The medical examiner and deaths in the hospital setting

There has been a perceived increase in the number of medical negligence claims in recent years. The modern metropolitan medical examiner is increasingly called upon to deal with numerous medical, legal, social, and ethical issues. Nowhere is the role of the medical examiner more important than in the investigation of deaths related to surgical, diagnostic, anesthetic, or therapeutic procedures. Medical examiners have an important role in the investigative process. Through utilization of the offices and services of the medical examiner, questions raised by families, physicians, and other hospital employees may be satisfactorily answered a priori, and litigation may therefore be averted.     

The appointment-keeping habits of managed care patients

Among the controversies surrounding the provision of health care in a managed care environment is the belief that patients, because they have no particular allegiance to a single physician, are more casual in regard to their keeping appointments. To test this proposition, the authors conducted a study at a California independent practice association, comparing the habits of managed care patients with those of other types of patients. The findings, although based on a limited sample, suggest that managed care patients do indeed have a greater tendency to be appointment no-shows.     

Community rating--an approach that works

How our current system works and what changes need to be made are the subjects of intense scrutiny by policy makers today. One of the primary areas of concern with our present health care system is its accessibility to the average American, in terms of both price and ability to obtain insurance. With an estimated 37 million Americans without health care insurance, and countless others severely underinsured, this issue will lie at the core of any health care reform that results from the current debate. One possible approach to the uninsured problem that might alleviate the situation is community rating.     

Fertility incentives and participation in localities with limited means: a dynamic model of per capita resources

Several countries have attempted to change human fertility through economic incentives. This paper presents simple mathematical models of the participation of couples in a locally funded program of economic incentives. The models take as a springboard China's one-child program. Localities with low per capita incentives attract few couples to the program, while localities with high incentives attract many couples at first, but the value of the benefits is then watered down. The models show that participation in the program may persistently oscillate or may decay to a stationary level. Which behavior occurs is determined by whether there are decreasing, constant, or increasing returns in the rates of participation in response to successive equal increments in the incentive offered, and by the extent to which prospective parents learn from experience with past oscillations in the incentives. The models raise many empirical questions about the dynamics of incentive programs.     

Origins and destinies: Immigration to the United States since World War II

Contemporary immigration to the United States and the formation of new ethnic groups are the complex and unintended social consequences of the expansion of the nation to its post-World War II position of global hegemony. Immigrant communities in the United States today are related to a history of American military, political, economic, and cultural involvement and intervention in the sending countries, especially in Asia and the Caribbean Basin, and to the linkages that are formed in the process that open a variety of legal and illegal migration pathways. The 19.8 million foreign-born persons counted in the 1990 U.S. census formed the largest immigrant population in the world, though in relative terms, only 7.9% of the U.S. population was foreign-born, a lower proportion than earlier in this century. Today's immigrants are extraordinarily diverse, a reflection of polar-opposite types of migrations embedded in very different historical and structural contexts. Also, unlike the expanding economy that absorbed earlier flows from Europe, since the 1970s new immigrants have entered an hourglass economy with reduced opportunities for social mobility, particularly among the less educated, and new waves of refugees have entered a welfare state with expanded opportunities for public assistance. This paper seeks to make sense of the new diversity. A typology of contemporary immigrants is presented, and their patterns of settlement, their distinctive social and economic characteristics compared to major native-born racial-ethnic groups, and their different modes of incorporation in—and consequences for—American society are considered.     

The case. Bad care, good care, and spiritual preservation

A cancer patient learning to walk again finds that his relationships with his two physical therapists affect his recovery. One woman gives hope as well as instruction. He advises healers to meet their patients as equals, "to take down as many barriers as they can, give away as many distancing privileges as possible."     

Bridge employment and job stopping: evidence from the Harris/Commonwealth Fund Survey

This article analyzes a 1989 Louis Harris and Associates survey designed to elicit information on the employment histories and job-stopping behavior of men and women who then were approaching or had recently reached retirement age. The results indicate that retirement often occurs gradually and includes a substantial period of "bridge employment." Most bridge jobholders work full-time, by choice, and report high levels of job enjoyment. Occupational mobility occurring late in life typically involves upward movement, although the pattern of change is quite different when it takes place outside, rather than within, the longest job. The principal concern identified in this article is the limited ability of some groups of workers (nonwhites, females, the less educated, and those in poorly compensated occupations) to either retain longest jobs or to obtain acceptable bridge employment. Health problems also frequently lead to early departures from the labor force.     

The liability of nonprofits to donors

The success of the third sector depends on public confidence, and that confidence rests, in part, on holding managers, directors, and officers of nonprofits responsible for their conduct. This accountability can be accomplished by clearly defining the roles of these individuals and the stands that they are to uphold, and by providing channels for all interested to challenge uncontrolled activities. Though interest in this goal is unanimous, a debate exists over how to ensure oversight and accountability.