Why we cannot agree on the direction of health reform: an exploration of American values

Most of the articles in this series examine historical forces that have shaped American health care policy. This article will ask the reader to step back from the swirl of events that have led to a health care system that provides excellent care to many and minimal services to a substantial minority. The purpose of this article is to place often contradictory health policies within their philosophical context. Such an analysis can lead to an understanding of the reasons for the simultaneous appearance of both competitive and regulatory features in the American health care system.     

The high point of efforts to improve access to health care by "documentation"

The set of articles of which this article is a part has documented the tension between the advocates and the opponents of government intervention in the American health care system. This article will focus on a chapter of American health care history that is almost forgotten and has still never been told in its entirety. The story of the Committee on the Costs of Medical Care (CCMC), which existed from 1927 to 1933, represents the apogee of the factual approach effort to changing health care delivery in America.     

Strategic group decision support systems--a guide for the unwary

Considerable interest is currently being shown in the use of information technology to assist in improving group process, particularly those associated with strategic planning. Three major approaches are developing to provide this support, and these are described in this article. In general, articles about Group DSS are overwhelmingly favourable to the approaches, although research findings suggest that some forms of Group DSS can have deleterious effects on the quality of meetings. These research findings are discussed.     

How reporting delay,duration of follow-up and number of cases affect the estimates of the incubation time of transfusion-associated AIDS cases

The authors discuss the impact of reporting delay, duration of follow-up, and number of cases in a sample on estimates of the incubation time of transfusion-associated AIDS cases. "This article comes to the conclusion that the accuracy of the incubation time estimate would depend on the sample size rather than on the duration of follow-up." (SUMMARY IN FRE)     

Republic of Korea. Country feature

The Government of Korea's 5th 5-Year Economic and Social Development Plan (1982-86) seeks to reduce the population growth rate from its 1982 level of 1.58% to 1.49% by 1986; it is assumed that the population replacement level of fertility (total fertility rate, 2.1) will be attained in 1988. The task of achieving these demographic targets is expected to be made more difficult by factors such as the impact of the 1950s baby boom and widespread son preference. New population control policy measures announced in 1981 call for improvements in the current family planning program management system; a new social and institutional support system to inculcate the small family size norm; strengthened information, education, and communication activities for family planning; and establishment of coordination among the government organizations involved in population-related activities. Numerous social support measures have already been put into effect, including income tax exemptions for up to 2 children, inclusion of population education in the school curriculum, priority in alloting public housing to sterilization acceptors with 2 or fewer children, and provision of IUD services through the medical insurance system. The number of contraceptive acceptors in the government program increased 78.3% from 1981-83, from 614,000 to 1,094,600. Sterilization and menstrual regulation services have shown particularly sharp increases. Program achievement for 1983 was equivalent to 19% of eligible women ages 15-44 years. The total fertility rate stood at 2.7 in 1982. Major efforts now must be directed toward eradicating the strong parental son preference and ensuring better family planning program efficiency and effectiveness.     

The health belief model and the contraceptive behavior of college women: implications for health education

This study applied the "health belief model" in a comparison of the subjective perceptions, attitudes and beliefs between college women who were adequate or inadequate contraceptors. The 171 sexually active subjects were ascertained from clients of the Family Planning Clinic at the University of Illinois. A questionnaire was designed and tested to measure variables of perceived susceptibility to pregnancy, seriousness of unplanned pregnancy, benefits and barriers of contraceptive use. Inadequate contraceptors or risk-takers were defined as women who used no contraception, less effective methods such as rhythm, spermicides only or withdrawal, or effective methods sporadically. 49.5% of the subjects were risk-takers. Among the inadequate contraceptors, 17% were nonusers, 29% relied on ineffective methods, and 52% used effective methods sporadically. There was no difference between the 2 groups in their belief in seriousness of an unplanned pregnancy. The groups differed significantly in their perceived susceptibility to pregnancy (p.001). They also differed significantly in perception of overall costs and benefits of contraception (p.001), a score created by combining 12 questions on topics such as difficulty and embarrassment in obtaining contraceptives and inconvenience and awkwardness in dealing with them. There was a smaller significant difference (p.05) in a score termed "general use cost benefits," but no difference in a score called "method specific perceptions." These results were corroborated by a discriminate analysis which singled out the perceived costs and benefits and the perceived susceptibility variables as accurate predictors of the adequate contraceptor group. The health belief model showed considerable utility in explaining contraceptive behavior.     

An Interaction Model of Business Service Production and Consumption

This paper develops a conceptual framework and model of the production and consumption of a business service. The model captures the interacting and dynamic nature of relationships between individuals both within and between client and supplier firms. The role played by the client during the different phases of production of the service will influence the degree to which the final service delivered meets the customer's specifications and the probability of implementation. Some empirical evidence of the complex interactions that occur in the creation of business services is presented and is used to suggest a modified typology of business services.     

Global economic restructuring and international migration: some observations based on the Mexican and Central American experience

"The purpose of this article is to explore the relationship between processes of global economic restructuring and international migration through an examination of Mexican and Central American immigration to the U.S. and the experiences of Central American and Mexican immigrants in the U.S. This relationship is analysed as one of mutual causation: on the one hand, global restructuring affects conditions in both sending and receiving countries (it is not only a factor in emigration but also in the economic and political receptivity to immigrants at their point of destination); on the other, international migration in turn has an important impact on countries of origin, receiving countries, and the relationship between them." (SUMMARY IN FRE AND SPA)