An appraisal of organizational response to fiscally constraining regulation: the case of hospitals and DRGs

Results from analysis of 227,771 discharge abstracts from 68 short-term, acute-care hospitals and from interviews with a stratified random selection of 24 of the 68 chief executives of these hospitals demonstrate that institutions perceive implementation of DRGs as fiscally constraining, especially in light of other resource-constraining conditions (an increase in unemployment resulting in fewer people with hospitalization insurance, in addition to severe cuts in Medicaid rolls and budget). Hospitals responded to DRGs by decreasing the use of affected resources or services available to the hospitalized Medicare patient. In order to survive a more economically stringent marketplace, hospitals no longer protected the traditional core within the Medicare inpatient market. They opted instead to change practices and products at the unregulated margins of the DRG system.     

The Devil is in the Detail: Clinicians,Academics and Researchers Resolving the Problems of Clinical Research

The difficulties associated with conducting valid family therapy research within a clinical practice discourage many potential researchers. This article will describe collaboration between a group of academics, researchers and clinicians who decided to explore the process and efficacy of systemic family therapy conducted within a working private practice. The specific questions we are addressing are, whether the requests clients bring to their first session of therapy can be reliably classified by practitioners, whether these requests change over time, and whether the nature of the request is associated with therapist and client ratings of therapeutic outcome. Additional questions about the form and nature of the therapeutic alliance as experienced by both client and practitioner are also being explored. This paper will map the passage of the work from inception to its current state where over 140 clients are active participants. In doing so attention will be paid to the obstacles encountered: practical, financial and ethical, and the solutions devised to address these.     

Modeling collecting behavior: The role of set completion

Collecting is a complex behavior that has been studied from a variety of different perspectives. Art objects, stamps, coins, and other established collectibles markets, have been shown over the years to provide some degree of return to the collector in the economics literature. Wonderment over the success of certain collectibles such as Swatch watches and Beanie Babies has received much attention in the popular press. But how does one rationally explain the collecting of matchbook covers, Cracker Jacks toys, belt buckles, salt cellars, Aunt Jemima, etc.? Collecting in the absence of financial gain has received little attention in the economics literature. In the social psychology literature, many individuals are understood to have a natural desire to collect things for various reasons. Financial gain is only one of those reasons. Set completion is another. The reasons for collecting are not always mutually exclusive. For example, a complete set may be worth more in the secondary market, if one exists, than the sum of the individual pieces. This reflects the value of the rarest pieces and the opportunity costs of obtaining them. The model presented in this study explains how set completion motivates collecting behavior, which sheds light on collecting for both financial and nonfinancial reasons. The model accommodates both collectors and noncollectors and illustrates how consumption behavior may vary accordingly. Insight into how manufacturers of collectibles can use this behavior for commercial exploitation is explored.     

Politiques publiques et parcours de fin de vie: reconfigurations,dynamiques paradoxales et art combinatoire

Du fait de l'allongement de l'espérance de vie, de très nombreuses personnes vivent désormais un grand âge, c'est-à-dire une longue période de l'existence au cours de laquelle ils se confrontent à leur finitude. Ce nouveau temps de l'existence questionne la conception traditionnelle d'un cycle de vie ternaire, et la définition de la fin de la vie. Autour de cette dernière étape du parcours de vie, se révèlent les ambiguïtés de la culture des problèmes de la vieillesse et se noue une controverse concernant la désinstitutionalisation et la déstandardisation des parcours de vie. A partir des données issues de travaux empiriques cet article analyse les formes originales d'action publique qui s'esquissent à l’échelle des territoires et renouvellent les cadres normatifs institutionnels de gestion de la grande vieillesse. Il met au jour la dialectique qui s'engage entre une forme de production centrifuge et institutionnalisée des politiques publiques, initiée par l'Etat et un processus centripète dans lequel la diversité et la dispersion des acteurs participent de dynamiques coopératives vs concurrentielles.

Les éléments empiriques mobilisés dans cet article sont issus d'une recherche menée dans le cadre des conventions d’études conclues pour les années 2010 (projet n4) et 2011 (projet n 4) entre l'IRES au service des organisations représentatives des travailleurs et la CGT.     

To live an ordinary life: resource needs and additional costs for people with a physical impairment

Disabled people face increased risks of living in poverty largely due to lower incomes and extra resource requirements compared to non-disabled people. This study incorporated the social model of disability with an economic approach to costing to estimate the additional costs required by people with a physical impairment to achieve an adequate standard of living in New Zealand. Budgets estimating the additional equipment, modifications, transport, support and time required to achieve an adequate standard of living were developed and validated through focus groups with community members. The findings suggest that reducing barriers involves substantial costs ranging from NZ$645–$2,348 per week.     

Contingent on Context? Social Work and the State in Australia, Britain, and the USA

Correspondence to John Harris, School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, UK. E-mail: j.harris{at}warwick.ac.uk Summary The notion that social work is an international profession,operating with generally similar goals, methodologies, and commonvalues is considered critically. Examining the political andsocial contexts of three countries with liberal democratic governments—Australia,Britain and the United States—the role of social workwithin the welfare processes of each country is compared. Whilesocial work as an identifiable professional activity sharessome features, it is argued that the idea of its having a coreessence needs to be tempered with a realistic assessment ofthe importance of contextually created difference. Recent andrapid developments in the institutional context, such as thoseexperienced in these three countries, further underscore thelimited utility of the notion of a common professional project.