The Behavioral Model of Health Services Use was initially developed over 25 years ago. In the interim it has been subject to considerable application, reprobation, and alteration. I review its development and assess its continued relevance.

Revisiting the behavioral model and access to medical care: does it matter?

While heated arguments between practitioners of qualitative and quantitative research have begun to test the very integrity of the social sciences, Gary King, Robert Keohane, and Sidney Verba have produced a farsighted and timely book that promises to sharpen and strengthen a wide range of research performed in this field. These leading scholars, each representing diverse academic traditions, have developed a unified approach to valid descriptive and causal inference in qualitative research, where numerical measurement is either impossible or undesirable. Their book demonstrates that the same logic of inference underlies both good quantitative and good qualitative research designs, and their approach applies equally to each. Providing precepts intended to stimulate and discipline thought, the authors explore issues related to framing research questions, measuring the accuracy of data and uncertainty of empirical inferences, discovering causal effects, and generally improving qualitative research. Among the specific topics they address are interpretation and inference, comparative case studies, constructing causal theories, dependent and explanatory variables, the limits of random selection, selection bias, and errors in measurement. Mathematical notation is occasionally used to clarify concepts, but no prior knowledge of mathematics or statistics is assumed. The unified logic of inference that this book explicates will be enormously useful to qualitative researchers of all traditions and substantive fields.

Designing Social Inquiry: Scientific Inference in Qualitative Research

n today's fast changing and interconnected global world, researchers in a variety of areas have come to see identity as an important analytic tool for understanding schools and society. A focus on the contextually specific ways in which people act out and recognize identities allows a more dynamic approach than the sometimes overly general and static trio of "race, class, and gender." However, the term identity has taken on a great many different meanings in the literature. Rather than survey this large literature, I will sketch out but one approach that draws on one consistent strand of that literature. This is not to deny that other, equally useful approaches are possible, based on different selections from the literature.

Identity as an analytic lens for research in education

Organizational identity usually is portrayed as that which is core, distinctive, and enduring about the character of an organization. We argue that because of the reciprocal interrelationships between identity and image, organizational identity, rather than enduring, is better viewed as a relatively fluid and unstable concept. We further argue that instead of destabilizing an organization, this instability in identity is actually adaptive in accomplishing change. The analysis leads to some provocative, but nonetheless constructive, implications for theory, research, and practice.

Organizational Identity, Image, and Adaptive Instability

The concept of territoriality has been studied surprisingly little by students of international politics. Yet, territoriality most distinctively defines modernity in international politics, and changes in few other factors can so powerfully transform the modern world polity. This article seeks to frame the study of the possible transformation of modern territoriality by examining how that system of relations was instituted in the first place. The historical analysis suggests that “unbundled” territoriality is a useful terrain for exploring the condition of postmodernity in international politics and suggests some ways in which that exploration might proceed. The emergence of multiperspectival institutional forms is identified as a key dimension of the condition of postmodernity in international politics.

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Territoriality and beyond: problematizing modernity in international relations

Post-Modernism and the Social Sciences

Partnerships between the public and private sectors to fulfill public functions are on the increase at every level of government In the United States and Canada they currently operate in most policy areas, and in the US trial programs are planned by the Internal Revenue Service, the Census Bureau, and the Social Security AdministrationPartnerships represent the second generation of efforts to bring competitive market discipline to bear on government operations Unlike the first generation of privatizing efforts, partnering involves sharing both responsibility and financial risk In the best situations, the strengths of each sector maximize overall performance In these cases, partnering institutionalizes collaborative arrangements in which the differences between the sectors become blurredThis is the first book to evaluate public-private partnerships in a broad range of policy areas The chapters focus on education, health care and health policy, welfare, prisons, the criminal justice system, environmental policy, energy policy, technology research and development, and transportation The contributors come from a number of fields, including political science, education, law, economics, and public health They merge experiential and social-scientific findings to examine how partnerships perform, to identify the conditions in which they work best, and to determine when they might be expected to failContributors : Ronald J Daniels, James A Dunn, Jr, Sheldon Kamieniecki, Harry M Levin, Stephen H Linder, Nicholas P Lovrich, Jr, Mark Carl Rom, Pauline Vaillancourt Rosenau, Walter A Rosenbaum, Anne Larason Schneider, David Shafie, Julie Silvers, Michael S Sparer, Joseph E Stiglitz, Michael J Trebilcock, Scott J Wallsten

Public-private policy partnerships

In theory, public-private partnerships in many policy sectors are expected to create synergistic dynamics that draw on the strengths and weaknesses of each partner. Evidence from the articles in this issue suggests that this is not always the case. Partnering may, at least in the short term, decrease costs, if cost and efficiency are defined narrowly and externalities are discounted. Despite this advantage, public-private policy partnerships have substantial problems. They do not exhibit superior performance in the criteria of equity, access, and democracy. Rather than reduce regulation, public-private policy partnerships appear to increase it. Regarding accountability, public partners are the providers of last resort, although this could change if private partners gain more experience and partnering moves beyond minimalist forms to more fully developed policy partnerships. In short, public-private policy partnerships are imperfect and in need of refinement and reform. Several articles in this issue provi...

Introduction: The Strengths and Weaknesses of Public-Private Policy Partnerships

Objective. This article reports on a systematic review of data-based, peer-reviewed scientific assessments of performance differences between private for-profit and private nonprofit U.S. health care providers published since 1980.



Methods. Computerized bibliographic searches of all relevant databases yielded 149 studies (179 assessments) that compared the performance of for-profit and nonprofit health care providers on four performance criteria (access, quality, cost/efficiency, and/or amount of charity care). Reported findings on performance were coded in one of three ways: for-profit superiority, nonprofit superiority, or no difference/mixed results.



Results. Overall, the nonprofits were judged superior 59 percent of the time, the for-profits superior only 12 percent of the time, and for the rest (29 percent), no difference was found or results were mixed.



Conclusions. Caution is warranted on policies that encourage private for-profit entities to replace private nonprofit providers of health care services in the United States.

Two Decades of Research Comparing For‐Profit and Nonprofit Health Provider Performance in the United States*

This analysis of the United States health system reviews the developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The US health system has both considerable strengths and notable weaknesses. It has a large and well-trained health workforce, a wide range of high-quality medical specialists as well as secondary and tertiary institutions, a robust health sector research program and, for selected services, among the best medical outcomes in the world. But it also suffers from incomplete coverage of its citizenry, health expenditure levels per person far exceeding all other countries, poor measures on many objective and subjective measures of quality and outcomes, an unequal distribution of resources and outcomes across the country and among different population groups, and lagging efforts to introduce health information technology. It is difficult to determine the extent to which deficiencies are health-system related, though it seems that at least some of the problems are a result of poor access to care. Because of the adoption of the Affordable Care Act in 2010, the United States is facing a period of enormous potential change. Improving coverage is a central aim, envisaged through subsidies for the uninsured to purchase private insurance, expanded eligibility for Medicaid (in some states) and greater protection for insured persons. Furthermore, primary care and public health receive increased funding, and quality and expenditures are addressed through a range of measures. Whether the ACA will indeed be effective in addressing the challenges identified above can only be determined over time.

Pauline Vaillancourt Rosenau

Papers

Post-Modernism and the Social Sciences

Public-private policy partnerships

Introduction: The Strengths and Weaknesses of Public-Private Policy Partnerships

Two Decades of Research Comparing For‐Profit and Nonprofit Health Provider Performance in the United States*

United States of America: health system review