Marketing and the medical specialist in the managed care environment

Marketing means more than just communicating or advertising to potential patients; marketing means identifying your customers and working to meet or exceed their expectations. There are five key areas of a marketing plan: (1) Establish the foundation, beginning with your mission statement; (2) Assess your marketing environment by internal and external research; (3) Target your efforts, looking at image and perception; (4) Develop your particular mix of product, price, place of distribution, and promotion; and (5) implement and evaluate your marketing process. This article discusses the importance of a marketing plan for the medical specialist and highlights the features unique to a practice working in a system of capitated reimbursement. Applying these principles will help to demonstrate added value, protect the fundamental role of the patient-physician relationship, ensure that our efforts are aligned with professional missions and goals, and ultimately increase profitability and professional success.     

Prevalence of gambling among Minnesota public school students in 1992 and 1995

The purposes of this study were to examine the prevalence of gambling among youth, compare rates of gambling between 1992 and 1995, and determine what levels of gambling frequency may be considered common and uncommon. The two samples included 122,700 Minnesota public school students in the 6th, 9th, and 12th grades in 1992; and 75,900 9th and 12th grade students in 1995. Students were administered the Minnesota Student Survey, a 126-item, anonymous, self-administered, paper-and-pencil questionnaire that inquires about multiple content domains, including gambling behaviors. The same questionnaire, with minor revisions to the gambling items, was administered in both 1992 and 1995 to students in their classrooms by the Minnesota Department of Education. There were slight decreases in overall gambling rates from 1992 to 1995. The majority of students gambled at least once during the past year. However, most did not play any game on a weekly/daily rate and did not report any problems associated with their gambling. Gender, grade, and race effects were found for gambling frequency. Boys gambled more often than girls, and 9th and 12th grade students gambled more often than 6th grade students. Asian American and White students reported lower rates of gambling frequency than Mexican/Latin American, African American, and American Indian students. From a statistical standpoint (i.e., beyond the 97.7 percentile), it may be considered in the uncommon range for girls to play two or more games at a weekly/daily rate, and for boys to play four or more games at a weekly/daily rate. Variables associated with gambling frequency included antisocial behavior, gender, and alcohol use frequency. Although the finding that gambling did not increase from 1992 to 1995 is encouraging, this is the first generation of youth to be exposed to widespread accessability to gambling venues and gambling advertising and it will be important to continue monitoring the prevalence of youth gambling.     

Marriage selection and age patterns of mortality: a mathematical investigation

"In this paper, we use simulation models to demonstrate the complexity of the relationship between the marriage selection process and the resulting RMRs [relative mortality ratios]. In particular, we show that marriage selection alone can produce a relative mortality ratio which remains large and relatively constant at ages far beyond the marriage span....Our general objective...is to determine the range of age patterns of relative mortality which could, in theory, result from marriage selection on the basis of health characteristics. We also evaluate the effects of variations in the marriage selection mechanisms on the resulting mortality patterns....We develop and apply several simple mathematical models of the marriage selection process. In order to distinguish the potential consequences of marriage selection from marriage protection, we consider hypothetical populations in which causal effects are absent....We begin by considering an extremely simple marriage selection process and subsequently explore a more realistic selection model based on recent death and marriage rates for Japan."     

Genetic screening technology: ethical issues in access to tests by employers and health insurance committees

Whereas the introduction of new technologies previously has raised the ethical question of who ought to have access to a new procedure or device, genetic testing technology raises the new ethical question of to whom access to a new technology ought to be limited. In this article we discuss the implications of employers and private health insurance companies having access to genetic testing technology. Although there may be legitimate business interests in allowing employers and insurers to conduct genetic screening, there are other valid societal interests in regulating or limiting the use of this technology by third parties. Public policy developed in the area of new genetic technology must reflect such interests.     

Subsidized elderly housing: public-private partnerships on the brink

Starting in the early 1960s, the federal government joined with the private-sector housing developers in a partnership: in return for subsidized mortgages and tax benefits, developers would rent to low- and moderate-income tenants. Today, many elderly people live in these "publicly subsidized" units. The initial agreement, however, held out an escape clause: after 15 to 20 years, for-profit developers that wanted to end the partnership could prepay their mortgages, leaving tenants in those buildings "at risk" of rent increases and/or evictions. This article discusses that partnership, its options for dissolution, and the current solutions to the problem of the expiring agreements, including a moratorium, vouchers, and incentives. The compromise legislation responds to all interested parties--owners, current and would-be tenants, local governments, tax-payers--through a multi-stage sequence of dissolution, yet such a finely tuned, acutely sensitive legislative solution may not work easily or efficiently.     

Net worth and the economic diversity of the elderly

Using data from the 1984 panel of the Survey of Income and Program Participation (SIPP), this article examines characteristics of the older population disaggregated by net-worth quintiles. The authors argue that income is not a sufficient measure of economic status for current policy discussions on issues such as changing Medicare co-payments, increasing the taxation of social security benefits, or means-testing under Medicaid. Net worth is a better measure of economic status, particularly for the elderly, because it represents the net value of assets accumulated over the life course. Their results indicate that there is considerable diversity in the economic status of the older population, which is masked by aggregate statistics (such as means and medians) typically used to summarize the economic status of population groups. Stereotypical views of the elderly based on such aggregates result in misdirected policy formulation. In the future, policymakers will need to formulate policies and programs using information on the distributions of income and assets among the older populations rather than relying on statistical aggregates.     

