The Fall and Rise of Evidence in Criminal Justice

Practitioners within the criminal justice system have been cautious about claiming that their work with offenders directly impacts on the level of subsequent re-offending. This article provides an overview of the generation and use of evidence on effectiveness within the criminal justice system, particularly focusing on the supervision of offenders by the probation service. The article outlines the continuing debates about appropriate methodologies for evaluating effectiveness. It also describes some of the problems encountered in trying to get research evidence to have an impact on offender supervision practice. Finally, the strengths and weaknesses of the present move towards evidence-based criminal justice services are explored in order to provide learning opportunities for other public services.     

Dealing with Clinical Risk: Implications of the Rise of Evidence-Based Health Care

This article considers the nature of risk in health care and the use the National Health Service (NHS) makes of risk management. It explores how the concept of risk has been challenged by the rise of 'evidence-based' health care, accompanied and accelerated by a decline in professional prestige, status and mystique and much greater use of external measurement and controls as part of the New Public Management. The nature of evidence-based health care is outlined and the implications of the use of guidelines and other practice aids are explored. Finally, the article discusses how evidence-based health care is affecting our views of clinical risk.     

The Effects of Consumer-Directed Health Plans on Health Care Spending

We use unique data from an insurer that exclusively offers high-deductible, "consumer-directed" health plans to identify the effect of plan features, notably employer contributions to the spending account, on health care spending. Our results show that the marginal dollar contributed by the employer to the spending account is entirely spent on outpatient and pharmacy services. In contrast, out-of-pocket spending was not responsive to the amount the employer contributes to the spending account. Our results represent the first plausibly causal estimates of the components of consumer-driven health plans on health spending. The magnitudes of the effects suggest important health care spending consequences to higher employer contributions to spending accounts. Our findings are most directly relevant to health reimbursement arrangement plan designs, though our results are still of value to health savings account plan designs.     

Integrating Management Control and Human Resource Management in Public Health Care: Swedish Case Study Evidence

The debate on management reforms in the public health care sector has largely overlooked the role of human resource management (HRM) and its potential interaction with traditional management control (MC) mechanisms. This paper explores which factors associated with the integration between MC and HRM may foster organisational learning in a public health care setting. A case study in a public dental practice is used for examining this issue. Apart from highlighting the influence of various task characteristics, the case study suggests that the vertical as well as horizontal dimensions of integration are important to consider in this context. Implications for further research are discussed.     

The Meaning of Balanced Scorecards in the Health Care Organisation

This study investigates the introduction of balanced scorecards in a health care organisation. It analyses a top-down control system, built on measurement, in a medical professional context, where attempts at implementing systematic performance auditing are expected to meet resistance. The study shows, however, that balanced scorecards, redesigned by medical professionals and used in a dialogue about service activities and finances, are regarded attractive successors to criticised financial control systems. In the light of the markets, hierarchies and clans perspective, developed by Ouchi, this popularity becomes comprehensible. Balanced scorecards are seen to reduce both the ambiguity of performance evaluation and the goal in-congruence between parties in the organisation.     

医疗卫生体制改革对我国商业健康保险市场潜力影响分析

2009年,我国新一轮医疗卫生体制改革拉开了序幕,其对商业健康保险发展的影响又将如何?本文分析了医疗卫生体制改革对商业健康保险市场潜力的影响机制,对我国当前商业健康保险潜力进行定量评估,并对此次新一轮医疗卫生体制改革的影响作了预测,最后就我国健康保险监管思路调整给出了建议。     

Prices and Protocols in Public Health Care

This article addresses the problem of how to determine the optimalallocation of public expenditure in the health sector. The firstpart poses the question: How should the set of services providedin the public health care system and the fees charged for thembe chosen to maximize the health status of the population witha fixed budget? First, the findings show that policy reformshould take into account the response of the private sector.Substituting for a reasonably well-functioning private sectoris not as valuable as providing services the private sectorcannot. Second, the assumptions needed to justify the cost-effectivenessof medical interventions as a criterion for setting prioritiesare so restrictive as to make this method usable in few, ifany, circumstances. Third, prices for any one service shouldbe set to balance the conflicting goals of encouraging its useand of conserving the budget for more effective services. The second part broadens the objective of policy to cover thestandard welfare economics concerns of utility and market failure,that latter being extensive in the health sector. It reexamineswelfare maximization rules to show that only the market failurecomponents of shadow prices are needed to calculate the welfaregains from public investments.     

