4584 Community Tracking Study Physician Survey, 2004-2005
I choose the following data set:
http://www.icpsr.umich.edu/icpsrweb/ICPSR/studies/4584/detail
This data set is the survey section of the Community Tracking Survey Physicians Survey, conducted in 2004-2005. This survey is the fourth round of a physician’s survey component, the first round being conducted in 1996-1997. The survey details the changes in the U.S healthcare system and its effects on individuals. Information from this survey includes net income from practice, sex, race, specialty, board certification etc. Additionally the survey obtained views on a number of issues like patient-physician interaction, competition among practices, the influence of financial incentives on the quality of the services provided to the patients etc.
The research questions I am interested in and would like to pose are:
à Is there any evidence that physicians are making a greater part of their compensation through Medicare and Medicaid? How do race and sex affect the earnings of primary care physicians.
à What makes patients choose certain physicians besides their specialty? Are race or sex variables that play a part in this decision? For example do women prefer female physicians and would Hispanics prefer to visit a Hispanic physician?
Questions that could be posed to the class could be:
à Do you pick you primary care physician (PCP) at random, or are there some variables involved? If yes, than what are those? Do you prefer a PHD or an MD?
à Besides the rates that your insurance provider sets up, what do you think about that rates that are charged by your physician?
Saturday, October 9, 2010
Saturday, September 25, 2010
Assignment 3
· Lindblom
I would like to take the example of health policy since that is my primary interest and try to explain incrementalism. Incrementalism however can explain almost all policy related decisions. Issues like healthcare could be classified as “wicked problems” alongside with similar issues like poverty, drug problems etc. I feel that there is a difference between a policy being explained by incrementalism and it being good for the policy itself. Health policy has seen small incremental steps from time to time; it could be the Medicare or Medicaid provision added in 1965 or the SCHIP (State children’s health insurance program) added in 1997. In between there have been several cases and examples where incremental steps have been responsible for provisions or loopholes in this policy.
As much as I agree with incrementalism being a better way for building policy I cannot say I feel the same way when it concerns healthcare. Incremental policy can be blamed indirectly for the inherent costs of healthcare that have inflated from year to year. This does not mean that incremental steps adopted by some states like Massachusetts where health insurance is mandatory would be an example. On the contrary these steps end up saving the State more than they might spend on the program. The problem lies in the fact that the policy in play has cost a lot and continues to be a massive burden on the treasury, $1 in every $6 spend is on healthcare. There are obviously ways and means to make similar incremental steps in trying to scale back the costs, as Lindblom has explained, most of us approach policy problems within a framework given by our view of a chain of successive policy choices made up to the present. Policy is influenced by one’s knowledge of the incremental steps taken up to the present. An administrator has intimate knowledge of the past sequences and this thinking and that of the outsider will be different. To sum up it’s really up to the decision makers to weigh in the mistakes of the past and try not to repeat them in the present. With the healthcare bill being passed recently the outcomes will not be immediate. Just like the bill took into account the nitty-gritty that encompasses this field the effects will also be incremental and take a few years to kick in.
· Lowi
http://www.washingtonpost.com/wp-dyn/content/article/2010/09/11/AR2010091105326.html
This article from the Washington Post is about FTA (Federal Transit Administration) establishing their presence in transit safety. According to this article the FTA has plans to regulate public transit agencies. This move has been considered in light of several incidences of rail mishaps in Washington D.C, Boston, and San Francisco. The article is a clear example of the government’s regulatory power. The impact of this could be considered as being specific and individual in nature as only public transit agencies would be considered. So far public transit safety has not been regulated and the current administration has tried to make it a part of their proposal to reinforce safety. At the moment the FTA does not have enough authority to enforce safety standards for transit systems which the administration hopes to change.
The new authority i.e. the TRACS (Transit Rail Advisory Committee for Safety) created by the Department of Transportation would be responsible in regulating rail fixed guide way transportation systems. In the past most transport related accidents have been investigated by the NTSB, currently most public transit agencies are not fully regulated. As the article mentions, the principle reason for getting this group appointed would be to get the transit safety regulations up and running. At the moment transit safety in not being branched, since what works for airlines cannot work for rails or metros, there has to be some sort of delineation.
