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Cardiac sarcoidosis is associated with a high mortality rate. Given multiple barriers to obtaining cardiac PET imaging, we suspect individuals with access to this imaging modality are not representative of the Sarcoid patient population, which in the United States are predominantly Black females.To evaluate the demographics of patients with cardiac PET access and the cost-effectiveness of cardiac PET/MR imaging relative to standard of care.This is a retrospective, observational study. The demographic information of patients with suspected cardiac sarcoidosis and cardiac PET/CT imaging within a national registry of sarcoidosis were reviewed (n = 4561). An individual-level, continuous, time-state transition model was used for the evaluation of long-term cost-effectiveness for the combined cardiac PET/MR compared to standard of care cardiac MR followed by cardiac PET/CT.Patients who underwent cardiac PET in the national registry had 88.35% higher odds of being male (p 0.001) and 43.82% higher odds of being White (p = 0.003) than their counterparts who did not have cardiac PET imaging. Combined cardiac PET/MR had overall lower total lifetime costs ($8761 vs $10,777) and overall improved expected quality of life-years compared to the standard of care (0.77 vs 0.69).The findings suggest that patients with access to cardiac PET/CT are not representative of the patient population most likely to have cardiac sarcoidosis in this limited study evaluation. Universal insurance coverage should be considered for Cardiac PET imaging as same day cardiac PET and MR imaging has potential long-term cost and quality of life benefit.

To construct a new measure of end-of-life (EoL) spending-the elevated EoL spending-and examine its associations with measures of quality of care and patient and physician preferences in comparison with the commonly used total Medicare EoL spending measures.Medicare claims data for a 20% random sample of Medicare fee-for-service (FFS) patients, from the health care quality data for 2015-2016, from the Hospital Compare and the Medicare Geographic Variation public use file, and survey data about patient and physician preferences.We constructed the elevated EoL spending measure as the differential monthly spending between decedents and survivors with the same one-year mortality risk, where the risk was predicted using machine learning models. We then examined the associations of the hospital referral region (HRR)-level elevated EoL spending with various health care quality measures and with the survey-elicited patient and provider preferences. We also examined analogous associations for monthly total EoL spending on decedents.Medicare FFS patients who were continuously enrolled in Medicare Parts AB in 2015 and were alive as of January 1, 2016.We found a large variation in the elevated EoL spending across HRRs in the United States. There was no evidence of an association between HRR-level elevated EoL spending and established health care quality measures, including those specific to EoL care, whereas total EoL spending was positively associated with certain quality of care measures. We also found no evidence that elevated EoL spending was associated with patient preferences for EoL care. However, elevated EoL spending was positively and significantly associated with physician preferences for treatment intensity.Our findings suggested that elevated EoL spending captures different resource use from conventional measures of EoL spending and may be more valuable in identifying potentially wasteful spending.

Prostate cancer (PC) staging with conventional imaging often includes multiparametric magnetic resonance (MR) of the prostate, computed tomography (CT) of the chest, abdomen, and pelvis, and whole-body bone scintigraphy. The recent development of highly sensitive and specific prostate specific membrane antigen (PSMA) positron emission tomography (PET) has suggested that prior imaging techniques may be insufficiently sensitive or specific, particularly when evaluating small pathologic lesions. As PSMA PET/CT is considered to be superior for multiple clinical indications, it is being deployed as the new multidisciplinary standard-of-care. Given this, we performed a cost-effectiveness analysis of [18F]DCFPyL PSMA PET/CT imaging in the evaluation of PC relative to conventional imaging and anti-3-[18F]FACBC (18F-Fluciclovine) PET/CT. We also conducted a single institution review of PSMA PET/CT scans performed primarily for research indications from January 2018 to October 2021. Our snapshot of this period of time in our catchment demonstrated that PSMA PET/CT imaging was disproportionately accessed by men of European ancestry (EA) and those residing in zip codes associated with a higher median household income. The cost-effectiveness analysis demonstrated that [18F]DCFPyL PET/CT should be considered as an alternative to anti-3-[18F]FACBC PET/CT and standard of care imaging for prostate cancer staging. [18F]DCFPyL PET/CT is a new imaging modality to evaluate PC patients with higher sensitivity and specificity in detecting disease than other prostate specific imaging studies. Despite this, access may be inequitable. This discrepancy will need to be addressed proactively as the distribution network of the radiotracer includes both academic and non-academic sites nationwide.

