Policy Reform Options Research Articles

The doctor vote: Interactions between political ideological preferences and healthcare reform strategies among U.S. physicians

IntroImproving the American healthcare system has consistently predominated the domestic policy agenda in the United States for decades. However, physicians have traditionally played a small role in the U.S. legislative process despite their direct observations of the obstacles that cost, access, and quality can have on their patients and their care. The goal of this study was to examine the relationship between physician political ideological preferences and health policy reform options. MethodsWe conducted a cross-sectional survey of 3,001 currently practicing U.S. physicians to predict how self-identification as liberal, moderate, or conservative impacted a physician’s policy preferences under the domains of cost, access, and quality. ResultsA total of 536 (18.8%) out of 3,001 physicians responded to the survey. Overall, 32% of physicians identified as liberal, 43% as moderate, and 22% as conservative. ConclusionLiberal-identifying physicians favored traditionally liberal reform ideas (a national health plan or public option), while conservative physicians preferred conservative policies (free market optimization). However, variation within political groups and domains of healthcare suggest that no single reform policy will be unanimously supported by every physician within a political group. Nonetheless, physicians are unanimously dissatisfied with the state of our current system, and physician-supported healthcare reform should be a national priority.

Navigating Data Security Challenges: Policy Innovations and Reform Options

Navigating Data Security Challenges: Policy Innovations and Reform Options

U.S. Antitrust Policy in the Age of Amazon, Google, Microsoft, Apple, Netflix and Facebook

Sweeping changes have disrupted society courtesy of the Information Revolution, presenting great opportunities in radically transformed economic markets but also great challenges in adapting to new and different forms of organization. Antitrust laws and other elements of competition policy are being re-examined. Specifically, the House Judiciary Committee conducted hearings in 2020 in which it asked key questions about the pattern of development in U.S. markets and options for policy reform. This paper, answering such queries, finds strong evidence for the view that, relative to practical alternatives that include E.U.-style regulation, digital markets in the U.S. appear robust, generating considerable innovation that produces pro-consumer outcomes. The global Internet is dominated by U.S.-developed technologies and business models discovered and deployed in a process of competitive rivalry. Even given imperfect rules and regulations, U.S. markets have contributed strongly to economic advances embraced around the world.

Universal Credit and Automated Decision Making: A Case of the Digital Tail Wagging the Policy Dog?

Intended to simplify the benefit system and ’make work pay’, Universal Credit (UC) is the UK’s first ‘digital by design’ benefit. Proponents of UC highlight the greater efficiency and effectiveness of digitalisation, while critics point to costly IT write-offs and the ‘digital divide’ between people with the skills and resources to access digital technologies, and those without. Less attention has been paid to automation in UC and its effects on the people subject to these rapidly developing technologies. Findings from research exploring couples’ experiences of claiming UC suggest that automated processes for assessing entitlement and calculating payment may be creating additional administrative burdens for some claimants. Rigid design parameters built into UC’s digital architecture may also restrict options for policy reform. The article calls for a broadening of thinking and research about digitalisation in welfare systems to include questions of administrative burden and the wider effects and impacts on claimants.

Diversifying a resource-dependent economy: private\u2013public relationships in the Kuwaiti economy

The Kuwaiti economy is characterized by two major structural imbalances—heavy dependence on oil production and dominance of the public ownership. Kuwait has struggled over the years to implement a two-pronged development strategy —diversifying the country’s economic base away from the oil sector and promoting private sector development. This paper explores the economic impact of some policy reform options currently being considered. It employs a unique set of input–output tables, derived from supply–use tables, that distinguishes transactions made by private and public enterprises as well as providing a matrix of imports by industry. The public–private sector interdependence analysis revealed interesting results regarding sectoral differences in strengths of forward and backward linkages. For instance, the findings indicated that the strength of the publicly owned oil sectors lie in their forward linkages, supplying other sectors with their outputs, but their backward linkages is weak. On the other hand, the chemicals industry is identified as one of a few sectors with balanced and relatively strong forward and backward linkages in both public and private sector. The policy analyses conducted in this paper are highly relevant to the ongoing policy debate in Kuwait over the design of the economic reform programs. The public–private linkage analysis has revealed insights into policy synergies through which one instrument can affect more than one policy target.