If we look at this article from Lowi’s standpoint one could see clearly marked regulations in this scenario. Is the issue mentioned in the article bound to raise costs? Indeed they are. Also this policy cannot be disaggregated to the level of the individual or a single entity. Lastly, as to who would be indulged and who would be deprived is slightly tricky. As the FTA gets set for role in transit safety this would mean put the agency in the spotlight but deciding on who would be deprived is the tricky part.
I would like to take the example of health policy since that is my primary interest and try to explain incrementalism. Incrementalism however can explain almost all policy related decisions. Issues like healthcare could be classified as “wicked problems” alongside with similar issues like poverty, drug problems etc. I feel that there is a difference between a policy being explained by incrementalism and it being good for the policy itself. Health policy has seen small incremental steps from time to time; it could be the Medicare or Medicaid provision added in 1965 or the SCHIP (State children’s health insurance program) added in 1997. In between there have been several cases and examples where incremental steps have been responsible for provisions or loopholes in this policy.
As much as I agree with incrementalism being a better way for building policy I cannot say I feel the same way when it concerns healthcare. Incremental policy can be blamed indirectly for the inherent costs of healthcare that have inflated from year to year. This does not mean that incremental steps adopted by some states like Massachusetts where health insurance is mandatory would be an example. On the contrary these steps end up saving the State more than they might spend on the program. The problem lies in the fact that the policy in play has cost a lot and continues to be a massive burden on the treasury, $1 in every $6 spend is on healthcare. There are obviously ways and means to make similar incremental steps in trying to scale back the costs, as Lindblom has explained, most of us approach policy problems within a framework given by our view of a chain of successive policy choices made up to the present. Policy is influenced by one’s knowledge of the incremental steps taken up to the present. An administrator has intimate knowledge of the past sequences and this thinking and that of the outsider will be different. To sum up it’s really up to the decision makers to weigh in the mistakes of the past and try not to repeat them in the present. With the healthcare bill being passed recently the outcomes will not be immediate. Just like the bill took into account the nitty-gritty that encompasses this field the effects will also be incremental and take a few years to kick in.
· Lowi
http://www.washingtonpost.com/wp-dyn/content/article/2010/09/11/AR2010091105326.html
This article from the Washington Post is about FTA (Federal Transit Administration) establishing their presence in transit safety. According to this article the FTA has plans to regulate public transit agencies. This move has been considered in light of several incidences of rail mishaps in Washington D.C, Boston, and San Francisco. The article is a clear example of the government’s regulatory power. The impact of this could be considered as being specific and individual in nature as only public transit agencies would be considered. So far public transit safety has not been regulated and the current administration has tried to make it a part of their proposal to reinforce safety. At the moment the FTA does not have enough authority to enforce safety standards for transit systems which the administration hopes to change.
The new authority i.e. the TRACS (Transit Rail Advisory Committee for Safety) created by the Department of Transportation would be responsible in regulating rail fixed guide way transportation systems. In the past most transport related accidents have been investigated by the NTSB, currently most public transit agencies are not fully regulated. As the article mentions, the principle reason for getting this group appointed would be to get the transit safety regulations up and running. At the moment transit safety in not being branched, since what works for airlines cannot work for rails or metros, there has to be some sort of delineation.
If we look at this article from Lowi’s standpoint one could see clearly marked regulations in this scenario. Is the issue mentioned in the article bound to raise costs? Indeed they are. Also this policy cannot be disaggregated to the level of the individual or a single entity. Lastly, as to who would be indulged and who would be deprived is slightly tricky. As the FTA gets set for role in transit safety this would mean put the agency in the spotlight but deciding on who would be deprived is the tricky part.
Saturday, September 11, 2010
Assignment 2
Shulock
a) Briefly describe the two views of policy-making that Shulock outlines in her article?
The two views of policy making in the Shulock article are the traditional view and the interpretive view. Traditional policy analysis presumes that experts trained in analytical techniques can apply them systematically to the political market place, can discover and measure its impact on citizen interests, forecast and affect decisions.
