bluuebunny/crossref_metadata_2025 huggingface dataset:
A Century of Failure: Health Care Reform in America
Authors: Rothman David J.
Published: January 2008

To understand fully the persistent failure of the United States to enact national health insurance requires an appreciation not only of the role of government and the dynamics of politics but of underlying social realities. One consideration, which dates back to the Great Depression, is the absence of the middle class from a coalition in favor of such a policy. This absence reflects both the constricted vision of the middle class and the spirited campaigns of groups like Blue Cross to make certain that middle-class needs were met in order to reduce pressure for government intervention. Another critical social feature is the special entrepreneurial character of the American medical profession. Physicians saw themselves as small businessmen and, as such, shared and promoted a suspicion of governmental intervention. All the while, Americans justified the absence of a national program in terms of the ethos of voluntarism, which had a sufficient base in reality for the posture to be maintained without great embarrassment. In fact, the rhetoric that surrounded the enactment of Medicare reinforced these views, making it appear that, the elderly aside, all was well with the provision of medical services in the country. Even as national health insurance assumes a new prominence on the political agenda, it remains unclear whether these several considerations will allow for the enactment of sweeping changes.
Political Influence in the 1990s: From Iron Triangles to Policy Networks
Authors: Peterson Mark A.
Published: January 2008

To assess the prospects of comprehensive health care reform during the Clinton administration, we must examine the changes that have occurred in the political and structural contexts in which reform is debated. The political context includes the status of the health care system itself as well as public attitudes and voting patterns associated with health care reform; it may be friendlier now to reform than it has been in any previous period, but it cannot on its own produce policy change. The structural context, the representational community of organized interests and government institutions, is the means by which politics is either thwarted or translated into action. Changes in these organized interests and in Congress have transformed the health care reform policy community from an “iron triangle” dominated by an antireform alliance of medicine, insurance, and business to a more loosely bound policy network in which a reform coalition may now be able to prevail, especially under the direction of an activist president like Bill Clinton. I consider three hypotheses: The first claims that, despite the apparent structural changes, the core power relationships will remain the same as in the past, and the antireform alliance either will continue to block policy change or will push through a reform program that protects its constituent interests. According to the second, the structural changes produce an atomization of power, making coalition building in support of reform impossible. The third and most plausible hypothesis proposes that the structural changes, in combination with the shift in politics and Clintons election, have generated new opportunities for fundamental reform.
Is the Time Finally Ripe? Health Insurance Reforms in the 1990s
Authors: Skocpol Theda
Published: January 2008

Reformers feel certain that the time is now ripe for progressive legislation to ensure universal citizen access to health insurance and to contain rising costs in the health care industry. But history shows us that reformers were equally confident in earlier periods of modern U.S. history, only to find themselves defeated by conservatives willing to deploy ideological, emotionally charged arguments against government-sponsored reforms. Today's advocates of inside-the-beltway bargains for hammering out compromise reforms may be vulnerable to similar conservative counterattacks. Reformers need to engage the U.S. citizenry as a whole in democratic discussion about the ideals of government-sponsored health care reforms. Advocates of single-payer plans can do this more readily than supporters of complex public-private schemes such as play or pay or managed competition, but all those who want inclusive and effective reforms during the 1990s must face the challenge of democratic dialogue.
Is Health Care Different? Popular Support of Federal Health and Social Policies
Authors: Schlesinger Mark , Lee Tae-ku
Published: January 2008

