bluuebunny/crossref_metadata_2025 huggingface dataset:
Unemployment and Highway Fatalities
Authors: Leigh J. Paul , Waldon Harold M.
Published: January 2008

We considered unemployment, an often overlooked covariate of highway fatalities, hypothesizing that (1) as unemployment rises, aggregate driving decreases, especially among the unemployed, and as driving decreases, fatalities should decrease; (2) unemployment may influence drinking—some among the unemployed may drink less due to lower incomes, while others may drink more due to stress so the net effect would be ambiguous; and (3) unemployment may increase aggregate levels of stress and unhappiness, which can result in poor concentration on driving and thus, in turn, should result in more accidents and deaths. We used data from fifty states and the District of Columbia from 1976–1980, representing 255 observations. (No prior study has as many observations or controls for as many covariates.) Using econometric models of the data, we present evidence for two of the three hypothesized effects of unemployment. We conclude that, if the number of miles driven is held constant, worsening unemployment leads to higher fatality rates, most likely due to stress effects. But because more unemployment means less driving, increases in unemployment, on balance, are associated with decreases in fatalities.
Bypassing Rural Hospitals for Obstetrics Care
Authors: Bronstein Janet M. , Morrisey Michael A.
Published: January 2008

We use data from 1983 and 1988 on hospital use in Alabama to examine the decisions of rural pregnant women to bypass the nearest rural hospital providing obstetric services and seek care elsewhere. The proportion of women who made the decision to bypass the nearest rural hospital increased from 40 percent to 45 percent between 1983 and 1988, while the proportion who traveled to metropolitan areas increased from 41 percent to 68 percent. Women with resources appear to choose longer travel distances in order to use hospitals with high birth volumes and high-risk infant services, but women from counties with large Medicaid populations also more frequently bypassed nearby hospitals.
Tax Administration as Health Policy: Hospitals, the Internal Revenue Service, and the Courts
Authors: Fox Daniel M. , Schaffer Daniel C.
Published: January 2008

Since 1969 federal tax policy has permitted nonprofit hospitals to turn away indigent patients or to transfer them to public hospitals. The Internal Revenue Service made health policy, but its officials remain convinced that they were not making policy at all. Convinced that it was reasoning from legal principles, the Revenue Service accepted the hospital industry's view of the history and purpose of hospitals. The federal courts further obscured the problem. Moreover, the Revenue Service took no interest in the effects of its ruling on the services provided by tax-exempt hospitals until 1989. We describe these events and seek to explain them by linking the recent history of health policy to the assumptions that govern the making of tax policy. We conclude that the making of health policy by tax officials who are not accountable for it and who believe that they are not making policy at all is not in the public interest.
Can the Government Govern? Lessons from the Formation of the Veterans Administration
Authors: Stevens Rosemary
Published: January 2008

The federal hospital system for veterans, established in the aftermath of World War I in a context of decentralization, privatization, and rejection of compulsory health insurance, seems an anomaly in health care policy-making. It is actually a good case of how the federal government achieves results in an area fraught with conflict: via normalization of crisis, containment of political decision making, and the association of the program with previously accepted goals (in this instance, workers' compensation). In the veterans' case, political judgments were transformed into scientific and bureaucratic decisions via the pragmatic use of experts. The system worked; the federal government governed.
Selective Pregnancy Reduction: Medical Attitudes, Legal Implications, and a Viable Alternative
Authors: Gemmette Elizabeth Villiers
Published: January 2008

“Selective pregnancy reduction” is a medical procedure used to reduce a multiple pregnancy, often a multiple pregnancy induced by in vitro fertilization or drug therapy. In such instances, healthy embryos are sacrificed in order to maximize the chances of survival of the remaining embryos or to allow the mother to choose the number of babies she wishes to deliver. Physicians appear to rely on Roe v. Wade in assuming the legality of the procedure, although such an assumption may be erroneous. Rather than continue to implant an excessive number of pre-embryos, the American Medical Association and the Association of Obstetrics and Gynecology should adopt guidelines similar to those established by the Voluntary Licensing Authority in London, which limit the number to be inserted to a maximum of three. Careful ultrasound monitoring could ensure that no more than three embryos implant when fertility drugs are used. Such practices would help physicians avoid the many moral, ethical, legal, and philosophical problems caused by selective pregnancy reduction.
Will Paid Home Care Erode Informal Support?
Authors: Hartley Raymond J. , Wiener Joshua M. , Harris Katherine M.
Published: January 2008

