cost-effective (net cost per quality-adjusted life year saved less than $50,000). Results: The intervention cost was $870 per participant. It would be cost-saving if it led to 53 percent reduction in the proportion of participants who had any unprotected sex in 1 year and cost-effective with 17 percent reduction. If behavior change lasted 3 months, the cost-effectiveness threshold was 66 percent; if 3 years, the threshold was 6 percent. Conclusions: Although cost-saving thresholds may not be achievable by the intervention, we anticipate that cost-effectiveness thresholds will be attained.

Objectives. We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents.

Methods. Adolescents and young adults aged 12 to 21 years, recruited from community-based organizations in 2 different communities, were randomized into either a 3-session intervention or a control condition. We estimated outcomes from 3-month follow-up data using logistic and ordinary least squares regression.

Results. Female intervention participants were significantly more likely than female control participants to have scheduled a health care appointment (odds ratio [OR]=3.04), undergone a checkup (OR=2.87), and discussed with friends or family members the importance of undergoing a checkup (OR=4.5). There were no differences between male intervention and male control participants in terms of outcomes.

Conclusions. This theory-driven, community-based group intervention significantly increased preventive health care seeking among female adolescents. Further research is needed, however, to identify interventions that will produce successful outcomes among male adolescents.

Like many schools of public policy and management, New York University's Wagner School offers a capstone course in which teams of MPA students provide consultation to client organizations, This year, as the they began to assign students to teams, some members of the faculty sounded an alarm. Several of the projects might involve interviewing service recipients about sensitive issues. Other projects would give teams access to confidential information. Faculty members experience with their university human subjects review board knew that such projects, where they to be undertaken in a research context, would require lengthy and cumbersome review. Did the capstone projects need to go through the human subjects review process? If the answer was yes, the program would come to a grinding halt, given the open-endness of a capstone assignments and the bureaucratic nature of the committee application and approval process.

An invisible network of digital technology systems underlies the highly visible networks of roads, waterways, satellites, and power-lines. Increasingly, these systems are becoming the "infrastructure's infrastructure," providing a crucial array of data on network demand, performance, reliability, and security. "Digital Infrastructures" presents an interdisciplinary analysis of the technological systems that envelop these networks. The book balances analyses of specific civil and environmental infrastructures with broader policy and management issues, including the challenges of using IT to manage these critical systems under crises conditions. "Digital Infrastructures" addresses not only the technological dimension but, importantly, how social, organizational and environmental forces affect how IT can be used to manage water, power, transport and telecommunication systems. The book is organized four sections. First, fundamental themes of policy, management, and technology are presented to frame the domain of digital infrastructures. Second, the way in which information technologies are applied in specific infrastructure sectors provides an in-depth assessment of what the advantages and disadvantages have been over time. Third, cross-cutting themes of economics, earth systems engineering, and international sustainability show how various systems perspectives approach some of the barriers to integrating information technology and infrastructure. Finally, the concluding section looks at some of the new directions and challenges being posed by issues such as security. "Digital Infrastructures" is the first integrated treatment of how IT technology is fundamentally affecting how critical infrastructures are managed. It is geared to provide the new infrastructure professional with state of the art concepts, methods, and examples for use in creating public policies, strategic plans, and new systems. It will be an essential book for upper level undergraduate and graduate courses in infrastructure management, critical infrastructure, environmental systems management, and management of IT systems.

Background: Retesting 3 to 4 months after treatment for those infected with chlamydia and/or gonorrhea has been recommended.

Goal: We compared various methods of encouraging return for retesting 3 months after treatment for chlamydia or gonorrhea.

Study: In study 1, participants were randomly assigned to: 1) brief recommendation to return, 2) intervention 1 plus $20 incentive paid at return visit, or 3) intervention 1 plus motivational counseling at the first visit and a phone reminder at 3 months. In study 2, participants at 1 clinic were randomly assigned to 4) intervention 1, 5) intervention 1 plus phone reminder, or 6) intervention 1 plus motivational counseling but no telephone reminder.

Results: Using multiple logistic regression, the odds ratios for interventions 2 and 3, respectively, compared with intervention 1 were 1.2 (95% confidence interval [CI], 0.6-2.5) and 2.6 (95% CI, 1.3-5.0). The odds ratios for interventions 5 and 6 compared with intervention 4 were 18.1 (95% CI, 1.7-193.5) and 4.6 (95% CI, 0.4-58.0).

Conclusions: A monetary incentive did not increase return rates compared with a brief recommendation. A reminder phone call seemed to be the most effective method to increase return.

