The mandate for investigational cancer therapies

The heated national health care reform debate of the summer of 1993 has now simmered down, but pieces of the debate are still percolating along at the state level. Within the past year, numerous states have introduced bills that would mandate insurance coverage for investigational cancer therapies--in particular high-dose chemotherapy and bone marrow transplant for breast cancer. The problem with these initiatives, well-intended though they may be, is that they threaten to spread unproven technologies at a rapid rate and at the same time miss the opportunity to collect data that would prove the safety and effectiveness of the methods. The author explores these issues and suggests how managed care companies can play a more aggressive role in parrying the threat.     

Lifestyle Options and Economic Strategies: Subsistence Activities in the Mississippi Delta1

Abstract "Subsistence" and "informal economy" are contrasted in their utility as sociological concepts and their ability to explain a variety of activities in two rural Mississippi Delta communities. Literature on subsistence stresses that the desired outcome of participation is not an increase in income but the social rewards of participation itself. Two underlying dimensions of participation in these activities are documented through the literature and through a confirmatory factor analysis of empirical data: life-style choice and economic strategy. These were constructed into indexes and examined individually and in combination as dependent variables using regressors at the community, household, and individual levels. Community ties were weakly associated with participation in such activities. Whites and those with higher incomes participated more in lifestyle choice oriented activities. Participation in general was statistically related to households needing less weekly income and being of larger size. Potential connections with persistent rural poverty are discussed.     

Health care 2015: flight of the butterfly

Projecting out to the year 2015 sounds presumptuous. Who can predict that far ahead? Perhaps no one can. Social and organizational arrangements come slowly. It takes five years or so to implement simple concepts, sometimes decades for more radical changes. Once you have the ideas in tangible form, it can take another five years to get it working right. Early adopters bring others into the movement and, over 15-25 years, new directions dominate. It takes at least a generation of new practitioners to take on the new values and methods so what is likely to dominate in 2015 is beginning to be taken somewhat seriously as the successor movement to our current fad with externally imposed managed care. Put another way, entire generations of people will resist new ideas, making implementation unlikely until their control fades and a new generation takes the helm. The exciting challenge for the observer is to address the issue of where health is and should be going. Both are difficult challenges. Agreeing on what is important and what is not represents a competitive challenge. How do we perceive the world? Surely our value sets will color what we see. Who is not predisposed to select a future where they fit and their pet theories are likely to become reality. For these and other reasons, it is probably easier to agree on what we would like to see happen in the future than on what is happening. Unfortunately, unless we see the world as it is, we are less likely to be able to shift it in a direction we would like to see.     

Helping black grandparents and older parents cope with child rearing: a group method

The extended family and informal adoption practices of the black culture are frequently misunderstood by workers from different backgrounds. Particularly prominent is the responsibility for child rearing assumed by older family members. The authors present procedures, issues, and argument for use of a group method to strengthen the coping abilities of these families through attention to the needs of their senior members.     

An innovative approach to selecting an executive director

As a guide for how to select a new executive director, a family agency adopted the search committee process from higher education. The approach included clarifying agency goals and the director's qualifications, a board-staff screening, and interviews held jointly with public representatives before final board selection.     

高管持股与企业价值——基于利益趋同效应与壕沟防守效应的经验研究

本文以深交所78家民营上市公司为样本,从利益趋同效应和壕沟防守效应两方面研究了高管持股与企业价值的关系。与目前大多数相关研究不同,本文在计量高管持股比例时包括了高管人员通过间接方式持有的公司股权。本研究发现,高管持股比例不同引起的利益趋同效应和壕沟防守效应导致高管持股与企业价值之间呈显著的非线性关系。当高管持股比例在8%—25%之间,高管持股的壕沟防守效应占主导,而小于8%或大于25%时,高管持股的利益趋同效应占主导。研究结论对以激励为主要目的或以股权结构优化为主要目的的高管持股方案提供了经验证据。     

The Role of Shocks in Employee Turnover*

This paper reports the findings from a recent study of nurse leavers at eight large hospitals in the National Health Service (NHS) of England and Wales. The study develops and extends an influential theory of employee turnover by describing how for some leavers a single, jarring event or shock triggers the decision to quit. By elaborating on the nature of shocks for this sample of 352 nurse leavers, the paper allows for improved understanding of nursing turnover and thus offers an example of relevant management research. The analysis of shock illustrates how conventional research methodologies can lead to a distorted picture of turnover. This has wider implications, both for any organization wishing to manage turnover effectively and for future research. The paper adds to the limited body of empirical analysis on actual leavers, thereby contributing to an ongoing methodological debate concerning the use of proxy variables. By highlighting flaws in the dominant methodology used to study turnover, the paper offers an example of management research that is also rigorous, and thus ‘pragmatic’.