The Economic Impact of Health Policy Interventions

The rapid aging of the U.S. population, increases in the absolute prevalence of chronic diseases, and the associated rise in the proportion of the GNP expended on medical care all indicate the need for methods to accurately forecast future health care expenditures for specific chronic diseases. Additionally, if these methods are biomedically realistic, they can be used to evaluate the economic implications of specific prevention strategies designed to reduce chronic disease incidence, prevalence, and mortality. Projection strategies that are not biomedically realistic, such as models that assume that risks for demographic subgroups do not change over time (e.g., "static component" models), though possibly accurate over the short run, are not suitable for assessing the long term effects of specific proposed health policy interventions which are designed to alter risks.
In this paper we present a strategy for forecasting health care costs which is based on a model that represents the natural history of a chronic disease in terms of a preclinical state, a clinical state, case fatality rates, cures, and the implications of exogenous medical factors. Using this model we project that the treatment costs associated with respiratory cancer in the white male population of the U.S. may undergo a two-thirds increase in real dollars over the period 1977 to 2000. About one-half of this increase is due to a demographic shift to an older population structure, with the remainder due to higher respiratory cancer incidence rates in younger cohorts. Alteration of certain parameters of the model to simulate various interventions suggests that about three-quarters of the cost of this disease could be eliminated, though realization of any significant part of this savings would require a lengthy phase-in period.     

A Social Exchange Typology of Conjugal Relationships and Conflict Development*

In this article the authors attempt to demonstrate how the principles of social exchange, reciprocity and distributive justice can be used to explain the development and continuation of marital dissatisfaction and conflict. A typology of marital relationships is presented based upon the premise that marriages can be located on a continuum ranging from satisfying and voluntary to conflicted and nonvoluntary. Satisfying relationships are conceptualized as equitable reciprocal exchanges. Socially approved behaviors as well as deviant interpersonal responses which occur are seen as impersnal maneuvers which a spouse might utilize to restore an equitable balance of exchanges once the norm of equity has been violated. The type of strategy employed by a spouse will depend upon the relative power he/she possesses, the type of marriage in which the spouse is involved, and the availability of reinforcements which can be gained from sources external to the relationship. Practical suggestions for assessing the appropriateness of various forms of clinical intervention available to the therapist are discussed in the light of this typology and clinical implications are offered.     

Organizational Adaptations to Changing Cultural Contingencies*

An integrated conceptual framework acceptable across different disciplines and theoretical perspectives is presented. The scheme promotes one aspect of organizational environments, the cultural context, as crucial to explaining organizational structure or behavior. By crosstabulating member consensus and community consensus consistent predictions regarding survival, “character,” and goal behavior are achieved for a diverse range of case studies. It is suggested, therefore, that community consensus be treated as a common denominator in future attempts to ferret out the necessary and sufficient conditions associated with particular organizational structures and behaviors.     

Single-pass low-storage arbitrary quantile estimation for massive datasets

We present a single-pass, low-storage, sequential method for estimating an arbitrary quantile of an unknown distribution. The proposed method performs very well when compared to existing methods for estimating the median as well as arbitrary quantiles for a wide range of densities. In addition to explaining the method and presenting the results of the simulation study, we discuss intuition behind the method and demonstrate empirically, for certain densities, that the proposed estimator converges to the sample quantile.     

A life satisfaction measure: Additional validational data for the Congruity Life Satisfaction measure

Meadowet al. (1992) have developed a measure of life satisfaction based on judgment theory, referred to as Congruity Life Satisfaction (CLS). This paper reports the results of a major study involving six samples from different countries testing the construct validity of the CLS measure. The results of these studies provide additional validational support for the CLS measure.