What lies ahead for medical management?

The consensus is that, in spite of a reluctance in Washington to undertake any drastic reform of the health care financing and delivery system, the changes that are already in place in individual organizations and that are in place or being contemplated at the state level are certain to make the health care system of tomorrow very different from that of today. Physician executives can play an important role in the transition that will be required, but they will have to use a flexible, especially nondogmatic approach if they wish to cope successfully in this increasingly whirling environment. For such physicians, the author says, the opportunities, though unknown, are enormous.     

“Consumer Confidence” Indexes as social indicators

Consumer Confidence Indexes can be sensibly used in economic and social research conducted in theoretical and methodological framework of social indicators research. They are good predictors of other attitudes, such as voting preferences. Voting preferences are determined much more strongly by expectations of changes in economic conditions than by evaluations of present situation. On the other hand, Consumer Sentiment Indexes — irrespective whether they concern future or present times — are correlated more strongly with leading than with coincident indexes of economic cycles. That proves very important role of predictions, expectations and hopes in attitude formation.     

Recent migrations from Morocco to Spain

"This study addressed the problem of the Moroccan immigration into Spain within the context of South-North movements, focusing on analyzing provisional data from the last immigrant regularization in the country completed during the end months of 1991."     

The development of social pedagogy in Spain: The tension between social needs,political response and academic interests

The Spanish Civil War (1936—1939) interrupted the evolution and development of social pedagogy, which in Spain had reached similar levels as in other European countries. This was followed by a period when Spain was isolated from developments in social welfare and the changes that go along with the economic and social transformations of cities and give rise to community action, self-help and popular education programmes. The reinstatement of democracy and of new City Councils that are genuinely devoted to solve the problems of the population are the starting point for new social services, that is for social work and social pedagogy. Initially it was practical work that gave an answer to emerging demand, followed by theoretical analysis and efforts of conceptualisation. The professionals and later the universities lead the debate on methodology. The interest and involvement of the universities increased as the Diploma in Social Education was introduced as a new university degree.     

Finite mixture models with concomitant information: assessing diagnostic criteria for diabetes

The World Health Organization (WHO) diagnostic criteria for diabetes mellitus were determined in part by evidence that in some populations the plasma glucose level 2 h after an oral glucose load is a mixture of two distinct distributions. We present a finite mixture model that allows the two component densities to be generalized linear models and the mixture probability to be a logistic regression model. The model allows us to estimate the prevalence of diabetes and sensitivity and specificity of the diagnostic criteria as a function of covariates and to estimate them in the absence of an external standard. Sensitivity is the probability that a test indicates disease conditionally on disease being present. Specificity is the probability that a test indicates no disease conditionally on no disease being present. We obtained maximum likelihood estimates via the EM algorithm and derived the standard errors from the information matrix and by the bootstrap. In the application to data from the diabetes in Egypt project a two-component mixture model fits well and the two components are interpreted as normal and diabetes. The means and variances are similar to results found in other populations. The minimum misclassification cutpoints decrease with age, are lower in urban areas and are higher in rural areas than the 200 mg dl^-1 cutpoint recommended by the WHO. These differences are modest and our results generally support the WHO criterion. Our methods allow the direct inclusion of concomitant data whereas past analyses were based on partitioning the data.     

GENDER, EARNINGS, AND THE ENGLISH SKILL ACQUISITION OF HISPANIC WORKERS IN THE UNITED STATES

Using the 1980 and 1990 Public Use Microdata Samples, we find that labor market outcomes associated with English proficiency vary with respect to gender. For example, a synthetic cohort analysis provides evidence of gender-related differences in Hispanic workers' English skill acquisition. Moreover, we observe that Hispanic women face a lower English deficiency earnings penalty that rises more sharply with education than the penalty obtained by their otherwise similar male peers. Finally, English fluency appears to serve as a stronger occupational sorting mechanism for women than men. ( JEL J3, J1)     

Practicing managed care in the academic medical center

The purpose of this article is to outline the contrasts between the traditional AMC and an organization oriented toward the delivery of population-based managed care. Academic medical centers differ from one another considerably in the extent to which they serve as quaternary care community resources, the degree to which they emphasize primary care in training and care delivery, and the amount of research undertaken. Nor is there a single organizational structure for managed care; successful managed care is practices in IPAs, multispecialty groups, PHOs, and staff-model HMOs. Nonetheless, the contrasts outlined here between AMCs and managed care organizations (MCOs) are valid in most cases.