Financing reform for long-term care: strategies for public and private long-term care insurance

The way the nation provides for the financing and delivery of long-term care is badly in need of reform. The principal options for change are private insurance, altering Medicaid, and public long-term care insurance. This article uses the Brookings-ICF Long-Term Care Financing Model to evaluate each of these options in terms of affordability, distribution of benefits, and ability to reduce catastrophic out-of-pocket costs. So long as private insurance is aimed at the elderly, its market penetration and ability to finance long-term care will remain severely limited. Affordability is a major problem. Selling to younger persons could solve the affordability problem, but marketing is extremely difficult. Liberalizing Medicaid could help solve the problems of long-term care, but there is little public support for means-tested programs. Finally, universalistic public insurance programs do well in meeting the goals of long-term care reform, but all social insurance programs are expensive and seem politically infeasible in the current political environment.     

The majority legal status of women in southern Africa: implications for women and families

Women in many countries of southern Africa do not have majority status or have only recently gained this right. Majority status grants individuals adult legal status and the right to bring matters to court, own and administer property, have legal custody of children, and contract for marriage. This article summarizes the legal status of women in Botswana, Lesotho, South Africa, Swaziland, Zambia, and Zimbabwe. Lack of majority status contributes to the ongoing risk of poverty for women and makes them overly dependent on men. Compounding the situation in these countries is the presence of a dual legal system. Improving the situation of women and their families involves targeting changes in the legal system, influencing implementation of laws, educating women about their rights, and giving women needed support to seek their legal rights. The legal status of women must be viewed in the context of historical changes in the economic, educational, political, and cultural developments of society.The research for this paper was conducted during her previous faculty affiliation with the University of Michigan, School of Social Work. Her research interests include the impact of social change on women and families, rural mental health services, and health and mental health linkages. She received her Ph.D. from Rutgers University and her M.S.W. from the Columbia University School of Social Work.Her research interests are gender, work and family, culture and power, social transformations in rural and peri-urban communities, critical education, women and community politics, history of women, family and kinship issues, and community-based program development and evaluation. She received her M.S.W. from Dalhousie University, Halifax.     

Women and changes in the Chilean economy: some questions

The author argues that a new development model that encourages greater participation of women in the work force in domestic piecework, temporary work, and subcontracting may further lead to the exploitation of women in Chile. The importance of women in economic development in Chile should be based on building skills, providing support child care services, reorienting women's education, and tax incentives. Chile over the past decade has achieved relatively stable economic growth and increased employment of women. During 1990-93 the growth of women in the work force increased at a rate of 16.8%, while men's presence increased by only 9.8%. The Chilean economy is based on a sophisticated modern sector and a labor-intensive informal sector. The Chilean model of development relies on cheap, flexible labor and a government approval of this model. Increased participation of women in the labor force is usually perceived as increased economic empowerment. A 1994 Oxfam study found that women were being forced into the labor market due to declines in family income and low wages. 46% of men and women received wages that did not cover basic necessities. The Chilean labor market is gender-stratified. Men are paid better than women for the same work. Men are in more permanent positions. Labor laws are either inadequate or violated, particularly for hours of work and overtime pay and conditions of employment and benefits. Traditional female jobs are those that rely on women's natural attributes. These unskilled attributes are rewarded with low wages. Little opportunity is provided for upgrading skills or acquiring new skills. Some women turn down advancement because of a lack of role models. Women have little opportunity to develop their self-image as workers. Poor self-images affect women's work attitudes and motivation. Some firms use competition between women to boost production. Chilean women remain in subordinate roles.     

Meet the mandate to measure clinical quality

The mandate for health care organizations to be accountable for quality, as well as price, is now unavoidable. The Joint Commission's ORYX project is requiring every hospital to measure clinical outcomes of a majority of its patients within the next three years. This mandate can be met best with systems of clinical outcomes measurement that provide valid, reliable risk adjustment; yield meaningful information about many different diseases and procedures; and measure more than mortality or cost--all using primarily billing data. New outcomes measurement tools with all of these capabilities are available and have already enabled quality improvement in dozens of hospitals across the U.S.     

Where does informatics fit in health care organizations?

Why is medical informatics important to health care leaders? As an emerging science, informatics focuses on applying computing and communication technology to decision making for clinicians and managers. It enhances the understanding of how information and communication systems can impact the work health care managers must accomplish. As the cost of technology for digital information management continues to decline, organizations and individuals will look for ways to offset the human costs of managing and conveying information. The way of the paper medical record is being replaced by the less expensive and more efficient digital information systems. Leaders of health care organizations need to look for every opportunity to deploy networks and computers to reduce the labor costs of data collection, storage, retrieval, and analysis.     

Can you communicate cross-generationally?

What is fractured cross-generational communication? When what one person heard was not what the other person said. Regardless of your age, you need to understand some of the differences in communication styles that must be overcome if people are to work well together. This is especially important in health care right now when there are other pressing issues. Interpreters are at a premium because so much misunderstanding clouds the communication process. Two management strategies are presented that will help bridge the gaps between communication styles.     

Acing the 'chemistry' test

With the right boss, you can go far and learn much. The wrong boss could actually slow or even stall your executive career. When you interview for a job, you're also interviewing for a boss--and it's in your own interest to try to find the individual who is the best possible fit with your own management style. This is a matching process--not quite a courtship, but with some of the same characteristics. What can you do to ensure a good match with your new boss? (1) Do your homework; (2) Make your interview a dialog; (3) Use subtle strategies, too, such as watching for body language; (4) Ask the employer for references; and (5) Know yourself.     

Haunts on the Web for physician executives

Listed here are some medical management and health care related Web sites on the Internet worth visiting, as well as favorite search engines and how to use them. From health care systems and hospitals, to health plans and insurers, the industry is using Web technology to promote programs and outcomes, and to provide information on health and wellness.     

How could I have gotten it wrong?

Can you avoid ending up in a career-denting job: Are there potential pitfalls to recognize on the search for a rewarding position? Finding oneself in an impossible job, working for a boss who brings out your worst qualities and deepest insecurities, or joining an organization that is doomed are nightmare scenarios. How do these judgment errors happen? We asked physicians who've been there and, unfortunately, done just that. What they learned might help the rest of us skip the experience.