Over the past several years there has been a striking increase in policymakers' attention to health care reform. This paper explores whether there has been a corresponding shift in popular attitudes and identifies factors that may have changed these attitudes. The first part of the analysis relies on survey data collected between 1975 and 1989 to estimate a set of regression models, relating support for federal involvement in health care, antipoverty programs, and general domestic policies to a set of sociodemographic characteristics. Relative to other federal policies, support for health initiatives grew over this period. During this same period, long-standing differences in support between rich and poor, old and young, educated and uneducated, all narrowed for health care, though they did not for other types of federal policies. The second part of this study explores motivations that might account for these patterns. We identify a half dozen ways in which health care may be viewed as “different,” that is, more or less appropriate for federal action. Analysis of survey data from 1987 suggests that there are relatively small differences in the attitudes and perceptions that motivate support for federal health initiatives, relative to federal domestic policies in general. However, there are more striking differences between health programs and more overtly redistributive policies. Compared to redistributive federal programs, support for federal health initiatives are (a) less identified with racial minorities or economically disadvantaged groups, (b) less constrained by notions of individual responsibility, (c) more closely associated with concerns about equal opportunity in American society, and (d) somewhat more constrained by choices between federal and local government. These patterns persist whether or not respondents are politically active and whether they report themselves to be liberal or conservative. We suggest that the growing support for federal intervention in health care, relative to other social policies, is in part an inadvertent by-product of ideological positions popularized during the Reagan and Bush administrations. We draw from these results some predictions about the course of the ongoing debate over federal health policies.
Health Reform Impasse: The Politics of American Ambivalence toward Government
Authors: Jacobs Lawrence R.
Published: January 2008

This paper presents two interrelated arguments: it rethinks conventional understanding of the policy-making process and analyzes an important substantive issue regarding public opinion. The substantive issue involves the public's deep ambivalence toward government reforms: Americans are simultaneously supportive of significant reform and uneasy about expanding government involvement. The critical question is what, if any, impact this public ambivalence will have on policy deliberations. Answering this question requires an analysis of the role of public opinion in policy-making. Investigation of historic as well as contemporary health reform suggests that the impact of public opinion varies, depending on the character of both public opinion and the policy issue. The public's preferences are not especially influential when they are characterized by uncertainty or when an issue is not salient, but strong and sustained sentiment can affect agenda setting, interest group leverage over government officials, and policymakers' formulation of detailed administrative arrangements.
Can an Employer-Based Health Insurance System Be Just?
Authors: Jecker Nancy S.
Published: January 2008

It is America's distinctive practice to tie private health insurance to employment, and recent proposals have tried to retain this link through mandating that all employers provide health insurance to their employees. My primary approach to these issues is neither economic, nor historical, nor political but ethical. After a brief historical overview, I outline a general approach to evaluating the ethical significance of linking the distributions of distinct goods. I examine whether an unjust distribution of jobs spoils justice in the distribution of health insurance, taking as a central example gender inequities in employment and exploring their impact on job-based health insurance. Second, I explore the possibility that justly awarding jobs guarantees justice in employment-sponsored insurance. However, linking the distributions of different goods remains problematic, because such links inevitably undermine equality by enabling the same individuals to enjoy advantages in many different distributive areas. Finally, I examine recent proposals to reform America's health care system by requiring all employers to provide health insurance to their employees. I argue that such proposals lend themselves to the same ethical problems that the current system does and urge greater attention to alternative reform options.
New Wine in Old Bottles: Certificate of Need Enters the 1990s
Authors: Hackey Robert B.
Published: January 2008

Although state certificate- of-need (CON) programs have been the subject of intense criticism over the past decade, recent evidence suggests that CON programs may be more effective than commonly believed. While many state programs have yielded disappointing results, the CON process can also be used to achieve other important policy objectives, such as increasing access to care for the uninsured and increasing lay participation in health policy planning. In sum, rather than fading away after the termination of federal support for health planning in 1986, state CON programs are poised to assume new roles during the 1990s.
How Access to Long-Term Care Affects Home Health Transfers
Authors: Kenney Genevieve M.
Published: January 2008

This study examines the determinants of home health use after hospitalization for acute illness for eleven diagnosis-related groups (DRGs) in 1985, drawing on data from four primary sources: Medicare hospital bills, Medicare home health bills, the Medicare and Medicaid Automated Certification System files, and the American Hospital Association Survey. Separate Tobit models are estimated for each DRG. The analysis shows that transfers to home health care are heavily influenced by the hospital's long-term care arrangement and by conditions in local nursing home and home health care markets. Especially important is whether a hospital has its own long-term care unit, swing beds, or both, and whether nursing home beds are available in the local area. Patients discharged from hospitals are more likely to use home health care in areas with a low supply of nursing home beds and low Medicaid reimbursement levels for skilled nursing facilities. The results of this study have implications for proposals to extend Medicare's Prospective Payment System for hospital services to include postacute care. Proponents of a “bundled payment” that encompasses both acute and postacute services argue that the current system leads to inefficiencies and inequities. This analysis points to systematic relationships between home health and nursing home services, which should be factored into the development of a bundled payment policy.
Politics, Administration, and Conflict in Neighborhood Health Centers
Authors: Brandon William
Published: January 2008

