Smart money

Rick was an ambitious entrepreneur beginning the first of several businesses at age 16. He amassed a fortune by age 35. Between the ages of 42 and 50, his gambling rampage liquidated his assets, he lost his business and license to practice in his field, and he ended up in debt of over $1 million. Today at age 53 he is starting a new career in counseling and working with compulsive gamblers.     

Old and thin

Viewing an elderly patient's refusal of food from the perspective of the jain tradition of sallekhana (voluntary starvation) permits the author to reconcile her need to "do something" with her belief in the principle of patient autonomy.     

Delivery and funding are provincial matters in Canada

The following article is one of a series that deal with the provision of health care services around the world. Other countries in the series include Germany, Italy, Japan, Mexico, the Netherlands, and the United States. Countries scheduled for coverage in the series include Austria, France, Singapore, Spain, and the United Kingdom. The countries are described using a grid of characteristics so that comparisons may be made more easily. All of the analyses, along with further comparative data, will be gathered into a freestanding book to be published later in the year. Dr. Mendoza serves as editor for the project.     

Legal implications of managed care arrangements

Prior to the 1980s, managed care was virtually nonexistent as a force in health care. Presently, 64 percent of employees in America are covered by managed care plans, including health maintenance organizations (20 percent) and preferred provider organizations (44 percent). In contrast, only 29 percent of employees were enrolled in managed care plans in 1988 and only 47 percent in 1991. To date, the primary reason for this incredible growth in managed care has been economic-market pressure to reduce health care costs. For the foreseeable future, political pressures are likely to fuel this growth, as managed care is at the center of President Clinton's national health care plan. Although there are numerous legal issues surrounding managed care, this article focuses primarily on antitrust implications when forming managed care entities. In addition, the corporate practice of medicine doctrine, certain tax issues, and the fraud and abuse laws are discussed.     

Meeting the change challenge: managing growth in the nonprofit and public human services sectors

The current economic climate has been particularly hard on non-profit and public human services organizations, frequently resulting in managing organizational decline. The authors believe that the dominant concern should be with fostering organizational growth. To this end, they suggest that nonprofit board members and executives, as well as public sector leaders, need to concern themselves with the concurrent management of two agendas: Running the Shop and Meeting the Change Challenge. This can be done effectively through the use of strategic issue management, which is a set of techniques that represents a blend of traditional strategic management and change management approaches.     

Making room for alternatives

Alternative healing is an idea whose time has come, and 1993 was the critical year for that recognition. So believes internist David Edelberg, founder of the Chicago Holistic Center. There patients can see one of four allopathic physicians as well as practitioners in 37 additional therapies, including acupuncture, infant massage, homeopathy, nutrition counseling, and Ayurvedic medicine.