Outcomes Of Policy Change Research Articles

The Experiences of Skilled Nursing Staff in Memory Care Units During the COVID-19 Pandemic.

The novel coronavirus disease 2019 (COVID-19) resulted in the need for multiple mitigation strategies. The impacts of these safety measures were felt more extremely by healthcare providers. This qualitative study focused on the experiences of staff in skilled nursing facilities, specifically in locked memory care units, during the first year of the COVID-19 pandemic. This study used a basic interpretive methodology. In-depth interviews were conducted with skilled nursing staff members who worked in a locked memory care unit during the 2020 calendar year. Thematic analysis was used to organize and interpret the data. A total of 11 participants provided data that resulted in themes around reasons for working on a locked memory care unit, experiences working with people who have behavioral and psychological symptoms due to dementia, training, outcomes of shared experiences, outcomes of policy changes, management support, and suggestions for a future pandemic. The results of this study may have implications for skilled nursing facilities with locked memory care units that continue to grapple with the realities of providing care during a pandemic. Providing appropriate training, social support, and appropriate protective equipment are among the suggestions.

Social justice in socio-hydrology—how we can integrate the two different perspectives

ABSTRACT Socio-hydrology has become an important platform for discussion and exchange in current water research. A key challenge is the integration of the social into socio-hydrological logic. To date, most studies have excluded the potential outcomes of policy changes based on socio-hydrology models. The goal of this paper is to present a theoretical framework that extends the current debates in socio-hydrology around the concept of social justice. Social justice considers and reflects on the question of fairness in the allocation of resources, participation, and wealth across residents of a river basin. This critical review elucidates the role of social justice in flood risk management by considering the possible consequences of including social justice and by proposing how to integrate those consequences into the current socio-hydrology model. As such, the review contributes to the ongoing discussion of human–environment interaction in socio-hydrology.

Conceptualising changes to tobacco and alcohol policy as affecting a single interlinked system

BackgroundTo support a move towards a coordinated non-communicable disease approach in public health policy, it is important to conceptualise changes to policy on tobacco and alcohol as affecting a single interlinked system. For health economic models to effectively inform policy, the first step in their development should be to develop a conceptual understanding of the system complexity that is likely to affect the outcomes of policy change. Our aim in this study was to support the development and interpretation of health economic models of the effects of changes to tobacco and alcohol policies by developing a conceptual understanding of the main components and mechanisms in the system that links policy change to outcomes.MethodsOur study was based on a workshop from which we captured data on participant discussions on the joint tobacco–alcohol policy system. To inform these discussions, we prepared with a literature review and a survey of participants. Participants were academics and policy professionals who work in the United Kingdom. Data were analysed thematically to produce a description of the main components and mechanisms within the system.ResultsOf the people invited, 24 completed the survey (18 academic, 6 policy); 21 attended the workshop (16 academic, 5 policy). Our analysis identified eleven mechanisms through which individuals might modify the effects of a policy change, which include mechanisms that might lead to linked effects of policy change on tobacco and alcohol consumption. We identified ten mechanisms by which the tobacco and alcohol industries might modify the effects of policy changes, grouped into two categories: Reducing policy effectiveness; Enacting counter-measures. Finally, we identified eighteen research questions that indicate potential avenues for further work to understand the potential outcomes of policy change.ConclusionsModel development should carefully consider the ways in which individuals and the tobacco and alcohol industries might modify the effects of policy change, and the extent to which this results in an unequal societal distribution of outcomes. Modelled evidence should then be interpreted in the light of the conceptual understanding of the system that the modelling necessarily simplifies in order to predict the outcomes of policy change.

Has Social Policy Expansion in Latin America Reduced Welfare Decommodification and Defamilialisation? Evidence from an Overview of the Mexican Welfare Regime

Mexican social policy has been transformed in recent years with the introduction and expansion of social assistance programmes, causing a diversion from the trajectory based on social insurance since the first decades of the twentieth century. This article aims to understand the outcomes of that transformation, by applying welfare regime theory to establish how social policy reforms have affected the distribution of welfare responsibilities among the state, markets and families. The research identifies (de)commodification and (de)familialisation outcomes of policy changes in pensions, healthcare, unemployment and family support. Results suggest that the expansion has not produced significant reductions in decommodification or defamilialisation because of: a) the explicit or implicit role assigned to markets in policy design and implementation, and b) the reliance of the process of economic liberalisation on the welfare role performed by families. The case of Mexico may illustrate the current welfare challenges faced by societies across Latin America.

