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.     

The liability of nonprofits to donors

The success of the third sector depends on public confidence, and that confidence rests, in part, on holding managers, directors, and officers of nonprofits responsible for their conduct. This accountability can be accomplished by clearly defining the roles of these individuals and the stands that they are to uphold, and by providing channels for all interested to challenge uncontrolled activities. Though interest in this goal is unanimous, a debate exists over how to ensure oversight and accountability.     

Basic aspects of evolution strategies

Evolution strategies (ESs) are a special class of probabilistic, direct, global optimization methods. They are similar to genetic algorithms but work in continuous spaces and have the additional capability of self-adapting their major strategy parameters. This paper presents the most important features of ESs, namely their self-adaptation, as well as their robustness and potential for parallelization which they share with other evolutionary algorithms.Besides the early (1 + 1)-ES and its underlying theoretical results, the modern ( + )-ES and (, )-ES are presented with special emphasis on the self-adaptation of strategy parameters, a mechanism which enables the algorithm to evolve not only the object variables but also the characteristics of the probability distributions of normally distributed mutations. The self-adaptation property of the algorithm is also illustrated by an experimental example.The robustness of ESs is demonstrated for noisy fitness evaluations and by its application to discrete optimization problems, namely the travelling salesman problem (TSP).Finally, the paper concludes by summarizing existing work and general possibilities regarding the parallelization of evolution strategies and evolutionary algorithms in general.     

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.     

Gambling and the Law®: Endless fields of dreams

This article examines the current trends of proliferation of commercial gaming, especially in the United States, in the context of the third wave of legalization of gambling that has been experienced since the founding of the nation. The author looks at the historic foundations of the spread of casino-style gambling, and notes the types of casino gaming that have led the way in the current expansion. He also points out why it is reasonable to expect that this wave too may come crashing down, as general acceptance of wide-spread casino gaming in America may indeed be short-lived.Gambling and the Law^® is a registered trademark of I. Nelson Rose.     

You have the job you wanted--now what?

We've had calls from physicians who finally have the medical management job they always wanted and then a month later they wondered why they wanted it. I asked seven physician executives to come together as a group and talk to me about this issue. I also asked them what skills they needed most when they first got the job and, as time passed, which skills continued to be most useful. I have not used their names because they were open enough to talk about some very sensitive issues.     

Home,work and community: skilled international migration and expatriate women in Singapore

While skilled labour migration across international borders is a phenomenon of increasing significance in the age of globalization and an important component in the production of global cities, it has not been given sufficient attention in traditional migration analyses.
Recent research has focused on institutional mechanisms regulating the patterns of skill transfer rather than the individual experience of being part of the international labour circuit. Women, in particular, have usually been relegated to the role of "trailing spouses" and are generally invisible in the migration process.
Using a questionnaire survey and in-depth interviews, this article attempts to reinstate the importance of women's roles by portraying them as active agents who adopt a range of strategies in negotiating the move and coming to terms with the transformations wrought by the move in the domains of home, work and community. It argues that skilled labour migration is a strongly gendered process, producing different sets of experiences for the men and women involved in it.
While international circulation often represents "career moves" for expatriate men, their spouses often experience a devalorization of their productive functions and a relegation to the domestic sphere. As an adaptive strategy, expatriate women often turn to the social and community sphere to reach for grounding in their lives.
The article also points to the diversity of "expatriate experiences": while "western" expatriates tend to recreate a more exclusive world by drawing on strong institutional support, "Asian" expatriates find that they have to navigate much finer social and cultural divides between themselves and the host society.