THE EFFECTS OF PRESTIGE NAMES IN QUESTION WORDING

Although survey researchers are often warned against using prestigenames in questions (e.g., identifying Contra aid as "PresidentReagan's policy"), prestige names are still commonly used. Tolearn more about the effects of using prestige names, we analyzetwo sets of experiments—on judicial confirmation electionsand on an initiative on tax indexing. The results indicate thatprestige names do more than shift responses in one direction—they eliminate the effect of education on DKs and provide moreof a political basis for the responses.     

Religion: friend or foe of the aging?

Religion can be a guide in the quest of older adults for a fuller understanding of their lives and purposes as they cope with the diminishments brought about by aging.     

Triangular empathy: “The other” in psychotherapy with individuals

This paper seeks to explore triangular dimensions in individual psychotherapy. In addition to serving as the dyadic object of transference projection and/or as selfobject for a person in psychotherapy, the therapist may be called upon to help the patient work on relationships with certain early, important people or their representations and on the interplay between such relationships and the therapeutic one, that is, in a triangular configuration. Because patients' attempts to introduce others into individual psychotherapy are sometimes experienced by therapists as resistant rather than as integral to the therapeutic process, I propose an empathic reconsideration of such patient efforts to get us to help with the complicated dimensions of human relatedness.     

Population and towns in Senegal: demo-geographic growth

Using data from the 1976 and 1988 censuses, the author notes that the population of Senegal has grown by 37.6 percent over the period and that this growth is concentrated in urban areas. One feature of this trend has been the growing primacy of the capital Dakar and a decline in the relative importance of smaller towns. The need to discourage rural-urban migration by promoting socioeconomic development in rural areas is stressed. (SUMMARY IN ENG)     

Bringing baby home: a comprehensive case management program for obstetrical services

Originally presented to the Society of Home Health Care Management of the American College of Physician Executives at its November 16, 1993, meeting in Tucson, Ariz., the program described in this article was the winner of the College's 1994 Innovations Award in Medical Quality Management, sponsored by Merck Sharp & Dohme. The program shows the potential of case management for both improvement in the quality of care and containment of costs for a managed care population with a substantial Medicaid segment. This article is part of a continuing series on innovative programs in home health care.     

I get paid fast; what about you?

The process of billing an insurance company for health care services has changed radically. In the past few years, the emphasis has been on automation. The change is fueled by the opinion of cost containment experts who claim that automation will help reduce costs in the U.S. health care delivery system. Key to success for the provider in adapting to this change will be understanding the coding used in the billing process and following standards of accuracy and fairness. This article is not intended to represent the adjudication rules of any particular insurance company. It is the result of experience as a practicing surgeon and as a consultant in the health care field.     

How to fight the regulator glut: the role of the HCFA-type survey

More and more hospitals in this country are being threatened by the removal of their Health Care Financing Authority (HCFA) Medicare Certification. A perception of competitiveness among HCFA, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and other organizations has heightened this concern. This unpleasant situation has provoked many hospitals to prevent any type of regulator decertification. One of the practical methods of prevention is the use of a HCFA-type survey. These surveys prepare institutions for unexpected, unarmored review by regulators and should be part of the quality improvement (QI) process even in institutions with limited resources. This article discusses the means to accomplish the HCFA-type survey. The development of the survey process involves institutional commitment, hospital policy and procedures, a department review schedule, selection of review personnel, preparation of review personnel, record keeping, and department education.     

The ethics of health care system reform

The United States is now engaged in a momentous national debate about health care. How can we provide the best care possible while simultaneously containing cost (to promote the general economic integrity of society) and somehow maintain a semblance of a free health care marketplace. This is not just a political question; it is also a question of ethics. It is an ethical consideration because the current debate is not just about designing or promoting health care systems that can best address our concerns for costs, quality, and accessibility. It appears that at least some participants in the debate would not stop at arguing their beliefs as valid; they would make their beliefs law. Some urge the creation of the right to health care as a matter of law. There are significant differences between beliefs and rights, however, and they need to be considered carefully in the ongoing debate over the future of this country's health care delivery and financing system.     

Practice standards use with internal partners

U.S. Department of Defense experience with internal partnership programs has indicated that a lack of close supervision by medical treatment facilities can result in cost increases. The use of medical practice guidelines or standards is the subject of active investigation. The global guidelines tend to be too rigid or too vague to affect the provision of care. Their general acceptance can often be low. The use of clinical guidelines, with supervision by a clinic peer, has been determined to be a provider-friendly method of delivering cost-effective, high-quality care. Comparisons were made between the supervised partners against the total expenditures for ENT outpatient CHAMPUS care. The results indicated not only a savings but a reduction in the rate of cost increases by more than 250 percent. It is our feeling that specialty provider, peer-directed medical standards can be applied in a cost-effective manner. Their adoption as an organization-wide standard for referral can be an important tool in maintaining quality while containing costs.