The design of organizations and the right to act

Recent innovations in the structure of formal organizations suggest possible directions for the design of schools to bring about high achievement. The structure of output-driven in contrast to administratively-driven schools is described, and designs are described which address both the goal of high achievement and the goal of reduced inequality.An earlier version of this paper was presented as the author's Sorokin Lecture at the annual meeting of the Eastern Sociological Society, Boston, March 1993.     

Clinical supervision: Its role in “Containing” countertransference responses to a filicidal patient

This paper illustrates the role of supervision in processing countertransference responses with might have disrupted the therapist's empathy with a patient who had killed her child. The clinical material demonstrates how the therapist's responses of initial denial and subsequent disgust and fear were dealt with in supervision. As a result, the treatment process led to genuine, albeit limited, therapeutic change in a patient with severe character pathology.This paper is developed from a presentation of the case of Mrs. Jay at Department of Psychiatry Grand Rounds, University of Cincinnati College of Medicine, on May 2, 1989.     

The health care Titanic: women and children first?

The plight of people who lack access to health care has captured national attention and led to a number of proposals to remedy the problem. The authors look at three types of proposals being advanced--"pro-competition" plans, "pay-or-play" plans, and a national health care system--and find that they fail to address adequately the pressing needs of two groups of the poor: women of childbearing age and elderly women.     

Reformulating the development theory of welfare

Industrialization, technological change and overall economic development are often cited as important factors in the development of welfare states. This article examines the importance of cycles in economic activity and cycles in technological innovation to enhancing our understanding of welfare. The history of technological change in health-care services is used to illustrate the argument.     

Physician perceptions of medical malpractice and defensive medicine

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.     

Geographic distribution of undocumented immigrants: estimates of undocumented aliens counted in the 1980 census by state

"This article presents estimates of the number of undocumented aliens counted in the 1980 [U.S.] census for each state and the District of Columbia. The estimates, which indicate that 2.06 million undocumented aliens were counted in the 1980 census, are not based on individual records, but are aggregate estimates derived by a residual technique. The census count of aliens (modified somewhat to account for deficiencies in the data) is compared with estimates of the legally resident alien population based on data collected by the Immigration and Naturalization Service in January 1980." Estimates are provided "for each of the states for selected countries of birth and for age, sex, and period of entry categories.... The origins of the undocumented alien population [are described], as well as some of their demographic characteristics. Some of the implications of the numbers and distribution of undocumented aliens are also discussed." This paper was originally presented at the 1984 Annual Meeting of the Population Association of America (see Population Index, Vol. 50, No. 3, Fall 1984, p. 435).     

Are old-age security and the utility of children in rural India really unimportant?

Abstract Extract In their recent paper in this journal M. and Carol Vlassoff are to be commended for helping to remedy the dearth of empirical studies on the old-age security motive for children (and particularly sons) in rural areas of developing countries.(1) However, while the questionnaire which they applied to 357 ever-married men in a rural village in Maharashtra state in India is potentially useful, several of the conclusions they derive from it are unwarranted and, if left unquestioned, would undoubtedly have the effect of setting back the serious investigation of the effects of this motive rather than furthering it. The invalid or at least questionable inferences are taken up one at a time in the order of their appearance: