Minimal treatments and problem gamblers: A preliminary investigation

In view of the increasing popularity of minimal intervention treatments for problem drinking, a self-help manual for people who wish to reduce or stop gambling was prepared. Twenty-nine (ACT residents) who responded to advertisements for help with problem gambling were allocated to either of two minimal treatments, Manual (only) and Manual & Interview. On average, clients from both groups reduced the frequency of their gambling sessions, frequency of overspending, and amount spent per week in the first three months and next three months after first contact, but expenditure per session increased from three to six months, after an initial improvement. There was no evidence that a single in-depth interview added to the effectiveness of the manual.This project was funded by a grant from the Australian National University Faculties Research Fund.     

Medicine and the question of suffering

Doctors are not health care providers, and medicine is not a commodity. To practice medicine well, the doctor must attend to each patient as a whole person and be faithful in giving care when cure is not possible.     

Problems in measuring role strains and social functioning in relation to psychological symptoms

The problems that people experience in social roles can be regarded as either causes or consequences of psychological symptoms. To reflect one of these possibilities, Pearlin et al. (1981) developed measures of "role strains" which are considered sources of psychopathology. To reflect the other position, Dohrenwend et al. (1981) constructed measures of "role functioning" which are seen as consequences of psychopathology. We show that the measures developed by these two teams of investigators are similar in content and show substantial empirical overlap despite the different meanings attributed to them. In an effort to understand whether these highly correlated measures assess, "role strain" or "role functioning," we conduct an exploratory analysis of marital and housework role problems, using a small panel sample of New York City residents. Specifically, we use instrumental variables to identify reciprocal effects between psychological distress and each role area. We find that the relationship between housework role problems and distress is more consistent with Pearlin et al.'s interpretation, whereas the relationship between marital problems and distress is more consistent with that of Dohrenwend et al. Investigators interested in measuring either role strain or role functioning must bear in mind the strong possibility of contamination from the other construct.     

Bringing baby home: a comprehensive case management program for obstetrical services

Originally presented to the Society of Home Health Care Management of the American College of Physician Executives at its November 16, 1993, meeting in Tucson, Ariz., the program described in this article was the winner of the College's 1994 Innovations Award in Medical Quality Management, sponsored by Merck Sharp & Dohme. The program shows the potential of case management for both improvement in the quality of care and containment of costs for a managed care population with a substantial Medicaid segment. This article is part of a continuing series on innovative programs in home health care.     

The ethics of health care system reform

The United States is now engaged in a momentous national debate about health care. How can we provide the best care possible while simultaneously containing cost (to promote the general economic integrity of society) and somehow maintain a semblance of a free health care marketplace. This is not just a political question; it is also a question of ethics. It is an ethical consideration because the current debate is not just about designing or promoting health care systems that can best address our concerns for costs, quality, and accessibility. It appears that at least some participants in the debate would not stop at arguing their beliefs as valid; they would make their beliefs law. Some urge the creation of the right to health care as a matter of law. There are significant differences between beliefs and rights, however, and they need to be considered carefully in the ongoing debate over the future of this country's health care delivery and financing system.     

Time use in child care and housework and the total cost of children

The use of time for child care and housework among Swedish families is investigated. We allow the effect of children on child care and housework to vary by age of the child and also by whether the child is cared for outside the home or not. Our estimates allow us to compute the total cost of children in the form of the cost of time, and the cost of goods, services and housing.The result shows that time used for child care decreases sharply with the age of the child but this is not the case for time used for other housework. Considerable economies of scale is found to prevail for time used for child care. Child care outside the home reduces time use for other housework but the effect on time used for child care is quite small. For the average family time use cost make up more than half of total child cost. Our estimates indicate that decreased time use cost for children caused by care outside the home are not very different from a typical parental fee for public day care.This research was supported by a grant from the Swedish Council of Social Research (SFR). We thank Lennart Flood for useful comments on an earlier version.     

Demographic changes in East European countries and Russia

The authors outline demographic trends in Eastern Europe and Russia since 1970. Aspects considered include population size, birth rate and number of births, marriage and divorce, death rate, infant mortality, natural increase, sex ratio, and life expectancy.     

Employment-based health benefits: analysis of the April 1993 Current Population Survey

The April 1993 CPS differs from the March 1993 CPS in a number of respects. The April 1993 CPS supplement surveys only workers, whereas the March CPS examines the noncash benefits received by all Americans. The April CPS asks workers about health coverage in the week in which the questions were fielded, whereas the March CPS asks about coverage in the preceding year. In April 1993, there were 112.5 million civilian American workers between the ages of 18 and 64 with jobs. Eighty-two million (73 percent) of them worked for an employer that sponsored a health insurance plan, and 65 million (58 percent of all workers) participated in their employer's health plan. About one-third of workers at firms with fewer than 10 employees had employers who offer health benefits; about one-quarter of all of the workers in these firms participated in their employer's plan. Conversely, 94 percent of workers at firms with more than 1,000 employees had an employer who sponsored health benefits, and over 77 percent of these workers participated in their employer's plan. There are 16.5 million American workers whose employers sponsored health benefits but who did not participate in these benefits. Over one-half of these workers (8.5 million) chose not to be covered. Another 36 percent of these workers (5.9 million) did not participate because they were ineligible or denied coverage. Over 66 percent of the ineligible workers did not participate because they were part-time, contract, or temporary workers. Another 26 percent had not yet completed a probationary period. Among the reasons that those who chose not to participate in their employer's coverage, the vast majority (75 percent) stated they were covered by another health care plan. Twenty-nine percent stated that they chose not to purchase coverage because it was too costly or that they did not need or want the coverage. In 1993, there were 16.7 million workers with no health insurance coverage. The vast majority of these workers (95 percent) were employed by private employers. Sixty-six percent of the workers with no health insurance coverage were self-employed or worked for firms with fewer than 100 employees.