An invisible network of digital technology systems underlies the highly visible networks of roads, waterways, satellites, and power-lines. Increasingly, these systems are becoming the "infrastructure's infrastructure," providing a crucial array of data on network demand, performance, reliability, and security. Digital Infrastructures presents an interdisciplinary analysis of the technological systems that envelop these networks. The book balances analyses of specific civil and environmental infrastructures with broader policy and management issues, including the challenges of using IT to manage these critical systems under crises conditions.

Digital Infrastructures addresses not only the technological dimension but, importantly, how social, organizational and environmental forces affect how IT can be used to manage water, power, transport and telecommunication systems. The book is organized four sections. First, fundamental themes of policy, management, and technology are presented to frame the domain of digital infrastructures. Second, the way in which information technologies are applied in specific infrastructure sectors provides an in-depth assessment of what the advantages and disadvantages have been over time. Third, cross-cutting themes of economics, earth systems engineering, and international sustainability show how various systems perspectives approach some of the barriers to integrating information technology and infrastructure. Finally, the concluding section looks at some of the new directions and challenges being posed by issues such as security.

Digital Infrastructures is the first integrated treatment of how IT technology is fundamentally affecting how critical infrastructures are managed. It is geared to provide the new infrastructure professional with state of the art concepts, methods, and examples for use in creating public policies, strategic plans, and new systems. It will be an essential book for upper level undergraduate and graduate courses in infrastructure management, critical infrastructure, environmental systems management, and management of IT systems.

The results-oriented management reforms fostered by the New Public Management movement are often argued to emphasize the search for efficiency, quality and other typical market values at the expense of democratic accountability. On the other hand, challenging this view, some authors claim that results-based management reforms have the potential to enhance political accountability and representative democracy. There is however, limited empirical evidence of this relationship. This article uses some of the findings from a comparative study of public management evaluation systems in four Latin American countries to illuminate this relationship in practice. We discuss the fact that, in two of the four countries surveyed, the design features of the new systems were based on the explicit search for increased political accountability and the deepening of democracy. We also discuss the possible causes for the finding that the outcome and performance information generated is not being applied for decision-making purposes yet, as expected.

Indonesia is currently facing some severe challenges, both in political affairs and in economic management. One of these challenges is the recently enacted decentralization program, now well underway, which promises to have some wide-ranging consequences. This edited volume presents original papers, written by a select group of widely recognized and distinguished scholars, that take a hard, objective look at the many effects of decentralization on economic and political issues in Indonesia. There are many questions about this program: how will it be implemented, is there capacity at the local level to implement its reforms, is there sufficient local political accountability to make it work, and how will the decentralization affect the broader program of economic growth and stabilization? Topics covered include: the historical and political dimensions of decentralization, its macroeconomic effects, its effects on poverty alleviation, the assignment of expenditure and revenue functions across levels of government, the design of transfers, the role of natural resource taxation and the effects of local government borrowing. An authoritative, comprehensive collection, Reforming Intergovernmental Fiscal Relations and the Rebuilding of Indonesia will be of interest to economists and policy makers as well as students of public finance, development, and Asian economics.

An invisible network of digital technology systems underlies the highly visible networks of roads, waterways, satellites, and power-lines. Increasingly, these systems are becoming the ''infrastructure's infrastructure'' providing a crucial array of data on network demand, performance, reliability, and security. Digital Infrastructures presents an interdisciplinary analysis of the technological systems that envelop these networks. The book balances analyses of specific civil and environmental infrastructures with broader policy and management issues, including the challenges of using IT to manage these critical systems under crises conditions.

Digital Infrastructures addresses not only the technological dimension but, importantly, how social, organizational and environmental forces affect how IT can be used to manage water, power, transport and telecommunication systems. The book is organized four sections. First, fundamental themes of policy, management, and technology are presented to frame the domain of digital infrastructures. Second, the way in which information technologies are applied in specific infrastructure sectors provides an in-depth assessment of what the advantages and disadvantages have been over time. Third, cross-cutting themes of economics, earth systems engineering, and international sustainability show how various systems perspectives approach some of the barriers to integrating information technology and infrastructure. Finally, the concluding section looks at some of the new directions and challenges being posed by issues such as security.

Digital Infrastructures is the first integrated treatment of how IT technology is fundamentally affecting how critical infrastructures are managed. It is geared to provide the new infrastructure professional with state of the art concepts, methods, and examples for use in creating public policies, strategic plans, and new systems. It will be an essential book for upper level undergraduate and graduate courses in infrastructure management, critical infrastructure, environmental systems management, and management of IT systems.