The paper begins with a brief introduction explaining neighborhood health centers (NHCs), their ideology of “comprehensive health services,” and the origin of government sponsorship of this organizational form for the delivery of health care. In the generic account and in a subsequent discussion of a particular NHC (given the fictional name Peoples' Health Centers or PHC), particular attention is given to political aspects. PHC was established as a private, consumer-oriented, not-for-profit community corporation receiving grant funds from the Office of Economic Opportunity (OEO). Although the grantee was legally responsible for the funds, OEO required that a local university be awarded a large subcontract to provide health professional personnel and technological back-up. Severe conflict surrounded the relationship of these two local health institutions. In an analysis section offering an “explanation sketch” of an instance of political conflict, the paper develops a distinction between “political” and “administrative” perspectives that explains political conflict as a function of differences in the ways participants conceive of their organizations and activities. This distinction is then related to Etzioni's theoretical distinction between survival and goal-attainment models of organizational analysis. The paper concludes by making explicit four lessons that are intended to reassert the policy-orientation of the initial remarks.
Medicare Implementation and the Policy Process
Authors: Feder Judith M.
Published: January 2008

This article argues that Medicare policy toward hospitals has been profoundly influenced by the perspectives and goals its administrators acquired in a social insurance agency. The social insurance perspective meant priority to efficient claims payment over controlling the impact of payment on the costs and quality of medical care. Initially reinforced by concern that exercising control would antagonize the hospitals and threaten Medicare's survival, this perspective became entrenched over time as administrators grew accustomed to established operating procedures and working relationships with the hospitals. Despite internal skepticism about the appropriateness of some established arrangements, SSA sought to avoid the administrative disruption and political conflict associated with change. Even where external pressure arose, SSA's response was cautious and limited. The fact that such pressure has been both intermittent and significantly limited has reinforced SSA's preferred course of action. As a result. Medicare policy has continued to support inadequate and unsafe hospitals and to exacerbate hospital cost inflation.

The tendency for administrators to become committed to established procedures and avoid political conflict is not unique to Medicare. As the article shows. SSA's implementation strategy has much in common with strategies of similar agencies in similar circumstances. The lesson this experience offers is that new directions in policy require changes both in administrators' predispositions—through changes in organization, leadership, etc.—and in the pressures they face in the political environment.
A New Strategy for Regulating Long-Term Care Facilities
Authors: Ruchlin Hirsch S.
Published: January 2008

This study analyzes the failure of current regulatory efforts to elicit an acceptable level of performance in long-term care facilities and proposes a strategy for correcting that failure. Seven factors are identified as being responsible for the failure of current regulatory efforts: inadequate financing, inadequate knowledge, bureaucratic apathy, legal constraints, political constraints, a fragmentation of agency responsibility, and a shortage of conforming beds.

Public utility status, market regulation, and non-profit control are reviewed and rejected as alternatives to the current approach. A new strategy aimed at improving the regulatory process and environment is proposed. The process can be improved by adopting a program rather than taking a functional approach to agency organization; linking the inspection and rate-setting processes; creating a role for consumer groups in the inspection process; and exposing the process and results of regulation to public scrutiny. Five proposals are offered for improving the regulatory environment. These focus on eliminating barriers to entry, supporting alternatives to institutionalization, federalizing the Medicaid program, abandoning exclusive reliance on the medical model as the guide for regulatory standards, and changing the focus of regulation from structure-process to outcome.
Technology and the Governance of the Health Care Industry: The Dilemma of Reform
Authors: Strosberg Martin A. , Levine Charles , Mauet Alfred
Published: January 2008

With increasing public expenditures for health care services, the accountability of the health care industry has become a major political issue. Concomitant issues concern the structures and processes through which the public as patients, customers, and citizens can directly influence the delivery of health care services. These issues, which are currently part of the national health policy debate, are indicative of the larger question concerning the relationship of the individual to his increasingly complex society.

