Unintended Consequences In Terms Research Articles

BC Government Introduces Generic Pricing Legislation but uncertainty remains for pharmacy

The Government of British Columbia has introduced legislation setting out a framework for generic price reductions and restrictions on manufacturer incentives, but the details are to be developed later this year through regulations. The new Pharmaceutical Services Act gives the government authority to set pricing and to regulate the types of incentives that pharmacists may receive from drug companies. “Incentives are put under one umbrella that appears to include rebates, cash-back and ordinary commercial terms,” says Geraldine Vance, executive director of the British Columbia Pharmacy Association (BCPhA). “The health minister has indicated he wants to ban rebates, but until the regulations are developed, we won't know for certain.” The province's new legislation comes after it cancelled an earlier agreement with pharmacy that failed to produce the drug-plan savings the government had expected. That agreement set generic prices at 35% of brand-name prices, but the BC government now plans to lower that level to 25%. “If you have an imposition of change by the government, you may well have some unintended consequences in terms of instability for pharmacy” BC pharmacists face a period of uncertainty as the regulatory process unfolds and efforts are made to work out pharmacist compensation. “We are concerned about the lack of clarity in the legislation about a formal relationship between pharmacy and the government,” says Ms. Vance. The legislation says the health minister may establish advisory committees on generic pricing and incentives but he is not required to do so. “We believe that issue should be the first one sorted out, whether by regulation or simply by a declaration by the minister. If he doesn't commit to a formal advisory process, then you have an opportunity for some pretty sweeping ministerial discretion.” The other major issues for the BCPhA are compensation for lost revenue — including from any rebate bans — and a reasonable transition period to allow pharmacists to adjust to the new policy. “Pharmacy has to be involved in that discussion,” Ms. Vance says. “If you have an imposition of change by the government, you may well have some unintended consequences in terms of instability for pharmacy.” The next step, says Ms. Vance, is 1 or 2 days of government consultations with the BCPhA in July. She says the association is urging the government to come back to pharmacist organizations for further feedback, once the regulations are drafted.

The Impact of Mission-Oriented Initiatives on University Research: The Case of Nanotechnology

We examine how the National Nanotechnology Initiative (NNI), a most recent U.S. government’s mission-oriented initiative launched in 2000, impacts the nature of university research in nanotechnology. We characterize the NNI as a policy intervention that targets the commercialization of technology and a focused research direction to promote national economic growth. As such, we expect that the NNI has brought about unintended consequences in terms of the direction of university-industry knowledge flows and the characteristics of university research output in nanotechnology. Using the difference-in-differences analysis of the U.S. nanotechnology patents filed between 1996 and 2007, we find that, for U.S. universities, the NNI has increased knowledge inflows from the industry, diminished the branching-out to novel technologies, reduced the research scope, and decreased the likelihood of technological breakthroughs, as compared to other U.S. and non-U.S. research institutions. Our findings suggest that, at le...

