IRS offers safe harbor in physician employment contracts

Last year, the Internal Revenue Service (IRS) issued Revenue Procedure 93-19 (Rev. Proc. 93-19), which provides guidelines regarding service and other contracts involving facilities financed with tax-exempt bonds. Rev. Proc. 93-19 creates four "safe harbors" for certain contracts signed by tax-exempt organizations that will not jeopardize the organizations' tax-exempt bond interest. Those guidelines and methods for complying with them are the subject of the following article. "Health Law" is a regular feature of Physician Executive contributed by Epstein Becker & Green. Mark Lutes of the law firm's Washington, D.C., offices serves as editor of the column.     

Education and the professionals. Some aspects of innovation in medical education adopted by Ahfad University for Women

This article describes the establishment in 1990 of a School of Medicine at Ahfad University for Women in Sudan. The school was premised on the view that women doctors would have a better opportunity to affect and improve women's health than men doctors. The curriculum is innovative and relies on a community orientation and a problem-solving approach. Medicine and health are taught in a holistic way. The new approach is rooted in the Alma Ata Declaration in 1978 of Health for All by the year 2000. The new method of delivery of medical care in the School of Medicine is based on the promotion of health through health education, prevention of disease, proper nutrition, provision of a safe water supply, attention to maternal/child health and family planning, and attention to the treatment of endemic diseases. In order to teach primary health care, medical schools must change their practices. Delivery of health care will have to be changed. New curriculum approaches emphasize learning objectives in each of the teaching modules and small group teaching. Integrated learning means the separate disciplines of medicine are taught as a whole multidisciplinary unit. Case management learning has the potential for increasing motivation and the ability to discover the knowledge needed to solve the problem. McMaster University relies on a problem-oriented approach to medical education that prepares the student for coping with changes in medical knowledge in the future. The challenge for educators is to create an efficient and comprehensive curriculum that will prepare a doctor for lifelong learning. Health settings have also changed to deemphasize sophisticated hospital settings in favor of community-based health centers. Ahfad University is the only one of its kind in Sudan. Medical education includes 6 years of schooling divided into 3 phases.     

Cost-effective rehabilitation: Part 1--Basic principles

Patients may be referred for rehabilitation services with a variety of diagnoses, including stroke, spinal cord injury, brain injury, multiple trauma, orthopedic disorders, arthritis, multiple medical problems, and chronic pain. The goals and endpoints for treatment of these conditions are often unclear. The principles that are described in this article provide a structure for creating efficient and effective rehabilitation treatment plans. These principles can also focus the utilization and peer review processes and can assist in determining medical necessity of rehabilitation services. Part one of this two-part article discusses general principles of cost-effective rehabilitation. Part two, in the December 1995 issue, will focus on individual patient management issues.     

Accounting for the transition from inpatient to outpatient surgery

This article reports on some of the factors that have advanced and impeded hospital progress in moving from inpatient to outpatient surgery. Early on, patients, physicians, and hospital administrators all agreed that outpatient surgery had an intuitive appeal. Patients liked it because they didn't have to go in the hospital. Physicians liked it because they could get in and out of the outpatient surgery center more easily than the main hospital operating room. Administrators recognized the inherent appeal of outpatient procedures but were unable or unwilling to switch services from inpatient to outpatient for a variety of reasons. First, empty hospital beds and diminished scope of inpatient operations are a threat to the power of administrators. Moving surgery from inpatient to outpatient settings reduces inhouse operations. Second, reimbursement incentives were definitely in favor of continued inpatient care long after technology was in place for outpatient care. The third and most critical reason was that cost data on outpatient operations were just not available for making decisions on when to move into the outpatient setting. This review of the literature was intended to document the lack of relevant cost-based accounting. Instead, many other factors that more directly slowed progress were encountered. More than anything, this illustrates the erratic course of progress in health care reform.     

Coherent decision analysis with inseparable probabilities and utilities

This article explores the extent to which a decision maker's probabilities can be measured separately from his/her utilities by observing his/her acceptance of small monetary gambles. Only a partial separation is achieved: the acceptable gambles are partitioned into a set of belief gambles, which reveals probabilities distorted by marginal utilities for money, and a set of preference gambles, which reveals utilities reciprocally distorted by marginal utilities for money. However, the information in these gambles still enables us to solve the decision maker's problem: his/her utility-maximizing decision is the one that avoids arbitrage (i.e., incoherence or Dutch books).     

"SECRET BALLOTS" AND SELF-REPORTS IN AN EXIT-POLL EXPERIMENT

A controlled exit-poll experiment on Election Day (November3, 1992) shows that refusals to answer questions and other evasiveforms of responding were significantly lower when respondentswere given a self-administered "secret-ballot" questionnairethan when they were interviewed face-to-face. While there weresome suggestive interactions of this mode-of-data collectioneffect with age and sex, and with the partisan atmosphere ofthe precinct in which the interviews were conducted, they wereborderline in significance, inconsistent in pattern, or difficuitto interpret. More important, comparisons with official electionreturns (the truth) indicated that the secret-ballot techniquewas more accurate than were face-to-face interviews in estimatingthe final outcome on the most socially sensitive of three self-reportedvotes: a vote for or against a tax levy for elderly services.Using a genuine secret ballot in the tradition of the olderGallup preelection polls can thus increase the validity of self-reportsin exit polls today.     

A cultural economy perspective on service sector migration in the global city: the case of Hong Kong

This article argues that in order to fully understand the geography of labour migration to global cities, it is necessary to consider economic forces in conjunction with mediating socio-cultural influences. Support for this argument is based on an examination of the pattern of migration to Hong Kong, a city which plays a significant role in the world economy.
Reported here are the results of an analysis of recently released 1996 by-census data, and the authors' interviews with foreign domestic workers in Hong Kong. These findings have shown that highly skilled immigrant workers were drawn largely from developed countries, the main sources of inward investment in this city, while less skilled immigrants were drawn from less developed neighbouring labour markets.
While the geographical pattern of immigration followed broadly that predicted from Hong Kong's position in the world economy, the results have revealed that cultural influences such as language and social networks are also important in shaping the economic roles of migrant workers.     

Lifestyle Options and Economic Strategies: Subsistence Activities in the Mississippi Delta1

Abstract "Subsistence" and "informal economy" are contrasted in their utility as sociological concepts and their ability to explain a variety of activities in two rural Mississippi Delta communities. Literature on subsistence stresses that the desired outcome of participation is not an increase in income but the social rewards of participation itself. Two underlying dimensions of participation in these activities are documented through the literature and through a confirmatory factor analysis of empirical data: life-style choice and economic strategy. These were constructed into indexes and examined individually and in combination as dependent variables using regressors at the community, household, and individual levels. Community ties were weakly associated with participation in such activities. Whites and those with higher incomes participated more in lifestyle choice oriented activities. Participation in general was statistically related to households needing less weekly income and being of larger size. Potential connections with persistent rural poverty are discussed.