How States Stand to Gain or Lose Federal Funds by Opting In or Out of the Medicaid Expansion
The Commonwealth Fund Vol 32, December 2013
Sherry Glied and Stephanie Ma
Following the Supreme Court's decision in 2012, state officials are now deciding whether to expand their Medicaid programs under the Affordable Care Act. While the states' costs of participating in the Medicaid expansion have been at the forefront of this discussion, the expansion has much larger implications for the flow of federal funds going to the states. This issue brief examines how participating in the Medicaid expansion will affect the movement of federal funds to each state. States that choose to participate in the expansion will experience a more positive net flow of federal funds than will states that choose not to participate. In addition to providing valuable health insurance benefits to low-income state residents, and steady sources of financing to state health care providers, the Medicaid expansion will be an important source of new federal funds for states.
Conceptual Issues in Designing a Policy to Phase Out Metal-Based Antifouling Paints on Recreational Boats
Journal of Environmental Management 90(8), June 2009
Maria Damon, Richard T. Carson, Leigh T. Johnson, and Jamie A. Miller
In marine areas throughout the world where recreational boats are densely located, concentrations of copper in the water are being found to be in excess of government standards, due to the hull coatings used on these boats. Copper-based hull coatings are intended to be antifouling in that they retard the growth of algae, barnacles and tubeworms; but alternatives exist that can eliminate the harm that copper contamination does to marine organisms. A variety of policy options are available to mandate or provide economic incentives to switch to these less harmful alternatives. This paper puts forth a conceptual framework for thinking about how to design and evaluate alternative policies to transition to nontoxic boat hulls, drawing from the authors' experience designing a policy for use in San Diego Bay. Many of the issues raised are broadly applicable to environmental problems where the solution involves a large-scale replacement of durable consumer goods.
Putting a Price on the Welfare of Our Children and Grandchildren
In "The Globalization of Cost-Benefit Analysis in Environmental Policy", edited by Michael A. Livermore, and Richard L. Revesz. New York: Oxford University Press, 2013.
Maria Damon, Kristina Mohlin, and Thomas Sterner
Discount rates have a profound effect on estimates for costs and benefits that accrue over time or in the future. Given that minute differences in discount rates can result in enormous differences in future values, discounting implicates moral as well as technical issues. This chapter reviews some of the main issues that discounting presents and discusses some important recent debates over time-varying discount rates and the importance of relative prices when examining effects of public policy in the far future. The authors also collect and discuss the discount rates currently used by decision makers around the world, and explain how differences in level of development should and should not affect the discount rates used by analysts.
Environmental Policies and Political Realities: Fisheries Management and Job Creation in Pacific Island Countries and Territories
Journal of Environment and Development
Maria Damon and Joshua Graff Zivin
Effective environmental policymaking requires an understanding of how environmental goals interact with other political goals. This article analyzes development strategies in the PICT’s, where policymakers aim to leverage tuna resources into sustainable economic development and job creation. The authors develop a model that analyzes costs and benefits of different development strategies, with a focus on job creation and local socioeconomic factors that drive optimal policy mixes across PICTs. The analysis demonstrates that investment in fisheries management can effectively encourage economic development and create employment opportunities, and compare this strategy to others such as selling access permits and investing in processing capacity. While many benefits of fisheries management are widely recognized, its ability to create high-quality employment opportunities is often overlooked. For many PICTs, this may represent the lowest cost strategy for jobs creation and, coupled with selling fishery access to foreign vessels, can form a strong basis for economic development plans.
Policy Instruments for Sustainable Development at Rio +20
Journal of Environment and Development, June 2012
Maria Damon and Thomas Sterner
Twenty years ago, governments gathered for the United Nations Conference on Environment and Development in Rio de Janeiro. The “Rio Declaration” laid out several principles of sustainable development, including the central role of policy instruments. In this article, we take stock of where we stand today in implementing sound and effective environmental policy instruments throughout the world, particularly in developing and transitional economies. We argue that, as our experience with market-based environmental policies has deepened over the past two decades, so has the ability to adapt instruments to complicated and heterogeneous contexts—but we are only just beginning, and the need to be further along is dire. One key factor may be that economists have not yet meaningfully accounted for the importance of political feasibility, which often hinges on risks to competitiveness and employment, or on the distribution of costs rather than on considerations of pure efficiency alone.