An invisible network of digital technology systems underlies the highly visible networks of roads, waterways, satellites, and power-lines. Increasingly, these systems are becoming the "infrastructure's infrastructure," providing a crucial array of data on network demand, performance, reliability, and security. "Digital Infrastructures" presents an interdisciplinary analysis of the technological systems that envelop these networks. The book balances analyses of specific civil and environmental infrastructures with broader policy and management issues, including the challenges of using IT to manage these critical systems under crises conditions. "Digital Infrastructures" addresses not only the technological dimension but, importantly, how social, organizational and environmental forces affect how IT can be used to manage water, power, transport and telecommunication systems. The book is organized four sections. First, fundamental themes of policy, management, and technology are presented to frame the domain of digital infrastructures. Second, the way in which information technologies are applied in specific infrastructure sectors provides an in-depth assessment of what the advantages and disadvantages have been over time. Third, cross-cutting themes of economics, earth systems engineering, and international sustainability show how various systems perspectives approach some of the barriers to integrating information technology and infrastructure. Finally, the concluding section looks at some of the new directions and challenges being posed by issues such as security. "Digital Infrastructures" is the first integrated treatment of how IT technology is fundamentally affecting how critical infrastructures are managed. It is geared to provide the new infrastructure professional with state of the art concepts, methods, and examples for use in creating public policies, strategic plans, and new systems. It will be an essential book for upper level undergraduate and graduate courses in infrastructure management, critical infrastructure, environmental systems management, and management of IT systems.

An invisible network of digital technology systems underlies the highly visible networks of roads, waterways, satellites, and power-lines. Increasingly, these systems are becoming the "infrastructure's infrastructure," providing a crucial array of data on network demand, performance, reliability, and security. "Digital Infrastructures" presents an interdisciplinary analysis of the technological systems that envelop these networks. The book balances analyses of specific civil and environmental infrastructures with broader policy and management issues, including the challenges of using IT to manage these critical systems under crises conditions. "Digital Infrastructures" addresses not only the technological dimension but, importantly, how social, organizational and environmental forces affect how IT can be used to manage water, power, transport and telecommunication systems. The book is organized four sections. First, fundamental themes of policy, management, and technology are presented to frame the domain of digital infrastructures. Second, the way in which information technologies are applied in specific infrastructure sectors provides an in-depth assessment of what the advantages and disadvantages have been over time. Third, cross-cutting themes of economics, earth systems engineering, and international sustainability show how various systems perspectives approach some of the barriers to integrating information technology and infrastructure. Finally, the concluding section looks at some of the new directions and challenges being posed by issues such as security. "Digital Infrastructures" is the first integrated treatment of how IT technology is fundamentally affecting how critical infrastructures are managed. It is geared to provide the new infrastructure professional with state of the art concepts, methods, and examples for use in creating public policies, strategic plans, and new systems. It will be an essential book for upper level undergraduate and graduate courses in infrastructure management, critical infrastructure, environmental systems management, and management of IT systems.

Intelligent transportation systems (ITS) have gone beyond futuristic ideals and are becoming mainstream tools for managing highway and transit systems, as well as for providing information to the public. ITS has shown itself to be a cost-effective means for making best use of the current transportation system in an environment where the ability to expand capacity has become increasingly more difficult and expensive. There are several projects already in place at the regional level (e.g. E-ZPass, Transcom's IRVIN system, and MetroCard) and at the local level (e.g. sub-area traffic management centers and transit system real-time train information systems). More major ITS systems are expected in the next few years.

It was twenty-five years ago that this Committee took up the Civil Service Reform Act of 1978. That statute reflected an effort to modernize a personnel system that had not been reformed since 1946, and addressed many of the issues embedded in this bill. Launched in a bipartisan spirit by the Carter-Mondale Administration, the act was designed to create a new era in human resources management. It contained new procedures for pay for performance, accelerated hiring, and waivers for experimentation. It also created the Senior Executive Service, and sought to modernize the outmoded job classification system that governed the hiring and promotion of civil servants.
It is time to pass this bill and begin the next generation of reform. Civil service reform is not a Democratic issue or a Republican issue; it is a good government issue. It should be designed first and foremost to assure that talented Americans have the chance to serve their country. As President Carter argued in 1977, the public deserves a government as good as its people. There is overwhelming empirical evidence that this proposal would advance that cause.

Reorganization offers a significant opportunity to align agencies by mission rather than constituencies. If done well it can strengthen accountability, reduce wasteful duplication and overlap, tighten administrative efficiency, improve employee motivation, and provide the kind of integration that leads to impact. The question before this Committee today is not whether reorganization can provide needed improvements in government performance, however, but whether Congress should give the President of the United States reorganization authority of some kind. Light believes the answer is absolutely yes, particularly if granted through the expedited model envisioned by the National Commission on the Public Service chaired by former Federal Reserve Board Chairman Paul
Volcker.

