New information from the State Committee on Statistics of the USSR

Selected data concerning the USSR are presented. They concern vital statistics by republic for 1989 for rural and urban areas, birth order, life expectancy by sex, and population change and vital statistics for cities with a population over one million.     

The appointment-keeping habits of managed care patients

Among the controversies surrounding the provision of health care in a managed care environment is the belief that patients, because they have no particular allegiance to a single physician, are more casual in regard to their keeping appointments. To test this proposition, the authors conducted a study at a California independent practice association, comparing the habits of managed care patients with those of other types of patients. The findings, although based on a limited sample, suggest that managed care patients do indeed have a greater tendency to be appointment no-shows.     

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."     

Women,conflict, and culture in former Yugoslavia

The civil war in the former Yugoslavia has taken a toll on the women's movement which has disintegrated across male-defined nationalist borders. The women's movement in this area got its start during the Second World War but was disbanded under communism until women's groups began to form in the 1970s. Today the women's movement has lost the power to oppose the war and has been unable to prevent widespread violence perpetuated against women. Some feminists who have refused to embrace nationalism and patriotism have been vilified and have had to seek refuge abroad. Recently, however, hundreds of nongovernmental organizations have been formed to provide support to women and children victimized by the war. Women have been raped and impregnated as a strategy of male warfare, and raped women who refused an abortion were ostracized. War-related rape has yet to be fully recognized as an international human rights violation, and the issue is being used as political propaganda in the former Yugoslavia while it is ignored elsewhere. Sensationalist reporting of these rapes has further victimized women and made them unable to give voice to their trauma. War also increases women's suffering by destroying economic and social welfare systems. Oxfam is helping women record their testimonies of war and reconstruct the fabric of their societies through programs which provide income-generation and training in micro-enterprises. In addition, Oxfam is strengthening electronic communication and networking among women's groups throughout the region.     

A hospital protocol to resolve complaints against staff physicians

Complaints of discrimination or harassment in the workplace have become almost commonplace in recent years, increasing in both frequency and variety. In the hospital setting, this trend is manifested in allegations against members of the medical staff by hospital employees as well as by patients or their families. Whether real or fancied, such allegations are reflective of a potentially disruptive undercurrent of organizational tensions. Left unresolved, they can erode the essential partnership between staff physicians and other members of the health care delivery team. Unsatisfactory patient experiences may also damage the reputation of the institution and thereby undermine its viability. With either group of complainants, allegations of malfeasance that are not resolved at the source in a timely manner are far more likely to result in expensive, time-consuming, and potentially damaging litigation.