The courageous follower

With the recent changes in the delivery of medical care in the United States, physicians are being thrust into new and unsettling roles. Many are finding themselves for the first time in the role of the follower, subject to myriad types of leadership. Leaders frequently complain that leading physicians is like "herding cats." What are the characteristics of followers? Do physicians make good followers? This article examines the role of the "cats"--what is effective followership, why physicians may fall short in followership skills, and how physicians might become better "followers."     

Modelling regional population growth in China

"This paper develops a forward demographic rates-based multiregional population model on the basis of a set of multiregional population accounts. Forward emigration rates and immigration flows are adopted to describe the external migrations. The model is used to make consistent multiregional population projections of China at a provincial level....Three sets of multiregional population projections of China at provincial level are made for the period 1987-2087. It is found that the national population trend is a combination of various regional population trends. Some regions, such as Zhejiang, will reach their population peak as early as the beginning of the next century while other regions, such as Xinjiang, will face continuous population growth in the first half of the next century."     

The extent and nature of alcohol-related problems in public senior housing

To examine both the extent and nature of alcohol-related problems in senior housing and how management responds to these problems, 100 local housing authorities (LHAs) in Connecticut with responsibility for senior housing were surveyed. The response rate was 90%. Results indicated variability among LHAs regarding their experiences with alcohol misuse among residents. It was evident in the numbers of residents abusing alcohol, the procedures for addressing problems when they occur, and LHAs' assessment of the extent and seriousness of problems. Few LHAs had either staff training regarding alcohol abuse or policies to address alcohol-related problems. Conclusions concerning whether alcohol-related problems were widespread in public senior housing were related to the size of the LHA. Housing specialists, public policymakers, and educators should assist management personnel in developing policies and procedures regarding misuse of alcohol. In addition, resources should be directed to educate housing authority staff about detection of the problem and strategies for intervention.     

Racial differences in retirement income: the roles of public and private income sources

Despite great overall improvement in the elderly's economic status over the past two decades, minority elders still comprise the poorest population group of all. Nonetheless, the income security of minority elders has not been given special attention in the scrutiny in recent years of the size and the future of various federal programs affecting older persons. Based on data from the 1971, 1981, and 1991 public-use data tapes of the Current Population Survey, the racial difference in income status of the elderly and the role of Social Security and Supplemental Security income versus that of income from private sources are analyzed in terms of how income inequality among races is ameliorated or escalated. The findings show that racial/ethnic differences in income status increased between 1970 and 1990. The findings also confirm that, for both elderly singles and couples, Social Security is the most important income source. Without it, poverty rates among elderly black couples, for example, would have increased by as much as 48.5 percentage points in 1990. Policies that would help improve the income status of the low-income elderly are discussed.     

Private agencies for public purposes: some new perspectives on policy making in health insurance between the wars

The approved societies, who were charged with the administration of health insurance in Britain, have long been blamed for the failure of the scheme to expand its coverage or scope in the interwar period. This paper takes a closer look at the administrative process and argues that societies were more vulnerable to central regulation than is commonly thought and were unable to resist cuts in public subsidies and extensions in liability introduced at their expense. They provided a convenient scapegoat for policies emanating primarily from the economic orthodoxy subscribed to by both government and the Treasury, modified to protect the unemployed during the slump. Health insurance policy was dominated to a large extent by the Government Actuary, who aimed to guarantee the cost effectiveness of the scheme. This paper also shows how administrative definitions and practices affected the classification of claimants to state social insurance at this time. It re-establishes the major weaknesses of the system, arguing that--in the light of recent discussions about reviving a system of national health insurance--we have much to learn from looking again at the experience of the interwar period.     

The role of simulation techniques in the theory and observation of family formation

Summary The investigation of fertility change can involve the consideration of the results of micro-level empirical studies in the context of an economic theory of family formation. In particular, a change in the observable statistics can then be related to a change in behaviour, or factors influencing behaviour. The analysis of this relationship is hindered, however, by its complexity and by the large number of stochastic variables present. It is argued that an essential aid to such an analysis is the use of a model suitable for simulation. Here, we present such a model and illustrate possible applications with various experiments.     

Program evaluation: the experience in population education

The Population Education Program (PEP) of the Department of Education and Culture in the Philippines takes pride in a built-in evaluation system which assesses accomplishments primarily in light of objectives laid out and gathers feedback useful in improving future training programs. Its evaluation theoretically serves to measure 3 training dimensions -- before, during, and after each training course. Evaluation of both the 5- and 1-week training programs follows the same pattern. Pretraining evaluation is done by administering a pretest at the beginning of each course, which quantitatively measures trainees' baseline knowledge and attitudes. It is intended for the use of trainers in determining how the course should proceed. Assessment made while training is in progress (formative evaluation) is done through a steering committee meeting held at the end of a week or a day for the 5- and 1-week courses, respectively. The meetings focus on identifying weaknesses requiring immediate or future course revisions. At the end of the course, a posttest is given to measure positive or negative changes in the trainees' knowledge and attitudes. These changes are assumed to have been caused by training. Additional qualitative information is collected through an evaluation sheet containing open-ended questions on different aspects of the course. Problems of "who" should evaluate and "how to" evaluate are among current problems evident in practice, and a revised training scheme has been implemented to deal with these problems.