Reforming state-level coastal management and development policies: strategic retreat as an innovative, proactive and equitable coastal environmental management strategy

Atlantic and Gulf Coast shorelines include some of the most unique and biologically rich ecosystems in the United States that provide immeasurable aesthetic, habitat and economic benefits. Natural coastal ecosystems, however, are under increasing threat from rampant and irresponsible growth and development. Once a boon to local economies, complex natural forces – enhanced by global climate change and sea level rise - are now considered hazards and eroding the very foundation upon which coastal development is based. For nearly a century, beach restoration and erosion control structures have been used to artificially stabilize shorelines in an effort to protect structures and infrastructure. Beach restoration, the import and emplacement of sand on an eroding beach, is expensive, unpredictable, inefficient and may result in long-term environmental impacts. The detrimental environmental impacts of erosion control structures such as sea walls, groins, bulkheads and revetments include sediment deficits, accelerated erosion and beach loss. These and other traditional responses to coastal erosion and storm impacts- along with archaic federal and state policies, subsidies and development incentives - are costly, encourage risky development, artificially increase property values of high-risk or environmentally sensitive properties, reduce the post-storm resilience of shorelines, damage coastal ecosystems and are becoming increasingly unsustainable. Although communities, coastal managers and property owners face increasingly complex and difficult challenges, there is an emerging public, social and political awareness that, without meaningful policy reforms, coastal ecosystems and economies are in jeopardy. Strategic retreat is a sustainable, interdisciplinary management strategy that supports the proactive, planned removal of vulnerable coastal development; reduces risk; increases shoreline resiliency and ensures long term protection of coastal systems. Public policies and management strategies that can overcome common economic misperceptions and promote the removal of vulnerable development will provide state and local policy makers and coastal managers with an effective management tool that concomitantly addresses the economic, environmental, legal and political issues along developed shorelines. (PDF contains 4 pages

The Seed

pages 37-5

SPRU report to the SPLiCE Project: a review of 'social appraisal' methodologies

No description supplie

Multicriteria mapping manual - version 2.0

Multicriteria mapping (MCM) is an interactive appraisal method for exploring contrasting perspectives on complex strategic and policy issues. The tool aims to help 'open up' technical assessment by systematically 'mapping' the practical implications of alternative options, issues, uncertainties and values. MCM uniquely bridges qualitative and quantitative approaches, and helps to get the best of both. It allows great flexibility, offering an appraisal method that is strongly grounded in theory but highly unconstrained in practice. This versatility has been reflected in its use internationally to explore contentious decisions in the fields of energy strategy, food production, environmental policy, radioactive waste management and public health. This MCM Manual offers basic advice on how to do multicriteria mapping. It suggests how to: design and build a typical MCM project; engage with participants; and analyse results – and get the most out of the online MCM tool. The online MCM software tool provides its own operational help so the manual is more focused on the general approach

After Closure: Options for Pursuing a High Performance Rural Health System

Presented at the 2017 National Rural Health Association Annual Meeting. Coburn, a member of the Rural Policy Research Institute Panel, discussed the following key questions: What kind of rural health system is possible in places that cannot support a full-service hospital? How does a rural community navigate the transition from hospital-centric care toward new models that deliver high performance? What implementation support will be needed? Coburn noted that there is no single model for re-configuring the rural health system after hospital closure; local assets, affiliations and partnerships, financial and delivery flexibility and capacities must be critically assessed to determine the community’s options and strategies

Federal Health Care Reform: An Overview

This policy brief discusses three of the main components of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare . These components are helath insurance coverage, delivery system improvement, and cost containment. The policy brief highlights some of the provision of the law that have already been implemented and those where importnat implementation decisions will have to be made. The brief is authored by Dr. Andrew Coburn, PhD, Professor of Public Health and Director of the Population Health and Health Policy program at the USM Muskie School, and was presented at the Maine Policy Leaders Academy Health Care Forum breakfast session, Feb. 26, 2013 at the Senator Inn in Augusta,sponsored by the Maine Health Access Foundation

Providing Better Care at Lower Cost: Building Maine\u27s health data infrastructure to support financing and delivery system reform

Maine needs a robust and functional health data infrastructure to support efforts by health care providers and purchasers to improve quality, address Maine’s health care cost problems, and improve the health of individuals and populations through payment and delivery system reform. Although Maine has been a leader in building and using health data systems such as the hospital discharge data set and the all-payer claims database, new performance-based financing and delivery system arrangements are highlighting shortcomings in these systems and the need for a renewed vision of Maine’s future health data infrastructure. The Health Data Workgroup was created by The Advisory Council for Health Systems Development (ACHSD) to address the stated goal of the 2010 – 2012 Maine State Health Plan to develop a “roadmap” for continuing to build Maine’s health data, analysis and research infrastructure to support health care payment and delivery system reform. This report presents the Workgroup’s recommendations. These recommendations focus on incremental steps needed to strengthen the capacity of Maine’s health data systems to support the key functions integral to new healthcare financing and delivery arrangements. Each of the recommendations is followed by a discussion of priority needs identified by the Workgroup and selected findings from the Workgroup’s background research and presentations to the Workgroup

Models for Integrating and Managing Acute and Long-term Care Services in Rural Areas [Working Paper]

Post-acute and long term care services for older persons and persons with serious disabilities are responsible for an ever-larger share of the costs of the Medicare and Medicaid programs. The need to control demand and expenditures has led states and the federal government to seek new managed care strategies, such as capitated financing and coordinated case management, that integrate the financing and delivery of primary care, acute and long term care services. Integration and managed care are viewed as encouraging a substitution of less costly and more appropriate home and community-based services for high cost medical and long term care services which have been heavily funded under fee-for-service financing systems. From a rural perspective, the development of organizational and delivery systems which better integrate and manage primary, acute and long term care services may help address long-standing problems of limited availability of and access to long term care services. Over the past decade, many rural hospitals have developed or acquired postacute care services such as home health agencies and/or skilled nursing facilities as a strategy for managing their inpatient use and diversifying their revenue base. And some rural hospitals have ventured into the world of long term care as well, offering assisted living, adult day service programs, respite programs, or sponsoring meal sites for older persons. The growing involvement of rural hospitals in the post-acute and long term care services may provide important opportunities to develop more integrated acute and long term care systems in these communities. Notwithstanding the significant challenges, there are emerging examples of rural networks and managed long term care programs that offer important insights into the opportunities and challenges of using these approaches in rural settings. This paper discusses the concept of integrated acute (medical) and long term care service networks, some of the model programs that have been demonstrated, the challenges that health care providers, state policymakers, and others have faced in developing these new integrated structures, and the future of integrated approaches in rural areas. The paper updates and expands upon key findings, insights, and conclusions from a recent study of several of these programs (Coburn et al. 1997)