The Accidental Pirate: Reassessing the Legitimacy of Counterpiracy Operations

With the collapse of central authority in the wake of the Cold War's end, Somalia became a prime example of a failed state. One of the symptoms of this state's failure has been the emergence of piracy off the Somali Coast. Sporadic incidents of piracy appeared almost immediately following Somalia's implosion in 1991. By 2006, however, a new and more organized piracy group emerged, (1) As a criminal start-up based in Somalia's Puntland region, the pirates have created a flourishing enterprise. (2) From a total of 18 incidents in 2006, there has been substantial growth in the number of piracy attacks on international shipping. In 2011, approximately 130 incidents were recorded. Another 68 assaults were committed beyond Somali territorial waters but widely ascribed to Somali piracy. (3) By any measure such figures demonstrate a serious and growing security problem off the East African Coast. Piracy, of course, presents itself as an essentially maritime problem. What, then, might be considered the relevance of this article for a journal that is ostensibly devoted to matters related to land warfare and broader security issues on terra ferma? More than might be imagined, because security problems at sea are invariably reflections of political problems on land. Perceiving an issue like Somali piracy solely in maritime terms, to be dealt with by navies or coast guards, is seeing the symptoms rather than the essence of the problem. Contemporary commentary tends to analyze Somali piracy in a nautical fashion, primarily as a discrete maritime problem. For example, author Stig Hansen looks at the issue in terms of whether or not the Somali pirates constituted a putative coast guard force? Such arguments, and others like them, focus on piracy with little mention of Somalia's internal situation, particularly its political economy, which provides a more effective framework for counterpiracy recommendations. It is this factor, as much as how to deal with the symptoms, that needs to be understood. Thus, while piracy is clearly a criminal act, a lack of appreciation within operational and planning assumptions of the domestic factors that give rise to Somali piracy risk exacerbating, rather than remedying the problem. To establish this argument, British Army doctrine--developed in Afghanistan--will be extended to an analysis and understanding of piracy. This framework will be discussed in relation to Somalia using a political economy analysis. It will, thereby, be possible to examine the broader efficacy of counterpiracy operations. Current Counterpiracy Operations The long-term success of counterpiracy operations should start with the assumption that piracy is a symptom of instability? Somali piracy is inextricably linked to the nation's long-standing conflict. Unique to Somalia is a problem of sanctuary; it is the only place where vessels and hostages are often held in situ for long periods allowing for lengthy ransom negotiations. (6) Therefore, while naval boarding operations and the capture and deportation of pirates to foreign courts can have a short-term effect, (7) clearly they are unlikely to reduce the threat of piracy in the long-term. Naval interventions against the pirates might contain the number of assaults but ultimately they have little durable deterrent value. Equally problematic are military interventions on land whether by use of Special Operations Forces raids (8) or airborne drones. (9) These operations might achieve a desired tactical impact, but experience from other conflicts, notably Afghanistan, suggests that unintended consequences in terms of collateral damage on civilian centers are always a hazard. Although land-based military interventions and maritime boarding operations may be legal, they are just as likely to be seen as illegitimate in the view of the local populace and thus be of declining utility over the longer-term. British Army Influence Operations in Afghanistan In current NATO military operations in Afghanistan, the notion of influence is a burgeoning sphere of thought. …

Attacking or Self-Promoting? The Influence of Tone of Advertising and Issue Relevance on Candidate Evaluations and the Likelihood of Voting for an Emerging Challenger in Korea

This experimental study examines the effectiveness of attacking strategy for a challenger candidate, and the moderating role of issue relevance in negative political advertising. Results indicate that the effects of negative advertising on the sponsoring candidate's personal attributes depend on issue relevance. That is, participants gave the highest evaluations of the sponsoring candidate's personal attributes when exposed to positive advertising with low-relevance issues. When it comes to the sponsoring candidate's qualification attributes, participants were more likely to give higher evaluations when issue relevance was high regardless of the tone of the advertising. As would be expected, the emerging challenger encountered unintended consequences in terms of participants' likelihood of voting when employing negative advertising to attack the leading candidate. Participants exposed to negative ads were less likely to vote for the sponsoring candidate than those who were exposed to positive ads.

Special treatment regulation in China: potential unintended consequences

PurposeThe purpose of this paper is to trace the behaviour of Chinese companies receiving a special treatment (ST) designation in order to determine the extent to which the application of this regulation may have led companies to engage in activities conducive to the removal of the ST designation. In particular, the paper examines evidence of opinion shopping or earnings manipulation by these companies.Design/methodology/approachEmpirical analysis of annual report databases for Chinese‐listed companies, including statistical significance testing relating to ST companies.FindingsMost ST companies have removed the ST status by the third year after the initial ST designation. Compared to non‐ST companies, ST companies losing the ST status are more likely to engage in practices indicating earnings manipulation. Also, compared to non‐ST companies, ST companies are more likely to change auditors after an initial or second year of ST designation. However, while this behaviour suggests opinion shopping, auditor switching for the ST companies is not associated with losses becoming profits nor with improved audit opinions.Research limitations/implicationsThe results reported in this paper must be considered in light of the limitations inherent in empirical analyses. That is, the relationships identified in this paper are indicative of potential earnings management or audit opinion shopping; however, the study cannot provide the actual reasons for these empirical results.Practical implicationsThe results suggest the ST regulation did not lead to unintended consequences in terms of auditor switching by ST companies to improve either their reported earnings or their audit opinion.Originality/valueThe ST status is unique to China and this paper is the first to report on potential reporting and audit quality implications of this regulation.

Assessment of the implementation of a national patient safety alert to reduce wrong site surgery

Background:In 2005, guidance on how to prevent wrong site surgery in the form of a national safety alert was issued to all NHS hospital trusts in England and Wales by...

