President Bush's vision of a democratic Middle East was premised in part on the region's popular Islamist groups reconciling themselves to the give-and-take nature of democracy.

It might make sense then, that the Bush administration would do what it could to support a party that has made such a transformation in Turkey. But it's not.

Turkey's Justice and Development Party (AKP), which fashioned itself as the Muslim equivalent of Europe's Christian Democrats, has stood out by passing a series of unprecedented political reforms as the country's ruling party.

Yet the Turkish Constitutional Court - bastion of the hard-line secularist old guard - is now threatening to close down the AKP and ban its leading figures, including Prime Minister Recep Tayyip Erdogan and President Abdullah Gul, from party politics for five years. And the Bush administration, in the face of this impending judicial coup, has chosen to remain indifferent. The consequences could reach beyond a setback to democracy in Turkey and affect the Middle East.

The Constitutional Court will rule as soon as next week on an indictment accusing the AKP of being a "focal point of antisecular activities."

Turkey's Constitution establishes secularism as an unalterable principle and allows the court to ban parties it deems antisecular. But disbanding a democratically-elected party on such dubious grounds as attempting to lift a controversial ban on wearing head scarves in universities - the crux of the case against the AKP - is not how mature democracies handle divisive issues. Judges should not decide parties' fates; voters should.

Indeed, voters have flocked to the AKP since its founding by break away reformists within the Islamic movement. The party was elected in 2002 on pledges to preserve secularism and vigorously pursue Turkey's efforts to join the European Union. It also explicitly disavowed the Islamist label.

The AKP-led government then passed a series of democratic reforms that led Brussels to begin formal accession negotiations with Turkey. Those reforms, together with a booming economy, spurred 47 percent of Turks to vote for the AKP in its landslide 2007 reelection.

To be sure, the AKP's democratic credentials are hardly perfect. It has been overly cautious in repealing certain restrictions on freedom of speech, and it abruptly lifted the head scarf ban without first initiating a national dialogue.

Yet despite its flaws, the AKP is the most democratically inclined - and somewhat ironically, the most pro-Western - political party on the Turkish scene today. Closing it down would be a mistake.

A ban on a party that nearly half of the country supports could spark violence - which Turkey's secularist generals might then use as a pretext for a direct military intervention. Regardless, senior EU figures have criticized the closure case and warned that banning the AKP could gravely damage Turkey's candidacy.

Even more troubling is the message it would send to the rest of the Muslim world - no matter how much Islamists moderate, they won't be accepted as legitimate participants in the democratic process.

In recent years, mainstream Islamist groups throughout the region - including in Egypt, Jordan, and Morocco - have embraced many of the foundational components of democratic life. Yet their moderation has been met with harsh government repression, or more subtle designs to restrict their political participation.

More is at stake than may initially appear. If the AKP - the most moderate, pro-democratic "Islamist" party in the region today - is disbanded, it will strengthen those Islamists who see violence and confrontation as a surer means to influence political power.

During the past year, a number of Islamist leaders we've spoken to in Egypt and Jordan have warned that rank-and-file activists are losing faith in the democratic process, and may soon become attracted to more radical approaches. A ban on the AKP would only make it that much harder for moderates to continue making the case that participating in elections is worthwhile.

Though US Secretary of State Condoleezza Rice praises the AKP's democratization agenda, last month she said, "Obviously, we are not going to get involved in ... the current controversy in Turkey about the court case." Yet moments later she opined, "Sometimes when I'm asked what might democracy look like in the Middle East, I think it might look like Turkey." It's difficult to tell if she's referring to the new, democratizing Turkey of the past five years - or the reactionary Turkey where judges and generals flagrantly overrule the people's will.

President Bush has one last opportunity to reinvigorate the cause of Middle East democracy. By publicly denouncing the closure case, the administration would signal that the US not only supports Turkish democracy against a dangerous internal assault, but that it is also committed to defending all actors willing to abide by democratic principles in a region that desperately needs more of them.

The fortunes of the Jordanian Muslim Brotherhood may be shifting after three difficult years that saw the group's worst electoral result in history, reports of diminished influence, and sustained government repression. After hitting an unprecedented low, the relationship between the Jordanian regime and the Muslim Brotherhood, the country's largest opposition grouping, has improved recently. This is the opposite of what many observers, including this author, expected. Hammam Sa'id, known as a hardliner, was elected General Guide of the organization in May 2008, leading many to predict heightened confrontation between regime and opposition. Analysts Matthew Levitt and David Schenker wrote, for instance, that the leadership change suggested the Brotherhood "can no longer be considered ‘loyal' to the kingdom." During Sa'id's tenure, however, events have moved in an unexpected direction. Since being elected, he has toned down his abrasive rhetoric, emphasized domestic priorities, and made an effort to reach understandings with the government of Prime Minister Nader al-Dahabi on key issues of contention.

The question of the Palestinian Resistance Movement (Hamas) is one area where Islamists and the regime have moved closer to each other. After nine years of severed ties, Jordan has opened a dialogue with Hamas, recognizing the group's growing influence and its strong position in Gaza. With its close ties to Hamas leaders, the Jordanian Muslim Brotherhood and its political arm, the Islamic Action Front (IAF), played a critical role in facilitating the resumption of contacts.  

Moreover, Jordan's King Abdullah-known as one of the region's most pro-Western rulers-has attempted to strengthen ties to other U.S. adversaries, including Iran and Russia. He has met with Russian President Dmitri Medvedev three times in the last eight months, and their discussions have increasingly revolved around military assistance and cooperation, including joint production of multi-caliber grenade launchers. Such moves have given Islamists hope that Jordan is beginning to shake off Washington's tight embrace.  