Novel approaches to identify and characterize young key population networks in southern Africa.

Novel approaches to identify and characterize young key population networks in southern Africa.

Governance challenges of small-scale gold mining in Ghana: Insights from a process net-map study

The artisanal small-scale mining (ASM) sector – commonly described as low-tech, labor-intensive mineral extraction and processing, in developing countries, is increasingly associated with the use of heavy earth moving machines and hazardous chemicals for ore extraction, which can have negative implications on agricultural land use and the environment. Moreover, land reclamation, or the lack thereof, associated with ASM is a rising concern. Despite the potentially far-reaching effects of informal ASM operations on the environment and human health, the legal framework for ASM, particularly in sub-Saharan African countries, is not well implemented. Focusing on Ghana as a study case, this paper explores the factors that hinder the implementation of its legal framework for mining. A combination of qualitative explorative methods was applied, including an innovative tool called “Process Net-Map”, a visual participatory mapping technique. The results help to explain the governance challenges of the ASM sector, enabling identification of policy reform options to address them. The findings exposed outdated legislature, which fails to capture the ever-growing complexities of the subsector’s operations, as a major bottleneck. Hurdles associated with formal licensing bureaucracies and fees, land tenure, compliance monitoring, and ineffective collaboration of relevant stakeholders with and at the local level were identified as hindering the implementation of the existing legal framework. These bottlenecks must be addressed. Moreover, we recommend the adoption of collaborative governance systems, like co-management, which has been successfully implemented in other disciplines, in the ASM sector to ensure sustainability.

Innovation for the German energy transition - Insights from an expert survey

Germany has committed itself to drastic reductions in greenhouse gas emissions through an energy transition, which combines the massive expansion of renewable energy in electricity generation with energy savings and energy efficiency improvements. Innovative low-carbon technologies will be central to a successful energy transition. In this context, we address three questions: (i) which innovative low-carbon technologies are key for the energy transition in different sectors of the economy, (ii) what are the obstacles to low-carbon innovations, and (iii) what are policy reform options to foster the German energy transition. Based on an expert survey, we find that key innovative low-carbon technologies are already available today. However, their market diffusion is hindered by insufficient pricing of CO2 externalities, lock-in effects, and counterproductive regulatory constraints. Overcoming these obstacles will require in first place a more stringent pricing of energy carriers based on their actual CO2 content.

Facing the option for the legalisation of cannabis use and supply in New Zealand: An overview of relevant evidence, concepts and considerations.

IssuesNon‐medical cannabis policies are changing, including towards legalisation‐with‐regulation frameworks. New Zealand will hold a public referendum on cannabis legalisation in 2020. We reviewed data on cannabis use and health/social harms; policy reform options; experiences with and outcomes of reforms elsewhere; and other relevant considerations towards informing policy choices in the upcoming referendum.ApproachRelevant epidemiological, health, social, criminal justice and policy studies and data were identified and comprehensively reviewed.Key FindingsCannabis use is common (including in New Zealand) and associated with risks for health and social harms, mainly concentrated in young users; key harms are attributable to criminalisation. ‘Decriminalisation’ reforms have produced ambivalent results. Existing cannabis legalisation frameworks vary considerably in main parameters. Legalisation offers some distinct advantages, for example regulated use, products and user education, yet outcomes depend on essential regulation parameters, including commercialisation, and policy ecologies. While major changes in use are not observed, legalisation experiences are inconclusive to date, including mixed health and social outcomes, with select harms increasing and resilient illegal markets. It is unclear whether legalisation reduces cannabis exposure or social harms (e.g. from enforcement) for youth.Implications/ConclusionsNo conclusive overall evidence on the outcomes of legalisation elsewhere exists, nor is evidence easily transferable to other settings. Legalisation offers direct social justice benefits for adults, yet overall public health impacts are uncertain. Legalisation may not categorically improve health or social outcomes for youth. Legalisation remains a well‐intended, while experimental policy option towards more measured and sensible cannabis control and overall greater policy coherence, requiring close monitoring and possible adjustments depending on setting‐specific outcomes.

