Psycho-social impacts of terrorism and organized crime: The counterfinality of the practico-inert

The phrase, the counterfinality of the practico-inert is from Sartre with reference to implications of modern technology as a shorthand for that enormous properly human and anti-natural power of dead human labor stored up in our machinery — an alienated power, which turns back on and against us in unrecognizable forms and can symbolize the massive dystopian horizon of organized crime as well as individual terrorist praxis (Jean-Paul Sartre (1948).Situations II. Paris: Gallimard).     

The mandate for investigational cancer therapies

The heated national health care reform debate of the summer of 1993 has now simmered down, but pieces of the debate are still percolating along at the state level. Within the past year, numerous states have introduced bills that would mandate insurance coverage for investigational cancer therapies--in particular high-dose chemotherapy and bone marrow transplant for breast cancer. The problem with these initiatives, well-intended though they may be, is that they threaten to spread unproven technologies at a rapid rate and at the same time miss the opportunity to collect data that would prove the safety and effectiveness of the methods. The author explores these issues and suggests how managed care companies can play a more aggressive role in parrying the threat.     

Corporate compliance programs: risk management for the future

The Department of Justice has estimated that the government loses $100 billion annually in health care fraud. Consequently, the government's health care fraud enforcement activities with respect to all health care providers and suppliers continue to grow. Last year alone, the government collected more than $8 billion in settlements, fines, and penalties involving health care fraud. Recent settlements with the government have begun to include corporate compliance programs that require continued government oversight of the health care organization as an essential part of the settlement. The first section of this article describes the legal significance of health care companies' having corporate compliance programs. The second section provides a sample list of topics that should be included in any corporate compliance program. Finally, we describe various issues related to the creation and implementation of corporate compliance programs.     

A hospital protocol to resolve complaints against staff physicians

Complaints of discrimination or harassment in the workplace have become almost commonplace in recent years, increasing in both frequency and variety. In the hospital setting, this trend is manifested in allegations against members of the medical staff by hospital employees as well as by patients or their families. Whether real or fancied, such allegations are reflective of a potentially disruptive undercurrent of organizational tensions. Left unresolved, they can erode the essential partnership between staff physicians and other members of the health care delivery team. Unsatisfactory patient experiences may also damage the reputation of the institution and thereby undermine its viability. With either group of complainants, allegations of malfeasance that are not resolved at the source in a timely manner are far more likely to result in expensive, time-consuming, and potentially damaging litigation.     

A comparison of quality and utilization problems in large and small group practices

Physicians practicing in large, multispecialty medical groups share an organizational culture that differs from that of physicians in small or independent practices. Since 1980, there has been a sharp increase in the size of multispecialty group practice organizations, in part because of increased efficiencies of large group practices. The greater number of physicians and support personnel in a large group practice also requires a relatively more sophisticated management structure. The efficiencies, conveniences, and management structure of a large group practice provide an optimal environment to practice medicine. However, a search of the literature found no data linking a large group practice environment to practice outcomes. The purpose of the study reported in this article was to determine if physicians in large practices have fewer quality and utilization problems than physicians in small or independent practices.     

Mortality differences in Norway. Two biographical data analyses and one question about female mortality differentials

"The aim of this paper is, first, to give an overview of the local history approach developed in adult mortality differentials; secondly, to present its potentiality compared with a more usual approach.... Our methodology was applied to Norwegian data."     

Environmental hazards and the health status of women and children in a riverine community in Nigeria: Nikrowa in Edo State

Nikrowa is a riverine village located in Ovia North-East Local Government Area of Edo State. This paper examines the relationship between the environment and the health status of women and children in the village. Data used in this essay were obtained mainly in focus groups from a study of women and health service utilization in Nikrowa. Women in Nikrowa farm, fish, collect water and firewood, and process and prepare food. They also bear many children. Their hard physical labor causes them to suffer continuous body aches and pains. Environment-related illnesses such as malaria, measles, dysentery, and diarrhea are prevalent among children. The geographical isolation of Nikrowa limits access to modern health care facilities, so traditional therapies are used to treat prevailing illnesses. It is suggested that women have access to fertilizers in order to improve soil fertility and agricultural yields. Fuelwood and adequate and safe water supplies should be made readily available to women. Moreover, access roads to rural areas should be improved to facilitate transport to modern health care facilities, and rural primary health care facilities should be helped to provide efficient services by providing trained staff and ensuring regular supplies of drugs.     

Coherent decision analysis with inseparable probabilities and utilities

This article explores the extent to which a decision maker's probabilities can be measured separately from his/her utilities by observing his/her acceptance of small monetary gambles. Only a partial separation is achieved: the acceptable gambles are partitioned into a set of belief gambles, which reveals probabilities distorted by marginal utilities for money, and a set of preference gambles, which reveals utilities reciprocally distorted by marginal utilities for money. However, the information in these gambles still enables us to solve the decision maker's problem: his/her utility-maximizing decision is the one that avoids arbitrage (i.e., incoherence or Dutch books).