This paper presents three arguments. (1) The medical profession, through its control of technology and its monopolistic hold on legitimate claims of expertise, is the primary determiner of the way health services are structured and resources are allocated. (2) Domination of doctor-patient relationships, medical care delivery organizations, and the national health care policy process, enables physicians to remain unaccountable to democratic institutions and insulated from public participation in decision-making. (3) Lack of accountability, disproportionate professional power and the failure of governmental regulation raise questions about the role and impact of the medical profession as a quasi-institutional political actor in terms of (a) the return on the investment of $135 billion spent annually for medical care, (b) claims of expertise and self-regulation, and (c) overarching democratic values.
The Future of Blue Cross
Authors: Schonbrun Michael
Published: January 2008

This paper analyzes the reasons for the rise and decline of Blue Cross, a unique American institution. Its inability to respond to the crisis in today's health system is described as nothing more than the failure of the ailing American health system to cure itself.

The early rise of Blue Cross is attributed to its success in addressing pressing social needs: helping patients afford the costs of hospitalization and helping hospitals meet expenses. Its later decline is traced to several factors: the striking increase in the costs of health care; the rise of the state insurance commissioner; the anticipated passage of national health insurance; and the increased competition from commercial insurance carriers, specialty health care data and management firms and state governments.

In concluding, the question is raised whether society should invest further in the future of Blue Cross, a social institution which may have irrevocably lost the confidence of the general public, government and the health provider community. Four possible futures for Blue Cross are set forth: the outright collapse of several plans, a “Lockheed-type” bailout, a “Naderist” organization strongly allied with consumers, and a quasi-governmental agency.
Health Services Research and Health Policy Formulation: An Empirical Analysis and a Structural Solution
Authors: Williams Sherman R. , Wysong Jere A.
Published: January 2008

This article examines the history of the National Center for Health Services Research (NCHSR) from 1970 to 1976 in terms of the research projects funded, the structural relationships of NCHSR to policy formulation, and the make-up of advisory committees. The analysis of support for research on substantive policy issues indicates that there are no major trends; the variations that do occur can be traced to publicly articulated concerns of Congress or the Executive. On the other hand, there have been major shifts in research strategies. from an early emphasis on large-scale development and demonstration to support for short-term, targeted analytical research. This shift has occurred without a thorough examination of the effectiveness of either strategy for policy-making. The analysis of the structural relationships of the Center do not provide any evidence of a stable, systematic linkage of research and policy-making functions. Nor does the analysis of the various advisory groups show that policy-makers have had a significant involvement in guiding the National Center program.

As a result of these analyses, it is our conclusion that measures need to be taken to provide a systematic, formal linkage of the National Center to health policymakers in the administrative and legislative arms of government. We propose that a National Council for Health Services Research and Policy be instituted for the National Center for Health Services Research to assure accountability in choice of priorities and research strategies, and to provide for policy-maker participation in the program of the agency. The objective of the Council would be to provide timely and comprehensive research information and policy alternatives to appropriate national policy-makers, health care providers and consumers.
The Distributional Effects of National Health Insurance in Quebec
Authors: Morreale Joseph C.
Published: January 2008

In November of 1970 a major change in public health policy occurred in Quebec: the movement from a mixed private-public system to a completely public system of financing health care (known as Medicare). This policy change had important economic effects on the distribution of income, taxation, and health care costs. This paper analyzes these economic effects by focusing on the changes in financial burden of medical care costs between 1969–70 and 1971–72 for eight income classes. The key results that emerge are: the total cost of medical care increases sharply for all of the income groups, and the burden of the cost of medical care becomes more equitable across the income groups. Based on these results, policy considerations for the present debate on national health insurance in the United States are offered.
The Politics of Health Care Regulation: The Case of the National Health Planning and Resources Development Act
Authors: Altman Drew
Published: January 2008