The theory of symbolic representation expects that citizens will view the actions of government as more legitimate when administrators share their characteristics. Although there is support for this assertion in some service areas, the evidence in policing is mixed. We draw on Expectancy Disconfirmation Theory to develop the expectation that policing is an area where we may be unlikely to see a positive relationship between representation and positive citizen perceptions of government officials. We test this expectation in an individual-level analysis of citizen complaints against police from four American cities between 2014 and 2017. The results suggest that, all else equal, complaints against Black officers are as or more likely to be filed by Black citizens than by citizens of other races. We conclude with a discussion of the implications of these results for both the study of representative bureaucracy and for the management of police citizen interactions.

Scholars have demonstrated that public service motivation (PSM) may be conditional and activated in certain contexts or by particular primes. However, to date researchers have focused on the impact...

High-profile fatal police shootings of persons of color in recent years have led some to propose changes in the ways that police officers are trained to reduce violence in interactions between officers and citizens. This article explores the impact of a non-stress-oriented training model that some police academies have adopted as an alternative to traditional militaristic training models. We integrate multiple theoretical perspectives to develop the expectation that training interventions will have a significant impact on the nature of police/citizen interactions only when turnover of officers is sufficiently high. Results from analyses of 133 middle- to large-sized municipal police departments in 2013 suggest that non-stress training is significantly associated with reductions in use of deadly force by officers in those departments where recruits trained under such regimes make up a larger portion of the force. We do not find a significant direct or moderated effect on the number of police injured in confrontations with citizens or in the prevalence of discretionary arrests.

The public administration literature on the accountability-performance relationship depicts a mixed picture, with some studies arguing that accountability leads to a deterioration in performance an...

The Cost, Price, and Debt of Medical Education By 2018, the mean price of a U.S. medical education was about $300,000; 75% of students took on loans, and their average debt at graduation was $200,0...

Under forfeiture laws, law enforcement organizations seize billions of dollars a year from U.S. citizens based on demonstrated or suspected connections between the assets and criminal activity. Int...

The billions of dollars in assets seized by law enforcement each year represent a crucial source of revenue for these organizations, but also raise important constitutional questions and can create significant tensions within the jurisdictions they administer. Research on asset forfeiture to date has focused heavily on municipal police, largely neglecting forfeiture activities by sheriffs. Thus, it has missed an important opportunity to build theory about the differences between appointed and elected administrators and neglected an important source of institutional variation that may help to explain this particular administrative activity. To develop expectations about the relative levels of asset forfeiture and the response to intergovernmental incentives related to forfeiture, we draw on and extend scholarship comparing the behavior of elected versus appointed administrators in other settings. We test those expectations in analyses of more than 1,200 sheriff’s offices and over 2,200 municipal police departments between 1993 and 2007. Results suggest that sheriffs receive less forfeiture revenue than municipal police and are less responsive to state-level policies that change the financial rewards of asset forfeiture for agencies. These results hold whether we examine forfeitures made through the federal Equitable Sharing Program, where civil and criminal forfeiture cases can be distinguished, or jurisdictional level data on forfeiture, where civil and criminal forfeitures are combined. We conclude with a discussion of implications for both the research on asset forfeiture and on elected versus appointed public administrators more generally.

The international environmental community and many donor countries have encouraged developing countries to adopt renewable energy (RE) policies that will encourage low-carbon energy development. While the drivers of RE policy adoption have been well-studied in the U.S. and Europe, we know little about the factors that drive RE policy adoption in developing countries. Both theory and anecdotal evidence suggest that policies often spread when one country emulates another’s policy, but scholars of policy diffusion have tended to focus on emulation of political and ideological peers, overlooking other factors that may be particularly critical for driving RE policy adoption, including emulation of peers with similar electric sector conditions and emulation that is driven by coercive donor-recipient aid relationships. We use a directed dyadic analysis to assess the factors that prompt a country to emulate another’s policies and to determine whether emulation patterns differ across developed and developing countries. We find that both sets of countries tend to emulate the policies of their political peers, and that developing countries tend to emulate the policies of donors. The effect of electric sector similarities varies by policy type. Countries emulate feed-in tariffs of countries with similar electric sector conditions, but they emulate quota policies of countries with dissimilar levels of reliance on renewable energy. Results suggest that different policies may diffuse via different emulation patterns.

