Proposed Policy Changes Research Articles

Mental health impact assessment: population mental health in Englewood, Chicago, Illinois, USA

In this paper, we describe a pilot mental health impact assessment (MHIA) undertaken by the Institute on Social Exclusion (ISE) at the Adler School of Professional Psychology. This pilot involved a multi-method approach that included literature reviews and direct engagement of community stakeholders. It resulted in a policy document that summarized the anticipated effects of a proposed amendment to Chicago's Vacant Buildings Ordinance on the collective mental health of people living in Englewood, a neighbourhood located on the city's southwest side. The Chicago City Council passed the proposed amendment in the summer of 2011.Working to advance health impact assessment (HIA) practice, the project aimed to assist Englewood residents by empowering them to participate in the systematic review of a proposed policy change that would impact their own community's mental health. Additionally, the pilot sought to ensure that any policy decision reflected an evidence-based understanding of its probable effects on the mental health of Englewood residents. Thus, these efforts were designed to narrow several health inequities as suggested by key indicators of community mental health.

The Analytics of the Australian Private Health Insurance Rebate and the Medicare Levy Surcharge

This paper presents an analytical framework for examining changes in the Private Health Insurance rebate (PHIR) and the Medicare Levy Surcharge (MLS), and uses it to establish three key propositions. First, increases in the MLS rate tend to reduce the elasticity of demand for private health insurance. Second, simultaneously increasing MLS rates and thresholds has a theoretically ambiguous effect on PHI take-up rates. Third, means testing the PHIR can never increase PHI take-up, and will reduce it in some circumstances. The paper concludes with a discussion of the possible consequences of recently proposed policy changes to private health insurance in Australia.

Abstract P319: Which Types of Hospitals Have Higher Readmission Rates for Heart Failure

Reducing readmissions is an important policy goal, and heart failure (HF) is the most common cause of both hospitalizations and readmissions in the Medicare program. Most proposed policy changes involve penalizing poorly-performing hospitals, yet we know little about what kinds of U.S. hospitals have high readmission rates, and therefore might be at particularly high risk of facing financial penalties. We created multivariable regression models using Medicare inpatient data from 2006-2007 to examine the relationship between hospital characteristics and 30-day all-cause readmission rates for patients with a primary discharge diagnosis of HF. Given that many pay-for-performance programs penalize poor performers based on categorical cutpoints, we also examined the likelihood that a hospital would be in the worst quartile or decile of readmission rates nationally. Among the 4,010 hospitals in our sample, critical access hospitals and small hospitals had significantly higher 30-day readmission rates than medium or large hospitals ( Table ). Hospitals not part of a system had higher readmission rates than hospitals that were members of systems, and both public hospitals and for-profit hospitals had higher readmission rates than private non-profit hospitals. These same hospitals were far more likely to perform in the bottom quartile or decile nationally (Table). Consequently, these hospitals will be at significantly higher risk of payment reductions if cut-points are used to target institutions for penalties. Given that some of the most resource-poor hospitals in the country are among the worst performers for HF readmissions, quality improvement efforts that rely on penalties and rewards may further widen the quality gap. Concerted efforts are needed to understand why these hospitals perform poorly, why the top hospitals perform well, and how best to design interventions to improve the quality of care for all HF patients, regardless of where they seek medical care. Hospital Characteristics 30-day readmission rate P value OR (95% CI) for worst quartile P value OR (95% CI) for worst decile P value Hospital Type Critical Access 28.2% <0.001 12.4 (7.2, 21.4) <0.001 12.5 (4.3, 36.6) <0.001 Small 27.1% 8.1 (4.9, 13.6) <0.001 8.9 (3.1, 25.4) <0.001 Medium 25.4% 3.0 (1.8, 4.8) <0.001 2.4 (0.9, 6.6) 0.10 Large 24.2% 1.0 Ref 1.0 Ref Hospital System Non-member 26.5% 0.048 1.2 (1.0, 1.4) 0.02 1.5 (1.2, 1.9) 0.002 Member 26.0% 1.0 Ref 1.0 Ref Ownership For-profit 27.0% <0.001 1.7 (1.3, 2.1) <0.001 1.6 (1.1, 2.3) 0.007 Public 26.7% 1.3 (1.0. 1.5) 0.02 1.3 (1.0, 1.7) 0.03 Non-profit 25.7% 1.0 Ref 1.0 Ref

The Analytics of the Australian Private Health Insurance Rebate and the Medicare Levy Surcharge

This paper presents an analytical framework for examining changes in the Private Health Insurance rebate (PHIR) and the Medicare Levy Surcharge (MLS), and uses it to establish three key propositions. First, increases in the MLS rate tend to reduce the elasticity of demand for private health insurance. Second, simultaneously increasing MLS rates and thresholds has a theoretically ambiguous effect on PHI take-up rates. Third, means testing the PHIR can never increase PHI take-up, and will reduce it in some circumstances. The paper concludes with a discussion of the possible consequences of recently proposed policy changes to private health insurance in Australia.

