Brief case: managing inputs

Jane Carmichael's views on Managing Inputs provide a further interesting contribution on a topic, strategic control, that we have covered on several occasions in this column. Carmichael's approach is to dig back behind the results being achieved to the 'inputs' on which they depend. But, while this may unearth causes of performance that can often be missed by a bottom-line orientation, results must ultimately remain vital; a business that is on track with all its input measures, but is missing its output goal is still in trouble. We continue to be interested in hearing from readers with views on strategic control processes, particularly those who have found productive ways of setting input and output targets.     

National Practitioner Data Bank--incomplete and future cloudy

Nearly six years after the National Practitioner Data Bank was authorized by Congress in the Health Care Quality Improvement Act of 1986, and more than a year after its actual creation, the device is still only partially operational. What is more, the success of even those limited efforts is being questioned, and the timetable for future developments remains to be firmed up. Also, the costs are much higher than estimated.     

Clinical program renovation management

The day-to-day management of medical practice is so heavily influenced by tactical imperatives that few physicians have the time to think strategically. Traditionally, the difference between tactics and strategy is not a major concern of most physician executives. The realm of tactics is the short run, when managers must make do with the fixed resources at hand. Strategy addresses the long run, when all resources and markets are variable. A tactical focus is understandable, maybe even acceptable, in industries where nothing challenges traditional approaches to production of an established product or service. However, medical care in the 1990s is changing so fast that a physician executive must devote an incredible amount of time and effort just to stay confused about what is going on.     

Immigrant fertility: an examination of social characteristics and assimilation

"This study compares the fertility patterns of foreign-born and native-born women in Canada and examines whether [the] same set of social characteristics accounts for differential fertility among both the groups. The study also assesses the importance of social characteristics and assimilation on immigrant fertility behavior. Two generations of currently married/cohabiting women with spouse present are analyzed using multiple regressions. The results reveal similar effects on fertility of social characteristics for foreign-born and native-born, while in the case of younger generations the effects are stronger."     

European Community legislation and intergovernmental cooperation on migration

Recent trends in migration policy in the European Community are outlined. The focus is on the need to increase cooperation between the member states and to increase the power of the Community's Court of Justice in decision-making about migration and refugee policy.     

The politics of health in the fourth world: a northern Canadian example

This paper describes the major structural and historical dimensions of health ideology and praxis in the Canadian Arctic. It examines the problems that occur when primary care services exclude their clients from meaningful involvement in planning and administration. It argues that the structure of health services in northern Canada reflects an internal colonial political economy which is characteristic of most Fourth World situations.     

Empirical findings on socioeconomic determinants of fertility differentials in Costa Rica

"This paper seeks to (1) identify socioeconomic variables that are expected to generate fertility differentials; (2) hypothesize the direction and magnitude of the effect of each variable by reference to a demand-for-children model; and (3) test empirically the model using evidence from Costa Rica. The estimates are obtained from a ten-percent systematic random sample of all Costa Rican individual-family households. There are 15,924 families in the sample...." The authors specifically seek "to capture the effects of changing relative prices and available income and time constraints on parental preferences for children. Least-squares estimates show statistically significant relationships between household fertility and opportunity cost of time, parental education, occurrence of an extended family, medical care, household sanitation, economic sector of employment, and household stock of nonhuman capital."