Medicaid nursing facility reimbursement in flux: effects of federal regulatory changes and prevailing fiscal conditions, 1978-1998

Basic concepts and trends are examined in Medicaid nursing facility reimbursements between 1978 and 1998, because Medicaid payment reform is a common budget reduction strategy pursued by state officials. Non-incremental changes in state rate-setting methods, as well as incremental changes in per diem rates and expenditures per recipient, are analyzed. In addition to substantial cross-state variation, results reveal clear trends in reimbursement policy characteristics over time. Not only do these track closely with changes in the federal regulatory environment, but they also track closely with prevailing fiscal and economic conditions. Given the serious ramifications reimbursement policy changes can have for nursing home residents and providers, it is imperative that the impact of federal disengagement from this policy area be understood.     

Jesus and Matthew: Monsters, Si[g]ns, and Wonders

In the American New Right's outraged war against all things anti-family, -nation, and -civilization, the authority of Jesus, crucified yet triumphant, is held out as potent augury against all forces of evil. For many evangelical Christian groups, one archenemy in particular exemplifies the forces of Satan and civil distress. The resulting scene of Manichean conflict can only be called Gothic Verite: The suffering, broken body of Jesus, whose blood is piously read as atonement, rebukes the demonized and monstrous homosexual, whose blood, Gothically read, contains the taint of private immorality, public domestic threat, and world-ending civic collapse. This powerful clash of images, cosmic worldviews and mundane politics can be observed at the funeral of Matthew Shepard—beaten to death, most observers conclude, because his assailants thought he was gay. In the tense confrontation of Christians and homosexuals at his funeral, one sees a historic tension within the heart of Christianity threatening, at whatever cost, to reconcile. That is, at issue is the recognition, however dim, that the angel and the demon, the prayerful and depraved, mirror each other more than they differ.     

The choice of a forecasting model

The major purpose of studies of forecasting accuracy is to help forecasters select the ‘best’ forecasting method. This paper examines accuracy studies in particular that of Makridakis et al. [20] with a view to establishing how they contribute to model choice. It is concluded that they affect the screening that most forecasters go through in selecting a range of methods to analyze—in Bayesian terms they are a major determinant of ‘prior knowledge’. This general conclusion is illustrated in the specific case of the Makridakis Competition (M-Competition). A survey of expert forecasters was made in both the UK and US. The respondents were asked about their familiarity with eight methods of univariate time series forecasting, and their perceived accuracy in three different forecasting situations. The results, similar for both the UK and US, were that the forecasters were relatively familiar with all the techniques included except Holt-Winters and Bayesian. For short horizons Box-Jenkins was seen as most accurate while trend curves was perceived as most suitable for the long horizons. These results are contrasted with those of the M-Competition, and conclusions drawn on how the results of the M-Competition should influence model screening and model choice.     

The therapist as a catalyst in promoting separation-individuation

This paper describes a therapeutic approach to patients fixated at or regressed to a developmental point in the separation-individuation phase. The normal developmental sequence from autism and symbiosis to the achievement of a position of on-the-way-to object constancy as elaborated by Mahler and her colleagues is summarized. Though the original experience cannot be replicated, a precise understanding of what has been missed in the early dyad between mother and child enables the therapist to help repair lesions and promote growth through the patient-therapist relationship and carefully designed interventions. A case illustration is offered of treatment of a patient with profound difficulties at the symbiotic phase which impede negotiation of separation-individuation.     

The Ranking of Self-Actualization Values: The Effects of Class, Stratification, and Occupational Experiences*

This paper examines the influence of social class, occupational experiences, and a variety of stratification factors on the ranking of a set of important life goals. Based on a national sample of Canadians from 1977, the findings indicate modest class differences in the evaluation of four "self-actualization" values. Specifically, middle class respondents rank "self-development,""achievement," and "activism" as more important than do working class respondents. There are no significant differences on the fourth concern, "independence." Multi-variate analysis reveals that the class differences in values are wholly attributable to differences in occupational experiences and educational training in the two class groupings. These findings are consistent with Kohn's thesis of "class and conformity." Additional controls on a set of stratification factors-sex, income, age, and language group (English/French)-suggest almost no differences between dominant and subordinate groups in the ranking of the four values. Only age has a significant influence, with the young rating self-actualization as more important than the old. The implications of these results for the study of dominant values and ideology and for the relationship between social inequality and values are briefly considered.     

Interhousehold grants in peninsular Malaysia: Impact of grantors' characteristics on amount of grants given

Grants of money, goods, and services are one-way transfers between households. Tobit analysis reveals that race, household structure, household income, transportation resources (viz., vehicles owned), goods and service grants received, husband's education, and stock of small animals owned (viz., a common commodity gift in Malaysia) are characteristics of granting households that are influential in determining the amount of grants given. The incidence of granting is substantially lower among Indian than among Chinese or Malay households, although Indian households give the highest mean amount of grants. Multivariate analysis reveals that, other factors held constant, Malay households are the most generous and Indian households the least so in giving interhousehold grants. When giving of grants is conceptualized as a consumption expenditure, granting is observed to have a relationship to income similar to that of necessities rather than luxury goods.His areas of research interest are grants economics, labor economics, welfare economics, and consumer rights and protection. He received his Ph.D. in Consumer and Family Economics from the University of Missouri.His research interests include various aspects of social policy and family economic circumstances and functioning. He received his Ed.D. from the University of Missouri.     

The U.S. EPA Geographic Information System for Mapping Environmental Releases of Toxic Chemical Release Inventory (TRI) Chemicals

This study characterizes the environmental releases of toxic chemicals of the Toxic Chemical Release Inventory (TRI) in the southeastern United States by using the U.S. Environmental Protection Agency (EPA) Geographic Information System (GIS) to map them. These maps show that the largest quantities of TRI releases in the Southeast are usually near densely populated areas. This GIS mapping approach takes the first steps in defining those areas in the region which may be potential exposure zones and which could be strategic targets for future risk screening efforts in this geographic area.     

Extrapolating human probability judgment

We advance a model of human probability judgment and apply it to the design of an extrapolation algorithm. Such an algorithm examines a person's judgment about the likelihood of various statements and is then able to predict the same person's judgments about new statements. The algorithm is tested against judgments produced by thirty undergraduates asked to assign probabilities to statements about mammals.