Evidence and Evaluation: The National Minimum Drinking Age Act of 1984

When considering federal legislation to encourage states to raise the drinking age to twenty-one, public officials faced a common problem: assessing the efficacy of a proposed policy change from evidence that is deficient in quality and quantity. These deficiencies mandated a discerning evaluation of the evidence, but instead the opposite occurred: a consensus that inflated, rather than dampened, the overly-optimistic estimates of existing studies. This outcome, which is not limited to this legislation, can be explained by three structural factors, organizational, intellectual, and process, which can be ameliorated to some extent by methodological and institutional reforms.

Medical Malpractice in the Military

A judicial rule known as the Feres doctrine prohibits military personnel from suing for malpractice. The authors propose policy changes to improve compensation to military personnel injured as a result of malpractice and to promote higher-quality care.

Access to Long‐Term Care: The True Cause of Hospital Congestion?

Much attention has been paid to lengthy wait times in emergency departments (EDs) and much research has sought to improve ED performance. However, ED congestion is often caused by the inability to move patients into the wards while the wards in turn are often congested primarily due to patients waiting for a bed in a long‐term care (LTC) facility. The scheduling of clients to LTC is a complex problem that is compounded by the variety of LTC beds (different facilities and room accommodations), the presence of client choice and the competing demands of the hospital and community populations. We present a Markov decision process (MDP) model that determines the required access in order for the census of patients waiting for LTC in the hospitals to remain below a given threshold. We further present a simulation model that incorporates both hospital and community demand for LTC in order to predict the impact of implementing the policy derived from the MDP on the community client wait times and to aid in capacity planning for the future. We test the MDP policy vs. current practice as well as against a number of other proposed policy changes.

Vitamin D nutritional policy needs a vision for the future

Historically vitamin D is known to be essential for normal bone growth and quality, and thus appropriate dietary vitamin D supplementation can eliminate vitamin D deficiency childhood rickets and adult osteomalacia. In spite of many government and medical associations' worldwide guidelines for the reference daily intake (RDI) of vitamin D, scientists and nutritionists from many countries agree that at present about half of elderly North Americans and Western Europeans and probably also of the rest of the world are not receiving enough vitamin D to maintain healthy bone. In addition, over the past decade there has been a dramatic increase in our understanding of the many biological actions that result from vitamin D acting through its daughter steroid hormone, 1alpha,25-dihydroxyvitamin D(3) [1alpha,25(OH)(2)D(3)] in collaboration with its cognate vitamin D receptor (VDR). Consequently, evidence has accumulated that beside intestine and bone, there are five additional physiological systems where the VDR with 1alpha,25(OH)(2)D generates biological responses. These include the immune system (both the innate and adaptive), pancreas and metabolic homeostasis, heart-cardiovascular, muscle and brain systems as well as the control of the cell cycle, and thus of the disease process of cancer. Acting through the VDR, 1alpha,25(OH)(2)D(3) can produce a wide array of favorable biological effects that collectively are projected to contribute to the improvement of human health. Responsible medicine demands that worldwide vitamin D nutritional guidelines reflect current scientific knowledge about vitamin D's spectrum of activities. Thus, worldwide vitamin D nutritional policy is now at a crossroads. This paper presents several proposed policy changes with regard to the amount of vitamin D daily intake that if implemented will maximize vitamin D's contribution to reducing the frequency of many diseases, which would then increase the quality and longevity of life and significantly reduce the cost of medical care worldwide.

