Suchergebnisse

Scholars of policy networks consistently find that agreement on policy explains network ties, but inconsistent results on the importance of strategic considerations, such as the influence of potential partners. We use original data on communications between bureaucrats and lobbyists on pending Medicaid legislation to distinguish network ties (contacts) from bureaucrats' use of those ties to attempt to advance their policy goals (requests for lobbying help). We find that policy agreement explains both the strength of network ties and bureaucrats' requests for advocacy from their partners, but that interest group influence and unified partisan control of government explain only the latter.

AbstractResearch on bureaucratic power typically focusses on rulemaking and policy implementation, while bureaucrats' participation in the legislative process remains underexplored. We theorise and test a specific mechanism by which bureaucrats attempt to sway legislative outcomes, which we termindirect bureaucratic lobbying. Using a novel survey of state-based health lobbyists in 25 states, we show that state Medicaid agency staff routinely request lobbying assistance from provider associations and consumer advocates. We also provide the first systematic evidence of the conditions under which indirect bureaucratic lobbying is likely to occur. Our results suggest that individual-level policy agreement interacts with institutional factors, most notably agency performance and gubernatorial power, to increase the likelihood that bureaucrats will use this strategy to attempt to influence legislative deliberations.

AbstractThe effects of competition within alternative food networks (AFNs) remain largely unexplored. Using a study of farms that operate Community Supported Agriculture (CSA) programmes in California, the state in the USA with the most CSAs, we empirically examine the effects of competition within alternative food networks. We conducted a statewide survey of CSA farmers in California, which collected data from 111 CSAs. For this analysis we construct a perceived competition index composed of variables that measure farmers' perceptions of competition with numerous market outlets and their being constrained in raising their prices due to competitive pressures. Our analysis shows that perceived competition is negatively correlated with CSA farms' profitability, farmers' satisfaction on a number of fronts, various indicators of the social embeddedness of CSA, and two community food security strategies. We conclude that competition is a real, although differential, phenomenon experienced by many CSA farmers in California, and that this competition impacts CSA in ways that undermine some of its commonly held values, especially fair farmer compensation and strong member‐farmer relationships.

IMPORTANCE: Bariatric surgical procedures have been associated with increased risk of unhealthy alcohol use, but no previous research has evaluated the long-term alcohol-related risks after laparoscopic sleeve gastrectomy (LSG), currently the most used bariatric procedure. No US-based study has compared long-term alcohol-related outcomes between patients who have undergone Roux-en-Y gastric bypass (RYGB) and those who have not. OBJECTIVE: To evaluate the changes over time in alcohol use and unhealthy alcohol use from 2 years before to 8 years after a bariatric surgical procedure among individuals with or without preoperative unhealthy alcohol use. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study analyzed electronic health record (EHR) data on military veterans who underwent a bariatric surgical procedure at any of the bariatric centers in the US Department of Veterans Affairs (VA) health system between October 1, 2008, and September 30, 2016. Surgical patients without unhealthy alcohol use at baseline were matched using sequential stratification to nonsurgical control patients without unhealthy alcohol use at baseline, and surgical patients with unhealthy alcohol use at baseline were matched to nonsurgical patients with unhealthy alcohol use at baseline. Data were analyzed in February 2020. INTERVENTIONS: LSG (n = 1684) and RYGB (n = 924). MAIN OUTCOMES AND MEASURES: Mean alcohol use, unhealthy alcohol use, and no alcohol use were estimated using scores from the validated 3-item Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), which had been documented in the VA EHR. Alcohol outcomes were estimated with mixed-effects models. RESULTS: A total of 2608 surgical patients were included in the final cohort (1964 male [75.3%] and 644 female [24.7%] veterans. Mean (SD) age of surgical patients was 53.0 (9.9) years and 53.6 (9.9) years for the matched nonsurgical patients. Among patients without baseline unhealthy alcohol use, 1539 patients who underwent an LSG were matched to 14 555 ...