This article addresses the relationship between the choices of a policy target and the institutional structure of the delivery system, focusing on states' desire to increase the production of primary care physicians. We examine two possible strategies—an institutional strategy in which state dollars are provided directly to medical schools and an individual strategy in which financial incentives are provided directly to students. We hypothesize that a state's choice between the strategies can be understood by institutional characteristics of the state's medical schools. Results indicate that these characteristics do have an influence on the choice of policy target.
Get full access to this article
View all access options for this article.
References
1.
Alexander, E. R. (1982). Design in the decision-making process. Policy Sciences, 14, 279-292.
2.
American Academy of Family Physicians . (1992). State legislation and funding for family practice programs: Update through 1992. Kansas City, MO: American Academy of Family Physicians.
3.
American Association of Colleges of Osteopathic Medicine . (1992). 1992 statistical report. Rockville, MD: Author.
4.
Association of American Medical Colleges . (1993). Directory of American medical education 1992-1993. Washington, DC: Association of American Medical Colleges.
5.
Baumgartner, F. R. , & Jones, B. D. (1993). Agendas and instability in American politics. Chicago: University of Chicago Press.
6.
Berman, P. (1980). Thinking about programmed and adaptive implementation: Matching strategies to situations. In H. Ingram & D. E. Mann (Eds.), Why policies succeed or fail (pp. 205-227). Beverly Hills, CA: Sage.
7.
Browne, W. P. (1985). Variations in the behavior and style of state lobbyists and interest groups. Journal of Politics, 47, 450-468.
8.
Bryson, J. M. , & Ring, P. S. (1990). A transaction-based approach to policy intervention. Policy Sciences, 23, 205-229.
9.
Colwill, J. M. (1992). Where have all the primary care applicants gone?New England Journal of Medicine, 326, 387-393.
10.
Ebert, R. H. , & Ginzberg, E. (1988). The reform of medical education. Health Affairs, 7, 5-38.
11.
Elmore, R. F. (1980). Backward mapping: Implementation research and policy decisions. Political Science Quarterly, 94, 601-616.
12.
Elmore, R. F. (1987). Instruments and strategy in public policy. Policy Studies Review, 7(1), 174-186.
13.
Falcone, D. J. (1992). Political culture, political leadership, sustained advocacy and aging policy reform: The Oregon and North Carolina experiences. In H. Leichter (Ed.), Health policy reform in America: Innovations from the states (pp. 73-101). Armonk, NY: M. E. Sharpe.
14.
Golembiewski, R. T. (1977). Public administration as a developing discipline. Part I: Perspectives on past and present. New York: Marcel Dekker.
15.
Huntington, C. , Sweeney, R., & Graham, R. (1992). The shortage of generalist physicians. American Family Physician, 45, 1573-1576.
16.
Ingraham, P. W. (1987). Toward more systematic consideration of policy design. Policy Studies Journal, 15(4), 611-628.
17.
Ingram, H. , & Schneider, A. (1990). Improving implementation through framing smarter studies. Journal of Public Policy, 10(l), 67-88.
18.
Institute of Medicine . (1989). Primary care physicians: Financing their graduate medical education in ambulatory settings. Washington, DC: National Academy Press.
19.
Jolly, P. , Jolin, L., Beran, R., & Sanderson, S. (1993). Medical school financing: Comparing different types of schools and departments. Academic Medicine, 68, 92-101.
20.
Kingdon, J. (1984). Agendas, alternatives, and public choices. Boston: Little, Brown.
21.
Krakower, J. Y. , Jolly, P., & Beran, R. (1993). U.S. medical school finances. Journal of the American Medical Association, 270(9), 1085-1091.
22.
Linder, S. H. , & Peters, B. G. (1987). A design perspective on policy implementation: The fallacies of misplaced prescription. Policy Studies Review, 6(3), 459-475.
23.
Linder, S. H. , & Peters, B. G. (1989). Instruments of government: Perceptions and contexts. Journal of Public Policy, 9(1), 35-58.
24.
May, P. J. (1981). Hints for crafting alternative policies. Policy Analysis, 7, 227-244.
25.
Office of Technology Assessment . (1990). Health care in rural America (OTA-H-434). Washington, DC: U.S. Government Printing Office.
26.
O'Toole, L. (1993). Interorganizational policy studies: Lessons drawn from implementation research. Journal of Public Administration Research and Theory, 3, 232.
27.
Pfeffer, J. , & Salancik, G. R. (1978). The external control of organizations: A resource dependency perspective. New York: Harper and Row.
28.
Salamon, L. M. (Ed.). (1989). Beyond privatization: The tools of government in action, Washington, DC: Urban Institute Press.
29.
Scharpf, F. W. , Reissert, B., & Schnabel, F. (1978). Policy effectiveness and conflict avoidance in intergovernmental policy formation. In K. Hanf & F. W. Scharpf (Eds.), Interorganizational policymaking (pp. 57-112). Beverly Hills, CA: Sage.
30.
Schneider, A. , & Ingram, H. (1988). Systematically pinching ideas: A comparative approach to policy design. Journal of Public Policy, 8(1), 61-80.
31.
Schneider, A. , & Ingram, H. (1993). Social construction of target populations: Implications for politics and policy. American Political Science Review, 87(2), 334-347.
32.
Walkington, R. A. (1989). Financing primary care residency training: Examples and lessons from successful programs. In Institute of Medicine (Ed.), Primary care physicians: Financing their graduate medical education in ambulatory settings (pp. 230-265). Washington, DC: National Academy Press.
33.
Weimer, D. L. (1991). The current state of design craft: Borrowing, tinkering, and problem solving. Public Administration Review, 53(2), 110-120.
34.
Weiss, J. A. (1989). The powers of problem definition: The case of government paperwork. Policy Sciences, 22, 97-121.
35.
Weissert, C. S. , Knott, J. H., & Stieber, B. (1994). Education and the health professions: Explaining policy choices among the states. Journal of Health Policy, Politics, and Law, 19(2), 361-392.
36.
Woodside, K. (1986). Policy instruments and the study of public policy. Canadian Journal of Political Science, 19, 775-793.