Prospective and Retrospective Presidential Rhetoric

Recent research by George Edwards and other presidency scholars suggests that presidential speech has little impact on public opinion on issues with scholars left to wonder why presidents bother to speak. The field of voting behavior offers an extensive literature supporting the conclusion that Americans frequently cast their vote based on their experiences with existing government policies. If presidential elections are based on retrospective voting behavior, our models of presidential leadership after the election should examine the possibility of similar evaluations by citizens.In this paper, we develop and test the argument that the White House shifts from prospective rhetoric (messages designed to win approval of policy change) to retrospective rhetoric (messages designed to support positive evaluation of previous administration actions) for strategic reasons over the course of a presidency. This shift helps explain why the utility of presidential persuasion may be underestimated by measures focused only on citizen responses to proposed policy change. We hypothesize that presidential speech is often more concerned with building prestige through shaping perceptions of current policy than with winning support for new initiatives.To test this hypothesis, we speeches from the Clinton administration to evaluate the degree to which presidents engage in prospective versus retrospective rhetoric. We anticipate that even in the first year of their administration, the president defends the actions already taken and speaks retrospectively. However, we expect that presidents increasingly focus on prospective speech as the administration continues as a means of building prestige and credibility.

Land-use change in the ‘edgelands’: Policies and pressures in London's rural–urban fringe

Green Belt policies have helped to create chaotic landscapes at the rural–urban interfaces of the United Kingdom's largest cities. Their prime functions, to control urban sprawl and preserve an encircling green girdle to separate the urban from the open countryside, have created ‘edgelands’ that have been remarkably dynamic despite relatively strong controls on certain types of development. A detailed case study of one part of London's Metropolitan Green Belt, drawing upon analysis of planning registers, reveals long-term trends in land-use change linked to the development controls operated within the context of the Green Belt and the adjacent built-up area. This paper also outlines the history of the Green Belt policy in the United Kingdom (UK) and discusses recently proposed policy changes that have provoked ongoing debate about this form of control on urban sprawl and its consequences for the land use of Green Belts and the edgelands.

Older adults as caregivers in Hong Kong

Along with many city and countries around the world, the age structure of the Hong Kong Special Administrative Region's population is shifting towards a greater proportion of older adults. In 1983, the aged population (65 years and above) reached 7% and this rate is expected to double to 14.4% by 2016, a relatively short period of 33 years. However, negative stereotypes of older adults are prevalent, particularly in societies such as Hong Kong. In addition to having low education and low literacy, most older adults lack retirement pensions, which reinforce negative images of them as non-productive and dependent. This paper considers the productive contributions of older persons in Hong Kong to family caregiving in three areas, namely, spousal caregiving, caregiving for adult children with physical and developmental disabilities, and grandparenting. The paper is organized into four sections. The first section reviews existing literature on family caregiving in Hong Kong. The second section addresses the effects of caregiving on caregivers themselves and their family members. The third section considers the policies and services currently available to support and reward older adults in their caregiving roles. The fourth section proposes policy changes to better enhance older adults' productivity and increase the value of caregiving. Case examples are provided to illustrate caregiving experiences in Hong Kong.

Presenteeism: a public health hazard.

"Presenteeism" occurs when an employee goes to work despite a medical illness that will prevent him or her from fully functioning at work. This problem has been well studied in the business and social science literature, and carries increased importance in the health care setting due to the risk of infectious disease transmission in vulnerable patient populations. In this manuscript, we discuss an outbreak of viral gastroenteritis in a long-term care facility and the role presenteeism played in disease transmission and extension of the outbreak. We use existing literature to point out the hazards of presenteeism in the health care sector. We will also discuss factors that may be involved in the decision to work while ill and propose policy changes that may reduce the incidence of presenteeism in health care organizations.

Interest Groups and Inequality in Democratic Responsiveness in the U.S.

In this paper, I examine the extent to which the link between public preferences and government policy is biased toward the preferences of high-income Americans. Using an original data set of almost 2,000 survey questions on proposed policy changes between 1981 and 2002, I find a moderately strong relationship between what the public wants and what the government does, albeit with a strong bias toward the status quo. But I also find that when Americans with different income levels differ in their policy preferences, actual policy outcomes strongly reflect the preferences of the most affluent but bear little relationship to the preferences of poor or middle income Americans. After documenting these inequalities, I examine the role of interest groups in shaping policy responsiveness to the preferences of the public. I show that neither the direction of interest group alignments nor the extent of interest group engagement significantly alters the patters of policy responsiveness to Americans at different income levels. Interest groups do influence federal policy, but they do so independently of the preferences of the public. Affluent Americans are more likely to see their preferences reflected in policy outcomes if the balance of interest groups on an issue share those preferences, but the extent to which the affluent move policy in one direction or another is independent of the influence of interest groups. Interest groups do sometimes move policy in a direction more consistent with the preferences of the poor, but these are offset by other instances in which interest groups are more aligned with the affluent. Moreover, the instances on which interest groups align more closely with the preferences of the less well off often reflect idiosyncratic circumstances - either interest groups that share the preferences of the poor by happy coincidence or the unique case of the AARP which cannot serve as a general model of interest group advocacy for the needs of the less advantaged. Consequently, interest groups do not appear to hold much promise for reformers who seek to equalize the voice of less affluent Americans in shaping government policy.

