Search

Implementing Telehealth in the American States This research examines the extent of telehealth program implementation across the states. Telehealth is defined as the use of electronic information and telecommunications technologies to support long-distance clinical healthcare; patient and professional health-related education; public healthcare and administration (House of Representatives 2157, 2001). The role of the states in telehealth policy is two-fold: service delivery in cases where public health or Medicaid are involved, and regulatory in the case of private sector use in telehealth. Previous research on e-government found professional networks were important in promoting the implementation in that policy area, which was an administrative reform with low political salience (McNeal, Tolbert, Mossberger, and Dotterweich, 2003). Telehealth could also be considered an administrative reform policy, as well as a regulatory policy with low political salience: highly technical, involving specialists, and generating little controversy among citizens. However, the issue has been more conflictual within the policy community of health specialists, and regulatory policies are often moderately conflictual (Lowi 1972). Drawing on 50-state data and using multivariate regression analysis, we expect that the extent of implementation of telehealth to be driven by legislative professionalism, and intrastate administrative networks, and interstate networks, such as the health insurance industry and nurses. We expect that policy specific demand variables, such as percentage rural would also be a positive determinant influencing the extent of telehealth implementation. In our preliminary findings, we find legislative professionalism and interest group power as significant, positive predictors for extent of implementation, while intrastate administrative networks were not statistically significant. State Information Technology (IT) administrative and management capacity, professional shortage areas for mental-health, healthcare per capita expenditures, percent of population over 64, Medicare and Medicaid Rural Health Clinics rate, and percentage rural were all found as significant predictors for implementation This suggests that where there is more controversy within the policy community of specialists, that interest groups play a larger role than state professional networks. State capacity and need also help to explain the state activity, whereas none of these measures were significant for understanding the implementation of e-government. Our findings have important implications for understanding policy innovation as the scope of policy implementation, and how factors influencing implementation may vary by political salience. Additionally, the findings may have some broader implications for innovation and implementation of healthcare policy. [ABSTRACT FROM AUTHOR]

Deciding how to finance multiple levels of government is a challenging task for all political systems. Federal states, in addition, have a constitutional contract to divide financial accountability across national and subnational governments. In comparison with unitary states, federal states are arguably more committed to fiscal decentralization precisely because of this constitutional contract. Nevertheless, a wide variation in the extent of fiscal centralization is observed even among developed federal states. This paper explores the political economy of fiscal centralization in six developed federal states, Australia, Canada, Austria, Germany, the United States, and Belgium, from 1961 through 1995. [ABSTRACT FROM AUTHOR]