The interpretive view can be considered more of a language for framing political discourse, as a legitimate rationalization behind legislative action, and as a symbol of legitimate decision process. The interpretive view is a democratic process as opposed to a problem solving process. Is more responsive to the public and engages the public in the process.
b) In your opinion, which of these views of policy making is most accurate? Why?
I favor the interpretive view as this view is more of a democratic process than a problem solving process. This process is responsive to the public and engages them. For example the New England style town hall meetings, a form of direct democratic rule. Shulock points out interpretive use as being a tool of the democratic process, used by policymakers, interest groups and citizens.
The traditional view has a different feel to it, this view feels more like a set standard that might have been authorized decades ago and has not undergone any changes. This view has more of an elitist feel to it. For example some of the characteristics of the traditional view involve monopoly jurisdictions and passive citizens.
It is interesting to note that Shulock based both her hypothesis on the interpretive theory. She has based these hypotheses on policy analysis being used more in cases of jurisdictional competition (interpretive) than in cases of jurisdictional monopoly (traditional), and secondly policy analysis being used when public attention to issues is high. Shulock in her conclusion (pg 239) mentions critiques of traditional policy analysis argue that new forms of policy analysis must be devised to remedy the deficiencies of the traditional form. The two type of deficiencies presented are an over-reliance on a positivist framework and an antidemocratic tendency.
c) Post a link to a newspaper article that demonstrates an example of policy making that supports your opinions expressed in part b above. Briefly explain why this supports your views from part b?
http://www.nytimes.com/2010/09/04/health/policy/04fda.html?ref=politics
This article is about the removal of the drug midodrine from the market by the FDA since the drug makers never tested the drug for being effective against spells of dizziness and fainting. Sometime drugs are approved by the FDA in an abbreviated process; this process involves bringing the drug into the market without extensive tests.
Since midodrine was the only available option many had the FDA was flooded with complaints by those who were debilitated by the condition. The article has given two examples of individuals suffering from dizziness so acute they can barely live their normal lives.
The FDA acted on its own set of regulations (traditional view), one could argue that the agency was merely following protocols. The intensive drug testing that is needed was never conducted by the drug manufacturer. The fact that the FDA had to change their decision is something in response to a flawed step on the part of the agency and the drug makers. Firstly the FDA took the drug out with out any warning or even trying to find out if the drug was helping people. Had there been a democratic forum where the FDA could investigate the drugs effectiveness and if it was helping people, such a situation would not have arisen. Interesting to note there is no mention of a fine or a penalty on the pharmaceutical company manufacturing midodrine.
Hird
a) What does Hird conclude about the use of policy analysis in decision making?
Hird focused on the influence of non-partisan policy analysis organizations (NPRO) on their main clients: state legislators. Point to note, Hird finds that there is a negative association between legislators’ evaluations of the strength of their NPRO and their belief that the NPRO mostly gathers and synthesizes information rather than analyzing it. The study conducted by Hird finds a consistently significant impact of state nonpartisan policy research organizations on both legislators’ evaluations of their access to information and their assessment of the quality and capabilities of their NPRO’s.
While NPROs in relation to other constituencies do not have substantial policy making influence, the larger and more analytical NPROs have significantly more influence over policymaking than smaller/descriptive ones.
b) Are you convinced by his research and his argument? Why or why not?
While I feel the research and the argument are on the right line it could be more conclusive. The article has examined the relationship between the analytical capacities of the NPRO by taking NPROs across 19 states into consideration. Taking 19 states is a small sample; the accuracy could be a hit or a miss. While Hird concludes larger NPROs having greater influence than smaller ones, Hird might have increased his accuracy had he taken a sample of 25-30 states. Instead of taking all the NPROs in that state he could have divided them into categories according to size. Another interesting aspect of the study could try to divide the sample states into red and blue states and see the outcomes. The response rate while consistent is still low at 25 %. While I agree with Hird, his conclusion and finding I feel the methodology could be reliable is the sample size was increased.
a) Briefly describe the two views of policy-making that Shulock outlines in her article?
The two views of policy making in the Shulock article are the traditional view and the interpretive view. Traditional policy analysis presumes that experts trained in analytical techniques can apply them systematically to the political market place, can discover and measure its impact on citizen interests, forecast and affect decisions.