One of the main barriers to the expansion of paid home care for the chronically disabled is the fear that policymakers have that it will cause friends and relatives to curtail their informal caregiving efforts. Using the first wave of the National Long-Term Care Survey, we examine whether the amount of paid home care used by disabled elderly persons had a significant influence on the amount of informal support they were receiving. Results from a two-stage least squares regression analysis suggest that the amount of informal home care received was not significantly affected by the level of formal care. This conclusion held for subgroups of formal care users most likely to exhibit substitution: those without cognitive problems, the disabled elderly with above average income, and persons who lived alone. Even the more severely disabled elderly, who are the target of most proposals to expand paid home care, did not substitute paid care for unpaid. Thus, our study suggests that an increase in paid home care will not erode informal support.
Toward a National Personal Assistance Program: The Independent Living Model of Long-Term Care for Persons with Disabilities
Authors: Batavia Andrew I. , DeJong Gerben , McKnew Louise Bouscaren
Published: January 2008

Long-term care for people with disabilities in this country traditionally has been provided through family members and friends. Federal and state policy has focused primarily on financing professional health care services provided through nursing homes and home health agencies. An alternative to these models of long-term care is the “independent living model,” which is based on the provision of services by nonprofessional personal assistants in the disabled person's home. We describe the model and consider why it is not the dominant approach to long-term care in the United States. We go on to assess options for developing a national personal assistance services program based on the independent living framework, discussing how covered services should be defined, how the program should be financed, whether the program should use means testing, bow eligibility and level of benefits should be determined, and what role government should play in implementing the program. Several legislative approaches to developing a national program are explored.
Seeking Common Ground: A History of Labor and Blue Cross
Authors: Markowitz Gerald , Rosner David
Published: January 2008

In recent years, voluntary health insurance costs have become a major source of friction in labor-management negotiations. What was once a “fringe” has led to job actions, strikes, and intensive bargaining. We examine the history of labor's participation in New York Blue Cross from the 1930s to the recent past and show that labor's participation in the plan was crucial to Blue Cross's success in the plan's early decades. By the late 1950s, serious tensions developed over rate increases and the participation of labor in Blue Cross governance. Ultimately, the issue was one of the control over what was provided by the plans and who would pay for the costs of care. We posit that labor was never able to achieve an important role in the control of the third-party payer, and in the antilabor environment of the 1980s this proved detrimental to labor's interests.
When Siting Works, Canada-Style
Authors: Rabe Barry G.
Published: January 2008

Hazardous waste management poses increasing problems for Canadian provinces and American states, given the vast quantities and types of wastes generated and the virtual inability to open new storage, treatment, or disposal facilities. The Canadian experience is very similar to the American one in many respects, except for the fact that three provinces (Alberta, Manitoba, and Quebec) have devised alternative approaches to siting that appear successful in moving beyond the political gridlock so common on this issue. In each of these cases, traditional, top-down approaches to siting have been eschewed in favor of a more comprehensive approach that includes extensive public participation, economic and social compensation packages, formal partnerships between public and private organizations, and direct links between siting proposals and other aspects of waste management, including waste reduction, recycling, and export/import control.
Deciding on Access and Levels of Care: A Comparison of Canada, Britain, Germany, and the United States
Authors: Grogan Colleen M.
Published: January 2008

Americans view universal coverage as a reality only if a minimum benefit package is explicitly defined, and discussions about expanding access take place under the slogan of minimum benefits. The policy environment is different in Canada, Britain, and Germany. There, health care costs are controlled and benefits provided under universal coverage plans. Yet the medical services provided in these countries result not from difficult decisions about rationing care at a “minimum” benefit level but from difficult political decisions about the structure of the health care system. Institutional factors rather than explicit policy influence the implicit health priorities in these countries. The United States, in contrast, develops policies that explicitly designate a minimum level of benefits.
Privatization in Health and Human Services: A Critique
Authors: Smith Steven Rathgeb , Lipsky Michael
Published: January 2008

Privatization currently enjoys wide appeal as a solution to public problems. Supporters of privatization hope that shifting responsibility for the funding, administration, and delivery of services to private organizations and individuals will spur market competition and thus lower costs, improve service effectiveness, and enhance program quality. An increasingly common form of privatization in health and human services is contracting with nonprofit organizations. Such contracting, in practice, does not follow market principles but is, instead, fraught with politics and inadequate information and built on long-term relationships between government and contract agencies. The operations and practices of contracting have important implications for the ongoing debate on the desirability of vouchers for health care insurance and for reform in the contracting process.
The Subsidy Provided Under Medicare to Current Enrollees
Authors: Christensen Sandra
Published: January 2008

Contributions made by or for current enrollees to Medicare will cover less than a third of the costs of their expected lifetime benefits, on average. This subsidy is of concern for two reasons. First, because the subsidy is provided regardless of income, some transfers are effectively made to Medicare enrollees from needier groups in the non-Medicare population. Second, as the ratio of Medicare beneficiaries to the working-age population increases in future years, the current generosity of the program may be difficult to maintain.
Philip Morris's Failed Experiment in Pittsburgh
Authors: Samuels Bruce E. , Begay Michael Evans , Hazan Anna Russo , Glantz Stanton A.
Published: January 2008

