Principal Agency Theory and Health Care Utilization

This article uses a principal agent framework to examine the role that monitoring costs faced by an insurer have on health care utilization. We compare hospital lengths of stay for fee-for-service and capitated patients in low and high monitoring cost situations. Monitoring costs associated with a particular procedure are assumed to be high when there is large variation across patients in hospital lengths of stay. The empirical results indicate that differences in utilization between fee-for-service and capitated patients increase as monitoring costs increase. However, we do not find that fee-for-service reimbursement is used less in the difficult to monitor situations. (JEL I1 )     

The Experience of Pervasive Loss: Children and Young People Living in a Family Where Parental Gambling Is a Problem

Gambling research has contributed much to our understanding of the effects of gambling on families, yet we have only the most cursory understanding of the child's perspective on what it is like to grow up in such a family. The aim of this qualitative study was to gain a deeper understanding of the experiences of Australian children who live in families where a parent or caregiver has a serious gambling problem by exploring the perspectives and understandings of the children and young people themselves. This paper reports a central finding, the experience of Pervasive Loss, from our interviews with 15 young people, 11 males and 4 females, aged between 7 and 18 years. Their sense of loss encompassed both physical and existential aspects of the child's life, including their parent(s), relationships, trust, security, sense of home, and material goods. The dimensions of this experience of pervasive loss are explored from the child's perspective. Children living in families where gambling is a problem experience threats to their overall well-being to the extent that parental problem gambling must now considered to be a significant child health as well as social problem.     

Meeting communication needs: topics of talk in the nursing home

Nursing home residents primarily rely on staff for communication and interpersonal relationships. Challenged by staffing shortages and increasingly complex care, staff who provide the most communication with residents lack awareness and skills to effectively communicate with older adults. This study, a secondary analysis of staff-resident interactions from one nursing home, explores communication topics and the effects of an intervention. Staff from one unit were recorded during 2 hours of caregiving to provide a representative sample of their communication with residents. Staff then attended an educational program targeting improved awareness of communication needs and reducing "elderspeak". Recording was repeated post-intervention. Baseline conversations focused on activities of daily living (ADLs), personal-social, technical care, and health assessment. Post-intervention ADL talk decreased in staff-resident interactions, while personal-social topics increased. These findings suggest that residents' limited opportunities for communication with staff are primarily focused on care tasks. With increased communication awareness, staff can learn to modify conversational topics to better meet older adults' psychosocial needs.     

A profile of gaming machine players in clubs in Sydney,Australia

New South Wales, Australia, is one of the major markets in the world for machine gaming, with its 1,441 registered clubs holding the dominant share of the state's machines. This study examined machine gambling behavior amongst a random sample of 3,000 club members from six of the largest clubs in Sydney, the capital city of New South Wales. The findings identify their machine gambling preferences and participation levels, isolate significant sociodemographic and other differences between gaming machine and non-gaming machine players, measure the prevalence of probable pathological gambling associated with machine gambling, and identify certain characteristics which differ significantly between probable pathological and non-pathological machine gamblers amongst the respondents.     

Training issues in churches

The national and local frameworks of the Christian churches in the UK provide important resources to families and to young people and children. To promote awareness and effective responses to child abuse, training needs to address organizational issues and individual learning, and should do so at community, regional and national level. In training within churches, the part played by beliefs and values cannot be overlooked. Key concerns are identified and discussed.     

Registration completeness and international comparisons of infant mortality

The physical development of the live born infant is the single most important variable governing its survival: infant mortality among those weighing 2,500 grams (5 1/2 pounds) or less at birth is 17 times the mortality among those weighing more than 2,500 grams at birth. The variation in mortality according to birth weight (or gestation) is greater than for subclasses of color, sex, maternal age, or birth order. Infant mortality in the United States is significantly higher than in a number of other countries e.g., Sweden, Netherlands, Norway. The difference is thought, by some, to be due to underregistration of low birth weight infants in other countries. In this paper, distributions of live births by birth weight for Denmark, England and Wales, New Zealand, and the United States, and infant mortality data for Denmark and the United States are examined. The data do not support a hypothesis of gross underregistration of live born infants in other countries. The results indicate that some index of physical development (birth weight, gestation, or a combination of both) should be included in any appraisal of infant mortality.     

The social costs and benefits of gambling: an introduction to the economic issues

This paper surveys the range of economic issues that need to be addressed in attempting to evaluate the social costs and benefits of gambling. It considers, inter alia, the nature of private and social costs and benefits and their policy significance, the important distinction between real and pecuniary costs, the incidence of gambling costs and benefits and the sources of gambling costs and benefits. Similarities and differences between the analysis of gambling and alcohol are considered. The paper concludes with a consideration of why various estimates of the social costs of gambling have produced such divergent results.     

Whose ‘Ordinary Life’ Is It Anyway?

This paper offers a feminist critique of current community care policy and of the normalisation ideology which underpins it. Drawing on experience in services for people with learning difficulties and people who use mental health services, the authors draw a series of parallels between 'clients' and women in our society. They discuss the mechanisms whereby groups of people are accorded second class status and the ways in which such oppression is experienced. Strategies for change are discussed with reference to feminist scholarship and the development of the women's movement. The prevailing philosophy of normalisation, which is both apolitical and highly individualistic, is challenged to take more account of collective and communal ways forward and to acknowledge the interdependence of people who need care and their carers. Despite the rhetoric of community care, the work of carers (most of whom are women) is undervalued and unsupported. Mainstream values such as competitiveness and self-reliance are incompatible with the integration of people with disabilities and a theoretical framework which confronts such conflicts of interest is required.     

The Attitude of Husbands to Working Wives

This study examines the attitude of 256 men whose wives had been surveyed in relation to their workforce experience. Husbands with working wives and non-working wives were surveyed, and their different responses analysed. Variables which could affect responses, such as ages of children, full-time or part-time work, and impact on husbands' own jobs were all considered. In this survey, it was found that neither the level of education of the husband, nor his age were statistically significant indicators of his attitude towards working women.