This article proposes a theory of how mandated institutional cooperation transforms into individual cooperative behavior. Using qualitative strategies, we draw insights about cooperation in three public-sector efforts of labor-management cooperation (LMC). We report an association between critical shifts in the roles of stakeholders and the change from adversarial to cooperative labor relations. While managers became team players along with their employees, labor representatives assumed managerial responsibilities. These changes were also associated with a service-oriented perspective, better understanding of the other's experiences, and a view of cooperation as partnership. At the heart of these transformations, we found critical changes in communication patterns associated with incrementally growing levels of trust. We propose a model that depicts the links between collective and individual levels of organizational action related to LMC. We conclude that the positive shifts in mental models regarding work and the value of cooperation justify the promotion of LMC efforts.

Public agencies have the mandate to consider the plurality of values, concerns and voices of the larger population in their work, as well as to include a wide variety of citizens in their workforce. When diversity is pursued as an organizational objective, more efficient management and the democratic values of responsiveness and representation in public administration are both said to be better achieved.

The public sector currently employs around 40 percent of all union members in the United States. Pressures for cost-effective and quality government services have placed new demands on the labor-management relationship. A fluctuating set of expectations about the appropriate responsibilities of government and a shifting political culture are severely testing the ability of the public sector to meet demands for increased accountability and expanded services. Especially in an age of knowledge workers, the traditional division between labor and management regarding leadership and work may no longer be viable. Going Public examines the forces affecting labor and management and the prospects for adopting service-oriented cooperative relationships as a key strategy for meeting the expanded demands on the public sector.

The management of international organizations is attracting growing attention. Most of this attention is highly critical of both the UN system and International NGOs. Sometimes, this criticism lacks depth or reflects insufficient understanding of these organizations, or is based on narrow, and sometimes biased, internal political concerns of a particular country. International relations theory has insufficiently studied the type of linkages that these organizations provide between international decision-making and Northern fundraising on the one hand, and practical action in the South on the other. As a result, current theory too rarely focuses on the inner functioning of these organizations and is unable to explain the deficiencies and negative outcomes of their work. While the authors identify and describe the pathologies of international organizations in, for example, international diplomacy, fundraising, and implementation, they also stress positive elements, such as their intermediary role. The latter form the basis for more efficient and effective policies and action that, in addition to some recent political trends also described in this volume, hold hope for a stronger functioning of these organizations in the future.

Studies over the last decade have demonstrated the effectiveness of public health interventions based on social and behavioral science theory for many health problems. Little is known about the extent to which health departments are currently utilizing these theories. This study assesses the application of social and behavioral science to programs in the New York City Department of Health (NYCDOH). Structured open-ended interviews were conducted with executive and program management staff of the health department. Respondents were asked about the application of social and behavioral sciences within their programs, and about the benefits and barriers to increasing the use of such approaches. Themes related to the aims of the study were identified, a detailed coding manual developed, narrative data were coded independently by two investigators (kappa.85), and data analyzed. Interviews were conducted with 61 eligible individuals (response rate 88%). The most common applications of social and behavioral science were individual-level behavior change to prevent HIV transmission and community-level interventions utilizing community organizing models and/or media interventions for health promotion and disease prevention. There are generally positive attitudes about the benefits of utilizing these sciences; however, there are also reservations about expanded use because of resource constraints. While NYCDOH has successfully applied social and behavioral sciences in some areas of practice, many areas use them minimally or not at all. Increasing use will require additional resources. Partnerships with academic institutions can bring additional social and behavioral science resources to health departments and benefit researchers understanding of the health department environment.

After the terrorist attacks on the World Trade Center in New York City on September 11, 2001, the ability to rapidly restore transportation, power, water, and environmental services to users was absolutely critical, especially to those involved in the immediate search, rescue, and recovery operations. What better way could infrastructure serve its users-both emergency workers and the general public-than to be able to respond quickly in a crisis? The ability to provide these services required a degree of flexibility, often unanticipated and unplanned, that only became apparent as the response efforts unfolded. The capability of basic infrastructure service providers to respond to public needs for transportation, energy, communication, water, sanitation, and solid waste removal after the September 11th attacks was to a great extent influenced by the flexibility of the initial infrastructure design and management functions to respond to normal system disruptions and to extreme, but not necessarily terrorist-related, events.

A major issue on the national agenda in the United Kingdom is how to improve public services. There is no single, simple solution. A serious commitment to that goal will require additional resources and innovative leadership that can use the funding wisely. Such an effort also will require new organizational forms for the delivery of services. Alternatives to both traditional public bureaucracies and for-profit businesses are likely to be an essential component of designs for more cost effective public services. The Public Management Foundation (PMF) in London is a ‘think tank' that has begun to address the emerging need for new organizational structures. Their suggestion is to develop an entity that they call a ‘public interest company' (PIC). Such a body is proposed as one of many ways to help improve services: ‘Our collective point is that the way in which the British system allows organisations to deliver public services has been too restrictive and a far wider variety of organisational forms for public service delivery needs to be encouraged. The public interest company will be just one of these.'