The diffusion of plug-in electric vehicles (PEV) is a topic that has received substantial attention in recent years. In part, this heightened interest reflects rapid concurrent developments in policy, technology, and industry strategies designed to spur the uptake of this radical, emerging technology. Governments from all levels are enacting various monetary and non-monetary incentives to encourage PEV adoption; developments in battery technology are likening the performance of PEVs to conventional vehicles; and all major vehicle manufacturers now have a PEV offering. Ultimately, however, the effect of these developments is contingent upon consumer interest. Thus, in this paper we study whether, alongside technology and market developments, consumer interest in PEVs has changed over time. To answer this question, we evaluate the degree to which intent to purchase or lease a battery electric vehicle and plug-in hybrid electric vehicle, respectively, has changed between 2011 and 2017, and how the factors that explain variation in such intent have also changed over time. Our data come from two national surveys of potential car buyers in the 21 largest American cities. Among the key findings that we derive from the analysis are that, among survey respondents, intent to purchase a PEV has increased between 2011 and 2017, and perceptions about the trialability, observability, network effects, and policies explain an increasing share of the variation in intent to purchase as time evolves.

Many countries use uniform cost-effectiveness criteria to determine whether to adopt a new medical technology for the entire population. This approach assumes homogeneous preferences for expected health benefits and side effects. We examine whether new prescription drugs generate welfare gains when accounting for heterogeneous preferences by constructing quality-adjusted price indices in the market for colorectal cancer drug treatments. We find that while the efficacy gains from newer drugs do not justify high prices for the population as a whole, innovation improves the welfare of sicker, late-stage cancer patients. A uniform evaluation criterion would not permit these innovations despite welfare gains to a subpopulation.

Many countries use uniform cost-effectiveness criteria to determine whether to adopt a new medical technology for the entire population. This approach assumes homogeneous preferences for expected health benefits and side effects. We examine whether new prescription drugs generate welfare gains when accounting for heterogeneous preferences by constructing quality- adjusted price indices for colorectal cancer drug treatments. We find that while the efficacy gains from newer drugs do not justify high prices for the population as a whole, innovation improves the welfare of sicker, late-stage cancer patients. A uniform evaluation criterion would not permit these innovations despite welfare gains to a subpopulation. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Introduction This study assesses the associations between the recent implementation of robust features of state Prescription Drug Monitoring Programs and the abrupt discontinuation of long-term opioid therapies. Methods Data were from a national commercial insurance database and included privately insured adults aged 18–64 years and Medicare Advantage enrollees aged ≥65 years who initiated a long-term opioid therapy episode between Quarter 2 of 2011 and Quarter 2 of 2017. State Prescription Drug Monitoring Programs were characterized as nonrobust, robust, and strongly robust. Abrupt discontinuation was measured on the basis of high daily morphine milligram equivalents over the last 30 days of a long-term opioid therapy episode or no sign of tapering before discontinuation. Difference-in-differences models were estimated in 2019‒2020 to assess the association between robust Prescription Drug Monitoring Programs and abrupt discontinuation. Results Among nonelderly privately insured adults, robust Prescription Drug Monitoring Programs were associated with an increase from 14.8% to 15.4% (4% relative increase, p=0.02) in the rate of ending long-term opioid therapy with ≥60 daily morphine milligram equivalents. For older Medicare Advantage enrollees, strongly robust Prescription Drug Monitoring Programs were associated with a reduction from 4.8% to 4.3% (10.4%, p=0.01) and from 3.0% to 2.4% (17.3%, p=0.001) in the rate of ending long-term opioid therapy with ≥90 and 120 daily morphine milligram equivalents, respectively. Prescription Drug Monitoring Programs robustness was not associated with clinically meaningful changes in the rate of discontinuing long-term opioid therapy without tapering. Conclusions Discontinuation without tapering was the norm for long-term opioid therapies in the samples throughout the study years. Findings do not support the notion that policies aimed at enhancing Prescription Drug Monitoring Program use were associated with substantial increases in abrupt long-term opioid therapy discontinuation.

