Retiree medical plan design: determining the philosophy, communicating the need

Much has been written, both in benefit-related journals and in the general press, about the recent statement, FAS 106, issued by the Financial Accounting Standards Board (FASB). This statement requires most employers to begin accounting for retiree health care benefit costs for active employees as well as current retirees, creating a significant negative financial impact. Most of the attention has been focused on getting the numbers that will tell the extent of the impact resulting from FAS 106. The next step has been to review retiree medical coverage to see how the affected companies can change it to reduce their liability. Although the urge is strong to adopt a quick-fix solution, employers can greatly benefit by reviewing their benefit philosophies and making plan decisions that make sense for them. This article discusses key questions that can help focus the issue on company philosophies and lays out a framework for determining suitable plan designs that can also help companies manage the retiree medical liability.     

The effects of regulatory tools on organizational populations

One of the main activities of regulation is the control of market development by influencing the number of firms in an industry, their entry into an industry, and their exit from an industry. Population ecology is used as a framework for explaining both the direct and indirect effects of regulatory activity on entry, exit, and market structure. This framework is then used to derive specific propositions about regulatory effects on entry, exit, and market structure in the health maintenance organization industry.     

The seasons of a CEO's tenure

This article proposes a model of the dynamics of the CEO's tenure in office. The central argument is that there are discernible phases, or seasons, within an executive's tenure in a position, and that these seasons give rise to distinct patterns of executive attention, behavior, and, ultimately, organizational performance. The five delineated seasons are (a) response to mandate, (b) experimentation, (c) selection of an enduring theme, (d) convergence, and (e) dysfunction. The theoretical and practical implications of the model are discussed.     

From QA to TQM

In the decade from 1950 to 1960, two quality-related processes--medical audit and total quality management--were being developed, one directly in the health care field and the other in the manufacturing sector. These processes remained isolated from each other until the mid-1980s. Each would have a separate but major effect on the health care industry.     

Survey provides overview of profession's responsibilities

At the end of 1990, the Physician Executive Management Center, Tampa, Fla., undertook a survey of College members to determine levels of compensation and benefits and to provide a glimpse at the roles and responsibilities of physician executives. The results of the survey have recently been published by the Management Center. In this article, the roles and responsibilities of physician executives for the overall sample are summarized.     

Migration,race and ethnicity, 1960-1980

"This article compares racial and ethnic patterns in interstate and interregional migration in the years 1960 to 1980.... This research looks at geographical assimilation--the extent to which patterns of migration and regional distribution of minority groups resemble those of whites. Attention is directed to United States-born Asian Americans, blacks, Hispanics, Native Americans and whites, and attempts to answer the following questions: 1) To what extent do the patterns of interstate migration of these groups resemble one another? 2) To what extent do the regional distributions and patterns of net regional migration of these groups resemble one another?" This is a revised version of a paper originally presented at the 1988 Annual Meeting of the Population Association of America (see Population Index, Vol. 54, No. 3, Fall 1988, p. 495).     

Assaultive behavior. Does provocation begin in the front office?

1. Provocation is an important risk predictor because these issues can be recognized, assessed, and appropriate interventions can be implemented to reduce the associated risks. It is only by the reduction of such "non-fixed" risk factors that any reduction of assaults can be accomplished. 2. Involuntary admission, patients with dementia or organic brain disorder, physical or verbal limits, staff attitude, denial of the possibility of assaults, and the educational level and clinical experience of the staff may help provoke an assaultive episode. 3. An important step is assessing the assault to identify provocation due to certain medical causes, and to document the extent of degeneration in patients with dementia or organic brain disorder. Medical intervention would be indicated and would appropriately address the causes of some violent episodes.     