Discusses the challenges posed by incorporating Statement No. 34 of the U.S. Governmental Accounting Standards Board, Basic Financial Statements-and Management's Discussion and Analysis-for State and Local Governments (GASB 34) in the core curriculum of a school. Generally accepted accounting principles and GASB 34; Pedagogical issues in GASB 34; Dynamism in learning governmental accounting.

This collection of original manuscripts-representing a cross-section of the timeliest scholarship in public personnel administration-explores the theme of "problems and prospects" in public personnel administration. The contributions are organized into four broad sections: The Setting, The Techniques, The Issues, and Reform and the Future. Section One focuses primarily on the social, political, economic, and legal trends that have served as catalysts in the transformation of public personnel administration. Section Two is composed of selections that summarize developments in the practice of HRM, with special emphasis on emerging personnel techniques and the ways that traditional approaches to the staffing function are being revised. Section Three discusses and suggests responses to some of the most troublesome or pervasive issues in modern personnel management. The final section assesses the probable trends in the field's future, and analyzes the efficacy of recent reform efforts. For human resource personnel looking to broaden their perspective in the field.

This study assessed the effectiveness of a sexually transmitted disease (STD)/HIV behavior change intervention in increasing women's use of the female condom. Methods. A total of 604 women at high risk for STDs and HIV in New York City, Baltimore, Md, and Seattle, Wash, enrolled in a randomized controlled trial of a small-group, skills-training intervention that included information and skills training in the use of the female condom. Results. In a logistic regression, the strongest predictors of use were exposure to the intervention (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 2.8,10.7), intention to use the female condom in the future (OR = 4.5; 95% CI = 2.4, 8.5), having asked a partner to use a condom in the past 30 days (OR = 2.3; 95% CI = 1.3, 3.9), and confidence in asking a partner to use a condom (OR = 1.9; 95% CI = 1.1, 3.5). Conclusions. Clinicians counseling women in the use of the female condom need to provide information, demonstrate its correct use with their clients, and provide an opportunity for their clients to practice skills themselves.

Community interventions are rare in the field of sexually transmitted disease (STD) control and prevention. The goals of the Gonorrhea Community Action Project are to design and implement interventions for the reduction of gonorrhea in high-prevalence areas and to increase the appropriateness and effectiveness of STD care in the participating communities. Key to conducting the formative research and developing the interventions was the creation of a community-academic-health department collaborative partnership. Using a staged model, this article presents a case study of collaboration development in the community of Harlem, New York.

This report recommends a comprehensive reassessment of federal health policies, programs, and processes, including federal-state roles and relationships, and some immediate actions to promote and protect the nation's health and to provide leadership in world health. The report concentrates on the challenges facing the secretary of the U.S. Department of Health and Human Services (DHHS) as the head of the lead health agency in the federal government. The federal government is responsible for five main functions related to health policy: financing; public health protection; collecting and disseminating information about U.S. health and health care delivery systems; capacity building for population health; and direct management of services.

Unlike the current categorical, or highly specialized, approach leading to policies and programs addressing the needs of a specific population, illness, or organizational constituency, a new, comprehensive approach to policy for the 21st century should promote coordinated efforts across programs in order to achieve three goals:

* create conditions that lead to longer, healthier lives for all Americans;
* eliminate health disparities;
* protect communities from avoidable health hazards and help them to address their own health problems.

One of the few books that addresses financial and managerial accounting within the three major areas of the public sector � government, health, and not-for-profit�the Second Edition provides the fundamentals of financial management for those pursuing careers within these fields. With a unique presentation that explains the rules specific to the public sector, this book outlines the framework for readers to access and apply financial information more effectively. Employing an engaging and user-friendly approach, this book clearly defines essential vocabulary, concepts, methods, and basic tools of financial management and financial analysis that are imperative to achieving success in the field. This book is intended for financial managers and general managers who are required to obtain, understand, and use accounting information to improve the financial results of their organizations, specifically within the areas of government or public policy and management, not-for-profit management, and health policy and management.

This book explores the role of community in facilitating the transition to market relationships in economic development, and in controlling and sustaining local public goods such as irrigation, forests, grazing land, and fishing grounds. Previously it was customary to classify economic systems in terms of varying combinations of state and market control of resource allocation. In contrast, this book recognizes community as the third major element of economic systems. This new approach also departs from the conventional view that markets and community norms should be treated as mutually exclusive means of organizing economic activity, instead clarifying the situations in which they may become complementary. Further discussion focuses on the conditions under which management of local commons can, and should, be delegated to local communities rather than subjected to the control of central government.

