A computerized financial planning model for a health maintenance organization

The time and resource costs needed to plan and start a prepaid medical program or health maintenance organization (HMO) are extensive. It can take up to 3 years to bring one on line and another 3 to 4 years to reach financial stability. Depending on the type of prepaid medical plan designed, the cost can reach $6 to $8 million before breakeven occurs. Because the financial stakes are so high, a systematic and sound business approach must be taken to find that one ‘best’ design that will survive in the market place. Thousands of hours are required to study all of the possible HMO design configurations. This paper describes how a corporation constructed a computerized financial planning model to simulate the financial behavior of a prepaid medical program with different organizational formats, operational policies and pricing and compensation schemes in varying market, economic and cost environments. Model development and application was a corporate affair. The computerized model provided a special design team with the capability to evaluate the economic impact of many different designs by asking ‘what if’ questions dealing with several key design and operating variables concerning different health benefit options, service utilization rates, staffing patterns, inflation rates and price and premium schedules. Thousands of hours of design time were saved and the corporation was able to find the ‘best’ possible design in a reasonable time and at a reasonable cost.     

Predictors of father-son communication about sexuality

Examining the factors that influence adolescents' sexual behaviors is crucial for understanding why they often engage in risky sexual behaviors. Using social cognitive theory, we examined predictors of father-son communication about sexuality. Fathers (N=155) of adolescent sons completed a survey measuring 12 variables, including self-efficacy and outcome expectations. We found that (a) son's pubertal development, father's sex-based values, father's education; father's communication with his father, outcome expectations, and general communication accounted for 36% of the variance in information sharing communication and (b) son's pubertal development, outcome expectations, general communication, and father-son contact accounted for 20% of the variance in values sharing communication. Study findings can aid professionals in designing guidelines for programs to promote father-son general communication and sex-based communication.     

The Ethnographic Turn: Fact,Fashion, or Fiction?

Commentators have suggested that a qualitative turn occurred in the social sciences in the last couple of decades of the twentieth century. We examine evidence on publication patterns, finding that the ethnographic turn consisted more of a proliferation of specialty journals than increased publication in mainstream sociology journals. This difference is important because it moves methodological debate inside the community of qualitative scholars, changing the focus from a contrast between qualitative and quantitative methods to questions about the relative merits of different styles of ethnographic work. Thus far, our data suggest, the main effect of the ethnographic turn may have been to institutionalize a set of labels rather than a set of practices.     

U.K. statistics on immigration: development and limitations

This article discusses the data on international migration to the UK, their limitations, and their origins. No 1 source gives a demographically satisfactory account of net migration, and different sources of data are not compatible with each other. Their present form can only be understood in the context of a reluctant acceptance, in the face of domestic political pressure, of the need to impose the same controls on the entry of Commonwealth citizens from 1962-1971 as had been imposed on the entry of aliens since 1920. Coleman asserts that UK migration statistics suffer 1 major omission and several systematic deficiencies. The omission is the absence of any information, either from the International Passenger Survey (IPS) or from the Home Office, on gross or net migration flows to the UK from the Republic of Ireland. Neither the IPS nor the Home Office data provide a very satisfactory form of measurement of other migration streams. Neither has much time depth, the former not existing before 1963, the latter being affected by changes in rules and procedures. As a voluntary sample with only relatively few interviews per year on intended migrants, the IPS can only provide a crude overall estimate of the general demographic import of migration flows, incapable for statistical reasons of any refined sub-division or analysis, and prove both to error and bias. The Home Office statistics do not treat immigration in a demographically useful way. They measure flows only in 1 direction, provide no demographic or socioeconomic characteristics on those accepted for settlement, and are not compatible with the IPS in most ways. For political reasons, no action to resolve the Irish anomaly is likely, especially when the trend is for less, not more, control and counting on the entry of European Community citizens.     

