Study tour examines health care systems in Germany, Holland--Part II: The German system

In October 1992, the American College of Physician Executives sponsored a study tour to Berlin, Germany, and Amsterdam, Holland. Meetings were held with government officials, third-party payers, and providers, and on-site visits were made at hospitals, clinics, and academic centers. The purpose was to study the health care delivery system in those countries and to share some insights with the countries' hosts on the U.S. system. In a series of reports that began in the July issue of the journal, 5 of the 10 study tour participants describe their impressions of the tour and of the health care systems in the countries that were visited. In the first report, the health care delivery systems of the United States, Germany, and Holland were compared. In this report, the German system is analyzed in greater detail.     

Correlates of honor ratings in a clinical clerkship employing a faculty forum evaluation system

5he purpose of this study was to determine whether or not suspected variables affected a surgery clerk's chances of being awarded an honor rating. Findings indicated a significant relationship between a student receiving an honor rating and his or her preceptor's predetermined level of student advocacy, the number of completed patient interview and physical examination write-ups, and final examination scores. There was no significant relationship found between honor ratings and the preceptor's status, the sequence in which the student was discussed or the length of time spent discussing the student at the final evaluation meeting, or the number of clinical faculty present at the meeting. These results lend support to the faculty forum evaluation approach, but suggest a need for further scrutiny of some influencing variables to ensure all students are fairly considered and honor ratings judiciously awarded.     

Scientific management and class relations

Conclusion It has been the contention of this article that the true significance of the scientific management movement lies in what it can tell us about the engineering profession. Scientific management was not simply capitalist ideology, nor were the engineers who developed it simply the prisoners of capitalist ideology. Instead, scientific management was the product of the insertion of once-independent engineers into the complex, collective labor process in large corporations. It reflects both their inability to break loose fully from the dominant ideology and the fact that their interests as engineers were in conflict with the interests of their capitalist employers.The significance of this point, however, lies beyond the experience of turn-of-the-century shop culture engineers. For, if even as unpromising a group as the scientific managers could develop a program with implications inimical to the interests of capital, what of other, less commercialized groups? We have already seen that the early school-based engineers initiated a professionalizing project that included a claim to autonomy that was incompatible with the needs of their employers. It seems clear that the engineer's status as an employee, albeit an employee in an ambiguous position in the labor process, constitutes a basis for the development of conflicts with capitalist employers. This has been the thrust of our earlier discussion of the process of class formation. Gramsci's analysis of the situation of engineers in capitalist class relations, then, may not be without foundation:With the urban intellectuals it is another matter. Factory technicians do not exercise any political function over the instrumental masses, or at least this is a phase that has been superseded. Sometimes, rather, the contrary takes place, and the instrumental masses, at least in the person of their own organic intellectuals, exercise a political influence on the technicians.It may very well be that engineers, given a more militant labor movement, a more penetrating ideology, or a weaker capitalist class, could find themselves on the same side as more subordinate employees in conflicts with their employers.It is all the more important, then, that we understand the process by which American engineers have been domesticated. This has not happened automatically; far from it. Although there are ambiguities in the engineer's situation that make this process easier, the rapprochement of engineers with capital has had to be made. In this regard, the active intervention of business interests has been of particular importance, especially their efforts in fostering among engineers a safe variant of professionalism.Nor does this historical lesson apply only to engineers. For, there are other professional occupations that, increasingly, find themselves in situations comparable to engineers. Accountants, nurses, teachers, even certain kinds of lawyers have long been employed in large numbers by complex organizations. More recently, even doctors have begun to experience the condition of being an employee. For each of these occupations, we must avoid the easy assumption that there is something inherent in their social structural position that leads them into an accommodation with capital. On the contrary, as with engineers, we must stress the existence of real conflicts generated by capitalist relations of production, and then examine each occupation historically, asking what specific circumstances explain why its members do or do not enter into explicit conflict with their employers. However, while we must be aware of the possibility that professionals can (and sometimes do) enter into conflict with their employers, we also need to be sensitive to the complexity of the structural position of many professionals. Many professionals find themselves in positions of authority of some kind - either over subordinate workers in the case of engineers, or over clients in the case of doctors. This can be conducive to the attitude that the professionals' interests are different from those of the groups over which they have authority, or that their interests are the same as their employers'. Alternatively, as we saw in the case of engineers, this structural ambiguity may promote the formation of narrow occupational ideologies among professionals - i.e., the idea that their interests differ from those of both employers and subordinates. Therefore, while we need to be aware of the existence of employer/ professional conflict, we also need to recognize the existence of barriers to, and complexities within, the evolution of such conflicts.It is with this in mind that this article has stressed the importance of developing an adequate approach to the process of class formation. To restate briefly some of the arguments made earlier, the process of class formation in capitalist society is set in motion by the antagonisms inherent in capitalist relations of production. This is not, however, all that we need to know about the process of class formation - we also need to recognize the existence of both objective and historical barriers to this process. Nevertheless, one must be clear about what exactly these barriers are. There is, for example, an important difference between the relations of production that constitute class in the first place and workers' functions in the labor process. Similarly, one should not confuse barriers to the process of class formation with full-fledged class divisions. If we fail to distinguish among these various factors, we will be in danger of artificially placing a class barrier between engineers and other forms of wage-labor. If, on the other hand, we do make these distinctions, we will be able to account for both engineers' opposition to their employers and their domestication.

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Demographic changes as a problem for social security systems

The relationship between demographic changes and the social security system is explored. The focus is on the current situation in the Federal Republic of Germany, but consideration is also given to comparable developments in other developed countries. Emphasis is placed on how changes in the age distribution of modern populations affect the relative proportion of the productive and the dependent populations.     

Premarital information efforts under way

Premarital couples are among priority targets of family planning information in the Philippines national population program as they can serve a pivotal role in slowing population growth. Applicants for marriage licenses are required to attend a family planning session as a prerequisite. Following recommendations of a training effort and seminar on Premarital Family Planning Counseling, on July 20, 1976, premarital information was institutionalized in the country by Presidential DEcree 965 which made family planning counseling obligatory to the marriage license applicants. Shortly after that, a multiagency effort gathered information on the status of the Premarital information program in the Philippines, which showed that there is no full-time specialist for the work. Medical officers; social workers; community welfare supervisors; and program and training officers do this work of information in addition to their usual duties. Distribution of the applicants varied greatly in age groups, educational levels, and professional category. The size of the group, length of session and topics of discussion varied greatly. Necessary efforts should be made to solve the major problems by selecting better sites for group sessions and training more personnel for the purpose. There is a great need fordeveloping more effective and research oriented information, education and communication materials, according to the needs and cultural traits of the target audience.     

Program analysis using the client oriented cost outcome system.

The client oriented cost outcome system has been under development in Pennsylvania community and hospital programs since 1972. The system builds upon the behavioral and decision data generated with or on behalf of consumers. Flexibility for local program system design is permitted if the procedures of consumer intake, review, and termination document each consumer's (a) problems, resources, and goals, (b) overall functioning level in their ordinary community, and (c) services intended and rendered as related to (a), above. While the system's primary application is in providing feedback for local program quality assurance and evaluation procedures, aggregation of data permits program planning and evaluation at county, state, and federal levels in terms of (a) client demographic or diagnostic characteristics, and (b) program service characteristics and objectives.     

Optimal Times to Contact Sample Households

Finding a suitable respondent at home is an essential and expensivecomponent of a household survey. This article reports on theresults of a study of the probabilities of finding someone aged14 or older at home and discusses the application of such datato survey design and budgeting.