Physician fee-setting requires scrutiny.

To avoid antitrust liability from physician fee-setting in HMOs and PPOs, participating physicians should share the risk of profit and loss. "Health Law" is a regular feature of Physician Executive contributed by the law firm of Epstein Becker and Green, P.C. Douglas A. Hastings, Esq., a partner in the firm's Washington, D.C., offices serves as column editor.     

Overcoming fieldwork challenges in urban health research in developing countries: a research note

With rapid growth in the global urban population over the next two decades, health will increasingly have an urban bias. The picture of public health is particularly complex in African cities, where rates of urbanisation, poverty and inequity are high. This paper identifies the main data collection problems encountered within a panel study in low‐income areas of Johannesburg, with special emphasis on sampling, access and partnerships. The paper will be of relevance to anyone considering research in the cities of developing countries, especially in Africa.     

Eliciting Stance and Mitigating Therapist Authority in Open Dialogue Meetings

Open Dialogue is a collaborative systemic approach to working with families in crisis. A core feature is the creation of dialogue through the elicitation of a multiplicity of voices. Using conversation analysis, we studied 14 hr of Open Dialogue sessions. We found that therapists recurrently produced utterances containing “I’m wondering.” These utterances topicalized particular issues and invited stance positions from other participants while also allowing the therapist to mitigate their deontic authority and present potentially disaligning stances. Therapists thus exercised authority in eliciting stances, but provided recipients with multiple avenues for responding. These findings illustrate that therapist authority is not necessarily antithetical to dialogue and, in well‐crafted forms, may even be necessary for the creation of polyphony through the elicitation of multiple stances.     

Subverting Social Policy on the Front Line: Agencies of Resistance in the Delivery of Services

An understanding of policy implementation issues in many of the core fields of social policy requires attention to the mode of service delivery that is characteristic of those fields: face‐to‐face interaction between frontline service staff and service users. A focus on implementation as interaction between these groups reveals the significance of ‘agency’ to the analysis of why and how certain social policy outcomes occur – and in particular why outcomes may sometimes be different from those anticipated by formal policy objectives. This article considers how the agency of workers and users shapes the processes of mediation, negotiation and adaptation that occur in different service delivery contexts, and identifies ways in which resistance to intended policy outcomes, and to the practices expected to deliver them, is formed and expressed. Drawing on a wide range of empirical research material, the article shows how agencies of resistance produce outcomes that are uncertain, fragile and contested, and whose effect can be the subversion of formal policy intentions.     

‘The language is disgusting and they refer to my disability’: the cyberharassment of disabled people

Disabled people face hostility and harassment in their socio-cultural environment. The use of electronic communications creates an online context that further reshapes this discrimination. We explored the experiences of 19 disabled victims of cyberharassment. Five themes emerged from the study: disability and health consequences, family involvement, misrepresentation of self, perceived complexity, and lack of awareness and expertise. Cyberharassment incidents against disabled people were influenced by the pre-existing impairment, perceived hate-targeting, and perpetrators faking disability to get closer to victims online. Our findings highlight a growing issue requiring action and proper support.     

The Relationship Between Distance from Gambling Venues and Gambling Participation and Problem Gambling Among U.S. Adults

In this article we examine the relationship between extent of gambling for U.S. adults and the distance from their residence to the nearest casino or track. We employ data from a telephone survey of U.S. adults conducted in 2011–2013. The chances that the respondents gambled in the past year, were frequent gamblers, or were problem gamblers were greater if they lived close to a casino. The chances that the respondents gambled in the past year or were frequent gamblers were greater if they lived close to a horse or dog track. The effects of closeness to a casino on the likelihood of past-year gambling, frequent gambling, and problem gambling, as well as the effect of closeness to a track on past-year gambling, extended to about 30 miles from the respondent’s home. In addition, the concentration of casinos within 30 miles of the respondent’s home was positively related to the respondents’ chance of being a frequent or problem gambler. If a respondent had no casinos within 30 miles, he or she had a 2.7 % chance of being a problem gambler; if one casino, a 3.9 % chance; if six or more, a 6.2 % chance. The authors estimate that at least part of this effect is causal.     

Qualitative Research: Valuable or Irrelevant?

This paper evaluates qualitative research methods in relation to the emancipatory research model. It identifies the main reasons why researchers opt for qualitative research, describes the principal data collection techniques used by them, and discusses some of the problems associated with these procedures. Drawing on insights gained from doing qualitative research in day centres for disabled young adults, I argue that these methodologies are fundamental to the emancipatory research paradigm; but their relevance can only be determined by researchers' willingness to challenge the institutions which control disability research production.