Openness, Inflation and Output Under Alternative Monetary Policies: A Structuralist Approach

This article theoretically revisits the issue of how trade openness and inflation are interconnected in the light of conduct and optimal design of monetary policy. Central banks in open economies all over the world face a problematic dilemma when it comes to providing a nominal anchor to the economy in the sense that they have to choose between monetary targeting and inflation targeting. The experience has been varied worldwide with respect to these alternative policies in containing inflation. Different dimensions of openness like fully flexible exchange rate and capital mobility have also had significant impacts on the outcomes of policy changes. In this paper, we have constructed two theoretical open macro-economy models using the AD-AS framework under regressive expectations. The first model considers interest-rate targeting incorporating Taylor rule, whereas the second one deals with monetary targeting. The models show that alternate monetary policy rules do not change the basic results of different macroeconomic policies, although the underlying transmission mechanisms are quite different. JEL Codes: E12, E31, E43, E52, F41

Resilience through policy integration in Europe? Domestic forest policy changes as response to absorb pressure to integrate biodiversity conservation, bioenergy use and climate protection in France, Germany, the Netherlands and Sweden

In this paper, we analyse how and why domestic forest policies in Europe have responded to pressures to integrate biodiversity conservation, climate and bioenergy policies. We use content analysis of documents and interviews to analyse change and stability in domestic forest policy goals, instruments and practices in France, Germany, the Netherlands, and Sweden over time. We find that decision-makers in forest policy and practice responded to pressure to integrate biodiversity into forestry through four different types of policy change outcomes and processes. Depending on the context, these responses included layering, drift, conversion and/or replacement. In all countries, the forest policy changes were driven by (partly shifting) coalitional politics and changes in external conditions. Domestic forest policy regimes shifted from ‘timber production’ towards ‘multifunctional’, ‘sustainable forest management’ or ‘biodiversity’ primacy, and then back to ‘timber harvesting’. Forest policy also integrated bioenergy and climate change policies in order to minimise pressure by EU and national biodiversity policy sectors and to enable ‘timber harvesting’ (re-)turns in forest policy. We conclude that policy integration processes and the shifts in forest policy they contain refer to a sectoral resilience, that is, the ability of forest policy to react to, minimise, and absorb pressures to integrate biodiversity conservation policies.

Relationships Between Theoretically Derived Short-Term Outcomes and Support for Policy Among the Public and Decision-Makers.

Purpose and ObjectivesPolicy change is a lengthy and complex process. Thus, it is important to articulate hypothesized causal pathways between advocacy activities and policy change outcomes and to identify and monitor early indicators of progress toward policy change.Intervention ApproachThe Kansas Health Foundation supports grantee efforts to address the public health effects of obesity through evidence-based policy, systems, and environmental change interventions. To build support for policy, systems, and environmental changes in schools, workplaces, and health care and retail settings, grantees mobilize communities, educate government policy makers, and advocate with organizational decision makers.Evaluation MethodsTo understand whether early outcomes from obesity-prevention advocacy efforts predict interim outcomes related to eventual policy change, we conducted surveys of the general public and of opinion leaders in Kansas, which were designed to measure components of Kansas Health Foundation’s theory of change. We then used structural equation modeling to test the theory of change’s underlying relationships by using support for obesity prevention policies as the outcome.ResultsOur findings supported the hypothesized model: perceptions of obesity as a serious community problem influence beliefs about causes of the problem. Beliefs about causes predict beliefs about who is responsible for the solution to the problem, which in turn predicts support for obesity prevention policies.Implications for Public HealthEvaluators of advocacy for policy change interventions can use this approach to monitor proximal changes in public and opinion leader beliefs related to eventual policy change and to determine whether efforts are likely to be successful or need to be adapted or abandoned.

PCN73 - Economic Outcomes of Medicare Reimbursement Policy Change on Erythropoiesis-Stimulating Agents in Cancer Patients

Centers for Medicare and Medicaid Services (CMS) issued a Medicare reimbursement policy change for erythropoiesis-stimulating agents (ESAs) in cancer patients because clinical trials found that ESAs were associated with increased risks. The economic impact of the policy change is unknown. The objective of this study is to examine economic outcomes of Medicare reimbursement policy change in cancer patients using ESAs. In this study, the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database was used. The study design was a retrospective incident user cohort design. Economic outcomes were measured by anemia-related costs and total medical costs. The treatment group was composed of cancer patients and the control group was composed of chronic kidney disease (CKD) patients. A difference-in-difference (DID) design was used to examine economic outcomes of the policy change. A generalized linear model (GLM) with a log link and a gamma distribution was used in the analysis. In the treatment group, we identified 17,382 incident users of ESAs in the pre-policy period and 4,490 in the post-policy period. In the control group, we identified 3,069 incident users of ESAs in the pre-policy period and 1,306 in the post-policy period. After controlling for covariates, the policy change was associated with a 11.20% (P=.0113) reduction in anemia-related costs and a 11.96% (P=.0001) reduction in total medical costs. Specifically, in anemia-related costs, Medicare payment was reduced by 9.83% (P=.0310) and patient cost-sharing was reduced by 18.40% (P<.0001). In total medical costs, Medicare payment was reduced by 11.59% (P=.0003) and patient cost-sharing was reduced by 13.58% (P<.0001). Medicare reimbursement policy change reduced anemia-related costs and total medical costs in cancer patients using ESAs. The policy change was effective in reducing expenditures in CMS and patients.

