Community rating--an approach that works

How our current system works and what changes need to be made are the subjects of intense scrutiny by policy makers today. One of the primary areas of concern with our present health care system is its accessibility to the average American, in terms of both price and ability to obtain insurance. With an estimated 37 million Americans without health care insurance, and countless others severely underinsured, this issue will lie at the core of any health care reform that results from the current debate. One possible approach to the uninsured problem that might alleviate the situation is community rating.     

Fertility incentives and participation in localities with limited means: a dynamic model of per capita resources

Several countries have attempted to change human fertility through economic incentives. This paper presents simple mathematical models of the participation of couples in a locally funded program of economic incentives. The models take as a springboard China's one-child program. Localities with low per capita incentives attract few couples to the program, while localities with high incentives attract many couples at first, but the value of the benefits is then watered down. The models show that participation in the program may persistently oscillate or may decay to a stationary level. Which behavior occurs is determined by whether there are decreasing, constant, or increasing returns in the rates of participation in response to successive equal increments in the incentive offered, and by the extent to which prospective parents learn from experience with past oscillations in the incentives. The models raise many empirical questions about the dynamics of incentive programs.     

Defining the health care product to ensure quality and manage costs

The frenzy of health care reform activity now led by the Clinton Administration's American Health Security Act of 1993 might end in the worst of all possible outcomes: a new government entitlement program financed by business and a global budget. Unbridled entitlement could drive utilization of benefits to the maximum and, with a budget cap, guarantee rationing. So far, the administration has talked about expanding access and controlling costs--not about the health care product. Given the threat that change poses for vested interests, time will undoubtedly lapse before final implementation of a new system. Unless physicians involved in health management seize the opportunity during this window of opportunity to help shape the future of health care delivery, the likelihood of preserving the U.S. health care delivery system as we know it will be dim indeed.     

The case. Bad care, good care, and spiritual preservation

A cancer patient learning to walk again finds that his relationships with his two physical therapists affect his recovery. One woman gives hope as well as instruction. He advises healers to meet their patients as equals, "to take down as many barriers as they can, give away as many distancing privileges as possible."     

Bridge employment and job stopping: evidence from the Harris/Commonwealth Fund Survey

This article analyzes a 1989 Louis Harris and Associates survey designed to elicit information on the employment histories and job-stopping behavior of men and women who then were approaching or had recently reached retirement age. The results indicate that retirement often occurs gradually and includes a substantial period of "bridge employment." Most bridge jobholders work full-time, by choice, and report high levels of job enjoyment. Occupational mobility occurring late in life typically involves upward movement, although the pattern of change is quite different when it takes place outside, rather than within, the longest job. The principal concern identified in this article is the limited ability of some groups of workers (nonwhites, females, the less educated, and those in poorly compensated occupations) to either retain longest jobs or to obtain acceptable bridge employment. Health problems also frequently lead to early departures from the labor force.     

The liability of nonprofits to donors

The success of the third sector depends on public confidence, and that confidence rests, in part, on holding managers, directors, and officers of nonprofits responsible for their conduct. This accountability can be accomplished by clearly defining the roles of these individuals and the stands that they are to uphold, and by providing channels for all interested to challenge uncontrolled activities. Though interest in this goal is unanimous, a debate exists over how to ensure oversight and accountability.     

The new health care civilization: integration of physician land and manageria

Changes occurring in health care demand that physicians expand their professional knowledge and skills beyond the medical and behavioral sciences. Subjects absent from traditional medical education curricula, such as the economics and politics of health care, practice management, and leadership of professional organizations, will become important competencies, particularly for physicians who serve in management roles. Because physicians occupy a central role in planning and allocating medical care services and other health care resources, they must be better prepared to work with other health care professionals to create a new civilization, even if this means leaving the cloistered domain of "physician land" to serve as interface professionals between the delivery of medical services and the management of health care. Our research findings and conclusions strongly suggest that economic, management, and leadership competencies need to be incorporated into the professional development of physicians, especially in postgraduate and continuing education curricula.     

Political theater and student organizations in the 1989 Chinese movement: A multivariate analysis of Tiananmen

Social movement research has often been divided between organizational and cultural analyses of collective action. Organizationally oriented theorists have viewed indigenous organizational structure as the critical variable in the emergence of collective action. Political culture and cultural frame theorists have focused instead on the cultural frames that resonate with audiences, mobilizing them to action. But social movements cannot be the result of one or the other of these factors. An analysis of the 1989 Chinese movement illuminates the multivariate aspects of this social movement. This movement was a two-tiered movement with an organized student leadership tier and a mass audience. Enmeshed in university organizations and student networks, the student leaders relied on an organizational structure that had been emerging since the mid-1980s. This organized leadership tier employed cultural symbols and acts to mobilize mass audiences that were beyond the scope of the students' organizational linkages. The political theater of the organized student leaders was complemented by institutional changes that had been occurring over the decade of reform in China and a political opportunity that allowed wide coverage of the students' activities.