This paper examines the political and bureaucratic dynamics of health regulation under the National Health Planning and Resources Development Act and, to a lesser extent, the Carter Cost Proposal now before Congress. A number of underlying issues that affect the day-to-day exercise of health planning are considered, including the contest between state and local and federal government for program control, jurisdictional conflict between state and local planning agencies, and the unsettled roles to be played by professional planners, consumers, and providers. When we assess regulatory policy in health, these complicating factors must be added to the long list of handicaps that already exist. One important finding is that local planning agencies have embraced the task of health regulation somewhat more fully than had generally been expected. A number of explanations for this are offered. In short, the controlling factors in health planning are political, not technical, and there is more occurring at the state and local levels than many had predicted, although any impact is not likely to be dramatic.
Variations in State Medicaid Programs
Authors: Davidson Stephen M.
Published: January 2008

Many federal laws permit the states considerable latitude in determining the important characteristics of programs created under them. Yet, frequently, this aspect is overlooked in the analyses of differences in state-level programs. The purpose of this paper is to present a measure to aid in the analysis of one such program, Medicaid, and to illustrate some of the ways it can be useful.

The Medicaid Program Index (MPI) differentiates among state Medicaid programs according to four important characteristics: inclusion of the medically indigent, the optional services covered, limitations on the provision of the basic services, and arrangements for paying providers. Data are presented to show that, in fact, the states do vary considerably on these factors, which can be analyzed in the aggregate (i.e., as the MPI) or separately. In addition, several uses for the MPI are discussed. They include: (1) identifying variations in state programs; (2) accounting for those differences by comparing them to promising explanatory variables; (3) identifying trends in program characteristics over time; and (4) developing hypotheses to account for those trends. Finally, it was suggested that similar measures can be developed to facilitate analyses of other federal/state programs.
Policy, Politics, and Child Health: Four Decades of Federal Initiative and State Response
Authors: Altenstetter Christa , Bjorkman James Warner
Published: January 2008

This paper analyzes the continuity and change in the relationship between federal and state governments in the formation and implementation of child-health programs. After reviewing developments in federal child-health policy since the Sheppard-Towner Act of 1923, methods of implementation and changes in state laws and administrative organization in Vermont and Connecticut are compared with a focus on the major programs authorized by Title V of the Social Security Act. Four broad interactive areas of comparison—governmental relations, program delivery systems, expenditure patterns, and private interests—serve as vantage points for exploring, understanding and explaining the process of policy implementation. Specific conclusions are drawn regarding each area and the overall conclusion is that federal efforts under Title V have not lessened the general neglect of child health in state legislation; nor have they greatly expanded the volume of direct services for child care. They have been sufficiently ambiguous and diffuse to leave the providers dominant, treating diseases and existing conditions rather than focusing energy on preventive measures. Federal resources have been absorbed by expanding administrative overhead, state bureaucracies have been inflated rather than motivated.
Market Power and Resource Misallocation in Medicine: The Case of Neurosurgery
Authors: Blackstone Erwin A.
Published: January 2008

This article concludes that substantial excess neurosurgical capacity exists. Neurosurgery like other specialties has permitted almost free entry and as a result of such factors as high earnings and status, excess capacity has developed and because of insufficient competition it has not been eliminated. The costs of excess capacity include idle capacity and an alleged reduction in skill levels. The neurosurgery market's performance is evaluated and it is found that while relative income has declined, entry has continued at a high rate; excess capacity is therefore not being eliminated. Policy recommendations of a pro-competitive variety are suggested to improve the market's performance instead of regulation (whether governmental or by the profession itself).
Health Care Cost Containment Experiments: Policy, Individual Rights, and the Law
Authors: Galblum Trudi W.
Published: January 2008

In a climate of increasing pressure to contain health care costs. legislators and health services researchers from time to time have proposed experiments involving reductions in benefits currently authorized under the Medicare and Medicaid programs. This paper examines three court challenges to the conduct of such experiments in California, New York, and Georgia. The rulings on the California and New York cases were in favor of continuing the experiments on the grounds that the Secretary of Health, Education, and Welfare had judged the projects to be helpful in promoting the objectives of Titles XIX and IV-A, respectively, of the Social Security Act. In the Georgia case, however, the plaintiffs contended that federal regulations protecting human subjects were applicable to the experiment at issue. While the precedent of past cases upholding the Secretary's authority to approve benefit-reducing experiments was not overturned in Georgia, the Court held that the human subjects regulations were applicable and, consequently, that such experiments must be reviewed prior to implementation by an Institutional Review Board. If the experiment places human subjects at risk, the regulations require that informed consent be obtained from participating subjects. The paper concludes by examining the implications of the Georgia ruling in terms of future efforts to contain health care costs while ensuring that the rights of individual beneficiaries are adequately safeguarded.
Substitution of Outpatient Care for Inpatient Care: Problems and Experience
Authors: Freiberg Lewis
Published: January 2008

