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Cost-benefit analysis, as a tool of general use in policy analysis or as a mandated analytical process in some rulemaking, provides protocols for assessing the relative efficiency of policy alternatives. However, inconsistent and apparently irrational decisions by consumers in some situations call into question the validity of inferring the values that consumers place on outcomes from their observed choices. It also opens the door for \"nudges\" that change the architecture of choice to promote more \"rational\" consumer choice. Differences between decision utility and experience utility and the willingness of consumers to pay for reductions in temptation provide conceptual bases for thinking about the efficiency of nudges. However, assessment of nudges and their role in behavioral public administration should also recognize that heterogeneous preferences can result in increases in utility for some and decreases for others. Therefore, nudges require systematic assessment like other policy instruments.

In 2016, the Centers for Medicare & Medicaid Services (CMS) introduced 3 new quality measures (QMs) to its report card, Nursing Home Compare (NHC). These measures—rehospitalizations, emergency department visits, and successful discharges to the community—focus on short-stay residents. We offer a first analysis of nursing homes’ performance in terms of these new measures. We examined their properties and distribution across nursing homes using descriptive statistics and regression models. We found that, similar to other QMs, performance varies across the country, and that there is very minimal correlation between these 3 new QMs as well as between these QMs and other NHC QMs. Regression models reveal that better performance on these QMs tends to be associated with fewer deficiencies, higher staffing and more skilled staffing, nonprofit ownership, and lower proportion of Medicaid residents. Other characteristics are associated with better performance for some but not all 3 QMs. We also found improvement in all 3 QMs in the second year of publication. This study contributes to the validity of these measures by demonstrating their relationship to these structural QMs. It also suggests that these QMs are important by demonstrating their large variation across the country, suggesting substantial room for improvement, and finding that nursing homes are already responding to the incentives created by publication of these QMs.

One way for jurisdictions with limited analytic resources to increase their capability for doing cost-benefit analysis (CBA) is to use existing shadow prices, or \"plug-ins\", for important social impacts. This article contributes to the further development of one important shadow price: the value of an additional high school graduation in the United States. Specifically, how valuable to a student, government, and the rest of society in aggregate is a high school graduation? The analysis builds on the method developed by the Washington State Institute for Public Policy and presents numerical updates and extensions to their analysis. For the U.S., the estimated net present value (the social value) using a 3 percent real discount rate of this shadow price is approximately $300,000 per each additional graduate. In appropriate circumstances, this value can be \"plugged-in\" to CBAs of policies that either directly or indirectly seeks to increase the number of students who graduate from high school.

The adequacy of provider networks for plans sold through insurance Marketplaces established under the Affordable Care Act has received much scrutiny recently. Various studies have established that networks are generally narrow. To learn more about network adequacy and access to care, we investigated two questions. First, no matter the nominal size of a network, can patients gain access to primary care services from providers of their choice in a timely manner? Second, how does access compare to plans sold outside insurance Marketplaces? We conducted a \"secret shopper\" survey of 743 primary care providers from five of California's nineteen insurance Marketplace pricing regions in the summer of 2015. Our findings indicate that obtaining access to primary care providers was generally equally challenging both inside and outside insurance Marketplaces. In less than 30 percent of cases were consumers able to schedule an appointment with an initially selected physician provider. Information about provider networks was often inaccurate. Problems accessing services for patients with acute conditions were particularly troubling. Effectively addressing issues of network adequacy requires more accurate provider information.

The Patient Protection and Affordable Care Act (ACA) of 2010 has been one of the most controversial laws in decades. The ACA relies extensively on the cooperation of states for its implementation, offering opportunities for both local adaptation and political roadblocks. Health insurance exchanges are one of the most important components of the for achieving its goal of near-universal coverage. Despite significant financial support from the federal government, many governors and legislatures have taken actions that have blocked or delayed significant progress in developing their exchanges. However, many state commissioners of insurance have played constructive roles in moving states forward in exchange planning through their expertise, leadership, and pragmatism, sometimes in spite of strong political opposition to the from governors and legislatures.

