CONTEXT EFFECTS FOR CENSUS MEASURES OF RACE AND HISPANIC ORIGIN

This paper reports on the results of a split-ballot experimentconducted in 1987 to test alternative versions of the decennialcensus long form. Two forms were randomly assigned and self-administeredin group sessions involving a total of 515 respondents. Theorder of race and Hispanic origin items was experimentally manipulated.The standard long form asks race, then Hispanic origin. Theexperimental form reversed the order of the items in order toreduce perceived redundancy, and to create a more restrictedframe of reference for the race item. The objectives of thecontext manipulation were (1) to reduce item nonresponse forthe Hispanic origin item, and (2) to reduce reporting of "Otherrace" by Hispanics in the race item. Objective (1) was met.Objective (2) was met for Hispanics born in a U.S. state, butnot for immigrants. The results are interpreted as reflectinga process of acculturation that affects how Hispanic respondentsapply U.S. racial categories "white" and "black" in the census.     

Triangular empathy: “The other” in psychotherapy with individuals

This paper seeks to explore triangular dimensions in individual psychotherapy. In addition to serving as the dyadic object of transference projection and/or as selfobject for a person in psychotherapy, the therapist may be called upon to help the patient work on relationships with certain early, important people or their representations and on the interplay between such relationships and the therapeutic one, that is, in a triangular configuration. Because patients' attempts to introduce others into individual psychotherapy are sometimes experienced by therapists as resistant rather than as integral to the therapeutic process, I propose an empathic reconsideration of such patient efforts to get us to help with the complicated dimensions of human relatedness.     

How to fight the regulator glut: the role of the HCFA-type survey

More and more hospitals in this country are being threatened by the removal of their Health Care Financing Authority (HCFA) Medicare Certification. A perception of competitiveness among HCFA, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and other organizations has heightened this concern. This unpleasant situation has provoked many hospitals to prevent any type of regulator decertification. One of the practical methods of prevention is the use of a HCFA-type survey. These surveys prepare institutions for unexpected, unarmored review by regulators and should be part of the quality improvement (QI) process even in institutions with limited resources. This article discusses the means to accomplish the HCFA-type survey. The development of the survey process involves institutional commitment, hospital policy and procedures, a department review schedule, selection of review personnel, preparation of review personnel, record keeping, and department education.     

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.     

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.     

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.     

Origins and destinies: Immigration to the United States since World War II

Contemporary immigration to the United States and the formation of new ethnic groups are the complex and unintended social consequences of the expansion of the nation to its post-World War II position of global hegemony. Immigrant communities in the United States today are related to a history of American military, political, economic, and cultural involvement and intervention in the sending countries, especially in Asia and the Caribbean Basin, and to the linkages that are formed in the process that open a variety of legal and illegal migration pathways. The 19.8 million foreign-born persons counted in the 1990 U.S. census formed the largest immigrant population in the world, though in relative terms, only 7.9% of the U.S. population was foreign-born, a lower proportion than earlier in this century. Today's immigrants are extraordinarily diverse, a reflection of polar-opposite types of migrations embedded in very different historical and structural contexts. Also, unlike the expanding economy that absorbed earlier flows from Europe, since the 1970s new immigrants have entered an hourglass economy with reduced opportunities for social mobility, particularly among the less educated, and new waves of refugees have entered a welfare state with expanded opportunities for public assistance. This paper seeks to make sense of the new diversity. A typology of contemporary immigrants is presented, and their patterns of settlement, their distinctive social and economic characteristics compared to major native-born racial-ethnic groups, and their different modes of incorporation in—and consequences for—American society are considered.     

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.     

Non-profit institutions in a flow of funds framework

The benefits of providing a separate accounting for non-profit organisations in the financial accounts of the United States are discussed. At present, national economic accounts in the US include non-profit organisations with individuals in the household sector; separate information on the financial activity of non-profit institutions until now has not been available. In this paper, aggregate statistics from federal government tax-exempt filings for non-profit institutions are put into a US flow-of-funds framework. The data for the 1982–1988 period indicate that non-profit institutions accounted for a significant and growing proportion of assets of the household sector in the United States. Their liabilities were also a surprisingly large share of the household sector total. Moreover, funds supplied by the non-profit sector for investment were in some years comparable to funds made available by several important groups of non-depository financial intermediaries. Separate accounting for non-profit organisations within national economic accounts would be likely to reveal an important channel for investment financing in the United States and would significantly improve our ability to measure and analyse the financial activity of individuals by allowing for a purer household sector.The analysis and conclusions set forth are those of the authors and do not necessarily indicate concurrence by Salomon Brothers, the Board of Governors, Federal Reserve Banks or other members of their staffs.     

Parametric link modification of both tails in binary regression

Common binary regression models such as logistic or probit regression have been extended to include parametric link transformation families. These binary regression models with parametric link are designed to avoid possible link misspecification and improve fit in some data sets. One and two parameter link families have been proposed in the literature (for a review see Stukel (1988)). However in real data examples published so far only one parameter link families have found to improve the fit significantly. This paper introduces a two parameter link family involving the modification of both tails of the link. An analysis based on computationally tractable Bayesian inference involving Monte Carlo sampling algorithms is presented extending earlier work of Czado (1992, 1993b). Finally, the usefulness of the two tailed link modification will be demonstrated in an example where single tail modification can be significantly improved upon by using a two tailed modification.