Anirudh V. S. Ruhil

Institutions and Reform Reinventing Local Government

During the past few years, a new wave of reform has been launched under the rubric of reinventing government. Yet, despite the hype, little is known about the extent to which reinventing government is a reality across the country. The authors undertake a systematic analysis of reform activity in a large sample of suburban municipalities and find low rates of adoption of current reforms. Although a number of identifiable and theoretically important institutional constraints inhibit reform activity, city manager leadership appears to be critical for overcoming the impediments to efficient governance.

Associations Between Preoperative Physical Therapy and Post-Acute Care Utilization Patterns and Cost in Total Joint Replacement

BACKGROUND Health-care costs following acute hospital care have been identified as a major contributor to regional variation in Medicare spending. This study investigated the associations of preoperative physical therapy and post-acute care resource use and its effect on the total cost of care during primary hip or knee arthroplasty. METHODS Historical claims data were analyzed using the Centers for Medicare & Medicaid Services Limited Data Set files for Diagnosis Related Group 470. Analysis included descriptive statistics of patient demographic characteristics, comorbidities, procedures, and post-acute care utilization patterns, which included skilled nursing facility, home health agency, or inpatient rehabilitation facility, during the ninety-day period after a surgical hospitalization. To evaluate the associations, we used bivariate and multivariate techniques focused on post-acute care use and total episode-of-care costs. RESULTS The Limited Data Set provided 4733 index hip or knee replacement cases for analysis within the thirty-nine-county Medicare hospital referral cluster. Post-acute care utilization was a significant variable in the total cost of care for the ninety-day episode. Overall, 77.0% of patients used post-acute care services after surgery. Post-acute care utilization decreased if preoperative physical therapy was used, with only 54.2% of the preoperative physical therapy cohort using post-acute care services. However, 79.7% of the non-preoperative physical therapy cohort used post-acute care services. After adjusting for demographic characteristics and comorbidities, the use of preoperative physical therapy was associated with a significant 29% reduction in post-acute care use, including an

STRUCTURAL CHANGE AND FISCAL FLOWS A Framework for Analyzing the Effects of Urban Events

871 reduction of episode payment driven largely by a reduction in payments for skilled nursing facility (

Urban Armageddon or Politics as Usual? The Case of Municipal Civil Service Reform

1093), home health agency (

The Study of Local Elections

527), and inpatient rehabilitation (

Institutions, Bureaucratic Decisions, and Policy Outcomes: State Insurance Solvency Regulation

172). CONCLUSIONS The use of preoperative physical therapy was associated with a 29% decrease in the use of any post-acute care services. This association was sustained after adjusting for comorbidities, demographic characteristics, and procedural variables. CLINICAL RELEVANCE Health-care providers can use this methodology to achieve an integrative, cost-effective, patient care pathway using preoperative physical therapy.

Are We There Yet? The Voting Rights Act and Black Representation on City Councils, 1981–2006

The political and policy impacts of alternative governing arrangements are an enduring and important puzzle of urban politics. Locating the source of the empirical confusion over structural effects in the use of static data analysis, the author emphasizes the benefits of investigating the substantive consequences of identifiable events (e.g., changes in form of government, budgeting techniques, the election of a minority mayor) via dynamic multiwave panel data and appropriate estimation techniques. This point is illustrated by analyzing the fiscal effects of reformism in a panel of 222 cities (1946-1966). Findings suggest no more than transient decreases in per-capita city expenditures postadoption of council-manager government.

Book Review: Political Monopolies in American Cities: The Rise and Fall of Bosses and Reformers, by Jessica Trounstine. Chicago: University of Chicago Press, 2008. 296 pp.

For the better part of the twentieth century, the question of municipal reformism has drawn urban scholarship: Why do some cities change their governing arrangements while others do not? Focusing exclusively on merit systems, in this study I expose the political underpinnings of merit reform in American municipal history. A duration analysis of merit adoptions in a sample of 252 cities in the 1900–1940 period suggests that both state- (home rule status, state merit systems) and city-specific (at-large elections, term length, city size, percent foreign-born, regional location) factors largely determined when and where reform occurred.

60 (cloth);

Given the large number of cases and considerable institutional and contextual variation across and within local governments, one might assume that the study of local elections is an area already well harvested by political scientists. The truth, however, is that this area of inquiry is relatively unexplored. In fact, to say that a field of study on local elections exists would be a bit of an overstatement. Not only is the literature rather small and not particularly cohesive, but the data collection and methods of analysis are also somewhat primitive, particularly compared to research on state and federal elections. While, on the one hand, this lack of subfield development means that there are many unanswered and even unexplored questions, on the other hand, it means that the possibilities for future research are practically limitless. Clearly, the study of local elections has been made more challenging by the sheer number of local governments in the United States. Of the 89,527 governmental units enumerated in 2007, 89,476 (99.9%) were local governments, with municipalities numbering 19,492 (U.S. Census Bureau 2007a). Not surprisingly, the number of public officials holding elective positions in local government is also enormous—roughly half a million. In fact, 96% of all elected officials represent local rather than state or federal jurisdictions, and officials from municipalities constitute the largest share of this population, at 27%. Beyond the numbers, several additional features distinguish municipal governments from either state or federal governments and contribute to the complexity of their study. First, at no other level of government is the timing of elections so varied. Indeed, with only 23% of cities holding elections exclusively in even years (International City/County Management Association [ICMA] 2002), the term “off-cycle” would be irrelevant were it not for local governments. Keeping track of elections is thus no small matter. Second, the methods that cities adopt to elect officials are extremely varied. Unlike congressional and nearly all state legislative elections, most city council elections (66%) are multi-member (at-large) rather than singlemember (district/ward; ICMA 2002). Finally, the prevalence of nonpartisan elections is a notable feature of local elections, with 77% of cities reportedly using this type of election in 2001 (ICMA 2002). Heavy reliance on nonpartisan elections has likely discouraged elections scholars from studying local elections for the simple reason that it leaves no simple way to study vote choice. Indeed, scholars who have investigated vote choice have approached the subject as a choice between either the incumbent and challenger(s) (Berry and Howell 2007; Krebs 1998; Oliver and Ha 2007) or the minority and nonminority candidate(s) (Barreto 2007; Barreto, Villarreal, and Woods 2005; Brockington et al. 1998; for an alternate view, see Ferreira and Gyourko 2009). Consequently, apart from case study research, most local elections studies ignore vote choice completely.

22 (paper)

Although over the past 2 decades several scholars have documented a link between institutional arrangements and policy choices, few studies have demonstrated how different institutional arrangements give rise to different policy outcomes. Further, although some studies have related bureaucratic resources to policy decisions, almost none have illustrated that the way state agencies actually deploy regulatory resources—policy outputs—significantly influences policy outcomes. Focusing specifically on the insurance industry in the United States, in this article we illustrate the impact of state regulatory activities on the solvency of firms in the insurance industry from 1987 to 1997, and in doing so we emphasize the differences between policy outputs and policy outcomes. In the case of policy outputs, for example, we find that elected insurance commissioners, divided state government, budgetary resources, and larger insurance sectors lead to more aggressive solvency examinations of insurers. In addition to examinations, however, we discern an important role for both regulatory and political institutions in subsequent insurer insolvencies.