Some expectations and perceptions of electronic transfer of prescription systems

This article summarises the findings of five focus group sessions discussing the Electronic Transfer of Prescriptions (ETP), held in 2003 at Salford and Huddersfield Universities. The aim of this evaluation was to ascertain the views of the stakeholders towards the introduction of ETP and views on existing ETP pilot models. The eight hypotheses identified as most important from the findings [1] are described

Maxwell\u27s Equations, Part V

This is the fifth installment in a series devoted to explaining Maxwell’s equations, the four mathematical statements upon which the classical theory of electromagnetic fields – and light – is based. Previous installments can be found on Spectroscopy’s website (whose URL can be found throughout these issues). Maxwell’s equations are expressed in the language of vector calculus, so a significant part of some previous columns have been devoted to explaining vector calculus, not spectroscopy. For better or worse, that’s par for the course, and it’s my job to explain it well – I trust readers will let me know if I fail! The old adage “the truth will set you free” might be better stated, for our purposes, as “math will set you free”. And that’s the truth

Redesigning Sentencing

Design thinking purports to take the methods of industrial and product design and apply them to social and political problems. One particularly intractable problem in California is its bloated penal code, which has expanded almost continuously over the past forty years. Since 1983, more than a dozen bills have been introduced in the CaliforniaLegislature to establish a sentencing commission. All have failed. In this paper I explore how design thinking might help frame our discussion of mass incarceration in general and sentencing commissions in particular:what kinds of changes are possible within the foreseeable future, how wecan make any changes sustainable, and how we can make them appeal toa wider audience. I conclude that, without a broader base of supportamong policymakers, criminal justice officials, and the population at large, any sentencing commission, no matter how well it is designed, will fail. To build that support, then, I propose that California create a separate prison tax line item on state tax returns indicating the proportional amount a taxpayer must contribute to support the state prison system. Putting the cost of prisons in front of taxpayers right before they write their checks would distribute valuable information about the expense and overcrowding of prisons, as well as generate some fiscal impetus to control or reduce them

Defunding State Prisons

Local agencies drive criminal justice policy, but states pick up the tab for policy choices that result in state imprisonment. This distorts local policies and may actually contribute to increased state prison populations, since prison is effectively “free” to the local decisionmakers who send inmates there. This Article looks directly at the source of the “correctional free lunch” problem and proposes to end state funding for prisons. States would, instead, reallocate money spent on prisons to localities to use as they see fit — on enforcement, treatment, or even per-capita prison usage. This would allow localities to retain their decision-making autonomy, but it would internalize the costs of those decisions

Pay-for-Performance in Prison: Using Healthcare Economics to Improve Criminal Justice

For much of the last seventy-plus years, healthcare providers in the United States have been paid under the fee-for-service system, where providers are reimbursed for procedures performed, not outcomes obtained. Providers, insurers, and consumers are motivated by different individual and organizational incentives; costs and burdens of patient care are shifted from one part of the system to another. The result has been a system that combines exploding costs without concomitant increases in quality. Healthcare economists and policymakers have reacted by proposing a number of policies designed to reign in costs without sacrificing quality. One approach is to focus on the ultimate goal — improving health outcomes — by measuring those outcomes and reconfiguring incentives and structures to deliver healthcare in ways that are both efficacious and efficient. One particular strategy is pay for performance, under which providers are paid to improve health by whatever medically-appropriate method they choose. This means providers are no longer paid for simply doing a given “something” but, rather, are paid for doing “something effective.” In this Article, I argue that the criminal justice system is similarly fragmented, expensive, and inefficient, marked by many of the same distorted individual and organizational incentives that have plagued health care. Most significantly, in all but a handful of jurisdictions, states wholly subsidize commitments to prison — the fee-for-service model of doing “something” — without tying any of these subsidies to outcomes obtained in prison. This means prison is paid for even if it is neither effective nor efficient. These similarities with the healthcare system suggest that an outcome-oriented, pay-for-performance framework borrowed from healthcare economics might, if applied to criminal justice, improve its efficacy and efficiency. I envision this Article as the first of several applying healthcare economics to criminal justice. It will focus on the similarities of the two systems, the ways in which an outcome orientation might provide a useful framework for controlling costs without making quality subservient, and the suggestion that we begin considering sentencing choices within that framework

The Plausible and the Possible: A Bayesian Approach to the Analysis of Reasonable Suspicion

The United States Supreme Court uses the wrong approach to analyze reasonable suspicion. The Court asks whether, if criminal activity were afoot, an officer would be likely to see what she saw (e.g. furtive gestures or flight from police). The ultimate question we are interested in, however, is whether, given what the officer saw, her conclusion about criminal activity was reasonable. These two questions are different. Even if it is highly likely that an officer would make a set of observations when criminal activity is afoot, it does not follow that criminal activity is itself highly likely when an officer makes these observations. The answer to this latter question is the one we are most interested in. The Court’s analysis of reasonable suspicion is inaccurate and illogical, and it fails to consider all the relevant information. In this Essay, I propose that a Bayesian approach could improve judicial assessments of reasonable suspicion. Bayesian analysis is designed to deal with conditional probabilities (e.g., how likely is it that criminal activity is afoot given a furtive gesture) and relative likelihoods (of all the possibilities that might explain the furtive gesture, which is the most likely and by how much). Crucially, Bayesian analysis includes all relevant information — especially information about false positives that result from innocent people displaying the same behavior as those engaged in criminal activity. This essay will demonstrate how Bayesian tools might more easily reveal logical gaps in the analysis of reasonable suspicion and help to estimate the “reasonableness” of a given investigation more coherently, consistently, and accurately

Internal Revenue Service General Counsel\u27s Memorandum Threatens Tax Exemption for Charitable Hospitals

A recent memorandum from the General Counsel of the Internal Revenue Service changes the standard against which tax exempt entities will be measured, which change can adversly affect charitable hospitals\u27 tax exempt status. In addition, the memorandum makes clear that a violation of the Anti-Kickback statute, discussed in Mr. Aaron\u27s article, is inconsistent with tax exempt status