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251. Has the Use of Physician Gatekeepers Declined among HMOs? Evidence from the United States

Author:
Hai Fang, Hong Liu, and John A. Rizzo
Publication Date:
12-2008
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Since the mid-1980s, health maintenance organizations (HMOs) have grown rapidly in the United States. Despite initial successes in constraining health care costs, HMOs have come under increasing criticism due to their restrictive practices. To remain viable, this would seem to suggest that HMOs have to change at least some of these behaviors. However, there is little empirical evidence on how restrictive aspects of HMOs may be changing. The present study investigates one mechanism for constraining costs that is often associated with HMOs – the role of the primary care physician as a gatekeeper (e.g., monitoring patients' use of specialist physicians). In particular, we estimate the effect of primary care physician involvement with HMOs on the percentage of their patients for whom these physicians serve as gatekeepers. We examine these relationships over two time periods: 2000-2001 and 2004-2005. Because physicians can choose whether and to what extent they will participate in HMOs, we employ instrumental variables (IV) estimation to correct for endogeneity of the HMO measure. Although the single-equation estimates suggest that the role of HMOs in terms of requiring primary care physicians to serve as gatekeepers diminished modestly over time, the endogeneity-corrected estimates show no changes between the two time periods. Thus, one major tool used by HMOs to constrain health care costs – the physician as gatekeeper – has not declined even in the era of managed care backlash.
Topic:
Demographics, Health, and Human Welfare
Political Geography:
United States

252. New Initiatives on Conflict Prevention Human Security

Publication Date:
06-2008
Content Type:
Policy Brief
Institution:
EastWest Institute
Abstract:
An unacceptable gap continues to exist between the international community's rhetoric about conflict prevention and its responsibility to protect people from catastrophic human rights violations, and the reality of its efforts. The shameful record of human misery caused by violent conflict is testimony to the chronic lack of political will to respond collectively to new and emerging threats to peace, including environmental stress, around the world.
Topic:
Conflict Resolution, Diplomacy, Human Rights, and Human Welfare

253. Post-Tsunami Aid Effectiveness in Aceh: Proliferation and Coordination in Reconstruction

Author:
Harry Masyrafah and Jock MJA McKeon
Publication Date:
11-2008
Content Type:
Working Paper
Institution:
The Brookings Institution
Abstract:
On December 26, 2004, an earthquake measuring 9.0 on the Richter scale struck off the northeast coast of Nanggroe Aceh Darussalam (Aceh) on the island of Sumatra, Indonesia. In the subsequent tsunami that followed, over 150,000 people lost their lives, while an estimated 700,000 people were displaced. The scale of the damage to the local economy, infrastructure and administration was unprecedented. The magnitude of these events triggered a huge outpouring of compassion and generosity from around the world. The influx of aid and assistance into the province of Aceh in the weeks and months that followed was unprecedented and surpassed all expectations. This paper seeks to provide some insight into the effects of such an influx whilst also exploring some of the coordination mechanisms put in place to manage what was the largest reconstruction program in the developing world at the time.
Topic:
Development, Government, Human Welfare, Humanitarian Aid, and International Cooperation
Political Geography:
Indonesia

254. Ending Zimbabwe's Nightmare: A Possible Way Forward - Africa Briefing No. 56

Publication Date:
12-2008
Content Type:
Working Paper
Institution:
International Crisis Group
Abstract:
The inter-party negotiations that have sought to end Zimbabwe's political, economic and now full-blown humanitarian crisis following the fraudulent June 2008 presidential election run-off are hopelessly deadlocked. Robert Mugabe and his ZANU-PF will not accept genuine power sharing, and Morgan Tsvangirai and his Movement for Democratic Change (MDC) are unwilling to join a ZANU-PF dominated administration as a junior partner, responsible for ending international isolation but without authority to implement needed reforms and emergency humanitarian relief.
Topic:
Conflict Resolution, Conflict Prevention, Political Violence, Government, Human Rights, and Human Welfare
Political Geography:
Africa and Zimbabwe