Color versions of one or more of the figures in the article can be found online at www. tandfonline.com/upmj. The article of record as published may be found at https://dx.doi.org10.1080/10967494.2018.1550129 The ways in which managers use performance information is among the most salient topics in the study of public management. Drawing inspiration from several recent studies on the use of performance information by citizens, we adopt a behavioral approach to understand the influence of reference dependence on the interpretation of performance information by managers. Specifically, we run two experiments in a sample of professional managers, which allows us to test whether social and historical comparisons influence how respondents interpret performance information. The results suggest that framing an objective performance metric as poor relative to peer or competitor organizations leads managers to rate overall organizational performance significantly lower than managers in a control group who received the same metric, but no comparative frame. The results support expectations about the importance of social comparisons, particularly in the case of negative deviations from the reference point. The fact that we find no impact of historical comparisons on the interpretation of performance information deviates from recent work on citizen evaluations and suggests differences in the ways in which elites process such information. We conclude with a discussion of the implications of our results for the study of performance management and the behavioral approach to public management more generally.

OBJECTIVE: To determine whether assigning a dedicated general practitioner (GP) to a nursing home reduces hospitalizations and readmissions. DATA SOURCES/STUDY SETTING: Secondary data on hospitalizations and deaths by month for the universe of nursing home residents in Denmark from January 2011 through February 2014. STUDY DESIGN: In 2012, Denmark initiated a program in seven nursing homes that volunteered to participate. We used a difference‐in‐differences model to estimate the effect of assigning a dedicated GP to a nursing home on the likelihood that a nursing home resident will be hospitalized, will experience a preventable hospitalization, and will be readmitted. The unit of observation is a resident‐month. DATA COLLECTION/EXTRACTION METHODS: Data were extracted from the Danish public administrative register dataset. PRINCIPAL FINDINGS: We found that assigning a GP to a nursing home was associated with a 0.55 [95 percent CI, 0.08 to 1.02] percentage point reduction in the monthly probability of a preventable hospitalization, which was a 26 percent reduction from the preintervention level of 2.13 percentage points. The associated reduction in the monthly probability of a readmission was 0.68 [95 percent CI, −0.01 to 1.37] percentage points, which was a 25 percent reduction from the baseline level of 2.68 percentage points. Survey results indicated that the likely mechanism for the effect was more efficient and consistent communication between GPs and nursing home personnel. CONCLUSIONS: Assigning a dedicated physician in a nursing home can reduce medical spending and improve patients' health.

The American states are prolific energy policymakers. Over the past two decades, they have adopted a variety of policies aimed at technology innovation and carbon reductions. These policy decisions, however, are not made within a vacuum. States share peer relationships through which they exchange policy relevant information. Research on energy policy has recognized the existence of these networks, but measured them only indirectly, typically with a measure of geographic proximity. This approach likely provides an incomplete picture of the ways in which states share information in this important domain. Based on a pilot survey of expert informants in state energy policy, in this Perspectives article we show that policy information networks extend beyond geographic proximity. Our results reveal that measures used in studies of energy policy diffusion are overly simplistic, underestimate the importance of states sharing information, and fail to capture the actual reasons states look to one another. We argue that it is important to account for these alternative channels in future policy diffusion scholarship.

Calls for more representative police forces, made regularly over the past four decades, rest in part on the assumption that hiring minority officers will help departments overcome adverse selection...

The plug-in electric vehicle (PEV) is regarded by many as a viable alternative to the internal combustion engine, so long as the radical technology is able to overcome technical and financial shortcomings that dictate consumer acceptance. States have instituted a variety of policies aimed at mitigating these shortcomings and simultaneously increasing consumer demand for PEV vehicles. Motivated by a limited body of literature on the effects of these policies, and a significant need for information about policy efficacy, in this study we evaluate the relationship between a suite of state-level policies and PEV registrations. Results reveal that tax credits for individuals, grants programs for charging infrastructure and PEV purchases, and incentives for state-owned PEVs fleets increase PEV registrations. The observed impact of grant incentives is mediated by charging capacity or, alternatively phrased, much of the influence of grants on registrations is through the channel of first improving the charging infrastructure within a state.

