An empirical examination of cost-adjusting in outpatient clinics

This paper presents an empirical methodology for examining cost-adjusting in relation to multiple-output health care providers. The methodology is subsequently implemented using a sample of California outpatient clinics. The empirical evidence is that these clinics do cost-adjust; that is, the clinics respond to low Medicare reimbursement by using lower quality to control the marginal costs of those patient groups not insured under a government-sponsored plan. In addition, clinics do not cost-adjust with respect to Medi-Cal patients, implying that various government reimbursement systems have different effects on a provider’s cost-adjusting behavior.     

Ecocultural Attributes: Evaluating Ecological Degradation in Terms of Ecological Goods and Services Versus Subsistence and Tribal Values

It is becoming increasingly clear that scientists, managers, lawyers, public policymakers, and the public must decide how to value what is provided by, and is a consequence of, natural resources. While “Western” scientists have clear definitions for the goods and services that ecosystems provide, we contend that these categories do not encompass the full totality of the values provided by natural resources. Partly the confusion results from a limited view of natural resources derived from the need to monetize the value of ecosystems and their component parts. Partly it derives from the “Western” way of separating natural resources from cultural resources or values, and partly it derives from the false dichotomy of assuming that ecosystems are natural, and anything constructed by man is not natural. In this article, we explore the previous assumptions, and suggest that because cultural resources often derive from, and indeed require, intact and unspoiled natural ecosystems or settings, that these values are rightly part of natural resources. The distinction is not trivial because of the current emphasis on cleaning up chemically and radiologically contaminated sites, on restoration of damaged ecosystems, on natural resource damage assessments, and on long‐term stewardship goals. All of these processes depend upon defining natural resources appropriately. Several laws, regulations, and protocols depend upon natural resource trustees to protect natural resources on trust lands, which could lead to the circular definition that natural resources are those resources that the trustees feel they are responsible for. Where subsistence or tribal peoples are involved, the definition of natural resources should be broadened to include those ecocultural attributes that are dependent upon, and have incorporated, natural resources. For example, a traditional hunting and fishing ground is less valued by subsistence peoples if it is despoiled by contamination or physical ecosystem degradation; an Indian sacred ground is tarnished if the surrounding natural environment is degraded; a traditional homeland is less valued if the land itself is contaminated. Our argument is that intact natural resources are essential elements of many cultural resources, and this aspect requires and demands adequate consideration (and may therefore require compensation).     

The availability of personal and external coping resources: Thier impact on job stress and employee attitudes during organizational restructuring

This study examines the relationships among personal coping resources, social support, external coping resources, job stressors and job strains in a sample of 110 American Telephone and Telegraph employees undergoing a major organizational restructuring. The study expanded on a model suggested by Ashford (1988) by defining another category of coping resources that employees may draw upon to deal with the stressors and strains which occur during major organizational changes. External coping resources were defined as those which provided employees with a sense of 'vicarious control' in stressful situations. Results indicated that personal coping resources, social support and external coping resources had a direct effect upon job stressor and strain levels. No 'buffering' effect of these coplng resources was found. Hierarchical regression analyses indicated that external coping resources added to the prediction of job stressors and strains even when pertonal coping resources and social support were entered first into the prediction questions.     

Making ends meet: perceptions of poverty in Sweden

During the era after the Second World War, Sweden has built a welfare system based on labor market participation and income maintenance. Low unemployment and decent wages are supposed to guarantee people a labor market income or income maintenance, which in turn should provide a proper standard for everyone. However, a rapid increase in unemployment and economic problems have made the future of the Swedish welfare state more uncertain than ever. These circumstances have, among other things, led to the suggestion that Sweden should abandon the income maintenance policy and create a social policy system with the more limited ambition of guaranteeing everyone a minimum income. In that case, one central question must be answered: what constitutes a decent minimum income in today's Sweden? Where should we draw the poverty line under which people will not be forced to live? These questions are central in the current debate. The consensual poverty line method is used in this article to derive a poverty line relevant for today's Sweden. The results shows that more than every fifth household has an income below the consensual poverty line. That is, they have an income that most Swedes would argue is too low to make ends meet. The level of the consensual poverty line was compared with the National Board of Health and Welfare's guidelines for social assistance. The consensual poverty line was shown to be more generous to small households and the norm for social assistance was more generous to larger households. Finally, the expenditure for guaranteeing all Swedish household a minimum income equal to the consensual poverty line was estimated: more than SEK 25 billion per year. The results in the article casts serious doubt on the ability of the Swedish welfare state to secure a decent income to all citizens.     

Three Kinds of Anti-Intellectualism: Rethinking Hofstadter*

Hofstadter's landmark analysis of anti-intellectualism in American life is interpreted within the framework of the sociology of knowledge. His analysis suggests three analytically distinct types of anti-intellectualism: religious anti-rationalism, populist anti-elitism, and unreflective instrumentalism. Each type arises from within its own distinctive institutional matrix. Although Hofstadter fails to anticipate the growing cultural impact of mass media institutions, he demonstrates convincingly that anti-intellectualism is not a unitary phenomenon.