The print media and aging policy: how differential coverage of Medicare Catastrophic led congress astray

This article examines the role of the print media in covering complex policy issues. Two models of journalism are considered. "Pack journalism" predicts that print media coverage will be highly consistent in content due to the reliance by those in the media on the same sources of information. In this article, another model--"Beltway journalism"--is proposed. It implies that coverage by the print media indigenous to the Washington, D.C. area (inside the Beltway) will diverge from that of other print media, presenting a potentially distorted view of the world to policymakers in Washington. Using the Washington Post and the Los Angeles Times as possible indicators of the two models, aging policy is addressed through a case study of newspaper coverage during passage and repeal of the Medicare Catastrophic Coverage Act of 1988. Findings suggest that Congress was unduly influenced by the way that Medicare Catastrophic was framed in the Washington Post, lending credence to the Beltway journalism model. By paying insufficient attention to the way Medicare Catastrophic was being framed by sources of print outside the Beltway area, lawmakers allowed themselves to assume a grassroots-level understanding of the issue and support for the bill, both of which turned out to be illusory.     

The new health care civilization: integration of physician land and manageria

Changes occurring in health care demand that physicians expand their professional knowledge and skills beyond the medical and behavioral sciences. Subjects absent from traditional medical education curricula, such as the economics and politics of health care, practice management, and leadership of professional organizations, will become important competencies, particularly for physicians who serve in management roles. Because physicians occupy a central role in planning and allocating medical care services and other health care resources, they must be better prepared to work with other health care professionals to create a new civilization, even if this means leaving the cloistered domain of "physician land" to serve as interface professionals between the delivery of medical services and the management of health care. Our research findings and conclusions strongly suggest that economic, management, and leadership competencies need to be incorporated into the professional development of physicians, especially in postgraduate and continuing education curricula.     

The new illegal immigration in Japan, 1980-1992

"This article presents some of the latest available figures on illegal immigration in Japan, a process that did not assume significant proportions until the mid-1980s. It also discusses briefly the latest developments around 'immigration' policy--more precisely, the law on the entry and exit of aliens."     

Women's income generation activities in Merowe Province,Northern State,Sudan

Merowe province in rural northern Sudan has been divided into three local government council areas: Merowe, Karima, and Ed Debba. A government program was instituted to increase the welfare of residents and food production. A baseline survey of 490 respondents was conducted in order to ascertain how illiterate women viewed development in the area and to provide useful information for program design and implementation. Women from 24 villages were administered questionnaires, observed in their daily activities, and engaged in discussion in a local meeting place. Discussions were also held with members of the local Popular Committee. Demographic information was very sketchy about age, and 48% had no formal education in writing and reading. General reading and writing skills of the remainder were very poor. There were 500 female children and 502 male children, and the sex ratio varied among the 3 council areas. 52% were married and 14% were divorced or widowed and living with relatives. The average monthly income was from Ls. 700 to Ls. 3000 based on reports from only 59.3% of respondents. Most of the women had skills in food processing and 25.7% were skilled in handicrafts. Water was obtained primarily from local wells and not decontaminated before use. Pit latrines were the standard. One bathing facility was available in the compound for the entire council area. Health units were either in each village or within 20-30 minutes walk. Child mortality was 4.3% in Merowe province. 77 children 0-5 years old died out of a total of 1002 live births. Life expectancy was 41-50 years for women and 61-70 years for men. Cleanliness and healthful eating were observed. 58% owned no land; plots were under 5 feddans and usually half a feddan. 92.1% had no bank account and 90% had no experience with loans. 70.2% were indifferent about involvement in an income generation program. 26% were interested in part-time participation. Only 3.9% desired full-time participation. 8.6% said they wanted raw materials to produce handicrafts, and 21% said they wanted cash to raise livestock. 28.4% had radios. 80.4% lacked any farm equipment. 7.6% owned an electric pump and 7% had an ox plough. A program could be offered after lunch and coordinated with other activities after 4 P.M. at a local center. The population would have to be oriented to business and income generation would have to be planned very carefully.     

Ropes course training for youth in a rural setting: “At first I thought it was going to be boring ...”

Outdoor structured activities, such as Ropes Challenge Courses, are typically utilized as interventions for youth coming from urban settings. Evaluation of such programs is scanty at best. In this instance, the course experience is used as a prevention tool for high risk youth in a remote, rural setting of high unemployment, alcohol problems, and low income. The authors discuss the effectiveness of this approach, and the intended and unintended consequences for the rural community at large. The evaluation design relies on extensive qualitative methodology as well as quantitative methods to capture the unique nature of this rural project.     

Freud's “Anna O.”: Social work's Bertha Pappenheim

The story of Anna O. has loomed large in psychoanalytic history, but few social workers know that the young woman, who was so influential in the development of Freud's thinking, became a pioneer social worker in Germany. The story of the transformation of the troubled young woman, who was actually Joseph Breuer's patient, is the focus of this paper. In addition, some of the facts of the case are discussed as social constructions. Anna O./ Bertha Pappenheim participated in the creation of the talking cure and eventually went on to be a leading feminist, developer of social programs for women, and social reformer.     

Corporate compliance programs: risk management for the future

The Department of Justice has estimated that the government loses $100 billion annually in health care fraud. Consequently, the government's health care fraud enforcement activities with respect to all health care providers and suppliers continue to grow. Last year alone, the government collected more than $8 billion in settlements, fines, and penalties involving health care fraud. Recent settlements with the government have begun to include corporate compliance programs that require continued government oversight of the health care organization as an essential part of the settlement. The first section of this article describes the legal significance of health care companies' having corporate compliance programs. The second section provides a sample list of topics that should be included in any corporate compliance program. Finally, we describe various issues related to the creation and implementation of corporate compliance programs.     

A hospital protocol to resolve complaints against staff physicians

Complaints of discrimination or harassment in the workplace have become almost commonplace in recent years, increasing in both frequency and variety. In the hospital setting, this trend is manifested in allegations against members of the medical staff by hospital employees as well as by patients or their families. Whether real or fancied, such allegations are reflective of a potentially disruptive undercurrent of organizational tensions. Left unresolved, they can erode the essential partnership between staff physicians and other members of the health care delivery team. Unsatisfactory patient experiences may also damage the reputation of the institution and thereby undermine its viability. With either group of complainants, allegations of malfeasance that are not resolved at the source in a timely manner are far more likely to result in expensive, time-consuming, and potentially damaging litigation.     

A comparison of quality and utilization problems in large and small group practices

Physicians practicing in large, multispecialty medical groups share an organizational culture that differs from that of physicians in small or independent practices. Since 1980, there has been a sharp increase in the size of multispecialty group practice organizations, in part because of increased efficiencies of large group practices. The greater number of physicians and support personnel in a large group practice also requires a relatively more sophisticated management structure. The efficiencies, conveniences, and management structure of a large group practice provide an optimal environment to practice medicine. However, a search of the literature found no data linking a large group practice environment to practice outcomes. The purpose of the study reported in this article was to determine if physicians in large practices have fewer quality and utilization problems than physicians in small or independent practices.     

“Consumer Confidence” Indexes as social indicators

Consumer Confidence Indexes can be sensibly used in economic and social research conducted in theoretical and methodological framework of social indicators research. They are good predictors of other attitudes, such as voting preferences. Voting preferences are determined much more strongly by expectations of changes in economic conditions than by evaluations of present situation. On the other hand, Consumer Sentiment Indexes — irrespective whether they concern future or present times — are correlated more strongly with leading than with coincident indexes of economic cycles. That proves very important role of predictions, expectations and hopes in attitude formation.