Review: The Net Benefits of Depression Management in Primary Care
Medical Care Research and Review, 2010. Volume 67 / Issue 03 / January 2010, pp 251-274, Published online
Sherry Glied, Karin Herzog and Richard Frank
Depression is often diagnosed and treated in primary care settings. Organizational and systems interventions that restructure primary care practices and train staff have been shown to be cost-effective strategies for treating depression. Funders are increasingly calling for a cost–benefit assessment of such programs. In this study, the authors review existing cost-effectiveness studies of primary care depression treatments, classify them into categories, translate the results into net benefit terms, and assess whether more costly programs generate greater net benefit. The authors find that interventions that provide training to primary care teams in how to manage depression most consistently produce net benefits, with more costly interventions of this type generating larger net benefits than less costly interventions. Collaborative care interventions, which add specialized staff to primary care practices, and therapy interventions, in which clinicians are trained to provide therapy, also generate net social benefits at conventional valuations of quality-adjusted life years.
We All Want It, but We Don't Know What It Is: Toward a Standard of Affordability for Health Insurance Premiums
Journal of Health Politics, Policy and Law, 2011. Volume 36 / Issue 05 / July 2011, pp 829-853, Published online
Peter Muennig, Bhaven Sampat, Nicholas Tilipman, Lawrence D. Brown and Sherry A. Glied
The 2010 Patient Protection and Affordable Care Act (P.L. 111-148), or ACA, requires that U.S. citizens either purchase health insurance or pay a fine. To offset the financial burden for lower-income households, it also provides subsidies to ensure that health insurance premiums are affordable. However, relatively little work has been done on how such affordability standards should be set. The existing literature on affordability is not grounded in social norms and has methodological and theoretical flaws. To address these issues, we developed a series of hypothetical vignettes in which individual and household sociodemographic characteristics were varied. We then convened a panel of eighteen experts with extensive experience in affordability standards to evaluate the extent to which each vignette character could afford to pay for one of two health insurance plans. The panel varied with respect to political ideology and discipline. We find that there was considerable disagreement about how affordability is defined. There was also disagreement about what might be included in an affordability standard, with substantive debate surrounding whether savings, debt, education, or single parenthood is relevant. There was also substantial variation in experts' assessed affordability scores. Nevertheless, median expert affordability assessments were not far from those of ACA.
The Evolving Private Psychiatric Inpatient Market
The Journal of Behavioral Health Services & Research, 2011. Volume 38 / Issue 01 / January 2011, pp 122-131, Published online
Erica Hutchins, Richard Frank and Sherry Glied
The private psychiatric hospital market has exhibited great volatility over time. From 1976 to 1992, the number of hospitals more than doubled, while in the decade following, the number of facilities dropped by half. Recently, however, the industry has begun to grow again. The evolution of this market reflects the response of a private industry with access to capital markets to changes in both the supply of substitutes and the demand for services. Most recently, the limited supply of facilities and expanded demand for psychiatric services have spurred renewed growth. The two leading firms today, Universal Health Services, Inc., which rode the market crest and downturn since the 1980s, and Psychiatric Solutions, Inc., a newer entrant, have employed different strategies to take advantage of these opportunities. The rapid responsiveness of the private psychiatric hospital market, as exemplified by these two firms, presents significant potential for shaping future mental health policy.
Aligning Ideologies and Institutions: Reorganization in the HIV/AIDS Services Administration of New York City
Public Administration Review, 2011. Volume 71 / Issue 02 / March 2011, pp 243–252, Published online
Kimberley Isett, Michael Sparer, Sherry Glied and Lawrence Brown
How effective was organizational reform implemented inside one critical New York City health agency? Specifically, we examine the extent to which the reorganization of the HIV/AIDS Services Administration (HASA) into the Medical Insurance Services Administration (MICSA) achieved three goals: (1) realizing synergies among the component MICSA programs; (2) cross-fertilizing ideas among MICSA agencies; and (3) facilitating HASA operations through the lens of organization change theory. Qualitative methods including interviews, site visits, and document analysis triangulate the effects of the reorganization. Implications for organization change literature are explored, especially highlighting where more theoretical and empirical studies are needed.