In this analysis the authors compared the hospital networks available to California consumers in two types of insurance in the initial Marketplace enrollment period: private commercial coverage and coverage obtained through the state insurance Marketplace, called Covered California. They gathered data from Covered California to identify insurers that were offering plans and to identify their associated hospitals. They found insurers in each region that offered comparable plans through both Covered California and the commercial market. The resulting dyads of plans hold constant region, insurer, and plan type, which allows for a direct comparison of networks. They then compared the networks in terms of percentages of hospitals in the region, percentages of residents in the region within hospital markets, and average quality of included hospitals using three different quality measures. Although the hospital networks for Marketplace plans do appear to be, on average, narrower than those for the commercial plans, the Marketplace networks have comparable quality for two of the quality measures and actually have higher average quality for the third.

The Internet offers a number of advantages as a survey mode: low marginal cost per completed response, capabilities for providing respondents with large quantities of information, speed, and elimination of interviewer bias. Those seeking these advantages confront the problem of representativeness both in terms of coverage of the population and capabilities for drawing random samples. Two major strategies have been pursued commercially to develop the Internet as a survey mode. One strategy, used by Harris Interactive, involves assembling a large panel of willing respondents who can be sampled. Another strategy, used by Knowledge Networks, involves using random digit dialing (RDD) telephone methods to recruit households to a panel of Web-TV enabled respondents. Do these panels adequately deal with the problem of representativeness to be useful in political science research? The authors address this question with results from parallel surveys on global climate change and the Kyoto Protocol administered by telephone to a national probability sample and by Internet to samples of the Harris Interactive and Knowledge Networks panels. Knowledge and opinion questions generally show statistically significant but substantively modest difference across the modes. With inclusion of standard demographic controls, typical relational models of interest to political scientists produce similar estimates of parameters across modes. It thus appears that, with appropriate weighting, samples from these panels are sufficiently representative of the U.S. population to be reasonable alternatives in many applications to samples gathered through RDD telephone surveys.

Intellectual and practical endeavors almost always demand theory to help make sense of the complex world. Descriptive theories seek to predict what will happen, or at least understand what has happened, in particular circumstances. Normative theories seek to inform agents about what they should want or do in particular circumstances. As professionals seeking to promote good governance, public administrators must be able to predict consequences. To do so, they can make use of any relevant descriptive theory without concern for disciplinary boundaries. I argue that this catholic approach largely, though not completely, obviates the value of unique descriptive theories specific to public administration. In contrast, public administrators require normative theories that speak to the choices they must make as members of a profession that seeks to promote the good society. Thus, although as public administration scholars we face the same pressure as our disciplinary colleagues to create descriptive theories, our most important theoretical contributions are likely to be normative.

Report cards currently published by the Centers for Medicare and Medicaid Services (CMS) offer composite (summary) quality measures based on a five-star ratings system, such as the one featured on the Nursing Home Compare website. These ratings are \"one size fits all patients\" measures. Nursing Home Compare Plus is an alternative that allows patients and their families to create their own composite scores based on their own preferences and medical needs. We present data from 146 patients who were discharged from the hospital to nursing homes who used Nursing Home Compare Plus. We found that the individual patient-constructed composites differed from CMS's five-star ratings composite. Patients differed from each other and from CMS in the number of performance measures they chose to include in their composite and in their weighting of each performance measure. When comparing Nursing Home Compare Plus to Medicare's five-star ratings, we found only minimal agreement on ranking of nursing homes. We conclude that patients might benefit if current report cards are modified to include an option for personalized ranking.

Quality report cards have become common in many health care markets. This study evaluates their effectiveness by examining the impact of the New York State (NYS) Cardiac Surgery Reports on selection of cardiac surgeons. The analyses compares selection of surgeons in 1991 (pre-report publication) and 1992 (post-report publication). We find that the information about a surgeon's quality published in the reports influences selection directly and diminishes the importance of surgeon experience and price as signals for quality. Furthermore, selection of surgeons for black patients is as sensitive to the published information as is the selection for white patients.