Multistate life-tables and regression models

"A survey is given of the use of modern statistical techniques in event history analysis, and in particular in the study of multi-state life-tables in demography. Emphasis is placed on the interplay between partial likelihood and nonparametric maximum likelihood based methods, a) when analysing semi-Markov models or models with repeated spells, and b) in frailty models for unobservable heterogeneity."     

Data collection: are social workers reliable?

Social workers are required to collect a considerable amount of personal information about clients and their families which may be unrelated to direct clinical work. Administrators often use this for the purpose of payment, service documentation, agency planning, and accountability. The worker's concern about the appropriateness of collecting this data may result in poor compliance or even falsification of information. In a survey of Minnesota social workers, noncompliance with data collection requirements was substantial. The authors also found a significant degree of conflict about privacy and confidentiality issues. These findings suggest a basis of concern for those who must rely on accurate data for administrative planning.     

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."     

Bulgarian Turkish emigration and return

The main factors which determined the 1989 migration of Turks in Bulgaria back to Turkey are discussed. Background history is provided. After World War I, Turks in bulgaria comprised 10% of the total population. Bulgarian policy had been, up to the 1980s to send Rumelian Turks back, but the policy after 1980 was one of a national revival process to integrate Turks into the developed socialist society. Muslim traditions, customs, and Turkish language were interfered with. International disfavor resulted. In May 1989, the Communist Party declared, in an effort to show democratic ideals, open borders. Thus began the new emigration wave. 369,839 people fled to the Turkish border. 43% of the 9.47 ethnic Turks in bulgaria went to Turkey within 4 months. The numbers decreased in November, and soon after the communist regime ended. New laws were adopted allowing Turks to assume their original Turkish names. The huge migration was clearly political, and as such, the emigrant Turks should be determined as refugees and asylum seekers. The provocation of ethnic Turks was used by the communist regime to solve potential social conflicts. Not only did Turks flee to escape from violence or for religious, cultural, and moral reasons but also due to free market initiatives begun in Turkey in the early 1980s which improved Turkish quality of life. Food and consumer goods were cheaper and economic advantages were perceived. Emigrants were primarily peasants with lower levels of education, professional qualifications, and labor skills. 154,937 (42%) returned to bulgaria and 58% stayed in Turkey to comprise 25% of the former Turkish population. During this period, tensions between countries was high.l Bulgarians actively encouraged emigration and Turkey welcomed it. The emigrants to Turkey were seen as foreigners (muhacir or gocmen) but were received with good will and were readily accepted into menial positions. Emigrants were confronted with political, linguistic, and cultural differences. The unifying factor was the Islamic religion. For those returning to Bulgaria, the change in regime meant the government worked to solve the emigrants' housing problems and teaching Turkish in primary and secondary schools. The result of this massive migration has been a change in the demographics and social structure of Bulgaria, and the realization that forceful migration is inefficient in solving problems.     

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.