Measurement of Hispanic ethnicity in the U.S. census: an evaluation based on latent-class analysis

"Two models, the U.S. census model and the latent-class model, are compared in their application to evaluating measurements of ethnicity. Although the census approach assumes that the response categories of a questionnaire item correspond to groups in the population, the latent-class approach seeks to assess whether any set of response categories can represent observed ethnic heterogeneity. Data collected using the 1990 census Hispanic-origin question and other instruments for measuring ethnicity suggest that the latent-class approach is superior whenever the response categories are not known to be valid. In particular, using the latent-class model, this article rejects the census model's assumption of a single dimension of meaning underlying responses to the Hispanic-origin question."     

Estimating fecundability from data on waiting times to first conception

"This article tests assumptions invoked in the demographic literature to estimate the population distribution of fecundability from data on waiting times to first conception. In continuous time, the key assumption is that waiting times are realizations from a mixture of exponentials distribution. In discrete time, the key assumption is that waiting times are realizations from a mixture of geometrics distribution. The [U.S.] Hutterite data analyzed by Sheps (1965) are consistent with this assumption. Various models, however, have one representation in mixture of exponentials form. A fundamental identification problem plagues the conventional estimation procedure. Our analysis calls into question the conventional practice of checking model specification by using goodness-of-fit tests. The practical importance of the identification problem in duration models is demonstrated."     

Moral principles shaping public policy on euthanasia

People's fear of enduring a prolonged, costly dying while attached to life-sustaining machines has prompted support for the legalization of active euthanasia. Four major principles--sanctity of life, prohibition against killing, autonomy, and the common good--have a bearing on the debate.     

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.     

THE EFFECTS OF PRESTIGE NAMES IN QUESTION WORDING

Although survey researchers are often warned against using prestigenames in questions (e.g., identifying Contra aid as "PresidentReagan's policy"), prestige names are still commonly used. Tolearn more about the effects of using prestige names, we analyzetwo sets of experiments—on judicial confirmation electionsand on an initiative on tax indexing. The results indicate thatprestige names do more than shift responses in one direction—they eliminate the effect of education on DKs and provide moreof a political basis for the responses.     

Twelve questions to ask about your outcomes monitoring system--Part I

Outcomes monitoring is an integral part of any decision maker's information resources--the cornerstone of a provider's commitment to quality improvement or of a purchaser's strategy for seeking value. In their eagerness to obtain useful information about provider performance, purchasers and consumers naively may accept flawed evaluations and thereby create perverse incentives for providers that undermine the very qualities they wish to foster. Inaccurate or misleading information about provider performance will lead managers to reward the wrong behavior and so induce more of it. Inaccurate information also can discourage better providers whose performances are not recognized and can lead all providers to distrust and denounce clinical monitoring in general. When these things happen, the great value of outcomes monitoring systems as a tool for quality improvement is lost.     

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.