A Causal Mechanism of Policy Innovation: The Reform of Colombia’s Oil-Rents Management System

This article analyzes policy innovation in Colombia, through the adoption of a new centralized oil-rent management system in 2011, after 20 years of decentralized policies. Using a policy-design framework, we identify a causal mechanism linking the opening of a policy window to policy change as a combination of the emergence of a new policy network, the adoption of a new policy paradigm and the selection of a new instruments mix. Drawing on Bayesian statistics, the 11 tests conducted on the causal mechanism show the importance of State resources of information, authority, treasury and organization to assess the outcome of policy change.

Explaining cross-regional policy variation in public sector reform: Institutions and change actors in the health sector in Spain

How can we explain cross-regional policy variation? That is, how can we understand different policy outcomes within similar institutional and organizational settings? Scholars have recently reflected on the new institutionalist explanatory pitfall involved in assuming a causality link between institutional factors and policy outcomes and argue that such link needs to rely on evidence from policy variables. On this line, recent contributions have built a causal model that links types of institutional change to types of actors' roles and strategies, within particular contextual and organizational scenarios that favor or hinder their emergence. This paper pursues this explanatory interest by applying this model to the analysis of how decision-making by two regional governments in Spain has led to different institutional and policy change outcomes in the same policy sector, namely, public management reform in healthcare. This study confirms the explanatory relevance of the model's key variables, but provides evidence of how some of them may be reinterpreted to provide a dynamic explanation of their influence on the process and outcome of institutional and policy change.

Maternal age and trajectories of marijuana use over 17 years

hospital discharges. Linear regression was used to evaluate applications for medical marijuana over time. The application analysis was followed with an analysis exploring population growth as a confounder. Autocorrelation was evaluated and an AR1 structure was used as necessary. Finally, the association between monthly medical marijuana applications and monthly discharges coded as dependence was tested with linear regression to explore an ecologic dose response relationship. Results: From 2009 to 2013, both applications and discharges increased, where 4205 (p<0.001) additional applications were received per month, and a 0.9% (p<0.001) increase in population rate per month was detected in hospital discharges. This was not confounded by population growth. The association between applications and discharges was significant (p<0.001) but modest with only 1 discharge per 3159 applicants. Conclusions: Although statistically significant increases were detected over time, the relation between applications and discharges was small in the time period preceding the legalization of recreational sales. Other states considering the legalization of medical marijuana can use this report to assist in the evaluation of public health related outcomes of policy change. Financial support: NIH/NIDA, 5R01DA031816-04, The Impact of Medical Marijuana in Metropolitan Denver.

Disruptive Democratization: Contentious Events and Liberalizing Outcomes Globally, 1990–2004

Does contentious collective action matter? Whereas most social movement literature has addressed this question in the US context for policy change outcomes, this paper takes a different approach by bringing the question to a global context and examines democratization as a structural outcome. Accordingly, we test several hypotheses about the ephemeral, positive, and negative influences of contentious collective action on the democratization process in a given country, as well as the cross-border effect of the contention. To go beyond the limitations of previous studies, this paper uses a monthly time-series, cross-national model to examine potential liberalizing or deliberalizing effects of protest activities. Using data from 103 non-democratic countries from 1990 to 2004, we find that protests and riots increase the probability that a country will liberalize in a given month. We find that while contentious events in other countries do not directly increase the risk of liberalization, external contentious events, especially those that lead to political liberalization, increase the count of contentious events, thus indirectly boosting liberalization. We find no evidence that protest significantly increases the chances of deliberalization. Together, our findings show a key role for non-elite political actors to influence political liberalization.

Entropy Estimation of Disaggregate Production Functions: An Application to Northern Mexico

This paper demonstrates a robust maximum entropy approach to estimating flexible-form farm-level multi-input/multi-output production functions using minimally specified disaggregated data. Since our goal is to address policy questions, we emphasize the model’s ability to reproduce characteristics of the existing production system and predict outcomes of policy changes at a disaggregate level. Measurement of distributional impacts of policy changes requires use of farm-level models estimated across a wide spectrum of sizes and types, which is often difficult with traditional econometric methods due to data limitations. We use a two-stage approach to generate observation-specific shadow values for incompletely priced inputs. We then use the shadow values and nominal input prices to estimate crop-specific production functions using generalized maximum entropy (GME) to capture individual heterogeneity of the production environment while replicating observed inputs and outputs to production. The two-stage GME approach can be implemented with small data sets. We demonstrate this methodology in an empirical application to a small cross-section data set for Northern Rio Bravo, Mexico and estimate production functions for small family farms and moderate commercial farms. The estimates show considerable distributional differences resulting from policies that change water subsidies in the region or shift price supports to direct payments.