255. Social Welfare Conservatism

Author:
Douglas Besharov
Publication Date:
01-2008
Content Type:
Policy Brief
Institution:
American Enterprise Institute for Public Policy Research
Abstract:
Finding that an op-ed by Michael Gerson poorly defined the conservative approach to social problems, Douglas J. Besharov outlined six principles that underlie the conservative position on government social programs. Besharov notes that being cautious about the possible ill effects of government intervention is not unique to conservatives. It is simply realistic to be skeptical about the federal government's ability to mitigate serious social welfare problems.
Topic:
Human Welfare, Political Economy, and Politics
Political Geography:
United States

256. The New Deal Jobs Myth

Author:
Amity Shlaes
Publication Date:
01-2008
Content Type:
Policy Brief
Institution:
American Enterprise Institute for Public Policy Research
Abstract:
Democratic presidential candidates are invoking the New Deal as a model for addressing infrastructure, economic, and employment problems in the United States. But a careful look at New Deal spending suggests, in the words of Amity Shlaes, “not how much the public works achieved . . . [but] how little.” Advocates for new federal government spending on highways, buildings, and roads should carefully weigh the need against the damage that comes from projects and jobs created for political reasons.
Topic:
Economics, Human Welfare, and Political Economy
Political Geography:
United States

257. Global Tensions, Global Possibilities: Everyday Forces of Conformity and Contestation

Author:
Jean Michel Montsion, Samah Sabra, James Gaede, Jeremy D. Kowalski, Rhiannon Mosher, Teresa Kramarz, Kathryn Mossman, Adam Sneyd, Luis Alfredo Marroquin-Campos, Rob Downie, Heather Battles, Adrienne Smith, Ahmed T. Rashid, Joanne Nowak, Liam Riley, David Haldane Lee, Greg Shupak, Arun Nedra Rodrigo, Lauren Scannell, Naomi Achus, and Ethel Tungohan
Publication Date:
07-2008
Content Type:
Working Paper
Institution:
Institute on Globalization and the Human Condition, McMaster University
Abstract:
Academics theorizing and analyzing the impacts of globalization on everyday life are conventionally divided between those who highlight the (overt or hidden) opportunities and advantages afforded by globalizing processes and others who emphasize their negative impacts on populations across the world. The former tend to focus on such things as increased access to paid labour, faster modes of communication, and technological ease of transportation (of people and information) across global networks. The latter, in contrast, generally stress the vicious implications of globalization's systemic processes, which continue to exacerbate polarization between rich and poor and, invariably, mean uneven access to labour, communication, and transportation. With this division in mind, the Graduate Student Research Group of the Institute on Globalization and the Human Condition held a conference titled Global tensions, global possibilities in September 2007. The conference organizers intended to bring together graduate students to challenge the above oppositions which often characterize contemporary globalization theories. By gathering an eclectic group of young scholars from various disciplines and backgrounds, the key aim driving Global tensions, global possibilities was to question disciplinary and attitudinal divides in theorizing globalization. A secondary, and related, intention of the organizers was for the conference to be a space in which participants (i.e. presenters, discussants, and audience) would together (re)think the implications of globalizing processes in non-dichotomizing ways that transcend such traditional divides. The organizers recognized that their intentions were not necessarily revolutionary. The works of several prominent scholars in various disciplines have denoted the need to be critical of further polarizing contemporary globalization theory (Comaroff and Comaroff 2001; Mudimbe-Boyi 2002; Ong 2006). For example, in their discussions of globalization, Jean and John Comaroff (2001) have indicated that globalizing processes and their attendant consequences can be neither classified nor understood in simple terms. Like the Comaroffs, the conference organizers felt that one cannot deny the intense messiness of any investigation of globalizing processes. Instead, they wanted to stress that globalization is simultaneously creative and destructive, enabling and constraining, beneficial and detrimental. Given that it has come out of the conference, the same line of reasoning forms the driving force behind this graduate student volume of the Working Paper Series. Below, we discuss our rationale for organizing the volume in the way we have. We begin with a brief discussion of our understanding of the need to move beyond theorizing globalization as either liberating or oppressive. Throughout the following sections, we move back and forth between our theorization of this necessity and the specifics of how the dichotomy beyond which we want to move re-emerged in the context of the conference. In the final section, we provide a brief description of the papers and our motivation for organizing them as we have.
Topic:
Gender Issues, Globalization, Health, Human Rights, Human Welfare, International Organization, Markets, Migration, and Science and Technology

