Risk, commercialism and social purpose: Repositioning the English housing association sector

Originally seen as the ‘third arm’ of UK housing policy, the independent, not-for-profit housing association sector had long been seen as effective in ‘filling the gap’ where the state or market were unable to provide for households in need. Since the 1980s in particular, successive governments had viewed housing associations in favourable terms as efficient, semi-autonomous social businesses, capable of leveraging significant private funding. By 2015, in contrast, central government had come to perceive the sector as inefficient, bureaucratic and wasteful of public subsidy. Making use of institutional theory, this paper considers this paradigm shift and examines the organisational responses to an increasingly challenging operating environment. By focusing, in particular, on large London housing associations, the paper analyses their strategic decision-making to address the opportunities and threats presented. The paper argues that in facing an era of minimal subsidy, low security and high risk, the 2015 reforms represent a critical juncture for the sector. Housing organisations face a stark dilemma about whether to continue a strategy of ‘profit for purpose’ or to embrace an unambiguously commercial ethos. The article contends that the trajectory of decision-making (although not unidirectional) leads ultimately towards an increased exposure to risk and vulnerability to changes in the housing market. More fundamentally, the attempt to reconcile social and commercial logics is likely to have wider consequences for the legitimacy of the sector

Predictors of Prescription Opioid Misuse Based on Type of Healthcare Insurance

The misuse and abuse of prescription opioid (PO) medications has garnered the attention of lawmakers, healthcare professionals, and public health experts since the opioid epidemic was declared a national public health emergency in 2017. Our purpose in this study was to investigate the types of healthcare insurance that predict PO misuse. We also sought to inform stakeholders of potentially needed changes to the existing inconsistent drug utilization rules necessary to achieve parity among all types of healthcare insurance and minimize loopholes. We performed a secondary data analysis on the 2019 National Survey on Drug Use and Health data of noninstitutionalized U.S. citizens aged 12 years and older and used a binary logistic regression analysis to evaluate the data. Medicare beneficiaries were 1.79 times more likely and those who had private healthcare insurance through an employer or union were 1.68 times more likely (95% CI [ 1.025, 3.141] and [1.148, 2.463], respectively) than respondents with other healthcare insurances to use PO longer or in greater amounts than the prescription intended. Respondents who had Medicare were 2.226 times more likely than respondents with other healthcare insurance (95% CI [1.029, 4.989]) to misuse PO by taking the medications longer and for other reasons not specified. Our study demonstrates that the type of healthcare insurance is a predictor of PO misuse. Our research also emphasizes the need for stakeholders to use evidence-based research to ensure parity among insurances

The taxing problems of land value capture, planning obligations and viability tests: some reasonable models?

Given their increasing importance in the formation and implementation of planning policies in the UK, this paper focuses on the use of development viability tests to determine how land value uplifts actuated by planning consent could be distributed between developers, landowners and the community. Following a discussion of way in which planning obligations act as a quasi-betterment tax that can both capture and create land values, alternative approaches to operationalising Benchmark Land Value (BLV) are evaluated. The effects of different approaches to BLV on potential land value capture are simulated for a number of hypothetical development sites in order to identify and compare implied betterment tax rates and to estimate viable affordable housing proportions. It is concluded that large geographical variations in property prices produce large variations in the potential for land value capture. Different approaches to BLV have a range of strengths and weaknesses. In addition, given that viability models are susceptible to significant levels of error and potential bias, using such models to make and implement planning policies renders such processes vulnerable to opportunistic behaviour and prone to miscalculation