Advocacy Evaluation

Devising, promoting, and implementing changes in policies and regulations are important components of population-level health promotion. Whether advocating for changes in school meal nutrition standards or restrictions on secondhand smoke, policy change can create environments conducive to healthier choices. Such policy changes often result from complex advocacy efforts that do not lend themselves to traditional evaluation approaches. In a challenging fiscal environment, allocating scarce resources to policy advocacy may be particularly difficult. A well-designed evaluation that moves beyond inventorying advocacy activities can help make the case for funding advocacy and policy change efforts. Although it is one thing to catalog meetings held, position papers drafted, and pamphlets distributed, it is quite another to demonstrate that these outputs resulted in useful policy change outcomes. This is where the emerging field of advocacy evaluation fits in by assessing (among other things) strategic learning, capacity building, and community organizing. Based on recent developments, this article highlights several challenges advocacy evaluators are currently facing and provides new resources for addressing them.

Tears from an onion: Layering, exhaustion and conversion in British Columbia land use planning policy

Most previous studies of policy change in the BC resource and environmental sectors have stressed the importance of exogenous factors, notably the changing profitability of key industries, such as forestry; the appearance of new actors and policy ideas; and the domestic and international linkages so ably exploited by ENGOs. Without denying the importance of these factors, this case study of BC's integrated land use policy illustrates the weight that policy legacies bring to bear on the path of policy transformation. This study explores the interplay of the processes and outcomes of policy change by comparing the processes and outcomes of three consecutive regime transitions in BC land use policy. The transitions suggest a complex relationship between layering, exhaustion, and conversion, in which layered elements that are pushed to the background of the policy regime can either be allowed to die or be brought back to become the centrepiece of a policy transition that takes place without the appearance (and associated political costs) of novelty.

River Restoration in the American West: Assessing Variation in the Outcomes of Policy Change

Existing research has documented the ecological impacts from the damming of rivers. Recently, a political movement to restore rivers and related resources has grown and prompted changes to traditional polices of river development and management. This research focuses on such efforts in the American West, where unique combinations of climate, history, and politics suggest limited support for dramatic policy change. Why are particular dams removed and others not? Will dramatic policy options involving partial or complete dam removal diffuse to restoration cases involving increasingly larger and more complex dams? Using descriptive and bivariate statistics, an index of policy options is analyzed. Among the elements of Lowry's (2003) river restoration study, independent measures include political receptivity to change; physical complexity; and primary jurisdictional or administrative context. Findings indicate dramatic policy change can occur under diverse conditions; these include federal administrative contexts, arid climates, and cases with low political receptivity and high physical complexity.

Do crises help remedy regulatory failure? A comparative study of the Walkerton water and Jerusalem banquet hall disasters

Abstract: This study explores whether and how policy changes in the aftermath of a crisis. The authors ask why pre‐existing regulatory regimes that are identified as contributory factors to “failure” are not necessarily reformed in the wake of a crisis. The investigation adds to the literature that addresses the classic tension between reformism and conservatism in post‐crisis periods. Regulatory failure is identified as being largely responsible for two crises – the tainted drinking‐water tragedy in Walkerton, Canada, and the collapse of a banquet hall in Jerusalem, Israel. Despite similarities in the nature of media coverage, institutional procedures for investigation and commission findings, these two tragedies differ dramatically in policy change outcomes. A policy streams prism is used to identify, characterize and analyse reasons for very different policy responses to crises associated with regulatory failure.Sommaire: Cette étude examine si et comment les politiques changent à la suite d'une crise. Les auteurs se posent la question de savoir pourquoi des régimes de réglementation préexistants qui sont identifiés comme étant des facteurs contribuant à l'«échec » ne sont pas nécessairement réformés à la suite d'une crise. L'enquête apporte des éléments à la documentation portant sur la tension classique qui existe entre le réformisme et le conservatisme au cours des périodes postérieures à une crise. L'échec de la réglementation est identifié comme étant largement responsable de deux crises : la tragédie de l'eau potable contaminée à Walkerton, au Canada, et l'effondrement d'une salle de réception à Jérusalem, en Israël. Malgré des similarités dans la nature de la couverture médiatique, dans les procédures institutionnelles de l'enquête et les résultats des commissions, ces deux tragédies diffèrent radicalement dans les résultats des modifications de politiques. Un prisme des courants de politiques est utilisé pour identifier, caractériser et analyser les raisons des réactions très différentes en matière de politiques à des crises associées à l'échec de la réglementation.