'Reform' of the British national health service after the election of a labour government: Understanding the policy development process

The policy development process leading to the Labour government's white paper of December 1997—The new NHS: Modern, Dependable—is the focus of this project and the public policy development literature is used to aid in the understanding of this process. Policy makers who had been involved in the development of the white paper were interviewed in order to acquire a thorough understanding of who was involved in this process and how they produced the white paper. A theoretical framework is used that sorts policy development models into those that focus on knowledge and experience, and those which focus on politics and influence. This framework is central to understanding the evidence gathered from the individuals and associations that participated in this policy development process. The main research question to be asked in this project is to what extent do either of these sets of policy development models aid in understanding and explicating the process by which the Labour government's policies were developed. The interview evidence, along with published evidence, show that a clear pattern of policy change emerged from this policy development process, and the Knowledge-Experience and Politics-Influence policy making models both assist in understanding this process. The early stages of the policy development process were characterized as hierarchical and iterative, yet also very collaborative among those participating, with knowledge and experience being quite prevalent. At every point in the process, however, informal networks of political influence were used and noted to be quite prevalent by all of the individuals interviewed. The later stages of the process then became increasingly noninclusive, with decisions made by a select group of internal and external policy makers. These policy making models became an important tool with which to understand the policy development process. This Knowledge-Experience and Politics-Influence dichotomy of policy development models could therefore be useful in analyzing other types of policy development. ^

The medical malpractice insurance "crises" and federal medical malpractice tort reform: Collection and analysis of bills passed by the United States House of Representatives from 1995--2005

There have been three medical malpractice insurance "crises" in the United States over a time spanning roughly the past three decades (Poisson, 2004, p. 759-760). Each crisis is characterized by a number of common features, including rapidly increasing medical malpractice insurance premiums, cancellation of existing insurance policies, and a decreased willingness of insurers to offer or renew medical malpractice insurance policies (Poisson, 2004, p. 759-760). Given the recurrent "crises," many sources argue that medical malpractice insurance coverage has become too expensive a commodity—one that many physicians simply cannot afford (U.S. Department of Health and Human Services [HHS], 2002, p. 1-2; Physician Insurers Association of America [PIAA], 2003, p. 1; Jackiw, 2004, p. 506; Glassman, 2004, p. 417; Padget, 2003, p. 216). ^ The prohibitively high cost of medical liability insurance is said to limit the geographical areas and medical specializations in which physicians are willing to practice. As a result, the high costs of medical liability insurance are ultimately said to affect whether or not people have access to health care services. ^ In an effort to control the medical liability insurance crises—and to preserve or restore peoples' access to health care—every state in the United States has passed "at least some laws designed to reduce medical malpractice premium rates" (GAO, 2003, p.5-6). More recently, however, the United States has witnessed a push to implement federal reform of the medical malpractice tort system. Accordingly, this project focuses on federal medical malpractice tort reform. This project was designed to investigate the following specific question: Do the federal medical malpractice tort reform bills which passed in the House of Representatives between 1995 and 2005 differ in respect to their principle features? To answer this question, the text of the bills, law review articles, and reports from government and private agencies were analyzed. Further, a matrix was compiled to concisely summarize the principle features of the proposed federal medical malpractice tort reform bills. Insight gleaned from this investigation and matrix compilation informs discussion about the potential ramifications of enacting federal medical malpractice tort reform legislation. ^

State health care reform: An analysis of strategies

The United States health care system faces significant challenges, particularly with problems of the uninsured and with the rising costs of care. These problems lead many to study and discuss strategies for reforming the health care system. Four different plans for ideal health care reform, set forth by notable scholars or organizations, are explained herein. Then, states within the United States are examined in terms of their recent efforts at health care reform. Those states proposing significant changes to their health care systems are analyzed—namely, Maine, Massachusetts, and Vermont. The strategies used in these three states are compared to the strategies laid out by the experts in order to determine which strategies are the most popular in current health care reform efforts among the states studied here. These strategies are totaled to find which organization's plan for ideal reform seems to be the most popular. The strategies of managed competition are shown to be the most popular strategies among these three state health care reforms, while the strategies of the single-payer plan discussed herein were the least popular. All three states seem to utilize strategies that build upon their previous health care system, rather than implementing strategies that completely replace the previous system. ^

Implications of Health Care Reform (Medical Ethics Series, 2011)

A video of a panel discussion on how Obama's Health Care Reform would affect Texas Medical Center institutions and health care in general.Speakers include Tom Cole (moderator), Roberta Schwartz (Methodist Hospital), Pauline Rosenau (UT-Houston School of Public Health), and Laurence McCullough (Baylor College of Medicine).

Expanding Learning Time in Schools: Considering the Challenges of Implementation and the Potential Impact

Considering the broader context of school reform that is seeking education strategies that might deliver substantial impact, this article examines four questions related to the policy and practice of expanding learning time: (a) why do educators find the standard American school calendar insufficient to meet students’ educational needs, especially those of disadvantaged students? (b) how do educators implement a longer day and/or year, addressing concerns about both educational quality and costs? (c) what does research report about outcomes of expanding time in schools? and (d) what are the future prospects for increasing the number of expanded-time schools? The paper examines these questions by considering research, policy, and practice at the national level and, throughout, by drawing upon additional evidence from Massachusetts, one of the leading states in the expanded-time movement. In considering the latter two questions, the article explores the knowns and unknowns related to expanded learning time and offers suggestions for further research.

For Safety’s Sake: A Case Study of School Security Efforts and Their Impact on Education Reform

Several studies have shown that the need to create safe and orderly schools has increasingly been addressed in a manner that disconnects these priorities from broader concerns related to student success, school culture, and child development. In this paper, we explore the consequences of expanding security procedures in response to an incident involving interracial conflict at an urban high school in the United States. We offer this case study to demonstrate how the primacy placed on safety and security resulted in the neglect of other important educational goals, such as academic engagement and a positive school culture. Through an analysis of observational, interview, focus group, and survey data, we show that while it is essential for schools to take measures that ensure the safety of students and staff, it is equally important for safety to be recognized as part of a larger set of goals that schools must concurrently pursue in order to meet the educational and developmental needs of the students they serve.

Commentary on: "For Safety's Sake: A Case Study of School Security Efforts and Their Impact on Education Reform"

Invited commentary on the article "For Safety’s Sake: A Case Study of School Security Efforts and their Impact on Education Reform" by Rachel Garver and Pedro Noguera.

A Legacy of Reform and Innovation: Celebrating the Children's Bureau Centennial

Guest Editors Nancy Claiborne and Katharine Briar-Lawson introduce the latest issue of Journal of Family Strengths, celebrating the centennial of the Children's Bureau.

Editorial: The Impact of Welfare Reform on Families

On the horizon a huge wave is building, about to crash down on the poorest most hard pressed families in our country. The impact of welfare reform on families and on those who serve them will be profound The degree to which families and workers will be adversely affected is to date not fully understood. Yet as my son concluded, "...basically, if you are on welfare you had better win the lottery or learn to swim in the treacherous waters of poverty!" (C. Sallee, personal communication, November, 1996). We are also informed by looking back at the Elizabethan Poor Laws of 1601 where we find the origin of welfare reform. Orphanages, the responsibility of relatives, poorhouses and awarding relief work to the lowest private sector bidder, all introduced in the beginning of the welfare state, are key components of the current reform. The Personal Responsibility and Work Opportunity Act of 1996 washes away the entitlements and rights created during this country's greatest depression, leaving exposed the stark selfishness of the junk bond 1980's.