What will future historians say about the Clinton health reform act

In a series of articles that began in the March-April 1992 issue of Physician Executive, the author has provided historical background on the debate that currently rages on the nature and course of national health reform. In addition to tracing past efforts to expand access to health care for Americans, Dr. Goldfield has provided unique insights into the American political process and into the American psyche. In this final article in the series, Dr. Goldfield provides his personal assessment of what the chances for real reform of the health care delivery system are and his views on what that reform will ultimately look like. He calls himself a skeptic, not a cynic, saying that the likelihood of meaningful change is small, given the numerous proponents of the status quo.     

Poland's crisis and East European socialism

Conclusion We began this article by asking whether the Polish crisis is a socialist or a Polish disease. By citing the structural factors, we brought out the common difficulties affecting all East European societies in their political and economic development. These difficulties arose out of the transition from extensive to intensive economic growth and the consequent need to replace political mobilization of the population with their political integration. The structural contradictions occurred together with conjunctural developments in the world economy, the collapse of detente, the post-war demographic explosion, and natural calamities. Poland was least able to cope with these structural and conjunctural dynamics. The result was a society united on a national basis in its conflicts with the Party State apparatus. This conflict was never resolved by Solidarity nor by the subsequent military coup.While Poland and Romania had quite similar structural and conjunctural dynamics, it was only in Poland that the constellation of nation-specific factors yielded a societal reaction of system-threatening character. Looking at the rest of Eastern Europe, we do not see a similar constellation of factors. Rather, the combination of structural, conjunctural, and specific conditions has prevented the deeper contradictions from evolving into Solidarity-type mass movements of the Polish variety. Thus, we believe that the Polish developments will not be replicated in any of the other East European countries in the foreseeable future.Does this mean that the Polish experience is so unique that it is without relevance for the other East European states? On the contrary, the recognition of common structural problems points to fundamental conflicts in all the countries of actually existing socialism. The essence of these conflicts may be the same. It is the ability to identify and deal with them that distinguishes one East European regime from another. This ability varies with the specific and conjunctural factors as applied to each country. While there is little likelihood that the Polish disease will spread, this is partly because the other East European states are beginning to take preventive measures. In other words, they are learning from the Polish experience.There are several indicators that these regimes have learned from the Polish crisis. We can summarize them in the following predictions:First, we believe that state power and the repressive apparatus of the various East European countries will be reinforced and made more effective. This applies not so much to overt shows of force but to more sophisticated methods of social control and repression: e.g., limiting information channels, dispersing dissident groups, giving in to workers protests before they spread, taking practical measures to prevent consumer shortages from getting out of hand, and the like.Second, we can expect that oppositional forces, especially intellectuals, will be increasingly restricted in their ability to formulate and articulate system-threatening demands. The East European states will take any measures - jail, slander, internal deportation, cooptation, forced emigration - to make sure that intellectuals' contact with workers is weakened or at least strictly supervised.Third, we can expect the Eastern European states to take further measures to integrate potential system-threatening movements into the official system. We will see further attempts to improve the access possibilities for those social interests that have up to now been neglected, e.g. in physical and social infrastructures, neglected regions. Moreover, there will be renewed efforts to make the system of political socialization (education, propaganda, culture) more effective. Finally, we can expect anti-corruption campaigns within the State, Party, and industrial bureaucracies as the elites attempt to make these organs more legitimate in the eyes of the population.In recent months there seems to be considerable evidence that the East European regimes have taken all these measures. There have been attempts to re-invigorate the official trade unions. Yuri Andropov's succession was marked by a highly publicized anti-corruption campaign designed to win favor among rank-and-file workers. In Romania there have been exhortations towards more self-sufficiency and self-management, so that individual producers will be less dependent on State retail outlets, and the country less dependent on costly foreign imports. The reduction in East-West trade and decline of detente have also given more leeway for the East European repressive apparatus to crack down on dissidents and oppositional movements.With reduced trade, the economic benefits of detente no longer exist as a restraining factor on the authorities. The West now has reduced influence on domestic politics in East Europe. The combination of integration and repressive measures has so far prevented the structural contradictions from growing into true political crises of the Polish variety. Eastern Europe (and Poland) is remarkably quiet.With the broad enthusiasm fostered in the West by the rise of Solidarity, it is understandable that its brutal demise had generated parallel feelings of disillusionment. It would be erroneous to consider the Polish events as an archetype for Eastern Europe. The problems of East European regimes reflect a general system crisis (economic and political), each country's response depends on specific local conditions and fortuitous conjunctures. If the Polish events are to be understood, they must be explained as a variant in a larger East European context.Having concentrated on the crisis aspects in Poland and Romania should not blind us from the fact that these systems have an amazing ability to reproduce themselves - to muddle through. Actually existing socialism is more than simply brute force. Each of the East European societies exhibits a complex dialectic between the forces of functional stability and the forces of immanent contradictions. As such, in addition to their structural aspects, we must analyze each of these societies in their differing vulnerability to conjunctural events and in their specific political, social, and cultural characters.For those who seek to replace actually existing socialism with a more emancipatory socialism, the Polish crisis constitutes a key point of departure. It should be discussed both in terms of what it means for Poland, and for Eastern Europe. The Polish events provide further evidence that the tasks of social theory reside as much in explaining why societies muddle through as why they fall apart.