泰国的医疗融资改革

本文回顾泰国医疗体系研究机构建立、发展并不断提升对医疗政策与医疗体系的研究能力的过程，并以公务员医疗福利计划支付改革和医疗全覆盖计划的保险保障范围调整为例，探讨研究能力的提高对医疗体系政策决策的作用。泰国医保改革取得成功的关键是强烈的国家主人翁意识和自我驱动力、国际合作伙伴的外部支持、各类资金的长期资助以及研究网络建设。系统透明、广泛参与的工作程序也保障了研究成果获得全社会的支持并免受政治操纵的影响。     

Implementing Evidence-Based Practice in Health Care

This article summarizes recent research on the effectiveness of efforts to implement evidence-based health care. The authors conclude that the evidence in support of single interventions being effective in bringing about practitioner change is weak at best. The authors give examples and evaluative comments on more complex organizational and systemic interventions that are aimed at changing clinical practice, and discuss some of the barriers to their application.     

泰国的医疗融资改革

本文回顾泰国医疗体系研究机构建立、发展并不断提升对医疗政策与医疗体系的研究能力的过程,并以公务员医疗福利计划支付改革和医疗全覆盖计划的保险保障范围调整为例,探讨研究能力的提高对医疗体系政策决策的作用。泰国医保改革取得成功的关键是强烈的国家主人翁意识和自我驱动力、国际合作伙伴的外部支持、各类资金的长期资助以及研究网络建设。系统透明、广泛参与的工作程序也保障了研究成果获得全社会的支持并免受政治操纵的影响。     

印度的医疗卫生融资改革

印度公共医疗卫生支出水平较低,且在各邦之间分布不均。中央政府拨款对于各邦政府自身医疗卫生支出具有替代性。本文认为,要推进印度医疗卫生事业改革,必须扩大公共医疗卫生支出,提高政府支出效率,并重新设计转移支付制度。     

Health Care Reform,Efficiency of Health Insurers,and Optimal Health Insurance Markets

This research examines the efficiency of the U.S. health insurers. It shows that more insurers are less efficient than in the previous sample year; however, the results suggest that the federal health care reform has no significant effect on the overall efficiency of all insurers as a whole, which is very low but does not change much over time. This research explores how to improve the efficiency of the health insurance market by proposing state, regional, and national efficiency-based goal-oriented market models and an efficiency duplicating system, and it discusses important implications to the health care compacts, the health insurance exchanges or marketplaces, and the national multistate programs. It also analyzes further moves for efficiency enhancement with regard to payment methods and the health care delivery system. One interesting finding is that the Medicaid program is very efficient because it provides support to the offering of Medicaid coverage and further expansion, which enhances the health welfare of society with fewer resources inputs from the perspective of efficiency. This research should provide important insights for state and federal governments, policy makers, regulators, the health insurance industry, and consumers.     