Reconciling commodities and personal relations in industrial society

Conclusions I began this article with Colin Campbell's lament about the productionist bias in sociology and the related point that most sociologists concerned with consumption have ignored private meanings and small-scale structures in favor of public meanings and large-scale structures. This article calls attention to and builds on an emerging alternative approach to what happens after production, using an understanding of the social nature of objects that springs from Marcel Mauss's distinction between gifts and commodities.Mauss's model directs attention to the conflict in industrial societies between the two realms of commodity exchange and gift exchange, which I have cast as the conflict between the world of work and the world of family, and as the contrast between commodities and possessions. Thus, the model directs attention to the fact that objects are not simply transformed in production and displayed in consumption. However important these facts may be for understanding objects and society, they do not exhaust the important ways that people experience, use, and think about the objects that surround them. In particular, Mauss's model throws into relief the problematic nature of the objects that surround us and that we use in our social relations. And in doing so it directs attention to the ways that people try to reconstruct and redefine those objects by transforming them into personal possessions. This transformation makes objects acquired as commodities suitable for gift transactions, and hence suitable for the key task of recreating social relationships and social identities, the task of creating, not merely defining, who we are and how we are related to each other.Although the Maussian model addresses many of the links between people in the worlds of work and the home, and many of the ways that objects are part of these links, I am concerned here primarily with the ways that people can appropriate commodities in the process of purchase: shopping. This concern with shopping points out the social significance of retail trade, which I take to include advertising and shopping. This is not simply a passive conduit between production and consumption. Instead, it is an important point at which objects begin to leave the realm of work, commodities, and commodity relations and enter the realm of home, possessions, and gift relations. Shopping is an ubiquitous activity in industrial society and one that is highly significant culturally: we spend vast amounts of time, energy, money, and attention on it. Doubtless part of the reason for this is utilitarian, for we need to buy to live, but it would be foolish to reduce the significance of shopping to some combination of the need of individuals to acquire in order to survive and the need of companies to generate demand in order to profit. Thus, retail trade needs to be seen as well as a set of relations and transactions between seller and buyer that define and are defined by the objects and services involved, their history, and their future. My focus on purchasing food in supermarkets has the advantage of throwing into relief the problem of appropriation, because of the impersonality of object and social relations in large, self-service supermarkets. However, the very extremity of this example can create a false impression. As I noted, in other forms of shopping the social relations between buyer and seller, like the social identity of objects, can be more personal. This personality can be real, as when buyer and seller know each other or where the object is hand-made or even unique. Alternatively, it can be more purely symbolic, as when the selling company touts itself or its employees as friendly and caring or where the manufacturer advertises the personal nature of its commodities. In some cases, indeed, the manufacturing or trading company can present itself in such a way that the company itself becomes the person with whom the purchaser transacts. In addition, because of the focus on the appropriation of commodities in purchasing, I have touched only briefly on production and the world of work more generally. As does life at home, so life at work involves the transaction of objects and labor. Relations at work, then, will shape and be shaped by the nature of what is transacted. Co-workers who transact things that are more clearly stamped with their own identity, as among service workers and craft producers, will likely have more personal relations with fellow workers than will those who transact things that are themselves relatively impersonal, as in assembly-line production. This variability in the objects and relations at work suggests that people will have diverse understandings of work, and hence of manufactured objects more generally, which will affect the need they feel to appropriate commodities. In all, though, the point of this article is simple. People use objects to create and recreate personal social identities and relationships, and in industrial capitalist societies these objects are likely to be produced and purchased as commodities and understood as manufactures in Miller's sense. Our experience with and understanding of the production and sale of objects will affect the way we use them in transactions that create and recreate social identity and relationship, and will affect our understanding of the social identities and relationships that are created and recreated. Thus, the objects that people use in social relationships mediate between realms of economy and society, between the public realms where those objects are produced and distributed, and the private realms where those objects are transacted as part of social reproduction. The fact of this mediation and its effects on people's understanding of objects and social relations deserve careful attention.

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Temporal dimensions of the fertility transition: an age-period-cohort analysis of frontier fertility

"This paper evaluates age, period, and cohort effects on marital fertility during onset of the Utah fertility transition (1880-1900). Computerized genealogies are used to derive age-period-cohort fertility rates for 49,842 once-married couples. Age, period and cohort effects on marital fertility are then estimated using Johnson's (1985) relational model. Declining marital fertility in Utah is shown to be explained by both lower fertility levels across periods and increasing age-specific limitation across cohorts. Direct cohort effects on fertility are insignificant. These results are consistent with prior research, and the view that fertility levels were adaptive (in part through birth spacing across ages) to immediate contexts of childbearing while age-specific fertility truncation increased across cohorts (in part through the more general diffusion of contraceptive innovations)."     

Telling lies in everyday life: Motivational and organizational consequences of sequential preferences

This study of a collection of self-observed lies told in everyday interactions indicated that all informants lied; that lying was, generally, an easy and spontaneous activity; and that our varied informants told lies in much the same manner and for the same reasons. The analysis of the general features of the interactions in which lies were embedded showed that many lies are the consequence of a preference system that promotes acceptance and hides rejection in the sequential organization of interaction. The lies found in pre-acceptance and pre-rejection sequences indicate that both parties contrive for acceptance. The negative cases of lies told in rejection of deprecating assessments suggest a broader theoretical template that encompasses the lies told for acceptance as a subset of the interactional preference for social solidarity. In contrast to the view that telling lies undermines social cohesion by interfering with trust, this study indicates that many lies are told to affirm affiliation.