Striving for Influence: The Importance of Accessibility, Transparency and Humility in the Provision of Economic Policy Advice

It provides guidance on options for policy reform, on the consequences of alternative directions for policy reform and on the trade-offs that these may involve. Increasingly, independent fiscal institutions like the PBO and independent analytical institutions like the PC are being established across many countries to improve transparency around policy issues with the aim of improving the quality of the economic policy debate. [Extracted from the article]

Exploring Policy Reform Options for the Welfare Regime Shift in Korea

Exploring Policy Reform Options for the Welfare Regime Shift in Korea

The Challenge of Pension Reform in Georgia: Non-Contributory Pensions and Elderly Poverty

Georgia, a country characterized by an aging population with a high incidence of poverty and limited public financial resources, offers virtually complete non-contributory basic pension coverage. The basic pension has, to date, proved effective in dealing with poverty arising from political instability, military conflicts, economic deterioration, transition to a market economy, emigration of its younger population, and aging. But Georgia’s fiscal constraints and aging population also highlight the importance of developing and improving the pension system, in order to ensure its sustainability.Since 2012 the Georgian government has put forth a systemic reform proposal – a compulsory pension insurance – including the implementation of contributory pension schemes to supplement the basic non-contributory pension. While the proposal is a promising start, it alone would not be enough to ensure that the government’s fiscal burden remains reasonable, while maintaining the basic pension system’s long-term adequacy and flexibility to adapt to the evolving demographic environment. This paper presents policy reform choices, which suggest that, in Georgia, pension reform might also include increasing statutory retirement ages and reducing the generosity of benefits through means testing. These policy reform options would involve difficult tradeoffs, which are also described in this paper.Although the paper focuses on the Georgian non-contributory basic pension, its poverty reduction effect and policy reform options, the case of the Georgian non-contributory basic pension might hold value for some low- and middle-income countries that are considering implementation or expanding coverage of non-contributory pensions.

Has Structural Adjustment Programs Mitigated or Enriched: The Development of Sub-Saharan Africa

The policy paper analyzes the impact and effect of Structural Adjustment Programs (SAP) on the social cost living in Sub-Saharan African states. The issue of whether the implementation of SAP really mitigated the plight of many, or whether these policies pushed SSA in further economic deterioration. After a description of the background problem that consist of political, economic and socio/cultural factors that severely affect SAA, the policy paper analyzes the efficacy of the Structural Adjustment Program instituted by the International Monetary Fund to resolve the economic problems. The data accompanying this analysis, however, indicate a general trend of negative impact on economic and social lives. Significantly the socio-economic decline of SAA has occurred with much influence from overall funding strategies created by the IMF. The other purpose of this policy paper has been to identified and analyze the major socio/economic indicators that exemplify the living standards of the people of SAA. In addressing this issue, the paper employs interrupted time series analysis as a way to determine the levels of government expenditure in relation to socio-economic index. This is to determine the extent to which individuals/the private sector can resolve or be affected by government divestment of its role.Besides this policy reform options which are aimed at mitigation the effect of SAP on Sub Saharan African countries have been advocated.These policy options include:1. The Status Quo (SAP)2. Strengthening and diversifying Africa’s productive capacity3. Improving the level of income and its pattern for distribution 4. Rural Enterprise Programs5. Adjusting the pattern of public expenditure to satisfy people’s essential needs.The six criteria used for the evaluation of the policy options are:Effectiveness, adequacy, efficiency, equity, political feasibility, economic efficiency, and responsiveness.According to the information and data provided, the two policy options to be recommend to the sub-Saharan African countries are the strengthening and diversifying Africa’s productive activity and rural enterprise programs. These are equally recommended but priority should be giving to the first for short and long term effects.On recommendation, it has been suggested that there should be more inter and intra governmental coordination among SSA countries.

The known unknowns and unknown unknowns of European Monetary Union

The early literature on Economic and Monetary Union (EMU) in Europe provided insights into the difficulties involved in forming a monetary union among diverse economies. Several of the problems that emerged in the euro crisis were correctly diagnosed beforehand. The fact that they were not addressed is not attributable to the shortcomings of research but to a complacent reading of the literature by the policy community. The possibility of balance-of-payments crises within monetary union and the degree of correlation between the default risks of banks and sovereigns were however underestimated or even ignored in the literature. An analytical reassessment of EMU helps define options for policy reform.