碎片化医保制度设计弊端与农民工医保模式路径选择

我国二元社会保障模式的构建思维一直影响我国保障制度的建设,导致我国医保制度建设呈现碎片化趋势,农民工医保制度也受这一传导机制影响。鉴于碎片化医保制度存在的诸多弊端和单独构建农民工医保模式存在的制度缺陷,农民工医保模式的路径选择应该是纳入现有保障制度框架。当前最关键和最紧迫的问题是提高现有医保制度统筹层级、解决三大医保制度接续以及加强农民工医保制度的配套建设。     

Working Across Professional Boundaries: Primary Health Care and Social Care

Effective joint working between health and local authorities, and between health, social services and housing professionals, has long been recognized as vital to the provision of 'seamless' services for the most vulnerable members of society. Unfortunately, the history of formal joint working over the past 20 years has been largely a poor one. In this article the authors outline the findings from a recent study of working alliances across the primary health care/social care boundary. They examine how obstacles are being overcome and how, in some localities, the essential ingredients of inter-professional and inter-organizational trust are leading to the improved integration of services.     

Accounting, Modernity and Health Care Policy

The National Health Service of the United Kingdom has been the subject of many reforms since it was established in 1948. This paper examines the process of reform in relation to significant changes to the NHS in recent decades. This reform process places ideas of the modern at the heart of these various initiatives. This paper also examines the intended or actual role of accounting in this modernisation process to examine its significance in the making of health care policy.     

Managed Care and Health Care Utilization: Specification of Bivariate Models Using Copulas

This article studies the effect of managed care on health care utilization compared to traditional fee-for-service plans in private health insurance market. To construct our hypothesis, we build a game-theoretic model to study health care utilization under a two-sided moral hazard: of patients and providers. In econometric modeling, we employ a copula regression to jointly examine individuals’ health plan choice and their utilization of medical care services, because of the endogeneity of insurance choice. The dependence parameter in the copula reflects the relation between the two outcomes, based on which the average treatment effects are further derived. We apply the methodology to a survey data set of the U.S. population and consider three types of curative care and three types of preventive care for the measurement of medical care utilization. We find that managed care is in general associated with higher care utilization. Evidence is also found on the underlying incentives of both patients and medical providers.     

The Impact of Health Care Reform on Capital Acquisition for Hospitals

In this paper, the response of the market for hospital stocks to the episode of the Medicare Prospective Payment System (PPS) legislation and its resulting impact on the ability of hospitals to generate capital for expansion and growth are addressed. The response to PPS legislation is evaluated by examining stock returns of publicly traded hospital companies using both traditional event study analysis and intervention analysis. The paper focuses on the effect of PPS over time and uses qualitative data to support the empirical evidence. Before and after its passage, the market reacted negatively to PPS legislation. This result supports qualitative evidence showing that hospitals' capital positions were impaired. When profit margins fell, bond ratings went down, while borrowing costs increased; the rate of hospital bond defaults went up and capital improvements were delayed.     

美国医疗保险扩面改革之路的里程碑

虽然美国有两大类三大层次的医疗保险体系,但没有实现如其他大多数发达国家那样的全民医保,缺乏一张覆盖全国的社会医疗网络,始终是美国近10年来备受诟病的社会问题.没有医疗保险的问题始终处于社会政策争议的前沿和核心.之前克林顿总统失败的改革方案核心就是实现全民医保,15年后,奥巴马新医改方案又明确将扩大覆盖面作为其改革的重中之重.然而,历经波折得以通过的奥巴马医改法案却依然面临诸多反对和抗议,其中最为核心的是关乎强制参险的条款.2012年6月28日,美国最高法院裁定奥巴马医疗保险改革的大部分条款合乎宪法,最具争议的强制参险也得以保留,这意味着美国在实现全民医保时代的进程中向前迈出了一大步.     

医保改革面临挑战

当前,许多国家仍存在医疗服务可得性差、医疗成本高昂、公共卫生支出效率低下等问题,医保改革面临重大挑战。医保改革目标存在两难—既要改善人们的健康状况,又要控制支出成本,因而提高公共卫生支出效率是改善社会健康状况的最优选择。各国政府的干预形式和公共卫生支出水平因国别、时间等的不同而变化。财政状况较好的新兴经济体需在保证财政可持续的前提下扩大基本医保覆盖面;发达经济体则应注重提升公共卫生支出的效率并限制支出增长速度。