A persistent question in the literature on policy adoption and diffusion focuses on the ways in which jurisdictions gather policy information. Decades of research have offered numerous conclusions regarding knowledge transfer mechanisms assumed to drive diffusion. While important, we suggest that the characteristics of existing work may have limited what we know about the exchange of policy information among peers. Most studies infer learning indirectly, and as a result, the literature has tended to focus on exchange between geographic and ideological peers, to the exclusion of other channels. As an alternative, this study takes a more direct approach and draws on a survey of 112 U.S. expert informants in the area of energy policy. We use the information exchange channels revealed by these informants to predict the diffusion of state renewable portfolio standards and electricity deregulation among the American states to determine whether they offer explanatory leverage beyond the “traditional” channels.

Toward Facilitated Self-Service in Health Care Strategies for transforming health care using alternative payment systems, patient-centered care, and technology have had limited success. In other in...

Policy diffusion scholarship has long sought to understand when lawmakers will imitate innovations adopted by other jurisdictions and when they actually invest the time and resources necessary to learn about potential policies. We develop the theoretical rationale that term limits will reduce the incentive and capacity of state legislatures to gather information about policies available from previous adoptions in other states. We hypothesize that this will decrease the importance of previous adopters when term-limited legislators consider policy innovations. A multilevel analysis of the diffusion of eighty-seven policies between 1960 and 2009 provides support for this expectation. Our findings provide insight into the way in which institutional features shape policy diffusion.

Pharmaceutical cocktails often consist of two or more drugs produced by competing firms. The component drugs are often also sold as stand-alone products. We analyze the effects of a merger between two pharmaceutical firms selling complements for colorectal cancer treatment. In this setting there are two merger effects: the standard upward pricing pressure due to firms internalizing the substitution between the stand-alone products, and an additional effect where the firms internalize the impact of selling complements and reduce the price of the cocktail product. The net impact of a merger is a modest price increase, or even a price decrease.

Why do firms outsource research and development (R&D) for some products while conducting R&D in-house for similar ones? An innovating firm risks cannibalizing its existing products. The more profitable these products, the more the firm wants to limit cannibalization. We apply this logic to the organization of R&D by introducing a novel theoretical model in which developing in-house provides the firm more control over the new product’s location in product space. An empirical analysis of our testable predictions using pharmaceutical data concerning patents, patent expiration, and outsourcing at various stages of the R&D process supports our theoretical findings.

The article of record as published may be found at https://doi.org/10.30636/jbpa.21.3 Modern reforms meant to incentivize public managers to be more innovative and accepting of risk are often implicitly based in the longstanding assumption that public employees are more risk averse than their private sector counterparts. We argue, however, that there is more to learn about the degree to which public and private managers differ in terms of risk aversion. In order to address this gap, we field a series of previously validated experiments designed to assess framing effects and status quo bias in a sample of public and private sector managers. Our results indicate that public managers are not more risk averse or anchored to the status quo than their private sector counterparts; in fact, the findings suggest the opposite may be true under some conditions. In addition, our results fail to confirm previous findings in the literature suggesting that public service motivation is associated with risk aversion. We conclude with a discussion of the implications of these results for the study of risky choice in the public sector and for modern public management reforms.

In response to police-involved homicides of black citizens in Ferguson, Missouri, and elsewhere, some have suggested that more black police officers could reduce the number of these events. The authors offer an empirical test of this assertion. The literature offers conflicting expectations: some studies suggest that increased representation reduces discrimination, while others suggest that it increases discrimination. The authors reconcile these perspectives using the concept of critical mass, which leads to the expectation that an increase in black officers will reduce the number of black citizens killed in encounters with police, but only once the proportion of black officers is sufficiently large. We test this expectation in analyses of recently compiled data on police-involved homicides in 2014 and 2015 in large U.S. cities.

Research has demonstrated that management influences the performance of public organizations, but almost no research has explored how the success or failure of a public organization influences the decisions of those who manage it. Arguing that many decisions by public managers are analogous to risky choice, the authors use a well-validated model of relative risk aversion to understand how such choices are influenced by managers’ perceptions of organizational performance. They theorize that managers will be less likely to encourage innovation or give discretion to employees when they are just reaching their goals relative to other performance conditions. Analyses of responses to the 2011 and 2013 Federal Employee Viewpoint Surveys provide considerable support for these assertions. The findings have significant implications for our understanding of the relationship between management and performance in public organizations.

