Primary care networks: choose your physicians wisely

As hospitals and health care systems maneuver for a position in the integrated health care delivery system, no initiative is more important than building an effective and competitive primary care network. Yet this critical initiative is fraught with potential pitfalls. In their haste to develop primary care networks, hospitals and health care systems may fail to thoroughly evaluate network participants and in turn create large, inclusive, and inefficient primary care networks that don't come close to breaking even, much less repay practice acquisition costs. In an effort to become more efficient, practitioners often find themselves in the unenviable position of "de-selecting" peers retrospectively. The author presents criteria for evaluating and selecting network physicians.     

Physician organizations. Part 1: A report from the trenches of a start-up PO

How has Community Health Partners, a physician organization based in Kansas City, turned the corner as it rolls into the second year of operation? The biggest indicator is that CHP hammered out the city's first professional risk contracts and the PO has grown from 23 to more than 50 physician member/owners. Looking back, there are at least 10 reasons why CHP made it this far. These are not reasons you learn about in medical school or an MBA program. There is no one-size-fits-all template for building POs. No fixed organizational chart. No neon signs pointing to the best capital partner. Part I explores five reasons for success, such as having a strong board and physician leadership, as well as educating participating physicians about capitation and affiliating with any hospital or payer that really knows how to partner with physicians. Part 2 will focus on five more lessons learned from the trenches of a start up PO.     

The shape of public health policy: the Australian experience

Public health policy is shaped by many factors. A brief historical reflection is given on policy development in Australia to illustrate the various influences on health policy. Medical technology; ethical trade-offs; environmental, social, and political imperatives; popular movements; and changing patterns of disease; as well as market forces have helped to shape Australian contemporary public health policy. These multiple and often competing forces, however, can work against individual consumer choice in health care decisions. This article demonstrates through the eyes of history the factors that shape public health policy. As Australia has a short history compared to most industrialized democratic societies and can be viewed as a microcosm, it is used as the exemplar.     

阿拉贡:成长与变化

去年,为了庆祝法共作家阿拉贡的八十岁生日,法共通过它的报刊发表文章,对他的创作展开评价.在新里昂大学组织的"阿拉贡月"的一次报告会上,法共作家普列伏斯特作了这个题目的演说,对阿拉贡在创作道路上经历的三个阶段进行了分析.《新评论》杂志1977年6、7月号刊登了这篇演说,摘译如下.     

Differences in white-nonwhite community mental health center service utilization patterns

Routinely collected computerized data were used to study the process of service delivery in terms of admission patterns, type and quantity of services rendered, and status at termination for whites and nonwhites in two community mental health centers. Social area analysis techniques were employed to control for socio-economic status, ethnicity and life style variables, and an epidemiologic model was used to analyze admission and service delivery rate differences. It was found that nonwhite admission rates were at least twice as great as white rates. Service delivery rates to the population at large were considerably greater for nonwhites than for whites. Delivery of direct services within the centers differed for whites and nonwhites, but no consistent trends emerged when types and amounts of services rendered were analyzed, controlling for sex, ethnicity, age, diagnosis and social area. Disruption of care indices were greater for nonwhites than for whites. Highlighted were some of the complexities involved in interpreting results of utilization studies.     

Setting health priorities: a review of concepts and approaches

The setting of health priorities is primarily concerned with the equitable distribution of resources and is now more than ever an important part of strategic planning within the National Health Service (NHS). The basic information which can be used to assist in such decision-making and the process by which different agencies become involved are important aspects of priority-setting; this article is based on a major review of the research literature on these aspects and provides a discussion and an analysis of experience within health and other fields. From this material a number of possible approaches to priority-setting are identified and discussed. The article concludes that, before it can be decided how priorities should be set in the future, outstanding questions about how far rational approaches are feasible, about who is to be involved and what role they should play, and about how far such decisions are to be taken nationally or locally will need further consideration.     

经济理论的第二次危机

1971年12月27日,英国经济学家琼·罗宾逊在美国经济学协会第八十四届年会的理查德·艾黎讲座上作了一篇题为《经济理论的第二次危机》的讲演.罗宾逊夫人在讲演中提出了资产阶级经济理论正在经受第二次危机,并对美国凯恩斯派经济理论展开了猛烈的抨击.我国学术界对此讲演曾作过介绍.鉴于这场论争有助于我们了解垄断资产阶级经济理论的发展和演变,现将罗宾逊夫人的《经济理论的第二次危机》和美国凯恩斯派代表人物詹姆斯·托宾的《英国剑桥与美国剑桥之间的论战》两篇文章的摘要一并刊出;同时,我们请中国社会科学院经济研究所黄范章同志写了一篇文章:《从"两个剑桥之争"谈起》,对这场论争的背景和意义,作了扼要的评论.     

新的产业革命

微电子工业方面的非凡进展触发了一场"第二次产业革命".在这场革命中,新技术将使原来由人力操作的工种自动化.这种自动化看来会提高生产率,但将威胁大量的就业机会.当国家科学院的一个委员会声称,"现代的电子工业已经宣告了一场第二次的产业革命……它对社会的影响甚至比原来的产业革命更大",这时候就该引起我们迫切重视了.因为科学院的各个委员会向来是不夸大事实的.并不是唯独科学院指出了电子工业技术的最新进展是势不可挡的社会变革的先驱.在过