Out of Cairo: forging a new population policy

The 1994 International Conference on Population and Development (ICPD) was the first where thousands of women contributed to the agenda. The previous emphasis of population policies on the simple provision of family planning (FP) services has led to abuses such as coercion to have only one child in China or financial incentives for undergoing sterilization in India. The 1994 ICPD Program of Action provides a more humane basis for population programs by emphasizing the fact that women have fewer children when they are educated and gainfully employed. Thus, improving women's reproductive health and social status has become a central issue, and widening access to contraception remains an important objective. In addition to the 500,000 women who die of pregnancy-related causes each year, half a billion suffer infections of the reproductive tract. By failing to address these problems, many FP services actually exacerbate them. In Giza, for example, although 39% of 500 women studied used contraception (45% of those married and living with their husbands), only 1 in 7 was free of gynecological problems, urinary tract infections, and syphilis (50% had at least 2 of these conditions). The women who used contraceptives were no healthier than their neighbors who did not. Once FP clinics attempt to tend to reproductive health issues, they encounter cultural and religious constraints. For example, a woman may obtain an IUD and then suffer from severe side effects rather than return to the clinic for attention. Another woman may become infected from an illegal abortion obtained at her husband's insistence. The infection may preclude an IUD for months, so the woman may obtain oral contraceptives from a pharmacy although she knows her high blood pressure should preclude their use. Full implementation of the ICPD Program of Action would improve the status of women such as these, fostering their self-esteem, their access to education and employment, and their participation in the political process; eliminating violence against them; and making them aware of their legal rights. The success of the readjustments in FP programs, government resource allocation, and family structures which will accomplish this task will depend largely on the women who helped put reproductive health on the ICPD agenda.     

Extension of the sexual abuse questionnaire to other abuse categories: the initial psychometric validation of the Binghamton Childhood Abuse Screen

Study I represents a follow-up to a recently published study dealing with the initial development of the Sexual Abuse Questionnaire (SAQ). The SAQwas designed to be used to identify individuals experiencing psychological distress resulting from a history of childhood sexual abuse. Using a new data set (N = 2,806), this study utilized item analyses, exploratory factor analyses, and Receiver Operating Characteristics Curves to replicate and expand upon the initial psychometric properties of the SAQ, and to examine the sensitivity of the SAQ to other abuse categories. Findings from Study I indicated that the SAQ was sensitive to other abuse categories and in need of revision. Study II, using a new data set (N = 1,454), provided the initial psychometric evaluation of the newly constructed Binghamton Childhood Abuse Screen (BCAS).     

Understanding the role of Australian Aboriginal maternal infant care workers: bringing a cultural dimension to a critique of the ideal worker concept

Models of care that include a prominent role for Aboriginal workers are fundamental to improving the health of Aboriginal Australians. However, tension arises when these models co-exist with mainstream models, contributing to difficulties sustaining an Aboriginal workforce. The ‘ideal worker’ theory is drawn on to explore whether historical workplace norms undermine the roles of Aboriginal workers in an Australian hospital setting. In-depth interviews were conducted with 30 staff and clients of an innovative maternity service, featuring Aboriginal Maternal Infant Care (AMIC) workers caring for Aboriginal women in partnership with midwives. A phenomenological methodology highlighted that unrealistic and inappropriate assumptions embedded in the ideal worker notion underpin many challenges facing AMIC workers. These workers have deep ties to their communities, with extensive responsibilities beyond the workplace. Although the hospital system relies on these ties to engage clients, this time commitment and the unbounded ways in which AMIC workers provide care are not acknowledged. Findings illustrate how the ideal worker concept has a cultural and gender dimension, which undermines AMIC workers and does not value culturally relevant care. This work has implications for ingraining cultural competence into health care, suggesting the wide-ranging contributions of Aboriginal workers must be recognised to achieve sustainable reform.     

Gender differences in labor market wages: A comparison of industrial sector effects and a decomposition within four occupations

Women earn less than men. The reason may be due to either industrial segmentation or occupational segregation or both according to the current research. Researches focusing on one structure tend to neglect the other or to use an inadequate representation. This article examines the simultaneous impact of industrial sector and gender on imputed wages with labor force incumbents in four detailed occupations. These occupations are from a set identified as relatively internally homogeneous on measures of task performed from the Dictionary of Occupational Titles. Thus, within-occupational differences in work performed between males and females are minimized. The findings reinforce the importance of industrial sector for economic outcomes and demonstrate the value of an improved representation of occupation. The decomposition shows wage discrimination exists against females in each of these occupations, and in two sector-by-sector occupation comparisons, females should earn more than males.     

Gender, Hierarchy, and Leadership: An Introduction

Although women's status has improved remarkably in the 20th century in many societies, women continue to lack access to power and leadership compared with men. This issue reviews research and theory concerning women's leadership. The articles included in the issue provide evidence of bias in the evaluation of women, discuss effects of gender stereotypes on women's influence and leadership behaviors, and evaluate strategies for change. This introductory article provides a brief summary of changes in women's status and power in employment and education and the absence of change at the upper echelons of power in organizations. Also included is an outline of the contributions of the other articles in the issue.