The new century has been marked by a generalized sense that traditional work arrangements are inadequate to address the challenges organizations encounter today. The shifts from an industrial to an information-based society, and from a manufacturing to a service economy, compounded by the forces of globalization, have propelled revolutionary changes on work place arrangements. These trends have affected work not only in industrialized societies, but in all nations. Many assumptions about how to best organize tasks and people - as well as the solutions to organizational problems based on those assumptions - do not seem to make sense any more. A paradigmatic shift is taking place in how we think about contemporary organizations and their governance.

In this paper I explore the managerial challenges posed by diversity in addressing traditional and new requirements for effective performance in public organizations. I survey the core dimensions, concepts and approaches to diversity in reference to organizations dependent of civil
service as their core employment system. In doing so, I expect to show that the mandate to manage diversity in the civil service cannot be based on a one-size-fits-all strategy (Mor Barak, 2000). Designing and implementing this agenda requires a deliberate and methodical managerial strategy that starts with a diagnosis of how diversity affects organizational performance. It
continues with an analysis of the extent to which civil service rules and regulations, its practices and the underlying managerial philosophies about people promote or inhibit public agencies to advance through what scholars call ‘the diversity continuum' (Minors, 1996; Ospina, 1996), from exclusionary to multicultural workplaces (Cox, 1993). Only considering the degree of diversity and the historical, political, cultural and economic contexts of public employment in a given jurisdiction, can a tailored diversity agenda work.
The paper is structured as follows. First, focusing on the conceptual foundations of the diversity agenda, I use organization and management theory to explore what is diversity and why it is an imperative for all organizations. In a transitional section, I then discuss the implications of ‘what' and ‘why', for the agenda of managing diversity. Third, moving into the world of practice, I provide an overview of diversity approaches and strategies, highlighting the benefits of systemic,
proactive strategies to diversity management in contemporary public organizations. I return in the conclusion to the implications of the approaches presented for managing diversity in civil service.

The international scientific community has begun to focus upon the reality of global climate change and sophisticated research techniques provide increasingly accurate models of the potential impacts of associated weather extremes, disease outbreaks, and global and local environmental destruction. Yet decision-making institutions have not, for the most part, incorporated global climate change in their policies and planning efforts. This report presents the implications of climate change, thus far considered largely in a global context, in very local terms. As research and discussion of climate change begin to focus on anticipated regional impacts, decision-makers in the Metropolitan East Coast (MEC) Region and elsewhere should begin to consider and implement practical adaptation policies affecting land use, infrastructure, natural resource management, public health, and emergency and disaster response.

In the absence of universal coverage and an effective primary care delivery system for vulnerable populations, hospital emergency departments (EDs) are the ultimate safety net for many patients. This is especially true in New York City, where nearly 75 percent of ED visits in 1998 were for nonemergent care, or for emergent care that could have been treated in a doctor's office.1 Another 7 percent of visits required care in the ED, but were for potentially preventable conditions such as acute flare-ups of asthma or diabetes. New Yorkers who rely on EDs lack continuity in their health care and end up using costlier services. Why do so many patients depend on hospital emergency departments for primary care? Do they seek emergency care immediately, or do they have time and opportunity to obtain care at a doctor's office or neighborhood clinic? Do these patients have a usual source of care other than the ED? Do they have any contact with the health care system prior to their ED visit? Does insurance status, race, ethnicity, national origin, or gender have an influence on ED use?

To answer these questions, the Center for Health and Public Service Research at New York University conducted face-to-face interviews with 669 emergency department patients ages 18 to 55 at four hospitals in the Bronx.

A letter to the editor and a response to the letter by Nancy L. Van Devanter about the shortage of public health professionals and the need to support efforts to enhance public health training are presented.

Increasingly, nonprofit, for-profits, and public organizations have been cooperating in producing and distributing a wide range of goods and services. In many cases, the partnerships have arisen from the recognition that different activities are best suited to different governance structures. Yet, working through a cross-sectoral partnership can bring with it complicated managerial issues. This article explores partnering in two important sectors: higher education and welfare reform. In both areas, cooperation across the sectors is widespread and follows lines of comparative advantage. At the same time, there is ample evidence in our cases of classic transactions costs in implementing cross-sectoral partnerships. The article explores ways in which organizations deal with problems of opportunism and imperfect information in contracting across the sectors.