The campaign for passage and implementation of Pittsburgh's Smoking Control Ordinance in 1987 illustrates the role controversy plays in tobacco control. Proponents of the ordinance sought at first to keep it noncontroversial, while the tobacco industry tried to defeat the ordinance by generating controversy, claiming that severe economic and social disruption would occur. After the ordinance had been in force for a year, Philip Morris tried to take over its implementation, seeking to redefine the central issue as one of social accommodation rather than health. To succeed, Philip Morris's effort had to be widely accepted and noncontroversial. Proponents of the ordinance countered with controversy to undermine the campaign and expose the company's intentions. The controversy made the established health organizations uncomfortable, causing them to play only a marginal role. Surprisingly, the people who prevailed were the nonsmokers' rights activists, a small group with limited resources.
Financing Long-Term Care: A Practical Mix of Public and Private
Authors: Cohen Marc A. , Kumar Nanda , McGuire Thomas , Wallack Stanley S.
Published: January 2008

Congress is considering proposals to improve its financing of long-term care. The key issue is whether it should support a social insurance program or a program targeted to a population group defined by income and assets. Social insurance is expensive, costing between $15 and $20 billion. For the most part, it provides benefitsprimarily asset protectionto middle- and upper-income individuals. An improved Medicaid program, costing about $8 billion, benefits lower-income individuals but does not protect those with higher incomes. These two options cannot be viewed independently from trends in the private market. Sales of private long-term care policies have grown and between 30 percent and 40 percent of the elderly can be considered potential buyers. If private alternatives are available for those individuals who need asset protection, the case for a more targeted public approachalong with reliance on the private sectorbecomes more compelling. Congress should consider a program that enhances Medicaid; improves consumer education; assists states in regulating long-term care policies, so as to enhance consumer protection and confidence; and clarifies taxes on long-term care insurance to encourage workers and the elderly to protect themselves against catastrophic expenses.
Japan: Maintaining Equity Through Regulated Fees
Authors: Ikegami Naoki
Published: January 2008

Japan was the first non-Western country to introduce social insurance and the first to achieve universal coverage. It has been very successful in helping to bring about high health levels among its citizens at reasonable cost. Consequently, it provides a unique model for the newly industrialized countries of how to adapt modern technologies in structuring their own health care systems. Japan's financing system is organized by the government. Coverage is mandated for all citizens and is supplied by a number of insurance plans, whose variety reflects the differences in their development. The country relies mainly on the private provision of health care, delivered from physician-owned clinics and hospitals. The most prestigious facilities, however, are the public hospitals. Services are fragmented between clinics and hospitals, which compete for a share of the patients in their area. Patients can choose where to seek medical services. Providers are paid by a nationally uniform method and rate, which are decided by one central agency. Increases in payment rates are tied to the ceiling set by the government's general expenditure limitations. A uniform fee schedule has helped to control costs and to ensure equitable access. Challenges remaining for Japan's health care system are caring for an increasingly elderly population and ensuring quality of care.
Canada: The Real Issues
Authors: Evans Robert G.
Published: January 2008

Canadians are, by and large, satisfied with their health care system. It is for them a symbol of their community and distinguishes them from the United States. Unlike the health system of that country, it is universal, comprehensive, and accessible, and it costs less as a percentage of GNP to run. The difference between the two systems is rooted in differences in funding. By providing coverage of medically necessary care under a single nonprofit payer (the provincial governments, with guidance and some funds from the federal government), the Canadian system avoids the large overheads and profit incentives that make a fragmented private insurance industry so expensive and inequitable. Whereas health insurance in Canada is socialized, care is not: patients are free to choose among providers, physicians are primarily in private practice, and hospitals are independent, nonprofit institutions overseen by boards of trustees. Canada and the United States view the challenges confronting the Canadian system differently. To Canadians, the real issue is how to improve the management of a popular, effective, and heretofore affordable system, so as to preserve it in a more hostile economic environment. The specific areas of concern are common to all health care systems in the developed world but bear little resemblance to the misleading images of Canada fabricated in the United States for internal political purposes. For Canadians, the proof of their system is that it works, while millions in the United States go without.
Remodeling Health Care
Authors: Sprinkle Robert Hunt
Published: January 2008