MAKING SPACE FOR CANNABIS POLICY EXPERIMENTS

We thank Mark Kleiman for his considered and critical analysis of our book [1]. In the space of a brief reply we can address only some of the many interesting issues that he raised. We acknowledge that our book has not broken the cannabis policy stalemate. Our subtitle was, after all, moving beyond stalemate. Our aims were more realistic. We wanted to describe the important ways in which cannabis differs from other illicit drugs, namely: the greater extent of its global use, the modest adverse impacts it has on mortality and morbidity compared to the opioids and cocaine; and the selective and commonly discriminatory enforcement of criminal penalties against its use, even in countries such as the United States that are nominally tough on cannabis. We also wanted to summarize the international evidence on the mixed impacts of the limited policy reform options that are available to nation states under existing international drug control treaties. Secondly, we wanted to make the case for modifying the way that international control treaties govern cannabis to permit nation states to conduct and evaluate cannabis policy experiments that extend beyond minor variations in the severity of penalties for cannabis use. As Kleiman notes, such policy experiments could possibly include the regulation of a commercial cannabis market along the lines of current regulatory regimes for alcohol. We include this as one among a series of options without privileging it over the others. In choosing between these regimes, states will need to take into consideration many of the issues that Kleiman raised, namely, the potential irreversibility of such a policy; the likelihood that legal markets, lower price, implicit social approval and commercial promotion of the product could increase heavy cannabis use and cannabis-related harm; and uncertainty about the impact that increased cannabis use would have on alcohol-related harm. However, these states should not only look at the consequences of changing policy: they also need to examine the extensive adverse effects of current cannabis control regimes. We agree that there are policy options other than a legal cannabis market that deserve consideration as policy experiments. These include: the Spanish growers’ clubs; the Californian quasi-medical marijuana prescription regime; and state monopolies modelled on those adopted for alcohol in Scandinavia, Canada and many US states in the first part of the last century. All these are potentially interesting policy frameworks for cannabis, but there is necessarily very limited evidence on their impact because all are proscribed under current international treaties. Adequate evaluations will require serious trials and rigorous evaluations of these policy regimes. Our aim was to encourage the type of policy experiments and evaluations needed to better inform the development of cannabis policy. To that end we suggested how the international treaties could be liberalized to allow such experiments while allowing states to operate under the current treaty, if that is what they prefer. In our view, cannabis control systems that operate under the constraints of the current international regime fail to deliver good public policy and have an unfavourable balance of policy benefits and harms. There is a danger that the high standards that Mark Kleiman demands for evidence of the effectiveness of alternative cannabis policies will prevent the policy experimentation we advocate and so, by default, perpetuate the policy stalemate that we hoped to show a way beyond. None.

Deadly Inertia: A History of Constitutional Challenges to Canada's Criminal Code Sections on Prostitution

This paper examines rhetoric surrounding prostitution law reform in Canada from 1970 to the present. During the 1950s and 1960s, there was very little media or political attention paid to prostitution. It was not until the mid 1970s that perceived problems with prostitution law began to surface, driven by concerns that the criminal code statute prohibiting street prostitution was not enforceable. In 1983 the Liberal government appointed the Special Committee on Pornography and Prostitution to consider options for law and policy reform. However, the Conservative government that received the report in 1985 rejected the sweeping law changes the Special Committee recommended, opting instead to rewrite the street prostitution offence. Since then the murder of somewhere between 200 and 300 street prostitutes has prompted renewed calls for law reform. The debate on law reform culminated in 2006 with a parliamentary review that saw all four federal political parties agreeing that Canada’s prostitution laws are “unacceptable,” but unable to agree about how to change them. The majority report held that consenting adult prostitution should be legal, while the minority report held that it should be prohibited. In 2007 the Standing Committee on the Status of Women recommended that Canada adopt the Nordic model of demand-side prohibition. As the deadlock continues, women in the street sex trade continue to be murdered. Faced with this deadly inertia, two groups of sex workers have challenged several Criminal Code sections relating to prostitution, arguing that they violate several of their Constitutional rights, including their right to “life, liberty and security of the person”. The paper concludes with an update on the progress of the Charter challenges now before the courts.