Water pollution from agricultural pesticides continues to be a public concern. Given that the use of such pesticides on the farm is largely governed by voluntary behavior, it is important to understand what drives farmer behavior. Health belief models in public health and social psychology argue that persons who have adverse health experiences are likely to undertake preventive behavior. An analogous hypothesis set was tested here: farmers who believe they have had adverse health experiences from pesticides are likely to have heightened concerns about pesticides and are more likely to take greater precautions in dealing with pesticides. This work is based on an original survey of a population of 2700 corn and soybean growers in Maryland, New York, and Pennsylvania using the U.S. Department of Agriculture data base. It was designed as a mail survey with telephone follow-up, and resulted in a 60 percent response rate. Farm operators report experiencing adverse health problems they believe are associated with pesticides that is equivalent to an incidence rate that is higher than the reported incidence of occupational pesticide poisonings, but similar to the reported incidence of all pesticide poisonings. Farmers who report experiencing such problems have more heightened concerns about water pollution from fertilizers and pesticides, and illness and injury from mixing, loading, and applying pesticides than farmers who have not experienced such problems. Farmers who report experiencing such problems also are more likely to report using alternative pest management practices than farmers who do not report having such problems. This implies that farmers who have had such experiences do care about the effects of application and do engage in alternative means of pest management, which at least involve the reduction in pesticide use.

According to Paul C. Light's controversial new book, The New Public Service, this January's 4.8 percent federal pay increase will do little to compensate for what potential employees think is currently missing from federal careers. Talented Americans are not saying "show me the money" but "show me the job." And federal jobs just do not show well.

All job offers being equal, Light argues that the pay increase would matter. But all offers are not equal. Light's research on what graduates of the top public policy and administration graduate programs want indicates that the federal government is usually so far behind its private and nonprofit competitors that pay never comes into play.

Light argues that the federal government is losing the talent war on three fronts. First, its hiring system for recruiting talent, top to bottom, underwhelms at almost every task it undertakes. Second, its annual performance appraisal system so inflated that federal employees are not only all above average, they are well on their way to outstanding. Third and most importantly, the federal government is so clogged with needless layers and convoluted career paths that it cannot deliver the kind of challenging work that talented Americans expect.

None of these problems would matter, Light argues, if the government-centered public service was still looking for work. Unfortunately, as Light's book demonstrates, federal careers were designed for a workforce that has not punched since the 1960s, and certainly not for one that grew up in an era of corporate downsizing and mergers. The government-centered public service is mostly a thing of the past, replaced by a multisectored public service in which employees switch jobs and sectors with ease.

Light concludes his book by offering the federal government a simple choice: It can either ignore the new public service and troll further and further down the class lists for new recruits, while hoping that a tiny pay increase will help, or it can start building the kind of careers that talented Americans want

This book addresses a seemingly simple question: Just how many people really work for the federal government? Official counts show a relatively small total of 1.9 million full-time civil servants, as of 1996. But, according to Paul Light, the true head count is nearly nine times higher than the official numbers, with about 17 million people actually providing the government with goods and services. Most are part of what Light calls the "shadow of government"-nonfederal employees working under federal contracts, grants, and mandates to state and local governments. In this book--the first that attempts to establish firm estimates of the shadow work force-- he explores the reasons why the official size of the federal government has remained so small while the shadow of government has grown so large.

Light examines the political incentives that make the illusion of a small government so attractive, analyzes the tools used by officials to keep the official headcount small, and reveals how the appearance of smallness affects the management of government and the future of the public service. Finally, he points out ways the federal government can better manage the shadow work force it has built over the past half-century.

Presents a case study of a managerial training program implemented in a large nonprofit organization. Suggestion that human resources managers can enhance the effectiveness of managerial training programs by providing opportunities for horizontal and vertical integration; Consequences of implementing this approach, including an expanded communications process and bonding between team members.

This book is a collection of 18 essays by health services researchers that analyze Medicaid managed care, its historical context, its implementation in several states, its applicability to disabled and other special needs populations, and its potential for monitoring quality and provider performance.

Any organization can innovate once. The challenge is to innovate twice, thrice, and more?to make innovation a part of daily good practice. This book shows how nonprofit and government organizations can transform the single, occasional act of innovating into an everyday occurrence by forging a culture of natural innovation.

Filled with real success stories and practical lessons learned, Sustaining Innovation offers examples of how organizations can take the first step toward innovativeness, advice on how to survive the inevitable mistakes along the way, and tools for keeping the edge once the journey is complete.

Light also provides a set of simple suggestions for fitting the lessons to the different management pressures facing the government and nonprofit sector. Unlike the private sector, where innovation needs only to be profitable to be worth doing, government and nonprofit innovation must be about doing something worthwhile. It must challenge the prevailing wisdom and advance the public good. Sustaining Innovation gives nonprofit and government managers a coherent, easily understood model for making this kind of innovation a natural reality.