Standard models of patient demand for health care and health care suppliers' response to that demand imply that some manner of manipulation of the prices faced by patients must be chief among the mechanisms of systemic cost control. However convenient econometrically, these standard models cannot reflect the complexity of patient demand behavior, and they say little about the predominant causes of health-care cost escalation. This paper describes a richer Jevonian political-economic model that sensibly portrays patient demand and physician and corporate supply behaviors and suggests a range of cost-controlling and care-enhancing compensatory steps, some professional, some societal. This new model implies that reformers in the United States could take respectful advantage of the fundamentally self-regulating nature of patient demand for health care by shifting their attention away from its further discouragement and toward the modulation of other factors.
The Divergence of Federal and State Policies on the Charitable Tax Exemption of Nonprofit Hospitals
Authors: Potter Margaret A. , Longest Beaufort B.
Published: January 2008

Nonprofit hospitals have traditionally enjoyed charitable exemption from real estate taxes because they provide specific social benefits. However, in the past three decades, major health policy changes at the federal levelmost significantly, implementation of the Medicare and Medicaid programshave weakened this rationale. Federal tax regulations during this period have changed in ways that complement these federal health programs and the accompanying federal interests in encouraging efficiency and performance uniformity among hospitals. States and local governments, however, have different interests, and these may favor a strict set of tax exemption standards that disregard efficiency and elevate the importance of a measurable level of charitable service. Their divergent policies rest on a fundamental value judgment about whether nonprofit hospital care is intrinsically charitable or not. Increasingly, this judgment may be forced upon state courts and legislation by local governments seeking new tax revenues through the elimination of hospitals' exemption from real estate taxes.
The Success and Repeal of the Medicare Catastrophic Coverage Act: A Paradoxical Lesson for Health Care Reform
Authors: Aaronson William E. , Zinn Jacqueline S. , Rosko Michael D.
Published: January 2008

Congress intended the Medicare Catastrophic Coverage Act (MCCA) of 1988 to reduce the risk for illness-related catastrophic financial losses in the elderly. The act was short-lived, facing repeal just one year after passage. Many elderly persons were convinced that the costs of the program outweighed the benefits. However nursing home payment provisions of the MCCA may have affected out-of-pocket expenses paid by the elderly for long-term care more than consumers realized at the time of repeal. A transmittal memorandum, issued by the Health Care Financing Administration independent of Congressional action, enhanced consumers' ability to qualify for Medicare nursing home benefits. We investigated the effects of the Medicare policy change on nursing home payer mix and out-of-pocket expenses in 489 Pennsylvania nursing homes. We found that substantial shifts in payer mix from self-pay to Medicare payment sources occurred, reducing out-of-pocket expenses. Unfortunately the debate over the MCCA's repeal did not include discussion of the improved nursing home benefit structure. These findings, and the fate of the MCCA legislation, reinforce the importance of comprehensive information and clear communication in promoting health care reform.
Medigap Regulation: Lessons for Health Care Reform
Authors: Fox Peter D. , Rice Thomas , Alecxih Lisa
Published: January 2008

Congress enacted legislation in 1990 that dramatically changed the rules for selling supplemental health insurance, or “Medigap” policies, to the elderly. Most notably, policy coverage was standardized. Insurance carriers are allowed to sell only the ten specified packages of benefits, which reduces consumer choice but facilitates comparison shopping. This legislation is important in its own right and also offers lessons for U.S. health care reform. To examine the changes brought about by this legislation and analyze their implications for health care reform, we conducted site visits to nine states and interviewed insurer representatives, executive branch officials, congressional staff, and various interest groups for two years.
Nothing Succeeds Like the Right Kind of Failure: Postwar National Health Insurance Initiatives in Canada and the United States
Authors: Maioni Antonia
Published: January 2008

Health insurance was one of the most influential social reforms on the immediate postwar agenda in Canada and the United States. In both cases, proposals for national health insurance were not implemented. This article traces the evolution of these legislative proposals of the 1940s and shows how the events of this pivotal decade set the stage for future health reform in the two countries. The analysis focuses on how political institutions condition the role of state actors and the articulation of societal groups, and particularly on the crucial differences in party systems and the role of parties in shaping health reform in the two countries. In the United States, a divided Democratic party and the imperatives of political compromise made forging a consensus around health insurance more difficult. In Canada, meanwhile, the presence of a social-democratic third party led to a very different type of debate about health reform and opened the door for national health insurance.
The Effect of Fixed Payment on Hospital Costs
Authors: Kauer Robert T. , Silvers J. B. , Teplensky Jill
Published: January 2008

New Medicare regulations have replaced the cost-based system of reimbursement of capital expenditures by hospitals with a fixed payment per case based on assigned diagnostic-related groups. For the first time, hospitals must pay the governmental share of their capital costs. At the same time, overall reform points toward more capitation or fixed payments from all payers. This article discusses possible responses to legislative and competitive reforms by hospital management and the resulting effectiveness of the changes. To identify the potential effect of capital payment reform, we highlight some of the key provisions and assumptions of the new regulations, discuss the management implications of a changed capital payment system, and explore alternative models of hospital investment behavior in a world where one price for services for all buyers is a probable scenario.
It's the Institutions, Stupid! Why Comprehensive National Health Insurance Always Fails in America
Authors: Steinmo Sven , Watts Jon
Published: January 2008