258. Correcting Course: Victims and the Justice and Peace Law in Colombia - Latin America Report N°29

Publication Date:
10-2008
Content Type:
Working Paper
Institution:
International Crisis Group
Abstract:
The more than 155,000 victims of Colombia's conflict registered to date with the attorney general's Justice and Peace Unit (JPU) – mostly those who suffered from the paramilitaries – are mainly onlookers to, not actors in, a lagging transitional justice process. Over three years after passage, implementation of the Justice and Peace Law (JPL) is stymied by the relative disinterest in promoting victims' rights of the Uribe government and much of political and civil society. The problems are exacerbated by serious operational and financial bottlenecks in the judicial process and assistance and reparations to victims, as well as the persistence of armed conflict with the Revolutionary Armed Forces of Colombia (FARC) insurgents and the emergence of new illegal armed groups (NIAGs) and paramilitary successors.
Topic:
Conflict Resolution, Security, Civil Society, Government, Human Rights, and Human Welfare
Political Geography:
Colombia and South America

259. Uganda/Lord's Resistance Army Peace Negotiations

Author:
David Smock
Publication Date:
02-2008
Content Type:
Policy Brief
Institution:
United States Institute of Peace
Abstract:
Juba, Southern Sudan – Northern Uganda is one of the world's humanitarian disaster areas. Twenty thousand have been killed and up to two million have been displaced in Internally Displaced Person (IDP) camps over the last 20 years. This havoc has been created by the notorious Lord's Resistance Army (LRA), whose agenda and purposes have remained murky. Joseph Kony, the rebel commander, asserts that the LRA political program is based on the Ten Commandments, despite the fact that the LRA routinely violates most of them.
Topic:
Ethnic Conflict, Human Welfare, and War
Political Geography:
Africa, North Uganda, and South Sudan

260. Special Report No. 211: Would You Fight Again?: Understanding Liberian Ex-Combatant Reintegration

Author:
Richard Hill, Gwendolyn Taylor, and Jonathan Temin
Publication Date:
09-2008
Content Type:
Working Paper
Institution:
United States Institute of Peace
Abstract:
The potential for renewed fighting is closely linked to poverty and hardship. Liberian ex-combatants most commonly cited reasons for considering a return to combat include poverty and economic disadvantage, followed by a lack of jobs, benefits, or training. Unemployment plays a role in the potential return to combat, especially for those who were previously employed. As expected, a greater percentage of unemployed than employed respondents can envision returning to war. However, one population that is significantly more likely to return to combat is ex-combatants who held a job before the war but are now unemployed. problems in gaining acceptance by family and community are also closely linked to willingness to consider fighting again. Respondents who have had difficulty reintegrating into their home communities and who perceive bias against ex-combatants seem more inclined to return to combat. Women may be especially prone to fight again to find relief from poverty. There were comparatively few women fighters and, therefore, relatively few women in the sample, but results suggest that women, particularly those without families, might be more likely than men to fight if it becomes financially necessary. Tribal tensions still exist and could lead to outbreaks of violence. There are still feelings, especially among members of certain ethnic groups, that ex-combatants from their tribe are not accorded full citizen status by members of other tribes.
Topic:
Civil Society, Ethnic Conflict, Human Welfare, and Poverty
Political Geography:
Africa and Liberia