The D&T report

The D&T report

Value for money

2009 is turning out to be an interesting year for research funding in the UK. Everyone wants the best science to be funded, but it's not clear that the proposed policy changes will achieve this.

Women, Work and Industrial Relations in 2008

The year 2008 was a busy one for matters relating to women, work and industrial relations. The Labor Government introduced the Fair Work Bill with a new bargaining stream for low paid workers and new National Employment Standards, which include the right to request flexible working arrangements and extended unpaid parental leave. A number of public inquires on issues pertaining to women and work were also initiated. In this first annual review of women, work and industrial relations we focus on three topics highlighted in 2008 — pay equity, working hours flexibility and paid maternity leave — and assess the implications of the proposed policy changes for women and gender equity.

Recognizing the rights of consumers as brand co‐owners

PurposeThis paper aims to assert that trademark law is too restrictive and that consumers should have some rights to a brand independent of the brand owner.Design/methodology/approachThe paper examines the expansive tendency of trademark law and the concept of trademark fair use and the impact of trademark law on customer relationships.FindingsThe concept of trademark fair use offers only limited benefits to brand consumers.Practical implicationsDespite the ability to enforce exclusive ownership rights under trademark law, brand owners need to exert a broad view of customer co‐ownership or they risk less customer involvement with the brand.Originality/valueThe paper proposes policy changes to allow great consumer enjoyment of brands.

Best practices in community‐based prevention for youth substance reduction: towards strengths‐based positive development policy

AbstractSubstance use among youth remains a major public health and safety concern. One fundamental way to address youth substance use prevention is to keep young people on a positive trajectory by engaging them in positive activities from early years of their childhood. In this article, the author offers a best practice analysis of systematic review about 12 selected community‐based preventions, and proposes policy changes towards incorporating a strengths perspective. A substantive, methodological, and value‐based critical analysis of the strongly effective preventions was conducted. A strengths‐based positive youth development perspective is specified as one feasible needed improvement and subsequent policy changes in the school district as well as in the local, state, and federal levels are proposed along with the suggestion of a mandated community youth participation strategy. © 2008 Wiley Periodicals, Inc.

The Cost Benefit Analysis on the Swan River Flood Management and Integrated Land Development Project - Phase I & Phase II: Stage I

The Economic Cost Benefit Analysis (ECBA) is a method used by Japan Bank of International Cooperation to measure the economic efficiency of proposed policy changes for Swan River Flood Management and Integrated Land Development Project (SRFM & ILDP). It includes Phase I and Phase II (Part) namely stage I. The paper concludes that, Phase I is economically viable project in the long run, but the Phase II, economically not viable project in the long run.

Targeting in social programs: avoiding bad bets, removing bad apples

Should chronically disruptive students be allowed to remain in public schools? Should nonagenarians receive costly medical care at taxpayer expense? Who should be first in line for kidney transplants --the relatively healthy or the severely ill? In Targeting in Social Programs , Peter H. Schuck and Richard J. Zeckhauser provide a rigorous framework for analyzing these and other difficult choices. Many government policies seek to help unfortunate, often low-income individuals --in other words, These efforts are frequently undermined by poor targeting, however. In particular, when two groups of bad draws --bad and --are included in social welfare programs, bad policies are likely to result. Many politicians and policymakers prefer to sweep this problem under the rug. But the costs of this silence are high. Allocating resources to bad bets and bad apples does more than waste money --it also makes it harder to achieve substantive goals, such as the creation of safe and effective schools. And perhaps most important, it erodes support for public programs on which many good bets and good apples rely. By training a spotlight on these issues, Schuck and Zeckhauser take a first step toward much-needed reforms. They dissect the challenges involved in defining bad bets and bad apples and discuss the safeguards that any classification process must provide. They also examine three areas where bad apples and bad bets loom large --public schools, public housing, and medical care --and propose policy changes that could reduce the problems these two groups pose. This provocative book does not offer easy answers, but it raises questions that no one with an interest in policy effectiveness can afford to ignore. By turns incisive and probing, Bad Draws will generate vigorous debate.