Net worth and the economic diversity of the elderly

Using data from the 1984 panel of the Survey of Income and Program Participation (SIPP), this article examines characteristics of the older population disaggregated by net-worth quintiles. The authors argue that income is not a sufficient measure of economic status for current policy discussions on issues such as changing Medicare co-payments, increasing the taxation of social security benefits, or means-testing under Medicaid. Net worth is a better measure of economic status, particularly for the elderly, because it represents the net value of assets accumulated over the life course. Their results indicate that there is considerable diversity in the economic status of the older population, which is masked by aggregate statistics (such as means and medians) typically used to summarize the economic status of population groups. Stereotypical views of the elderly based on such aggregates result in misdirected policy formulation. In the future, policymakers will need to formulate policies and programs using information on the distributions of income and assets among the older populations rather than relying on statistical aggregates.     

The NTEE classification system: tests of reliability/validity in the field of higher education

An analysis of the field of higher education reveals a surprisingly large number of classification errors within the (US) National Taxonomy of Exempt Entities database. Of the nearly 4,000 non-profit entities coded within the universe of institutions of higher education, we estimate that approximately 60 per cent were incorrectly included (Type II errors). Institutions incorrectly excluded from the higher education universe (Type I errors) represent roughly 10 per cent of the institutions coded correctly. These errors result primarily from assigning codes on the basis of the names of organisations (for example, College Park Towers is classified as a college, when it is in fact a housing complex for senior citizens) and from trying too hard to assign codes in ambiguous situations. The consequences can be significant for the users of these data, and we recommend raising bright warning flags while simultaneously enlisting the help of the entire non-profit sector in improving the classification coding process.The authors are with The Andrew W. Mellon Foundation. In addition to our colleagues on the staff of the Foundation, we wish to thank Helmut Anheier, Ted Bozovich, Harvey Dale, Virginia Hodgkinson, Stephen Noga and Christopher Toppe for helpful suggestions.     

The effect of war on marriage,divorce and birth rates

The impact of war on marriage, divorce, and birth rates in the United States from 1933 to 1986 is explored. The author concludes that "the involvement of the nation in military activities was accompanied by a decrease in marriage and birth rates but not by any change in divorce rates. Mobilization of the armed forces and demobilization had no discernible impact on divorce, marriage or birth rates."     

Pastoral care in Candyland. Maintaining power and life in a world of illness

Wrestling with ghosts and staging fatal accidents with Matchbox cars allow a critically ill six-year-old to come to terms with the fears prompted by his illness.     

The health care system should produce health

Reform of the U.S. health care system along the lines to be proposed by the Clinton Administration will not be an easy task, and it will not be accomplished quickly. A fundamental objective of the changes should be a health system whose purpose is improvement in the health of U.S. citizens, and not just the provision of services to all. This column is jointly edited by Kevin M. Fickenscher, MD, and David A. Kindig, MD, PhD, chair and member, respectively, of the College's Forum on National Health Policy. Dr. Fickenscher is participating in various advisory capacities on health care in the Clinton Administration, and Dr. Kindig is Senior Advisor to HHS Secretary Donna Shalala.     

The minds of a medical director

This article is offered in a nod to all those readers who have been exposed to "whole brain" theory, either through the American College of Physician Executives or elsewhere. As managers struggle with balancing the "left brain" and "right brain" aspects of their work, the author says, they might consider exploiting a third area of activity, or inactivity--the "no brain." This center position can be especially effective in dealing with the high-technology aspects of delivering health care.     

The marriage of medicine and computers

Although computers, in one form or another have been around for several decades, they have only recently acquired the power, the simplicity of operation, and the cost-effectiveness to make their widespread application in health care a reality. But a reality it is, and no manager can be successful without a working understanding of how computers and information technology mesh with the information needs of health care delivery. Computer literacy is no longer a nice add-on--it is a basic weapon in every health care professional's armamentarium.     

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.     

Immigration reform,American style

This article reviews the background of the proposed Immigration and Reform Act (also known as the Simpson-Mazzoli bill), which seeks to overhaul US immigration law for the first time since 1952. This bill is consistent with President Reagan's hard line on border enforcement and mandates stiff penalties for those who transport illegal aliens for commercial advantage or private profit. It further offers Mexico preferential treatment in immigration (40,000 additional visas/year). It includes an amnesty program to offer legal status to qualified illegal residents. The bill directs the President to develop a secure national worker identification system and would create a large-scale temporary foreign agricultural program for perishable commodities. Agricultural workers' families would not be eligible to accompany them unless they also obtain temporary visas. Foreign temporary workers, employable only in cases where local domestic workers are not available, must be provided with wages and working conditions equal to those prevailing among domestic workers. Stiff penalties are stipulated for employers who fail to abide with the terms of the program. In the author's opinion, this bill fails to appreciate the global character of international migration and its complexity. It relects a fundamental ambivalence about a strictly controlled main gate versus a back door approach to immigration as well as the conflicting images of the US as a nation of immigrants versus the historical reality of American nativism and xenophobia. Needed are comprehensive initiatives whose mutually reinforcing components can address the multiple dimensions of the immigration problem within a framework that does not ignore workers who have contributed to the economic well-being of the US, regardless of their legal status.