Access, equity and the role of rights in health care

Modern health care rhetoric promotes choice and individual patient rights as dominant values. Yet we also accept that in any regime constrained by finite resources, difficult choices between patients are inevitable. How can we balance rights to liberty, on the one hand, with equity in the allocation of scarce resources on the other? For example, the duty of health authorities to allocate resources is a duty owed to the community as a whole, rather than to specific individuals. Macro-duties of this nature are founded on the notion of equity and fairness amongst individuals rather than personal liberty. They presume that if hard choices have to be made, they will be resolved according to fair and consistent principles which treat equal cases equally, and unequal cases unequally. In this paper, we argue for greater clarity and candour in the health care rights debate. With this in mind, we discuss (1) private and public rights, (2) negative and positive rights, (3) procedural and substantive rights, (4) sustainable health care rights and (5) the New Zealand booking system for prioritising access to elective services. This system aims to consider: individual need and ability to benefit alongside the resources made available to elective health services in an attempt to give the principles of equity practical effect. We describe a continuum on which the merits of those, sometimes competing, values-liberty and equity-can be evaluated and assessed.

Regulation and innovation: Rethinking 'inclusive' housing design

The Lifetime Homes (LTH) concept initiated in 1989 by the Helen Hamlyn Trust, and subsequently promoted by the Joseph Rowntree Foundation, emerged at a point when there was growing awareness of the decline of both private and public sector housing quality, especially in relation to floorspace standards (Karn & Sheridan, 1994). LTH were intended to offset the concerns of first, the house buying public of the appearance and affordability of homes suitable for successive generations, second, the private house building industry of the cost and marketability of incorporating 'inclusive' design features, and third, Registered Social Landlords (RSLs), who had to balance cost constraints with addressing the needs of a growing number of households with older and/or disabled people. Approved Document Part M of the building regulations was extended in 1999, from public buildings to private dwellings, and currently requires that all new housing meet minimal 'visitability' criteria. Indeed, although the signs are that Part M will be incrementally extended to comprise LTH principles, the paper argues that in their existing form they are insufficient to act as a key component of the government's 'new agenda for British housing'. This paper therefore explores how they might usefully be expanded from an approach, largely based on compromise, to one that inspires innovative, flexible and inclusive house forms, which also challenge design conventions.

Growth and public infrastructure

The paper analyzes a multicountry extension of the Barro model of productive public expenditure. In the presence of positive infrastructural externalities between countries, the provision of infrastructure will be inefficiently low if countries do not coordinate. This provides a role for a supranational body, such as the European Union, to coordinate the policies of the individual governments. It is shown how intervention by a supranational body can raise welfare by internalizing the infrastructural externality. Infrastructural externalities increase the importance of tax policy in the growth process and distribute the benefits of taxation across countries.

The inflation hedging characteristics of US and UK investments: a multi-factor error correction approach

Historic analysis of the inflation hedging properties of stocks produced anomalous results, with equities often appearing to offer a perverse hedge against inflation. This has been attributed to the impact of real and monetary shocks to the economy, which influence both inflation and asset returns. It has been argued that real estate should provide a better hedge: however, empirical results have been mixed. This paper explores the relationship between commercial real estate returns (from both private and public markets) and economic, fiscal and monetary factors and inflation for US and UK markets. Comparative analysis of general equity and small capitalisation stock returns in both markets is carried out. Inflation is subdivided into expected and unexpected components using different estimation techniques. The analyses are undertaken using long-run error correction techniques. In the long-run, once real and monetary variables are included, asset returns are positively linked to anticipated inflation but not to inflation shocks. Adjustment processes are, however, gradual and not within period. Real estate returns, particularly direct market returns, exhibit characteristics that differ from equities.

Fora, networks and public examinations: the role and significance of public participation in the new regional plan for South East England

This paper overviews the main conceptual frameworks for understanding participatory approaches to land use planning and explores their utility in analysing the experience of a recent regional planning exercise in South East England. In particular it examines the contribution of recent ‘New Institutionalist’ ideas to our understanding of participatory processes and the implications for practice of using them to build strategies of public involvement in policy-making and implementation.