The interpretive view can be considered more of a language for framing political discourse, as a legitimate rationalization behind legislative action, and as a symbol of legitimate decision process. The interpretive view is a democratic process as opposed to a problem solving process. Is more responsive to the public and engages the public in the process.
b) In your opinion, which of these views of policy making is most accurate? Why?
I favor the interpretive view as this view is more of a democratic process than a problem solving process. This process is responsive to the public and engages them. For example the New England style town hall meetings, a form of direct democratic rule. Shulock points out interpretive use as being a tool of the democratic process, used by policymakers, interest groups and citizens.
The traditional view has a different feel to it, this view feels more like a set standard that might have been authorized decades ago and has not undergone any changes. This view has more of an elitist feel to it. For example some of the characteristics of the traditional view involve monopoly jurisdictions and passive citizens.
It is interesting to note that Shulock based both her hypothesis on the interpretive theory. She has based these hypotheses on policy analysis being used more in cases of jurisdictional competition (interpretive) than in cases of jurisdictional monopoly (traditional), and secondly policy analysis being used when public attention to issues is high. Shulock in her conclusion (pg 239) mentions critiques of traditional policy analysis argue that new forms of policy analysis must be devised to remedy the deficiencies of the traditional form. The two type of deficiencies presented are an over-reliance on a positivist framework and an antidemocratic tendency.
c) Post a link to a newspaper article that demonstrates an example of policy making that supports your opinions expressed in part b above. Briefly explain why this supports your views from part b?
http://www.nytimes.com/2010/09/04/health/policy/04fda.html?ref=politics
This article is about the removal of the drug midodrine from the market by the FDA since the drug makers never tested the drug for being effective against spells of dizziness and fainting. Sometime drugs are approved by the FDA in an abbreviated process; this process involves bringing the drug into the market without extensive tests.
Since midodrine was the only available option many had the FDA was flooded with complaints by those who were debilitated by the condition. The article has given two examples of individuals suffering from dizziness so acute they can barely live their normal lives.
The FDA acted on its own set of regulations (traditional view), one could argue that the agency was merely following protocols. The intensive drug testing that is needed was never conducted by the drug manufacturer. The fact that the FDA had to change their decision is something in response to a flawed step on the part of the agency and the drug makers. Firstly the FDA took the drug out with out any warning or even trying to find out if the drug was helping people. Had there been a democratic forum where the FDA could investigate the drugs effectiveness and if it was helping people, such a situation would not have arisen. Interesting to note there is no mention of a fine or a penalty on the pharmaceutical company manufacturing midodrine.
Hird
a) What does Hird conclude about the use of policy analysis in decision making?
Hird focused on the influence of non-partisan policy analysis organizations (NPRO) on their main clients: state legislators. Point to note, Hird finds that there is a negative association between legislators’ evaluations of the strength of their NPRO and their belief that the NPRO mostly gathers and synthesizes information rather than analyzing it. The study conducted by Hird finds a consistently significant impact of state nonpartisan policy research organizations on both legislators’ evaluations of their access to information and their assessment of the quality and capabilities of their NPRO’s.
While NPROs in relation to other constituencies do not have substantial policy making influence, the larger and more analytical NPROs have significantly more influence over policymaking than smaller/descriptive ones.
b) Are you convinced by his research and his argument? Why or why not?
While I feel the research and the argument are on the right line it could be more conclusive. The article has examined the relationship between the analytical capacities of the NPRO by taking NPROs across 19 states into consideration. Taking 19 states is a small sample; the accuracy could be a hit or a miss. While Hird concludes larger NPROs having greater influence than smaller ones, Hird might have increased his accuracy had he taken a sample of 25-30 states. Instead of taking all the NPROs in that state he could have divided them into categories according to size. Another interesting aspect of the study could try to divide the sample states into red and blue states and see the outcomes. The response rate while consistent is still low at 25 %. While I agree with Hird, his conclusion and finding I feel the methodology could be reliable is the sample size was increased.
Monday, August 23, 2010
Subscribe to:
Posts (Atom)