We argue that the United States does not have comprehensive national health insurance (NHI) because American political institutions are biased against this type of reform. The original design of a fragmented and federated national political system serving an increasingly large and diverse polity has been further fragmented by a series of political reforms beginning with the Progressive era and culminating with the congressional reforms of the mid-1970s. This institutional structure yields enormous power to intransigent interest groups and thus makes efforts by progressive reformers such as President Clinton (and previous reform-minded presidents before him) to mount a successful NHI campaign impossible. We show how this institutional structure has shaped political strategies and political outcomes related to NHI since Franklin D. Roosevelt. Finally, we argue that this institutional structure contributes to the antigovernment attitudes so often observed among Americans.
Three Faces of the Health Care State
Authors: Moran Michael
Published: January 2008

That health care is a subsystem of the welfare state has dominated the study of states and health care policy. But this conception omits two other faces of the stateas a putatively democratic organization and as the manager of industrial economies in a capitalist world. Policy can be analyzed fruitfully in terms of the tensions between these three faces of the health care state.
Israel’s Health Policy Breakthrough: The Politics of Reform and the Reform of Politics
Authors: Chinitz David
Published: January 2008

After decades of attempts, Israel has enacted a national health insurance law and begun to substantially change its health care system. I explore the conditions that enabled final passage of the law in light of theories of nonincremental change in pluralist policy systems. I also discuss the implications of this policy breakthrough for links between policy subsystems, leadership, and the establishment of a new policy equilibrium.
Medicaid Eligibility Policy in the 1980s: Medical Utilitarianism and the “Deserving” Poor
Authors: Tanenbaum Sandra J.
Published: January 2008

Between 1981 and the early 1990s, the Medicaid program grew substantially, in part because, for the first time in the program’s history, eligibility for medical assistance was severed from eligibility for income-maintenance payments. Program participation had always been reserved for the “deserving poor,” and these were originally defined as persons excluded from market relationships through no fault of their own. The Medicaid expansion of the 1980s, however, created a new constituency of poor, and not-so-poor, persons whose actual or predictable medical problems promised a calculable return on program funds.
Improving the Reliability of the U.s. Vaccine Supply: An Evaluation of Alternatives
Authors: Mowery David C. , Mitchell Violaine
Published: January 2008

Since taking office, President Clinton has devoted considerable attention to childhood immunization and to the overall U.S. policy toward vaccine development, delivery, and pricing. But the reliability of U.S. vaccine supplies has received far less attention, despite several recent interruptions in vaccine production and supply. Moreover, the increasing producer concentration in the U.S. and global vaccine industries raises the possibility that more and more important vaccines will be produced by a single firm, often in a single production facility. Is a federal policy for vaccine supply assurance necessary, and what form should it take? Are sole-source suppliers a weak link in the U.S. vaccine supply chain? Are the recommendations of the Institute of Medicine’s Committee on Emerging Infections for a publicly owned “standby production capacity” of critical vaccines feasible or cost-effective? We consider these and other issues in our discussion of the U.S. vaccine industry, the potential role of foreign vaccine suppliers, and the use of existing federal facilities and policies to address a possible interruption in critical vaccine supplies.
Medical Malpractice and No-Fault Systems
Authors: Uzych Leo , Kinney Eleanor D.
Published: January 2008

Publishers Note Unsolicited responses to articles that appear in JHPPL are welcome and will be considered for publication on submission to the editor. Send items to Mark A. Peterson, Editor, 3G03 Forbes Quadrangle, University of Pittsburgh, Pittsburgh, PA 15260. JHPPL does not edit the communications that it publishes.
Measuring Defensive Medicine Using Clinical Scenario Surveys
Authors: Klingman David , Localio A. Russell , Sugarman Jeremy , Wagner Judith L. , Polishuk Philip T. , Wolfe Leah , Corrigan Jacqueline A.
Published: January 2008