From Research to Health Policy Impact
Health Services Research, 2012. Volume 47 / Issue 01 / February 2012, pp 337-343, Published online
Carolyn M. Clancy, Sherry A. Glied and Nicole Lurie
The opportunities for researchers to improve health and health care by contributing to the formulation and implementation of policy are almost unlimited. Indeed, the availability of these opportunities is a tribute to a generation of health services researchers questioning existing policies or studying essential "Why?" and “What if?” questions using rigorous analysis. Moreover, the steady albeit uneven transition of health care delivery from a paper-based cottage industry toward an enterprise that provides transparent information to clinicians, patients, policy makers and the public, and potentially vast amounts of data to policy researchers, combined with the expectations of an increasingly information-savvy public, have increased the focus on health care quality, access, and costs.
Our health care system, like those in other countries, confronts continued pressures from increasing costs; inconsistent quality; avoidable patient harms; pervasive disparities in health and health care associated with individual characteristics such as race, ethnicity, income, education and geography; and poor population health outcomes. The persistence of many of these challenges reflects, in part, a failure of science alone to improve heath. Strategies to address many of these challenges exist in the laboratory, but the contribution of this science to the health of the public is limited by a research enterprise that values discovery of new knowledge far more than its successful application.
Chronic Condition: Why Health Reform Fails
Cambridge: Harvard University Press, 1998.
Chronic Condition provides a compelling analysis of the causes of the current health care crisis and of the shortcomings of reform proposals. It also offers an ingenious new framework for reform that, while minimizing government interference, would provide a means for financing care for the less affluent.
Sherry Glied shows that rising health care spending is consistent with a rising standard of living. Since we can, as a nation, afford more health care, reform must address not the overall level of health care costs but the distribution of health care spending.
Prior reform proposals, Glied argues, have failed to account for the tension between the clearly manifested desire for improving the quality of health care and the equally widespread interest in assuring that the less fortunate share in these improvements. After careful analysis of the ill-fated Clinton plan, Glied proposes a new solution that would make the willingness to pay for innovation the means of financing health care improvements for the less affluent. While rejecting the idea that the distribution of health care should be perfectly equal, Glied's proposal would enable all Americans to benefit from the dynamics of the free market.
Better but Not Well: Mental Health Policy in the United States Since 1950
Baltimore: The Johns Hopkins University Press, 2006.
Richard G. Frank and Sherry A. Glied
The past half-century has been marked by major changes in the treatment of mental illness: important advances in understanding mental illnesses, increases in spending on mental health care and support of people with mental illnesses, and the availability of new medications that are easier for the patient to tolerate. Although these changes have made things better for those who have mental illness, they are not quite enough.
In Better But Not Well, Richard G. Frank and Sherry A. Glied examine the well-being of people with mental illness in the United States over the past fifty years, addressing issues such as economics, treatment, standards of living, rights, and stigma. Marshaling a range of new empirical evidence, they first argue that people with mental illness—severe and persistent disorders as well as less serious mental health conditions—are faring better today than in the past. Improvements have come about for unheralded and unexpected reasons. Rather than being a result of more effective mental health treatments, progress has come from the growth of private health insurance and of mainstream social programs—such as Medicaid, Supplemental Security Income, housing vouchers, and food stamps—and the development of new treatments that are easier for patients to tolerate and for physicians to manage.
The authors remind us that, despite the progress that has been made, this disadvantaged group remains worse off than most others in society. The "mainstreaming" of persons with mental illness has left a policy void, where governmental institutions responsible for meeting the needs of mental health patients lack resources and programmatic authority. To fill this void, Frank and Glied suggest that institutional resources be applied systematically and routinely to examine and address how federal and state programs affect the well-being of people with mental illness.
