Clinical program renovation management

The day-to-day management of medical practice is so heavily influenced by tactical imperatives that few physicians have the time to think strategically. Traditionally, the difference between tactics and strategy is not a major concern of most physician executives. The realm of tactics is the short run, when managers must make do with the fixed resources at hand. Strategy addresses the long run, when all resources and markets are variable. A tactical focus is understandable, maybe even acceptable, in industries where nothing challenges traditional approaches to production of an established product or service. However, medical care in the 1990s is changing so fast that a physician executive must devote an incredible amount of time and effort just to stay confused about what is going on.     

Immigrant fertility: an examination of social characteristics and assimilation

"This study compares the fertility patterns of foreign-born and native-born women in Canada and examines whether [the] same set of social characteristics accounts for differential fertility among both the groups. The study also assesses the importance of social characteristics and assimilation on immigrant fertility behavior. Two generations of currently married/cohabiting women with spouse present are analyzed using multiple regressions. The results reveal similar effects on fertility of social characteristics for foreign-born and native-born, while in the case of younger generations the effects are stronger."     

European Community legislation and intergovernmental cooperation on migration

Recent trends in migration policy in the European Community are outlined. The focus is on the need to increase cooperation between the member states and to increase the power of the Community's Court of Justice in decision-making about migration and refugee policy.     

The politics of health in the fourth world: a northern Canadian example

This paper describes the major structural and historical dimensions of health ideology and praxis in the Canadian Arctic. It examines the problems that occur when primary care services exclude their clients from meaningful involvement in planning and administration. It argues that the structure of health services in northern Canada reflects an internal colonial political economy which is characteristic of most Fourth World situations.     

Empirical findings on socioeconomic determinants of fertility differentials in Costa Rica

"This paper seeks to (1) identify socioeconomic variables that are expected to generate fertility differentials; (2) hypothesize the direction and magnitude of the effect of each variable by reference to a demand-for-children model; and (3) test empirically the model using evidence from Costa Rica. The estimates are obtained from a ten-percent systematic random sample of all Costa Rican individual-family households. There are 15,924 families in the sample...." The authors specifically seek "to capture the effects of changing relative prices and available income and time constraints on parental preferences for children. Least-squares estimates show statistically significant relationships between household fertility and opportunity cost of time, parental education, occurrence of an extended family, medical care, household sanitation, economic sector of employment, and household stock of nonhuman capital."     

Reintegration of circulating families in southwestern Puerto Rico

Puerto Rican migration to the US has been a more or less continuous process since 1917. The perspective of viewing return migration as a circulation process suggests that there are entries, exits, and reintergration into the metropolitan labor market. This study explores the circulatory movements of Puerto Rican families, events that influence the adaptation process when returning to Puerto Rico, and cultural identity aspects. Data collected by means of 2 research instruments that were administered to the respondents simultaneously were used: 1) a life history matrix and 2) an open-ended questionnaire. These interviews outlined the principal problems of adaptation as mentioned by the circulating migrants. The most difficult problems to adjust to were economic and employment (58%), followed by social acceptance (23%), education (17%), and language (15%). Transportation, medical services, and recreational facilities were also problems mentioned as being significant. It is expected that a great majority of migrant laborers will go to live in immigrant residential locations in large US cities. It is also expected that these migrants will meet with certain value conflicts by living in urban ghettos. These families will have serious difficulties finding economic stability and will possibly consider migrating once again as an alternative to their social reality. This study illustrates that: 1) the migrants return in family groups; 2) they face discriminatory problems in employment agencies and schools; 3) they look forward to a formal education as a means of social mobility; 4) they identify themselves with values, habits, and Puerto Rican traditions; and 5) they value the quality of life in Puerto Rico.     

Introduction

In the introduction to this special issue on temporary worker programs, the author defines the term temporary worker and reviews worldwide research, writings, and policies to date pertaining to temporary workers. Labor market and economic effects, socio-administrative conditions, and effects on the labor-sending societies are discussed. Noting that mutually exclusive arguments are presented within one issue of the journal, the author introduces the authors of the individual articles and their subjects. It is determined that the temporary worker phenomenon is now global and that having an understanding of these workers is increasingly central to understanding key socioeconomic and political processes affecting modern industrial and nonindustrial societies.     

Spontaneously settled refugees in Northwestern Province,Zambia

The UN High Commissioner for Refugees (UNHCR) commissioned researchers from the University of Zambia to conduct a socioeconomic survey and census of "spontaneously settled" Zairean and Angolan refugees in the Northwestern Province of Zambia in 1982. The sample consisted of 188 Angolans, 201 Zaireans, and 2 South Africans. The difficulties experienced by refugees in Northwestern Province in achieving integration were related to a combination of factors including the lack of a clear national policy on refugees and refugee status, a national concern for maintaining security, the popular belief that aliens are responsible for an increasing crime rate, the desire by immigration officials for stricter laws to control alien infiltration, conflict between traditional and modern leaders, and Zambia's deteriorating economic situation. In spite of the problems described, the integration of refugees into existing communities is a desirable goal and should be encouraged. One should not assume that self-settling refugees are able to live with ethnic kin, receive assistance and hospitality, and thus are better off than those in camps. The Zambian case provides ample evidence that integration is not easy even with kin support, shared ethnicity, language, and historical connections. Moreover, given the fact that Zambia will continue to receive refugees it is vital that there is a well defined refugee policy and an administrative mechanism for implementing that policy at all levels. This will be particularly important in Zambia as it will undoubtedly continue to receive large influxes of refugees, from countries such as Namibia, Uganda, Angola, Mozambique, and South Africa.