For more than two decades, advocates of malpractice system reform have claimed that the most damaging and costly result of the U.S. medical malpractice system is the practice of defensive medicine, in which physicians order tests and procedures primarily because of fear of malpractice liability. In this article, we discuss the issues raised by different definitions of defensive medicine and propose a working definition to guide measurement of the concept. We also consider the strengths and weaknesses of available approaches for measuring defensive medicine. Finally, we describe an empirical approach to measuring defensive medicine using clinical scenario surveys. The results suggest that, if physicians actually practice as they say they would in these surveys, defensive medicine does exist, although not to the extent suggested by anecdotal evidence or direct physician surveys. The results also suggest that defensive medicine varies considerably across clinical situations. In all of the scenarios, many physicians chose aggressive patient management styles even though conservative management was considered medically acceptable by the expert panels that developed the scenarios. In most cases, medical indications, not malpractice concerns, motivated clinical choices. Our results highlight the limitations of surveys as a method of measuring the extent of defensive medicine. The implications of managed care and health care reform for defensive medicine are also discussed.
The Quinlan Case Revisited: A History of the Cultural Politics of Medicine and the Law
Authors: Stevens M. L. Tina
Published: January 2008

This article explores the cultural politics of medicine and the law through a historical examination of the case of Karen Ann Quinlan. In viewing the Quinlan case as, in part, an unanticipated consequence of the 1968 redefinition of death, this article implicates the importance of historical perspective and methodology in examining the nuances of the cultural negotiation of professional power. Using popular, legal, medical, and bioethics sources in historical context, it reveals how the legal process can nurture misconceptions about medical practice and the role of technology. It also sheds light on how the search for legal protection can motivate medical behavior. In so doing, it challenges the view that Quinlan was an important gain for patients’ rights. Instead it views Quinlan’s chief legacy as its offer to the medical profession of freedom from criminal prosecution when removing life support from patients in a chronically vegetative state.
Has Medicaid Growth Crowded Out State Educational Spending?
Authors: Fossett James W. , Wyckoff James H.
Published: January 2008

Researchers have argued that the dramatic increase in Medicaid spending during the late 1980s and early 1990s “crowded out” state spending on other activities, particularly education. Medicaid growth has, at least in part, been driven by increased federal eligibility and service mandates, federal court decisions on hospital and nursing home rates, and health care inflation; and the need to respond to these outside forces has placed increasing pressure on state finances. Other evidence, however, suggests that the adverse effect of Medicaid growth on state finances has been overstated. During the late 1980s and early 1990s, states shifted many human service programs from general fund to Medicaid financing and took advantage of Medicaid rules governing the use of provider donations and assessments, such as state matching and claiming payments to disproportionate-share hospitals to increase federal reimbursement without increasing the claims on their own revenues. But the increased burden of Medicaid growth on state finances may be more apparent than real. In this article, we test the crowding-out hypothesis using a two-stage, least-squares fixed-effects model of Medicaid’s impact on educational spending from 1980 to 1990. Our results indicate that Medicaid growth has had no significant effect on educational spending. Rather, educational spending has responded more to changes in states’ own-source revenues than to growth in Medicaid spending.
Reform and Reaction in Australian Health Policy
Authors: Gray Gwendolyn
Published: January 2008

In every country we get backlash against reform but Australia is one of those unique countries where we get the backlash before we get the reform.—Dr. Peter Wilenski, comment to the 46th Summer School of the Australian Institute of Political Science, Canberra, Australia, 1980
Charity and Community: The Role of Nonprofit Ownership in a Managed Health Care System
Authors: Schlesinger Mark , Gray Bradford , Bradley Elizabeth
Published: January 2008

As American medicine has been transformed by the growth of managed care, so too have questions about the appropriate role of nonprofit ownership in the health care system. The standards for community benefit that are increasingly applied to nonprofit hospitals are, at best, only partially relevant to expectations for nonprofit managed care plans. Can we expect nonprofit ownership to substantially affect the behavior of an increasingly competitive managed care industry dealing with insured populations? In what ways will nonprofit ownership matter, and do these justify preferential treatment by policy makers? We address these issues conceptually and empirically. Drawing from historical interpretations of tax exemption in health care and from the theoretical literature on the implications of ownership for organizational behavior, we identify five forms of community benefit that might be associated with nonprofit forms of managed care. Using data from a national survey of firms providing third-party utilization review services in 1993, we test for ownership-related differences in these five dimensions. The results suggest that ownership-related differences do exist, although they are generally modest. Nonprofit utilization review firms generally provide more public goods, such as information dissemination, and are more “community oriented” than proprietary firms, but they are not distinguishable from their for-profit counterparts in addressing the implications of medical quality or the cost of the review process. However, a subgroup of nonprofit review organizations with medical origins are more likely to address quality issues than are either for-profit firms or other nonprofit agencies. Evidence on responses to information asymmetries is mixed but suggests that some ownership-related differences exist.
Palladium-catalyzed Amination in the Synthesis of Polyazapolyoxamacrocycles with Two and Three Anthracene or Anthraquinone Moieties: Scope and Limitations
Authors: Averin Alexei D , Ranyuk Elena R , Buryak Alexei K , Beletskaya Irina P
Published: January 2008

