Employment-based health benefits: analysis of the April 1993 Current Population Survey

The April 1993 CPS differs from the March 1993 CPS in a number of respects. The April 1993 CPS supplement surveys only workers, whereas the March CPS examines the noncash benefits received by all Americans. The April CPS asks workers about health coverage in the week in which the questions were fielded, whereas the March CPS asks about coverage in the preceding year. In April 1993, there were 112.5 million civilian American workers between the ages of 18 and 64 with jobs. Eighty-two million (73 percent) of them worked for an employer that sponsored a health insurance plan, and 65 million (58 percent of all workers) participated in their employer's health plan. About one-third of workers at firms with fewer than 10 employees had employers who offer health benefits; about one-quarter of all of the workers in these firms participated in their employer's plan. Conversely, 94 percent of workers at firms with more than 1,000 employees had an employer who sponsored health benefits, and over 77 percent of these workers participated in their employer's plan. There are 16.5 million American workers whose employers sponsored health benefits but who did not participate in these benefits. Over one-half of these workers (8.5 million) chose not to be covered. Another 36 percent of these workers (5.9 million) did not participate because they were ineligible or denied coverage. Over 66 percent of the ineligible workers did not participate because they were part-time, contract, or temporary workers. Another 26 percent had not yet completed a probationary period. Among the reasons that those who chose not to participate in their employer's coverage, the vast majority (75 percent) stated they were covered by another health care plan. Twenty-nine percent stated that they chose not to purchase coverage because it was too costly or that they did not need or want the coverage. In 1993, there were 16.7 million workers with no health insurance coverage. The vast majority of these workers (95 percent) were employed by private employers. Sixty-six percent of the workers with no health insurance coverage were self-employed or worked for firms with fewer than 100 employees.     

Administrative knowledge and skills needed by physician executives

A survey was mailed to 100 physician executives identified through the 1991 American College of Physicians Executives directory. The subjects were asked to rate 17 managerial areas on their value to the subjects' current work, on the subjects' preparation in the areas, and on the need for training in the areas. In addition, the subjects were asked how best to accomplish training in the areas and for a list of areas of greatest importance in the future for physician executives. The subjects rated communication skills, quality assurance, utilization review, and personnel management as being of primary value in their current roles. Preparation was most adequate in communication skills and most inadequate in the areas of finance and organizational management. Training was deemed desirable in all areas, but was thought to be most necessary in communication skills, negotiations, strategic planning, and organizational management. There was least desire for training in the areas of labor law and employment law. The most popular means of training were doing a fellowship in administrative medicine, receiving continuing education through seminars or workshops, or getting a degree in management.     

A rational approach to career change

Recently, the number of physicians who have been interested in alternative careers has vastly increased. Many physicians express dissatisfaction with clinical practice, but they are uncertain about which nonclinical options are appropriate for them. Pursuing a different career after many years of studying and practicing medicine can seem like an overwhelming task. In this article, the author briefly outlines a decision-making process that can be used in analyzing career options and suggests some careers that have provided challenging opportunities for physicians.     

Physicians in transition

The study of physicians as managed care executives has been relatively recent. Much of what was written in the past focused primarily on doctors who had taken hospital-based administrative positions, especially as medical directors or vice presidents of medical affairs.1 But the '80s brought rising health care costs and the emergence of the "O's"--HMOs, PPOs, UROs, EPOs, PHOs, H2Os, and Uh-Ohs--in response. It also brought a growing number of physicians who traded their white coats and their particular "ologies" for the blue suits of executive management. I am convinced that it is important now, and will be increasingly important in the future, to better understand that transition. That belief led me to undertake, with the help and support of ACPE, the survey that is reported in this article. A questionnaire was sent in 1994 to a random sample of 300 managed care physician executive members of ACPE. Responses were returned by 225 members, a response rate of better than 80 percent. Twenty-five of the responses were not applicable, having been returned by physicians who had never made a transition from clinical careers. The remaining 230 responses form the basis for this report.     

LET''''S MAKE ENGLISH MORE EXCITING

"Teacher, what are we going to do next class?" This is an exciting question which I often hear from my students. As an English conversation teacher, I can make the learning of English either a dull and boring duty, or an exciting adventure. It is very important that I make my students hate missing my class, and keep them guessing just what will happen the next time! Let us consider some important ways that any teacher can help his other students want to do their     

Economic integration and labor flows: stage migration in farm labor markets in Mexico and the United States

"This article examines the probable effects of the North American Free Trade Agreement (NAFTA) on migration from Mexico to the United States, disputing the view that expansion of jobs in Mexico could rapidly reduce undocumented migration. To the extent that NAFTA causes Mexican export agriculture to expand, migration to the United States will increase rather than decrease in the short run. Data collected in both California and the Mexican State of Baja California show that indigenous migrants from southern Mexico typically first undertake internal migration, which lowers the costs and risks of U.S. migration. Two features of employment in export agriculture were found to be specially significant in lowering the costs of U.S. migration: first, working in export agriculture exposes migrants to more diverse social networks and information about U.S. migration; second, agro-export employment in northern Mexico provides stable employment, albeit low-wage employment, for some members of the family close to the border (especially women and children) while allowing other members of the family to assume the risks of U.S. migration."