Physician perceptions of medical malpractice and defensive medicine

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.     

Major obstacles to control of irregular migrations: prerequisites to policy

This paper examines 3 basic obstacles thwarting all attempts to reduce irregular migration. The 1st, rather well known and analyzed, underscores the dependency of all regulation of migratory flows on the system of economic and political relations between developed and developing countries. The 2nd obstacle resides in the persistance and growth of subsequent dependent irregular migration. This obstacle also reveals the relative autonomy of population movements compared with the employment situation in the labor market. The 3rd generally ignored obstacle is the role played by migration itself, particularly the discriminatory status of foreign workers in the labor market, in producing irregular migration.     

Are old-age security and the utility of children in rural India really unimportant?

Abstract Extract In their recent paper in this journal M. and Carol Vlassoff are to be commended for helping to remedy the dearth of empirical studies on the old-age security motive for children (and particularly sons) in rural areas of developing countries.(1) However, while the questionnaire which they applied to 357 ever-married men in a rural village in Maharashtra state in India is potentially useful, several of the conclusions they derive from it are unwarranted and, if left unquestioned, would undoubtedly have the effect of setting back the serious investigation of the effects of this motive rather than furthering it. The invalid or at least questionable inferences are taken up one at a time in the order of their appearance:     

Premarital information efforts under way

Premarital couples are among priority targets of family planning information in the Philippines national population program as they can serve a pivotal role in slowing population growth. Applicants for marriage licenses are required to attend a family planning session as a prerequisite. Following recommendations of a training effort and seminar on Premarital Family Planning Counseling, on July 20, 1976, premarital information was institutionalized in the country by Presidential DEcree 965 which made family planning counseling obligatory to the marriage license applicants. Shortly after that, a multiagency effort gathered information on the status of the Premarital information program in the Philippines, which showed that there is no full-time specialist for the work. Medical officers; social workers; community welfare supervisors; and program and training officers do this work of information in addition to their usual duties. Distribution of the applicants varied greatly in age groups, educational levels, and professional category. The size of the group, length of session and topics of discussion varied greatly. Necessary efforts should be made to solve the major problems by selecting better sites for group sessions and training more personnel for the purpose. There is a great need fordeveloping more effective and research oriented information, education and communication materials, according to the needs and cultural traits of the target audience.     

Setting operational goals for corporate social responsibility

In this article the author argues that more formality in social responsibility planning efforts is a concept which is extremely pertinent in today's conditions. Rewards will accrue to the organization that can move beyond aesthetic objectives and achieve operationality in social responsibility goal setting. This requires, basically, the application of techniques that have proved to be successful in MBO programs. By translating broadly stated social objectives into goals that are clear, concise, time related and cost related, management will inject an increased measure of integrity into its planning process, improve social responsibility programs, assure future successes in the social performance arena, facilitate the appraisal of management personnel, and enhance the organization's credibility with its multiple publics. Positive benefits will flow to the organization, its immediate publics, and to the society at large as a consequence of operational planning methods as described herein.     

Differences in white-nonwhite community mental health center service utilization patterns

Routinely collected computerized data were used to study the process of service delivery in terms of admission patterns, type and quantity of services rendered, and status at termination for whites and nonwhites in two community mental health centers. Social area analysis techniques were employed to control for socio-economic status, ethnicity and life style variables, and an epidemiologic model was used to analyze admission and service delivery rate differences. It was found that nonwhite admission rates were at least twice as great as white rates. Service delivery rates to the population at large were considerably greater for nonwhites than for whites. Delivery of direct services within the centers differed for whites and nonwhites, but no consistent trends emerged when types and amounts of services rendered were analyzed, controlling for sex, ethnicity, age, diagnosis and social area. Disruption of care indices were greater for nonwhites than for whites. Highlighted were some of the complexities involved in interpreting results of utilization studies.     

Program analysis using the client oriented cost outcome system.

The client oriented cost outcome system has been under development in Pennsylvania community and hospital programs since 1972. The system builds upon the behavioral and decision data generated with or on behalf of consumers. Flexibility for local program system design is permitted if the procedures of consumer intake, review, and termination document each consumer's (a) problems, resources, and goals, (b) overall functioning level in their ordinary community, and (c) services intended and rendered as related to (a), above. While the system's primary application is in providing feedback for local program quality assurance and evaluation procedures, aggregation of data permits program planning and evaluation at county, state, and federal levels in terms of (a) client demographic or diagnostic characteristics, and (b) program service characteristics and objectives.