The synthesis of Nα,Nω-bis(haloaryl)polyamines and oxadiamines by Pd-catalyzed amination of 1,8-dichloroanthracene and 1,8-dichloroanthra-9,10-quinone is described, as well as the formation of 1,8-bis(polyamine)-substituted anthracenes and anthra-9,10-quinones. Scope and limitations of the application of these compounds in the synthesis of the macrocycles comprising two and three anthracene or anthraquinone moieites are shown and discussed.
Droplet Motion Induced by Spontaneous Breaking of Flow Symmetry in Aqueous Two-phase Systems
Authors: Ban Takahiko , Kita Tsuyoshi , Tominaga Harutoshi , Shioi Akihisa
Published: January 2008

We present self-induced motion of salt-rich or Dextran-rich droplets in a PEG-rich aqueous phase when the droplets contain di(2-ethylhexyl) phosphate. The motion is produced by self-organized flow around the droplets. For the case of a single droplet random motion appears, whereas for multiple droplet systems symmetry of flow around the droplets is broken, and then a group of the droplets is clustered in one place.
Incorporating Asymmetric Distributional Information in Robust Value-at-Risk Optimization
Authors: Natarajan Karthik , Pachamanova Dessislava , Sim Melvyn
Published: January 2008

Value-at-Risk (VaR) is one of the most widely accepted risk measures in the financial and insurance industries, yet efficient optimization of VaR remains a very difficult problem. We propose a computationally tractable approximation method for minimizing the VaR of a portfolio based on robust optimization techniques. The method results in the optimization of a modified VaR measure, Asymmetry-Robust VaR (ARVaR), that takes into consideration asymmetries in the distributions of returns and is coherent, which makes it desirable from a financial theory perspective. We show that ARVaR approximates the Conditional VaR of the portfolio as well. Numerical experiments with simulated and real market data indicate that the proposed approach results in lower realized portfolio VaR, better efficient frontier, and lower maximum realized portfolio loss than alternative approaches for quantile-based portfolio risk minimization.
Regulated Random Walks and the LCFS Backlog Probability: Analysis and Application
Authors: Baron Opher
Published: January 2008

Random walks have been used extensively within operations research models such as inventory systems and single-server queues to estimate performance measures. In this paper, we use sample-path analysis to express the steady-state probability of a one-sided regulated random walk to increase and be above a threshold, referred to as the last-come-first-serve (LCFS) backlog probability. We approximate the LCFS backlog probability under mild assumptions on the distribution of the random walk's steps and provide its exact expression when the steps are exponentially distributed, and a closed-form approximation when the steps are normally distributed. In our numerical experiments, the average relative gap between the approximated LCFS backlog probabilities and their simulated values is 5.13%. We further show that the LCFS backlog probability is an upper bound on the loss probability—the probability that a two-sided regulated random walk is at a boundary. This bound is tighter than the backlog probability—the probability that a random walk ever crosses a threshold—that also bounds the loss probability. In an inventory application, we demonstrate that using the LCFS backlog probability rather than the backlog probability reduces the inventory level required to satisfy a service-level constraint on the percentage of orders backlogged. In our examples, this reduction leads to cost savings of 31% on average.
The Impact of Personal Educational Experiences and Communication Practices on the Construction of Deaf Identity in Cyprus
Authors: Hadjikakou Kika , Nikolaraizi Magda
Published: January 2008

The aim of the study was to investigate for the first time the impact of educational experiences on the development of Cypriot deaf people's identity. To obtain relevant information in depth, semistructured interviews were conducted with 24 Cypriot deaf individuals ages 19–54 years who had graduated from a variety of school settings. The findings indicated that the type of school, and the academic and social experiences shared within the school between the participants and their classmates and teachers, played a crucial role in these deaf individuals' identity development. The findings have implications for curriculum development for deaf pupils, and for parents' counseling about their deaf children's development of "healthy" identities.
Understanding Communication Among Deaf Students Who Sign and Speak: A Trivial Pursuit?
Authors: Marschark Marc , Convertino Carol , Macias Gayle , Monikowski Christine M , Sapere Patricia , Seewagen Rosemarie
Published: January 2008

Classroom communication between deaf students was modeled using a question-and-answer game. Participants consisted of student pairs that relied on spoken language, pairs that relied on American Sign Language (ASL), and mixed pairs in which one student used spoken language and one signed. Although the task encouraged students to request clarification of messages they did not understand, such requests were rare, and did not vary across groups. Face-to-face communication was relatively poor in all groups. Students in the ASL group understood questions more readily than students who relied on oral communication. Although comprehension was low for all groups, those using oral communication provided more correct free responses, although the numbers were low; no significant differences existed for multiple-choice responses. Results are discussed in terms of the possibility that many deaf students have developed lower criteria for comprehension, and related challenges for classroom communication access.
Theory Materialized: Conceptual Art and its Others
Authors: Erber Pedro
Published: January 2008

