Under new management: the changing role of the state in the care of older people in the United Kingdom

This article examines recent changes and those currently being introduced in the formal care of older people in the United Kingdom. These are part of a general trend in all welfare states towards welfare pluralism but, in addition, the United Kingdom represents something of a special case because of the radical ideological engine that has driven the restructuring of the role of the state. The first part of the article outlines the main changes--the promotion of the private sector, the residualization of the public social services, and the new managerial role of the state in the care of older people. The second part considers the implications of these changes for older people and their informal helpers (or caregivers). The conclusion refers to both the particular changes taking place in the United Kingdom and, in general terms, to welfare pluralism as a policy goal.     

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.     

How well is debt managed by nonprofits?

Little is known about why nonprofits accrue debt, how much they owe, and whether the funds they borrow are used productively. This article distinguishes between productive, problematic, and deferred debt. Employing a data base representative of 114,726 tax-filing charitable nonprofits in the United States in 1986, it examines the pervasiveness of nonprofit debt and the relation between this debt and nonprofit financial health. The analysis finds that over 70 percent of the nonprofits hold debt, the distribution of this debt is highly concentrated, and the level of debt and leverage varies with asset size and type of activity. Nonprofits with higher leverage and absolute debt levels are financially healthier than those with lower levels. While the analysis does not determine whether financially stronger nonprofits are better able to borrow, the results support the view that borrowing in the nonprofit sector is economically efficient.     

A probablistic analysis for an optimal screening problem

Summary We consider a lotL formed byN apparently similar unitsW ₁,…,W _N, where each of theW _i may come from one of two different populationsP ₁ andP ₂;T ₁,…,T _N denote the corresponding lifetimes. The units fromP _i undergo a failure of kindi and their survival function isS _i (t). We assume that the failure rate function are known and that the units fromP ₁ are ?substandard?: λ ₁ (t)≥λ ₂ (t), ∀t≥0. We want to putW ₁,…,W _N under a pre-operational test (burn-in test) in order to eliminate at least a great part of the substandard units and we face the problem of obtaining a rule for stopping the test under the assumption that, with the failure of a unit, it is possible to recognize the population from which the unit comes. Such a problem will be formalized as an optimal stopping problem for a suitably defined Markov process. Our study shall evidentiate some fundamental aspects of the problem and the role of the prior distribution of the (random) numberM ₀ of those units inL coming fromP ₁ (substandard). The latter distribution has a great influence on the form of the solution. This research was supported by the C.N.R. Project ?Statistica Bayesiana e Simulazione in Affidalità e Modellistica Biologica?.     

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.