Medicaid Prescription Formulary Restrictions and Arthritis Treatment Costs

We used the Arizona Medicaid program as a model to examine the consequences of the relative restrictiveness of nonsteroidal anti-inflammatory drug (NSAID)-preferred drug lists on health care use and costs for Medicaid enrollees with arthritis. In a retrospective, cross-sectional study of Medicaid enrollees with rheumatoid arthritis or osteoarthritis, we used data from the Arizona HealthQuery database and generalized linear regression models to estimate the effect of the restrictiveness of formularies on the association between number of NSAID drugs covered and the number of emergency department visits, ambulatory physician visits, hospital stays, and total health expenditures. For plans with NSAID formularies that were more restrictive, enrollees with rheumatoid arthritis experienced 22% fewer ambulatory visits and 29% more hospitalizations, and enrollees with osteoarthritis experienced 38% fewer ambulatory visits and 52% more hospitalizations. These plans spent an additional $935 for medical care and prescription drugs annually per enrollee with rheumatoid arthritis. Formularies that are more restrictive significantly change the patterns of health care and prescription drug use and may have unintended consequences in terms of more frequent and, for those with rheumatoid arthritis, more expensive medical care.

Cultural Democracy by Default: The Politics of the New Deal Arts Programmes

The federal arts programmes of the New Deal and the Communist Party's Popular Front strategy have both been presented in retrospect as relatively short-term and expedient policies, the first out of line with the general tendency of governmental relations with art production in the United States, and the latter with the Communist Party's revolutionary aspirations. Direct state patronage of the arts as an alternative to the market did not become part of the model of a democratic polity in the United States in any of the normal variants, and insofar as state patronage is associated with communism, it is equated with the Stalinist model of authoritarian control of culture and has no actual democratic component. In this view, the New Deal, which certainly had no programme for social revolution, inadvertently provided a space for communist propagandising in cultural guise, while the Communist Party saw the New Deal in terms essentially defined by Moscow as a temporary ally against fascism, and infiltrated the cultural institutions it established and used them for its own political ends. However, the short-term nature of the programmes and the Popular Front was not immediately evident to many participants at the time, and in fact both had to be given an ideological rationale that assumed a permanent shift in orientation. Moreover, as I have shown elsewhere, the specific appeal of neither was limited to the period of their operation: both had an ideological afterlife.1 Communists and fellow-travellers were able to work within the projects in part because of the genuine liberalism of administrators such as Edward Bruce, Holger Cahill, Hallie Flanagan and Henry Alsberg on the one hand, and because the Communist Party's cultural functionaries could provide a plausible view of why the projects were truly progressive on the other. Thus the areas of overlap between the ideologies of both sides – as well as the real divergences – deserve consideration. There are things to be learnt about both the political economy of the arts and the problems of cultural democracy from this exercise. In this essay I argue that the policies of both the Roosevelt administration and the Communist Party had unintended consequences in terms of popular empowerment, and that it was precisely because of this that they issued in something that offers object lessons for cultural democracy.

Welfare versus Justice - Again!

This article reviews recent developments in government policy designed to provide an integrated framework for children’s services, in the light of the continuing and long-running debate between principles of welfare and justice. It is noted that at the level of policy, it has repeatedly been argued that responding to the offences of children and providing for their welfare are inseparable. However, this apparent consensus has resulted in a range of different service structures and delivery systems over the years, characterised by ‘turf wars’ amongst policy-makers and practitioners, and unintended consequences in terms of damaging outcomes for children. The article suggests that the most recent policy initiatives from government leave this tension unresolved; and it concludes that alternative rationales need to be developed to inform interventions with children who offend.

Distribution channel management in e-government: Addressing federal information policy issues

Abstract Part of the promise of electronic government (e-government) is its ability to transform the delivery of information services and products from government to users. E-government allows federal agencies to supplement and even supplant private sector roles intermediating between government agencies and users, creating unintended consequences in terms of policy, theory, and practice. The problem is called “channel conflict” in the marketing literature, and the typical response is called distribution channel management (DCM). After reviewing the literatures of e-government, information policy, and DCM, the paper explores differing DCM philosophies of two federal agencies: the Internal Revenue Service and the U.S. Census Bureau. An examination of these two DCM programs provides insights on how federal agencies may be able to manage their various channels for e-government offerings despite tensions in the current legal and policy context. The paper concludes by using DCM literature to help frame options for dealing with these tensions.