Through deeply divergent strategies, W. J. T. Mitchell's What Do Pictures Want? shares with Mieke Bal's Louise Bourgeois' Spider: The Architecture of Art-Writing and Ernst van Alphen's Art in Mind the attempt to discuss the ways in which theory materializes in concrete, nontextual objects. Erber analyzes their different positions on the matter, against the background of a questioning of the "object" contemporaneously developed by two avant-garde artists in the 1960s: Hélio Oiticica, from Rio de Janeiro, and Tokyo-based Akasegawa Genpei.
Cultural Contradictions and School Leaving: A Case Study of an Urban High School
Authors: Patterson Jean A , Hale Dalia , Stessman Martin
Published: January 2008

The high dropout rate in urban high schools, particularly among poor and racial minority youth, continues to be a vexing problem confronting public education in the U.S. Although much research and many prevention efforts have been devoted to this issue, dropout rates continue to soar. In this article, the authors present a case study analysis of an urban high school that was attempting to address the high dropout rate. Instead of focusing on social and academic risk factors that assume the problem lies in the student and his or her family, we examine how the culture and structure of the high school influenced teachers' instructional practices and resulted in contradictory beliefs about students and their families. These contradictions between school culture and structure, instruction, and many students' home culture contributed to the school's high dropout rate.
Beyond Tarzan and National Geographic : The Politics and Poetics of Presenting African Diasporic Cultures on the Mall
Authors: Thompson Krista A.
Published: January 2008

At the Festival of American Folklife, presenters are key mediators between culture bearers and festival visitors, fostering, in theory, dialogic cultural exchange. Examining the African Immigrant Folklife Program (1997), I evaluate the successes and failures of the presenter's position and the specific challenges of presenting African diasporic cultures at the festival. This first scholarly investigation of this key role concludes that many visitors overlook the presenters as they visually consume the sights on the Mall.
Catwalking through Culture: Notes from the 2002 Smithsonian Silk Road Festival
Authors: Combs Rhea L
Published: January 2008

This note examines the 2002 Smithsonian Folklife Festival, entitled "The Silk Road: Creating Culture, Connecting Trust," and focuses specifically on the work of the Central Asian and Japanese fashion designers. I explore how participants and presenters related to one another, considering many were strangers from different countries and social backgrounds when they arrived on the National Mall. The note demonstrates the contested interactions between the various designers and the Center for Folklife and Cultural Heritage (CFCH), particularly between the Japanese group and the CFCH. I posit that the varying agendas of the participants, the festival's principal designer, and the CFCH administration challenged the larger goal of creating a unified pan-Asian identity.
Histories, Resistances, and Reconciliations in a Decolonizable Space: The Philippine Delegation to the 1998 Smithsonian Folklife Festival
Authors: Trimillos Ricardo D
Published: January 2008

This article examines issues related to cross-cultural encounters through the presentation of Filipino folk culture at the 1998 Smithsonian Folklife Festival (SFF). Embedded in the project were issues of power—historical and current, actual and virtual—related to the differing U.S. relationships with the Philippines. I suggest ways in which Philippine values and modes of thinking determined or at least influenced the inception and reception of events, constructed communication, and informed Filipino intent in this particular presentation across cultures. I consider modes of complicity and responsibility that referenced Filipino and American experiences throughout the project.
A Sense of Place: Mapping Hawai'i on the National Mall
Authors: Diamond Heather A
Published: January 2008

Site design is an essential but overlooked underpinning to the festival-making process at the Smithsonian Folklife Festival. Through effective layout, structures, and captioning, spatial strategies undergird a program concept and crystallize the interpretive frame for performance. This article traces the 1989 Hawai'i program's site design from the initial concept to the preperformance stage. It examines the tension between hegemonic festival parameters and the organizers' efforts to problematize colonially inflected narratives, and it argues that rather than being a passive backdrop for performance, the Hawai'i program site design was a discursive field rife with contradiction and conflict.
Imagining Home, Nation, World: Appalachia on the Mall
Authors: Satterwhite Emily
Published: January 2008

This article reads the Smithsonian's annual folklife festival as a cultural product buffeted by changing material conditions and funding constraints as the United States transitioned from a Fordist industrial economy to a post-Fordist information economy. Based upon visitor interviews, promotional materials, and news reports, this article argues that the transition from a national to an international framework reconfigured the role of Appalachia in visitors' imaginations. In 2002, Appalachia represented ideals of "nation" and "home" in contrast to tantalizing and threatening foreign cultures and allowed visitors to entertain the wishful belief that the United States was a simple place peopled by simple denizens innocent of imperial ambitions.