Policy learning has been one of the primary mechanisms by which policy innovations are assumed to diffuse from one jurisdiction to another. Recent research suggests, however, that learning is more than simply observing policy adoption in other jurisdictions and must also include an assessment of the outcomes or effectiveness of those policies. This article argues that an assessment of the ability to implement an innovation is also likely to be a component of the learning process. Specifically, it argues that potential adopters are likely to ask not only, “Was the policy effective in other states that adopted it?” but also, “Can we make the policy work for us?” We test hypotheses drawn from this general argument in a directed dyad analysis of renewable portfolio standards in the American states between 1997 and 2009. Results indicate that shared implementation environments among jurisdictions help determine the impact that information about policy effectiveness has on adoption decisions. These findings suggest that implementation concerns may be an important part of the policy learning process.

Our understanding of the determinants of physician skill and the extent to which skill is valued in the marketplace is superficial. Using a large, detailed panel of new obstetricians, we find that, even though physicians’ maternal complication rates improve steadily with experience, initial skill (as measured by performance in a physician's first year of practice) explains more of the variation in physician performance over time than experience does. At the same time, we find that the trajectories of new physicians’ delivery volume develop in a way consistent with Bayesian learning about physician quality. As physicians gain experience, their volume becomes increasingly sensitive to the information in their accumulated prior belief, while responses to information on recent performance are detectable in only selected settings (e.g., vaginal delivery, commercially insured patients).

It has long been recognised that interstate diffusion of policy innovations is comprised of distinct decisions including adoption, reinvention and amendment. Interstate influences are an important driver of these diffusion processes, but studies to date have not investigated the degree to which external influences vary across these decisions. We theorise that geographical peers will have the largest impact in adoption decisions; that ideological peers are an important source of policy information when states make decisions about “reinventing” innovations adopted by others; and that internal factors will drive the decision by a state to amend a policy. We test these expectations for renewable portfolio standards in the American states between 1996 and 2009. Results suggest that state policymakers emulate peers in adoption or policy design choices, and that internal influences have a stronger influence on amendment decisions than do external influences. These findings further our understanding of policy diffusion and state-by-state relations.

Existing research on policy diffusion focuses almost exclusively on “successes” where many jurisdictions adopted the policy or policies under examination. Some have speculated that this “pro-innovation bias” compromises scholars’ ability to draw valid inferences about the factors that influence the diffusion process. We argue that the study of interstate compacts in the United States provides an analytic opportunity to assess whether these concerns are warranted because it allows us to examine an entire universe of cases with unusually wide variability in their adoption patterns. Based on a pooled event history analysis of the interstate compacts that are open to all fifty states, we conclude that the tendency to limit diffusion research to widely adopted policies affects the results of previous studies. Specifically, it appears to lead scholars to systematically overestimate the impact of geographic diffusion pressures and policy attributes, and to underestimate the importance of professional associations and the opportunity to learn from previous adoptions. In sum, the longstanding concerns about a pro-innovation bias in diffusion research seem to be warranted.

Existing research identifies partisan differences in taxing choices made by state governments. Research has also found that, even when controlling for intrastate characteristics such as party, jurisdictions respond to the taxing decisions of their neighbours, particularly when citizens can easily cross-border shop. These studies treat political and competitive factors as independent influences on taxes. We suggest they are more likely to interact in taxing decisions. We argue that the political costs of cross-border shopping are higher for Republicans, and the threat of it should have a greater negative impact on taxes when that party controls major state policy-making institutions. Our analyses of state cigarette taxes between 1980 and 2011 confirm that a higher threat of cross-border shopping has a larger negative impact on taxes under Republican governors. We conclude that, by missing the interaction between partisanship and the threat of fiscal mobility, previous work misestimates key influences on tax competition.

State governments have considerable discretion regarding when they use federal grants to deliver goods and service themselves and when they pass those grants through to fund service delivery by local governments, nonprofit organizations, and other substate entities. This discretion influences the expenditure, and potentially the impact, of many billions of dollars every year. Unfortunately, we know very little about the decisions states make regarding the volume of federal grant aid they pass through, or about the types of subrecipients most likely to receive that money. Drawing on delegation theory, this study develops the argument that the amount and target of pass-through funding will be a function of the state's capacity to produce desired goods, shared policy preferences between state and local actors, and the relative capacity of substate actors to produce those same goods. We test these hypotheses in analyses of the pass-through of ARRA grants to subrecipients by state governments between 2009 and 2012. The results from those analyses suggest that delegation theory provides a useful way to understand both the volume of pass-through that states engage in as well as the target of those monies.

