The minds of a medical director

This article is offered in a nod to all those readers who have been exposed to "whole brain" theory, either through the American College of Physician Executives or elsewhere. As managers struggle with balancing the "left brain" and "right brain" aspects of their work, the author says, they might consider exploiting a third area of activity, or inactivity--the "no brain." This center position can be especially effective in dealing with the high-technology aspects of delivering health care.     

Human genetic technology: who shall control?

The biotechnical "revolution" has fast come upon us. It promises to produce both substantial benefits and difficult dilemmas for individuals and society. Despite the growing attention being paid to biotechnology, a major unanswered question is who shall control the development and use of the powerful array of human genetic and reproductive innovations. Should the decisions be left to individual consumers and private industry or should they be made by the government or other social institutions? After briefly reviewing development in human genetics and reproduction and describing trends toward commercialization of them, this article discusses the dilemmas these trends raise for a democratic society. It argues for the urgent need to delineate societal goals and priorities for the future and for technology assessment as early as possible in the developmental process. The article concludes by presenting some examples of the social policy problems now emerging.     

Migration, remittances and rural development: findings of a case study in the Indian Punjab

Rural household survey data in the Ludhiana district of the Indian Punjab was used to study the nature and role of remittances in rural development. Of the 1646 outmigrants from the area since 1961, the 949 women who migrated for marriage and children under 12 years old were excluded from the study. Nearly all husbands who outmigrated had sent remittances. Parents and grandparents were 2nd and 3rd most likely to remit, but their numbers were small. Education did not correlate with remittance. Distance and time since emigration did not affect remittance. The frequency and the size of remittances are discussed. Remittances to outmigrants were insignificant. The remittances from outmigrants seem to raise the incomes and the levels of living of rural households. The remittances serve the purpose of redistributing income from urban to rural areas. Remittances also widened the gap between rich and poor in the rural areas because the better-off groups were more likely to receive remittances than the poorer groups. Most of the money sent from outmigrants was spent on consumable goods, food and clothing. Only a small proportion was spent on productive investment. This was usually done by farming families who invested in land or farm necessities. It is concluded that remittances from outmigrants can have a positive effect on the rural economies. Investment opportunities for nonagricultural families must be provided.     

Optimal Times to Contact Sample Households

Finding a suitable respondent at home is an essential and expensivecomponent of a household survey. This article reports on theresults of a study of the probabilities of finding someone aged14 or older at home and discusses the application of such datato survey design and budgeting.     

Evaluating a private foundation's health program

Public policy decisions in health are increasingly difficult and expensive. Although there will never be enough information available, private foundations can help to bridge the most important gaps in knowledge. Larger foundations may also wish to respond to those who doubt the value of foundation activities. This article reviews the experiences over the past eight years of The Robert Wood Johnson Foundation in employing evaluation and related social research procedures in the planning and implementation of a major philanthropic effort to improve the health and medical care of Americans. Discussed are the still evolving Foundation evaluation framework, the unanticipated problems in undertaking specific evaluations, and the substantive findings of some of the studies.