Managed care matures. What's behind the wave of anti-HMO legislation?

At first glance, it may appear as if managed care itself may be doomed. The avalanche of bills, measures, initiatives, Federal regulations, etc., seemed overwhelming in late 1996. Did this, in fact, portend a national shift away from managed care? What does the consumer protection and regulatory activity really mean? What directions for the future can be identified? This article seeks to answer those questions and highlights a case study of "reform gone awry" that may hold lessons for the national scene. The anti-HMO legislation activity does not represent a repudiation of managed care. Rather, it may be seen as a maturing of the entire process of redefining our medical delivery and financing system.     

Leaving Home and Destination of Early Nest Leavers: Ethnicity,Spaces and Prices

This study examines ethnic differences in leaving the parental home and the choice of destination (both location and quality of housing) in the Netherlands. Using unique individual administrative panel data, we study the mobility of the entire birth cohort 1983. In contrast to previous studies, this paper includes the geographical location and the quality of destination living arrangements in the analysis, in an attempt to explain ethnic differences in leaving the parental home. We show that ethnic minority youth, in particular those from Turkish and Moroccan origin, improve their housing quality when leaving the parental home. This results in earlier home-leaving than among young people of native Dutch origin. Our results on the early home-leaving behaviour of ethnic minority youth are robust with regard to the geographical distance of nest leavers.     

Axiomatization of a class of share functions for n-person games

The Shapley value is the unique value defined on the class of cooperative games in characteristic function form which satisfies certain intuitively reasonable axioms. Alternatively, the Banzhaf value is the unique value satisfying a different set of axioms. The main drawback of the latter value is that it does not satisfy the efficiency axiom, so that the sum of the values assigned to the players does not need to be equal to the worth of the grand coalition. By definition, the normalized Banzhaf value satisfies the efficiency axiom, but not the usual axiom of additivity.In this paper we generalize the axiom of additivity by introducing a positive real valued function on the class of cooperative games in characteristic function form. The so-called axiom of -additivity generalizes the classical axiom of additivity by putting the weight (v) on the value of the gamev . We show that any additive function determines a unique share function satisfying the axioms of efficient shares, null player property, symmetry and -additivity on the subclass of games on which is positive and which contains all positively scaled unanimity games. The axiom of efficient shares means that the sum of the values equals one. Hence the share function gives the shares of the players in the worth of the grand coalition. The corresponding value function is obtained by multiplying the shares with the worth of the grand coalition. By defining the function appropiately we get the share functions corresponding to the Shapley value and the Banzhaf value. So, for both values we have that the corresponding share functions belong to this class of share functions. Moreover, it shows that our approach provides an axiomatization of the normalized Banzhaf value. We also discuss some other choices of the function and the corresponding share functions. Furthermore we consider the axiomatization on the subclass of monotone simple games.     

Strategic planning in small and medium-sized companies

In analysing the characteristics of strategic planning applications in different types and sizes of companies, confusion often arises not because of the application but because of the definitions utilized. This paper analyses the use of strategic planning concepts in small and medium-sized companies in Holland. As the author points out, in this context the definition of small and medium-sized is determined by five strategically relevant criteria which are distinctive. The author points out, however, that whilst these criteria are distinctive of the category of small and medium-sized companies surveyed, they do not all have to occur at the same time; the higher the number that do occur, the more typical the company. Whilst this paper does not, as the author admits, represent the result of a systematic survey, the authors wide experience as a consultant is in itself a valuable background to his analysis. Indeed, the findings stated in this paper represent an analysis of the strategic planning practises of some 75–100 companies. Therefore, in view of the detailed criteria utilized and the number of companies analysed the results represent an important addition to our knowledge of the application of strategic planning.     

The business environment in the 1980s

Dr. Harold Linstone, the editor of ‘Technological Forecasting and Social Change’ holds that too often the future is too much discounted. This seems particularly true in the case of business corporations, which tend to pay lip service to long-range planning—especially when prospective studies point to threats rather than to opportunities.The author believes that truly long-range planning will rarely be operative until business corporations muster the political will to jointly write a scenario of their (interlinked) future, and to act accordingly. Illustratively and speculatively, such a scenario might read as follows:     

Civil Society in Comparative Perspective: Involvement in Voluntary Associations in North America and Western Europe

Involvement in voluntary associations is analyzed from the perspective of questions raised in the debate about civil society. After demarcating the concept of civil society in relation to the community, the market, and the state, expectations are formulated about the negative effects of modernization and individualization on volunteering and the positive effects of volunteering on social capital and public discourse. World Values 1990 data are used for inter- and intranational analyses. Neither rankings of thirteen Western nations nor in-depth analyses of the U.S., the Netherlands, and Italy support worried reflections about the effects of modernization. The Idea that involvement in voluntary associations is conducive to social cohesion and political democracy finds empirical support. Both mere membership of an association and actual volunteering within such an association appear to be important in this respect.     

Adolescent Gambling and Coping within a Generalized High-risk Behavior Framework

Data were collected for 1998 middle/high-school students in Ontario to assess involvement in gambling, substance use, and generalized risky behavior. To predict these outcomes, measures for anxiety, family cohesion, and coping style were also administered. Three a-priori models were posited to account for the impact of risk factors, protective factors, and combined risk/protective factors on the development of risky behaviors. A high-risk cohort composed of subjects endorsing at least one risky behavior (gambling, substance use, or generalized risky behavior) within the clinical range was created to test an unobserved outcome variable created from all three measures of risky behavior, which was successfully predicted by two of the three a-priori models. Implications for the inclusion of gambling within a constellation of high-risk behaviors and recommendations for future prevention efforts are discussed. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Functional capacity evaluation: An essential component of South African occupational therapy work practice services

South African occupational therapists have been involved in the delivery of work practice services since the inception of the profession in this country. Initial development in this area of practice appeared slow but following the acceptance of South Africa's first democratic Constitution in 1996, many opportunities for service delivery were facilitated by the implementation of disability equity legislation. One of the key services offered by practitioners is Functional Capacity Evaluation (FCE). Although the outcomes of FCE are many, the process in essentially the same. This entails: referral, the initial interview, evaluation of performance components and ADL, vocational evaluation, obtaining collateral and the closure interview, the work visit, hypothesis testing and reporting. This article reports on the Functional Capacity Evaluation process as followed by South African occupational therapists in various contexts.