Technology drives both health care spending and health improvement. Yet policy makers rarely see measures of cost growth that account for both effects. To fill this gap, we present the quality-adjusted cost of care, which illustrates cost growth net of growth in the value of health improvements, measured as survival gains multiplied by the value of survival. We applied the quality-adjusted cost of care to two cases. For colorectal cancer, drug cost per patient increased by $34,493 between 1998 and 2005 as a result of new drug launches, but value from offsetting health improvements netted a modest $1,377 increase in quality-adjusted cost of care. For multiple myeloma, new therapies increased treatment cost by $72,937 between 2004 and 2009, but offsetting health benefits lowered overall quality-adjusted cost of care by $67,863. However, patients with multiple myeloma on established first-line therapies saw costs rise without corresponding benefits. All three examples document rapid cost growth, but they provide starkly different answers to the question of whether society got what it paid for.

Despite the prevalence of state-level commissions convened to make policy recommendations, research to date has not systematically investigated the ways in which these bodies impact policy or degree to which state-level interest groups can use these institutions in that process. We argue that less powerful groups will favor these mechanisms and use them to get issues onto the institutional agenda and to increase the likelihood of legislative success. We also suggest that traditionally powerful groups will oppose the creation of reform-minded task forces, but will likely use them to hinder policy change once they are formed. We test this assertion in an analysis of the creation and recommendations of task forces convened to study autism insurance mandates, as well as the eventual adoption of such mandates, in the American states between 2001 and 2010. The results suggest that public and industry groups influence the formation and recommendations of task forces, but that the latter appears to have a relatively larger impact. They also suggest that a task force recommendation has a large impact on the likelihood of adopting an autism insurance mandate and that neither the insurance industry nor autism advocacy groups have a direct influence on adoption after controlling for the presence of a recommendation.

Several recent studies have examined the impacts of No Child Left Behind (NCLB) on school operations and student achievement. We complement that work by investigating the law’s impacts on teachers’ perceptions of their work environments and related job attitudes, including satisfaction and commitment to remain in teaching. Using four waves of the nationally representative Schools and Staffing Survey, which cover the period from 1994 to 2008, we document overall trends in teacher attitudes across this time period and take advantage of differences in the presence and strength of prior state accountability systems and differences in likely impacts on high- and low-poverty schools to isolate NCLB effects. Perhaps surprisingly, we show positive trends in many work environment measures, job satisfaction, and commitment across the time period coinciding with the implementation of NCLB. We find, however, relatively modest evidence of an impact of NCLB accountability itself. There is some evidence that the law has negatively affected perceptions of teacher cooperation but positively affected feelings of classroom control and administrator support. We find little evidence that teacher job satisfaction or commitment has changed in response to NCLB.

Programs administered by the U.S. Department of Energy under the American Recovery and Reinvestment Act (ARRA) of 2009 were designed to spur investment in clean energy and jump-start the economy. There was considerable variation, however, in the proportion of obligated funds that states spent during each year. A primary goal of the ARRA was to infuse as much money as possible into the struggling economy; however, there was significant variation in the success with which states implemented these programs. This article draws on and extends the literature on intergovernmental implementation to explain such variation. The authors argue that jurisdictional capacity and federal guidance were important determinants of the rate at which states spent ARRA funds and, more important, that these factors interacted with one another in the implementation process. This assertion is tested using a mixed-methods approach that includes a regression analysis of state ARRA spending between 2009 and 2012, as well as an evaluation of interviews conducted with 46 state agency representatives responsible for spending ARRA energy funds.

Are some American states inherently more innovative than others? This question has confounded researchers for more than four decades. In this study we develop a measure of collective policy innovation that measures formal cooperative policy arrangements among the states, compare the measure to existing measures of internal state policy innovation, and assess whether existing innovativeness measures explain policy cooperation among the states. This test of the innovativeness concept addresses internal and external validity concerns that have long plagued this research tradition. Our multivariate analyses indicate that policy innovativeness is often a statistically and substantively important determinant of compact participation. These results suggest that (i) innovativeness is a meaningful and durable state attribute, (ii) several existing indices successfully capture the underlying latent concept, and (iii) innovativeness provides analytic utility in multiple empirical contexts.