The Oxford Handbook of Health Economics
Oxford University Press.
Glied, Sherry and Peter C. Smith
The Oxford Handbook of Health Economics provides an accessible and authoritative guide to health economics, intended for scholars and students in the field, as well as those in adjacent disciplines including health policy and clinical medicine. The chapters stress the direct impact of health economics reasoning on policy and practice, offering readers an introduction to the potential reach of the discipline. Contributions come from internationally-recognized leaders in health economics and reflect the worldwide reach of the discipline. Authoritative, but non-technical, the chapters place great emphasis on the connections between theory and policy-making, and develop the contributions of health economics to problems arising in a variety of institutional contexts, from primary care to the operations of health insurers. The volume addresses policy concerns relevant to health systems in both developed and developing countries. It takes a broad perspective, with relevance to systems with single or multi-payer health insurance arrangements, and to those relying predominantly on user charges; contributions are also included that focus both on medical care and on non-medical factors that affect health. Each chapter provides a succinct summary of the current state of economic thinking in a given area, as well as the author's unique perspective on issues that remain open to debate. The volume presents a view of health economics as a vibrant and continually advancing field, highlighting ongoing challenges and pointing to new directions for further progress.
Economic analysis of a loan guarantee fund intervention in three midland communes: Design, justification, risks
Food and Agriculture Organization of the United Nations, Vietnam.
From Endeavor to Achievement and Back Again: Government's Greatest Hits in Peril
In To Promote the General Welfare: The Case for Big Government. Steven Conn, Ed., Oxford Univeristy Press
Paul C. Light
"These 10 articles from leading scholars address federal government activism in such areas as health, education, transportation, and the arts. In some areas, federal involvement has been direct; for example, while school public systems are governed locally, Washington provides about 10% of k–12 funding. Similarly, antipoverty programs, such as the New Deal’s Social Security Act and Aid for Dependent Children, have played a major role in reducing the poverty rate from around 40% in 1900 to 11.2% in 1974. At other times, Washington has exerted influence more subtly, through regulations and research. Examples include the 1933 Glass-Steagall Act, which mandated the separation of investment and commercial banking and the WWII-era research that yielded compounds to prevent and cure malaria, syphilis, and tuberculosis. Further, as public policy scholar Paul C. Light points out in a fascinating concluding piece, more than two-thirds of leading governmental initiatives have been supported by both Democratic and Republican administrations. However, Light adds, the massive tax cut in 2001 “continue[s] to constrain federal investment in problem solving.” The scholars brought together by Ohio State historian Conn (History’s Shadow) persuasively demonstrate how the growth of “big government” throughout the 20th century has benefited ordinary Americans so comprehensively and unobtrusively that they have often taken it for granted."
Integrated Policymaking for Sustainable Development: An operational manual
United Nations Environment Program, Geneva
Fritzen, Scott., Howlett, M., Ramesh M., Wu, X.
A (global) public policy primer
The Rockefeller Foundation’s Bellagio Center, nestled in the foothills of the
Alps, has a storied past. It was here that the Green Revolution and the Global Aids Vaccine initiatives were conceptualised. In June this year, the Center opened its doors to 20 representatives from policy schools around the world over four days – including Dean Kishore Mahbubani, Professor Kanti Bajpai and myself from the LKY School – to discuss the ‘future of global public policy education’. Delegates grappled with the question: does our increasingly globalised world demand a fundamentally new kind of public policy education?
Teaching Public Policy and Administration: Controversies and Directions
in Jabes, J. (ed) The Role of Public Administration in Alleviating Poverty and Improving Governance, Manila: Asian Development Bank, pp. 571-575.
Negotiation and conflict management: A Public Policy Perspective.
Encyclopedia of Public Administration and Public Policy, (ed: J. Rabin), New York: Marcel Dekker, Inc. (online and forthcoming in the second edition print edition, 2007) 8 pp.
Fuller, B.W., Fritzen, Scott.
Conclusion: Contradictions, contingencies and the terrain ahead.
Reasserting the Public in Public Services: New Public Management Reforms, Routledge.
Fritzen, Scott, Wu, X.