The growth of China and India: implications and policy reform options for Malaysia

This study explores the trade‐related impacts of rapid growth of China and India on the Malaysian economy and evaluates policy options to better position Malaysia to take advantage of these changes. Higher growth in China and India is likely to raise Malaysia's national income and to expand Malaysia's natural resource and agricultural exports, while putting downward pressure on exports from some manufacturing and service sectors. Increases in the quality and variety of exports from China and India are likely to increase substantially the overall gains to Malaysia. The expansion of the natural resource sectors and the contraction of manufacturing and services reflect a Dutch‐disease effect that will raise the importance of policies to facilitate adaptation to the changing world economy and improve competitiveness. Most‐favoured‐nation (MFN) liberalisation would increase welfare, and, by increasing competitiveness, raise output and exports of key industries. Preferential liberalisation with India and completely free trade with China would provide greater market access gains than MFN reform, but neither would be as effective in increasing income as MFN liberalisation, and free trade agreements would lead to greater competitive pressure on many of Malaysia's industries than MFN liberalisation. Increased investments in education and infrastructure could boost manufacturing and services sectors in Malaysia, while improving trade logistics would benefit sectors with high transport costs, including the agricultural and resource‐based industries.

Reforming State-Level Chemicals Management Policies in the United States: Status, Challenges, and Opportunities

During the last several years there has been increasing public concern about chemicals in everyday products. Scientific studies are increasingly revealing the build-up of some substances in ecosystems and in our bodies and new findings are linking exposures to hazardous chemicals to a range of adverse human health effects. Despite these trends, there has been little federal initiative in the United States on reforming chemicals management policies for well over two decades, even though a variety of analyses have identified significant gaps in the regulatory structure. As has historically been the case, states are beginning to fill the holes in federal leadership. This article explores this emerging state leadership and establishes a vision for and elements of policies to reduce hazardous chemicals in the products we buy and the places we go. It examines international efforts to reform chemicals management policies, such as the European REACH legislation and corporate leadership in advancing safer products. Finally, it outlines specific challenges states face in developing integrated, comprehensive chemicals management policies. We conclude that while there are plenty of challenges to implementation of chemicals policy reforms, it is a propitious time for states to become leaders in policy innovation that can help achieve safer production systems and products for future generations. This article is part of a Lowell Center for Sustainable Production report entitled "Options for State Chemicals Policy Reform" that provides in-depth analysis of the pros and cons of policy options to address a range of aspects of state-level chemicals policy reform. The article has been edited slightly for use in New Solutions. The report has been widely distributed to policy-makers, advocates, and others across the United States.

Intergovernmental Fiscal Relations in Leningrad Region

The purpose of this analysis is to describe the financial structure of the Leningrad Oblast government and its rayons, to describe the financial relations between the oblast and local governments, to identify the fiscal policy issues with which the government must deal in the next few years, and to suggest options for policy reform. The analysis reviews: Public Finances of the Region and the Regional Government Leningrad Regional Economy Budgetary Position in The Region: The Consolidated Government Sector Budgetary Position of the Oblast Government Oblast-Local Fiscal Relations Deficits and Deficit Financing Policy Issues and Reform Options Federal - Regional Issues Oblast-Local Relations A Proposed Revenue Sharing Approach For Leningrad Region

The Individual AMT: Problems and Potential Solutions

Originally targeted at high-income households, the individual alternative minimum tax (AMT) is now on the verge of switching from a class tax to a mass tax. Under current law, the AMT will encroach dramatically on the middle-class over the next decade and will become the de facto tax system for upper-income households. These changes occur because of the non-indexation of the AMT for inflation and the tax cuts enacted in 2001. The trends are troubling because the AMT is notoriously complex, its effects on efficiency and equity are questionable, and its underlying purpose is controversial. This paper provides information on the AMT, its economic effects, and options for policy reform, and is intended to help inform the debate and the eventual reforms that will be required in the near future.