Improving the contributions of technology assessment to the health care system of the U.S.A.

Summary Based on 14 case studies of highly effective therapies and the reasons they succeeded less frequently than they could, we propose a variety of steps to improve the health care system of the U.S.A. Whatever proposal emerges from current national debates until innovations are shown to be safe and effective, they should not be supported; when slightly better technologies are much more expensive than other good ones we need to consider appropriate choices carefully; simplified billing and bookkeping would reduce our costs; when a technology is rapidly introduced cautionnary measures may be needed; tracking immunization and repairing their omissions requires a new system; educational programs such as seen effective in hypertension should be applied in other areas such as vaccination; in organ transplantation the nation should consider “presumed consent”; our payment system sometimes creates perverse incentives and therefore needs review; and the preferences of the public in allocation of health resources need to be discovered once the public is informed about the issues. Research supported by Andrew W. Mellon Foundation.     

The gambling market in the Federal Republic of Germany and the helpseeking of pathological gamblers

The development of the gambling market in the Federal Republic of Germany since the middle of the seventies and data on pathological gamblers seeking help are described. The continuously increasing supply, together with increases in turnover, was followed-with some temporal delay-by an increase in the number of gamblers who sought advice and treatment. Preliminary measures taken by the health authorities as well as some consequences of pathological gambling are discussed.This article is a translation of a German article published in: Deutsche Hauptstelle gegen die Suchtgefahren (1990): Jahrbuch '91 zur Frage der Suchtgefahren. Hamburg: Neuland-Verlag.     

Dutch tax simplification: Unique in an international setting?

The Dutch reformed individual income tax was implemented on January 1, 1990. The rationale of the tax reform is described, and the major changes are discussed and compared to developments abroad. As far as rate reduction and base-broadening are concerned, the Netherlands has followed the trend in international tax reforms. The Dutch tax reform process, however, focussed more on simplification than in other Western countries.     

TESTAMENTARY BEHAVIOR:

Content analysis and qualitative analysis of all 319 last wills that were filed in Providence Probate Court, 1985, revealed that about ten percent of the testators used testamentary material, disinheritance or altruism to express their individuality. About 42 percent of the wills were personalized directly in other ways. Forty-eight percent displayed indirect influences of family, friends and community. Less that ten percent displayed primary influences of attorneys, banks, nursing homes, governments, religions or other organizations. In the light of these findings, while none of the three major theoretical positions on testamentary behavior prevails, the individualist position is manifested more often than is the family-community position. Both of these positions are manifested much more often than is the legalist position.
These findings are related to the work of Emile Durkheim and to contemporary sociological theories of the family, community and law.     

Scheduling Updates of Probabilistic Risk Assessments: The Arkansas Nuclear One-Unit 1 Experience

This paper presents the results of a study that identified how often a probabilistic risk assessment (PRA)should be updated to accommodate the changes that take place at nuclear power plants. Based on a 7-year analysis of design and procedural changes at one plant, we consider 5 years to be the maximum interval for updating PRAs. This conclusion is preliminary because it is based on the review of changes that occurred at a single plant, and it addresses only PRAs that involve a Level 1 analysis (i.e., a PRA including calculation of core damage frequency only). Nevertheless, this conclusion indicates that maintaining a useful PRA requires periodic updating efforts. However, the need for this periodic update stems only partly from the number of changes that can be expected to take place at nuclear power plants–changes that individually have only a moderate to minor impact on the PRA, but whose combined impact is substantial and necessitates a PRA update. Additionally, a comparison of two generations of PRAs performed about 5 years apart indicates that PRAs must be periodically updated to reflect the evolution of PRA methods. The most desirable updating interval depends on these two technical considerations as well as the cost of updating the PRA. (Cost considerations, however, were beyond the scope of this study.)     

Toward a formal theory of interactive resocialization: The case of adoptive parenthood

Resocialization is pulled out of its structuralist roots and recast into an interactionist framework. Building on a substantive theory of the resocialization experience of becoming an adoptive parent, three theoretical properties of interactionist resocialization are presented. These can be summarized as involving unlearning and relearning some aspects of a core identity; the interpretation and active reconstruction of that identity which has reciprocal effects on all actors involved; and finally, the effects of both situational and trans-situational norms that give shape to the resocialization experience. Suggestions are made for other substantive areas of research that could be used for comparative analysis in order to further refine a formal theory of interactionist resocialization.     

The Approved Social Worker -- Reflections on Origins

Correspondence to Pauline M. Prior, Department of Social Policy and Social Work, University of York, Heslington, York YO1 5DD. Summary The aim of this paper is to examine the role of social workersunder current mental health law, in order to see if the adventof the Approved Social Worker (ASW) represents any more thanthe re-appearance of old concepts in a new guise. It is arguedthat it is impossible for the ASW to be anything more than anupdated version of the Relieving Officer of the last century,in view of the fact that the Mental Health Act 1983 does notprovide a clear mandate for an effective professional advocateon behalf of mentally ill people.