For their part, Islamists are drawing a degree of optimism from their improved relations with the regime. Even IAF Secretary-General Zaki Bani Irsheid, one of the government's fiercest detractors, said in a private conversation in August that Jordan may be entering a "new political phase." Coinciding with the improved ties between Islamists and the regime, relations between internal Brotherhood/IAF factions have also improved after nine months of crippling internal divisions that had threatened to tear the movement apart. In early August, so-called hawks and doves reached an agreement that left both sides content, at least temporarily. The agreement reflects what had been a difficult and sustained round of internal negotiations over a variety of contentious issues, including Bani Irsheid's pending trial by an internal IAF court for allegedly sabotaging his own party's prospects in the 2007 parliamentary elections. This agreement might have postponed further infighting, however, rather than ended it; there are still factions within the Brotherhood that hold substantially different visions on how to proceed in what remains a challenging economic and political environment.  

It is unclear what the Jordanian regime's efforts at strategic repositioning-taking into account a perceived decline in U.S. influence in the region-bode for further political opening and reform. Over the last three years, the Jordanian government interpreted U.S. silence on reform as a green light to clamp down aggressively on Islamists. However, if it continues to see a need to reach out to Hamas, the regime will    need to expand political space for the Islamist opposition and maintain a mutually beneficial working relationship with it.  

Of course, there have been bouts of optimism before, and they have been misplaced. Each time the regime has reached out to the Brotherhood, as it did in advance of the November 2007 elections, it has quickly reversed course and resumed anti-Islamist policies. Islamists are unlikely to be fooled again. Despite the optimism expressed by Bani Irsheid and others, most Islamists see this as yet another round of tactical maneuvering. The Jordanian regime is not necessarily acting in good faith; it is acting in its own self-interest. So too is the Islamist opposition.

The Director of the Asia Health Policy Program, Karen Eggleston, served as guest editor of the International Journal of Healthcare Finance and Economics for the June 2009 issue. The eight papers of that issue evaluate different provider payment methods in comparative international perspective, with authors from Hungary, China, Thailand, the US, Switzerland, and Canada. These contributions illustrate how the array of incentives facing providers shapes their interpersonal, clinical, administrative, and investment decisions in ways that profoundly impact the performance of health care systems.

The collection leads off with a study by János Kornai, one of the most prominent scholars of socialism and post-socialist transition, and the originator of the concept of the soft budget constraint. Kornai’s paper examines the political economy of why soft budget constraints appear to be especially prevalent among health care providers, compared to other sectors of the economy.

Two other papers in the issue take up the challenge of empirically identifying the extent of soft budget constraints among hospitals and their impact on safety net services, quality of care, and efficiency, in the United States (Shen and Eggleston) and – even more preliminarily – in China (Eggleston and colleagues, AHPP working paper #8).

The impact of adopting National Health Insurance (NHI) and policies separating prescribing from dispensing are the subject of Kang-Hung Chang’s article entitled “The healer or the druggist: Effects of two health care policies in Taiwan on elderly patients’ choice between physician and pharmacist services” (AHPP working paper #5).

In “Does your health care depend on how your insurer pays providers? Variation in utilization and outcomes in Thailand” (AHPP working paper #4), Sanita Hirunrassamee of Chulalongkorn University and Sauwakon Ratanawijitrasin of Mahidol University study the impact of multiple provider payment methods in Thailand, providing striking evidence consistent with standard predictions of how payment incentives shape provider behavior. For example, patients whose insurers paid on a capitated or case basis (the 30 Baht and social security schemes) were less likely to receive new drugs than those for whom the insurer paid on a fee-for-service basis (civil servants). Patients with lung cancer were less likely to receive an MRI or a CT scan if payment involved supply-side cost sharing, compared to otherwise similar patients under fee-for-service. (This article is open access.)

The fourth paper in this special issue is entitled “Allocation of control rights and cooperation efficiency in public-private partnerships: Theory and evidence from the Chinese pharmaceutical industry” (AHPP working paper #6). Zhe Zhang and her colleagues use a survey of 140 pharmaceutical firms in China to explore the relationships between firms’ control rights within public-private partnerships and the firms’ investments.

Hai Fang, Hong Liu, and John A. Rizzo delve into another question of health service delivery design and accompanying supply-side incentives: requiring primary physician gatekeepers to monitor patient access to specialty care (AHPP working paper #2).

Direct comparisons of payment incentives in two or more countries are rare. In “An economic analysis of payment for health care services: The United States and Switzerland compared,” Peter Zweifel and Ming Tai-Seale compare the nationwide uniform fee schedule for ambulatory medical services in Switzerland with the resource-based relative value scale in the United States.

Several of the papers featured in this special issue were presented at the conference “Provider Payment Incentives in the Asia-Pacific” convened November 7-8, 2008 at the China Center for Economic Research (CCER) at Peking University in Beijing. That conference was sponsored by the Asia Health Policy Program of the Shorenstein Asia-Pacific Research Center at Stanford University and CCER, with organizing team members from Stanford University, Peking University, and Seoul National University.

As Eggleston notes in the guest editorial to the special issue, AHPP and the other scholars associated with the issue “hope that these papers will contribute to more intellectual effort on how provider payment reforms, carefully designed and rigorously evaluated, can improve ‘value for money’ in health care.”