'Manacled competition': market reforms in German health care. (17/1275)

In 1993 Germany joined the small but swelling ranks of societies determined to explore managed competition as a means of slowing the growth of health spending by giving stakeholders new incentives for efficiency. Realizing the benefits of competition, however, demands changes in institutional norms and regulatory practices that now largely handcuff those who would follow competitive logic into "managed care." In time Germany's system of "manacled competition" may evolve into a happy higher synthesis of managed care and managed competition. Or policymakers may conclude that the political price of installing workable market forces in health care is too high and reconcile themselves to more traditional applications of political pressure.  (+info)

Committee proposals and restrictive rules. (18/1275)

I analyze a game-theoretic model of committee-legislature interaction in which a majority decision to adopt either an open or closed amendment rule occurs following the committee's proposal of a bill. I find that, in equilibrium, the closed rule is almost always chosen when the dimension of the policy space is >1. Furthermore, the difference between the equilibrium outcome and that which would have occurred under the open rule can be arbitrarily small.  (+info)

Building peace from scratch: some theoretical and technological aspects. (19/1275)

A peace-building process is based on activity, acceptance, understanding of political reality, communication, and empowerment. Acceptance means accepting everybody as he or she is and let each know it. This is at the heart of peace work, it is the prerequisite for effective communication, and includes accepting other even in cases of severe disagreement. Peace work requires both an understanding of political reality and the expression of one's own political opinion. Acceptance and the expression of political opinion are not at variance but complementary. Combining acceptance and understanding of the political context provides hope for real communication in which messages are both sent and received, with appreciation and interest. Empowerment implies overcoming of the feeling of powerlessness, often present in conflict by all sides and in all social groups. It includes recovery of self-respect and respect for others. Education and economic independence are important facets of the empowerment concept. Essential principles of peace-building process are responsibility, solidarity, cooperation, and nonviolence. Responsibility encompasses caring for human rights, the suffering of others, and for consequences of our own intended and unintended actions. Solidarity allows learning through listening and understanding. Even with the best intentions on both sides, cooperation may be difficult and painful. Nonviolence is a way of life.  (+info)

Stochastic game theory: for playing games, not just for doing theory. (20/1275)

Recent theoretical advances have dramatically increased the relevance of game theory for predicting human behavior in interactive situations. By relaxing the classical assumptions of perfect rationality and perfect foresight, we obtain much improved explanations of initial decisions, dynamic patterns of learning and adjustment, and equilibrium steady-state distributions.  (+info)

Ecological inference. (21/1275)

Ecological inference is the process of drawing conclusions about individual-level behavior from aggregate-level data. Recent advances involve the combination of statistical and deterministic means to produce such inferences.  (+info)

Economic sanctions as human rights violations: reconciling political and public health imperatives. (22/1275)

The impact of economic sanctions on civilians has frequently been studied by public health specialists and specialized agencies of the United Nations (UN). This commentary explores some of the difficulties of the claim that sanctions constitute violations of human rights. The deprivation suffered by civilian populations under sanctions regimes often are violations of economic, social, and cultural human rights; however, the attribution of responsibility for those violations to the "senders" of sanctions (the UN Security Council or the US government, for example) is difficult to sustain, particularly in light of the efforts made by these entities to provide for humanitarian exemptions and humanitarian aid. A more productive approach to avoiding civilian harm is to prefer, as a matter of policy, arms embargoes, severing of communications, and international criminal prosecutions over trade embargoes. Promising recommendations have been formulated regarding "smart sanctions," which target regimes rather than people, and "positive sanctions" in the form of incentives. Health and human rights professionals have specific and important tasks in implementing such a restructured approach to sanctions.  (+info)

Political analysis of health reform in the Dominican Republic. (23/1275)

This article examines the major political challenges associated with the adoption of health reform proposals, through the experience of one country, the Dominican Republic. The article briefly presents the problems of the health sector in the Dominican Republic, and the health reform efforts that were initiated in 1995. The PolicyMaker method of applied political analysis is described, and the results of its application in the Dominican Republic are presented, including analysis of the policy content of the health reform, and assessment of five key groups of players (public sector, private sector, unions, political parties, and other non-governmental organizations). The PolicyMaker exercise was conducted in collaboration with the national Office of Technical Coordination (OCT) for health reform, and produced a set of 11 political strategies to promote the health reform effort in the Dominican Republic. These strategies were partially implemented by the OCT, but were insufficient to overcome political obstacles to the reform by late 1997. The conclusion presents six factors that affect the pace and political feasibility of health reform proposals, with examples from the case of the Dominican Republic.  (+info)

Zambia: the role of aid management in sustaining visionary reform. (24/1275)

As part of its ongoing reform of the health sector, Zambia has developed a number of systems and structures to coordinate and manage external resources. With increasing attention being given to the potential for sector-wide approaches (SWAps) to enhance the efficiency and effectiveness of health systems in low-income countries, Zambia provides an interesting case study of how this is emerging in practice over time. The paper outlines the different coordination mechanisms and assesses them in terms of selected criteria of effectiveness, finding that the potential to meet reform objectives is currently not being met. Factors influencing the effectiveness of these mechanisms are identified as falling into categories around personalities and human interaction, the nature of reform processes, and the impact of broader context. The need to maintain dialogue in the face of external constraints and uncertainties is stressed.  (+info)