EMERGING TRENDS IN THE PROVISION AND CONSUMPTION OF HEALTH SERVICES

Health services are examined in terms of emerging trends for the new millennium. On the one hand, centralization is increasing as payers tighten control over disbursements through managed care and more restrictive health insurance. On the other hand, health services are decentralizing as patients acquire more information and take more control of some aspects of treatment. Health services markets now also show signs of becoming global in nature, possibly benefiting both bulk purchasers of care and individual consumers. Any tendencies toward increased patient control are likely to be ephemeral, however: In the absence of reforms sparked by yet-to-be-experienced crises, advances in technology, particularly in medical informatics, will likely be used to strengthen the profit positions of insurance providers, not to provide more comprehensive health care services for patients.     

The sex composition of the Japanese American population

While both aversion therapy and psychotherapy can claim considerable success, they also fail occasionally. In view of this experience an attempt has been made to intergrate these therapies. Two cases are discussed in which such collaboration of representatives of both schools was achieved. After successful termination of the treatment, the patients filled out questionnaires in which they evaluated the contribution of each of these therapies.     

Quantum mechanics and the postmodern in one country

Abstract

The orthodox interpretation of Quantum Mechanics was banned in the Soviet Union in 1947, an episode usually glossed as another illustration of repressive Soviet science. This paper argues that the roots of this ban should be located at a much deeper level, in a tension existing between the ‘postmodern’ form of orthodox Quantum Mechanics and an ideology of modernization. In the West a similar ideological tension had a different result: when the occasion demanded, the orthodox interpretation was covertly exchanged for an agnosticism about metaphysical matters, and potential areas of conflict with the principles of modernization were thus defused. The latter strategy benefited the orthodox interpretation, which enjoyed a virtual monopoly in the West from the 1940s through to the 1960s. Using the Freudian notions of ‘transference’ and ‘disavowal’, I explain why the ideological tension with modernization was resolved differently in the West and in the Soviet Union.     

Colleges respond to student binge drinking: reducing student demand or limiting access

Administrators at 68% of 4-year colleges nationwide (N = 747) responded to a survey concerning the types of programs and policies they used in response to students' heavy drinking. Most schools conducted targeted alcohol education and invested in institutional prevention efforts; half conducted social norms campaigns; a sizeable minority restricted alcohol on campus. Schools that focused on demand reduction were less likely to ban alcohol use. One in 3 schools received funding for these programs from governmental agencies, and 1 in 5 from the alcohol industry. Such schools were more likely to conduct targeted alcohol education and social norms programs and were less likely to restrict alcohol use on campus or at college events. Colleges may want to reconsider prevention initiatives that focus exclusively on demand or supply. They may also want to examine the extent to which funding is the driving force shaping the direction of their alcohol initiatives.     

Facilitators and barriers to employment: the perspectives of people with psychiatric disabilities and employment service providers

This study examined the perspectives of people with psychiatric disabilities and employment service providers regarding factors that most directly help or hinder consumer efforts to obtain and maintain employment. Forty-four adults with serious mental illness (SMI) (consumers) and 30 providers participated in 12 focus groups across Massachusetts. We began both consumer and provider groups by posing two broad questions: 1) what factors most help people with SMI get and keep jobs (facilitators), and 2) what factors most prevent people with SMI from getting and keeping jobs (barriers)? Data were analyzed qualitatively and both person and environmental factors were highlighted. Among facilitators, participants agreed that quality consumer-provider relationships and individualized employment services are most instrumental in helping consumers achieve employment goals. Participants identified a range of environmental barriers, including issues related to the service system, entitlement programs, non-human resources, and social stigma. Implications for services are discussed.     

Guns and gun threats at college

A random sample of more than 10,000 undergraduate students, selected from 119 4-year colleges, answered a mailed questionnaire about gun possession and gun threats. Approximately 4.3% of the students reported that they had a working firearm at college, and 1.6% of them have been threatened with a gun while at school. Students are more likely to have a firearm at college and to be threatened with a gun while at college if they are male, live off campus, binge drink, engage in risky and aggressive behavior after drinking, and attend institutions in regions of the United States where household firearm prevalence is high. Having a firearm for protection is also strongly associated with being threatened with a gun while at college. Students who reported having firearms at college disproportionately reported that they engaged in behaviors that put themselves and others at risk for injury.     

Defining welfare spells. Coping with problems of survey responses and administrative data

The authors explore how to define a welfare spell and how well surveys measure welfare spells. By comparing survey and administrative data from the Work Pays Demonstration Project in California on the receipt of Aid to Families with Dependent Children (AFDC), they find that a substantial amount of administrative churning occurs in administrative data. Through a mixing model of several break lengths, the authors find that a single definition of a break in welfare is not applicable to all respondents. Additionally, it appears that there is substantial variation in the break lengths respondents utilize. Finally, the authors show that the complexity of defining an accurate break in spells creates difficulties for detecting biases in survey responses.