The past six decades have witnessed acceleration in both the number and variety of major administrative reform statutes enacted by Congress. This increase can be explained partly by the increased involvement of Congress, a parallel decrease in activity and resistance by the presidency, and heightened public distrust toward government. At least part of the variation in the tides or philosophies of reform involves a "field of dreams" effect in which the creation of new governmental structure during the 1940s, 1950s, and 1960s generated increased interest in process reforms. However, part of the acceleration and variety of reform appears to be related to the lack of hard evidence of what actually works in improving government performance. Measured by federal employees' perceptions of organizational performance, what matters most is not whether organizations were reformed in the past, but whether organizations need reform in the future and can provide essential resources for achieving their mission.

This article explores public-sector succession in the U.S. Most literature on succession and succession planning begin with a familiar lament: executive-level transition merits more attention than it gets in the literature. It is a serious matter that succession planning in the public sector, especially below the presidential level, has not received much attention in the literature. However, a more critical issue is that it has not received much attention in the actual world of public service. This omission, in part, reflects the fact that leaders in the public sector have themselves not taken the issue of succession planning seriously, except for obvious concerns like elections and mandates. Doing strategic executive searches in the public sector is difficult, but that is a secondary factor. What is primary is changing public-sector culture so that focusing on succession and beyond becomes a hallmark of strategic leadership. There are actually two challenges to managing succession: technology and turbulence. Public-sector leaders have limited access to search technology and search firms; they may not even understand the steps in a strategic search process. Public-sector leaders too often allow the turbulence to limit their scope of action, whereas private-sector leaders are expected to manage the turbulence.

Discusses the importance of case discussion teaching method in training professionals on public policy. Analysis and action cycle; Experience with issues of risk and uncertainty; Work with enactments to generate learning from parallel processes; Hazards of case teaching.

This report examines the high cost of City health insurance. The approach includes both an historical review of the City's program and comparative analysis of the practices of other large public and private employers. The report recommends structural reforms that would yield nearly $600 million in recurring savings and still provide employees and retirees with benefits better than most of their counterparts in government and business.

Presents the text of the presidential address given at the Fall 1994 meeting of the Association for Public Policy Analysis and Management by Ellen Schall. Reflection and learning from experience; Why reflective, swamp learning should be taken seriously; Development of new ways to investigate and frame theories for public management in the swamp.

Many organizations, especially public agencies, are in need of revitalization. Often the arrival of a new leader is an opportune moment to reinvigorate the agency, yet the yield from this opportunity critically depends on the way in which the leader joins with the existing staff. The following article examines some of the dynamics of a new leader's arrival and explores the power of a strategic theme to link the leader and the inherited staff productively. We examine the early phases of the emergence of a strategic theme and look at the critical transition when the theme begins to shape behavior. We conclude with advice on the use of themes as vehicles for revitalization.

This article addresses the importance of economic and demographic assumptions in framing the public policy process. It examines functions of such assumptions as an important aspect of government and as a new challenge for public managers. Using Social Security as a case study, the article suggests that recent fore- casts have been inaccurate for four basic reasons: (I) the social and economic environment, (2) technique, (3) assumption drag, and (4) politics. Nevertheless, the assumptions have been crucial at several key legislative turning points in recent Social Security reforms. The article reviews the impact of political pressure in three specific instances and suggests an emerging pattern in the use and misuse of assumptions. The article concludes with suggestions on how to address the importance of assumptions in the public policy process.

Examines the relationship between emergency management and governmental policies on technological disasters. Exploration of whether or not disasters exist from man-made technologies involving hazardous materials and what mechanisms are currently in place to cope with such emergencies; Review of incidents involving environmental contamination; Regulations in place to deal with contaminations; Conclusion that laws have become powerful tools for detecting and mitigating against environmental problems.

One hundred and seventy-eight denial laboratory technicians and 69 non-exposed controls participated in an epidemiological respiratory study. Eight technicians who had a mean of 28 years' grinding nonprecious metal alloys were diagnosed as having a simple pneumoconiosis by chest radiograph. Mean value for per cent predicted FVC and FEV[sub 1] were reduced among male nonsmoker technicians compared to male nonsmoker controls: after controlling for age. there was also a reduction in spirometry with increasing work years. An industrial hygiene survey was conducted in 13 laboratories randomly selected from 42 laboratories stratified by size and type of operation in the Sah Lake City, Utah metropolitan area. Personal exposures to beryllium and cobalt exceeded the Threshold Limit Values (TLVs) in one laboratory. Occupational exposures ia dental laboratories need to be controlled to prevent beryllium-related lung disorders as well as simple pneumoconiosis.