This paper provides a logical framework for considering possible alternatives to inpatient care. First it presents the concept of a substitute-complement relationship among factors of production (or goods and services in consumption) and examines several problems often encountered when applying this concept. Second, it presents four general sources of substitution: (1) technological innovation; (2) changes in organization; (3) capital accumulation; and (4) the dissemination of knowledge. Third, it examines nine activities which are frequently mentioned as providing alternatives to inpatient care. Fourth, it examines some problems and consequences of governmental efforts to plan substitution. The general thrust of the paper is that the substitution process is complex and often depends upon amorphous variables whose influences are subtle, generally nonquantifiable, and often of overriding importance. These variables introduce a downward bias in estimates of program costs and an upward bias in the estimates of program accomplishments. The result is that government attempts to plan substitution are not well conceived and will generally fall short of announced goals and/or cost significantly more than original estimates.
Children's Advocacy and Primary Health Care
Authors: Tompkins Richard F.
Published: January 2008

Children cannot always articulate their own interests or make their own decisions. Children's advocacy is fundamentally an attempt to improve the lives of children. The advocacy effort may be directed either toward improving the outcomes of the decision or the process through which the decision is made.

Children as a class are not well served by the health sector relative to other groups; poor children receive benefits and bear costs unequal to the nonpoor; and there is an unnecessary gap between what our technology is capable of offering and what is actually provided. These facts, in combination with the understanding that child health decisions are frequently made in arenas where the interests of children are not well represented, strongly suggest that child health care decision making can be improved. Children's advocacy offers opportunities for such improvement.
Structural Determinants of Union Activity in Hospitals
Authors: Becker Edmund R.
Published: January 2008

This study uses national data from the American Hospital Association and the National Labor Relations Board in a multivariate framework to assess the impact of various structural factors on union activity in hospitals. The theoretical framework includes both management and union perspectives in evaluating (1) whether the hospital had a signed collective-bargaining contract in 1980; (2) whether a union election had been held; and (3) whether the union won the election. The results indicate that certain structural characteristics (hospital size, ownership, teaching status, and location) have had a significant impact on union activity in hospitals, while other characteristics (third-party reimbursement and area factors) have not. The results also show that prospective reimbursement has a positive impact on union activity.
Quantitative Risk-Benefit Analysis in Regulatory Decision-Making: A Fundamental Problem and an Alternative Proposal
Authors: Bogen Kenneth T.
Published: January 2008

Increasingly, calls are being made for government regulatory agencies to rely on quantitative risk-benefit analysis, in a framework of cost-benefit balancing, to determine acceptable levels of public health risk arising from regulated activities. In condoning the trade-off of public health for economic benefits, this policy approach fails to correspond to moral values and legal precedents respecting individual autonomy. This paper proposes an alternative policy approach, one which requires such regulatory decisions to be justified on grounds of social necessity.
Protecting the Reproductive Health of Workers: Problems in Science and Public Policy
Authors: Valentine Jeannette M. , Plough Alonzo L.
Published: January 2008

This paper first reviews the scientific problems involved in assessing the effects on reproductive health of toxic substances in the work environment. It then describes the current status of regulatory policies designed to control workers' exposures to toxins believed to affect reproduction. Finally, the paper discusses the relationship between scientific uncertainty and regulatory strategies.

Because demonstrating reproductive health effects is extremely difficult, the assessment of the health risks of exposures, as well as of the economic costs of regulation, is probabilistic. Therefore, uncertainty is inherent in any regulatory decision in this area. And the case of reproductive risks is illustrative of the more general problem of protecting the health of workers within a context of scientific uncertainty, and within a highly charged political environment characterized by anti-regulatory sentiment and industries in economic decline.
Monitoring and Assessment in Maternal and Child Health: Recommendations for Action at the State Level
Authors: Peoples Mary D. , Miller C. Arden
Published: January 2008

Recent administration-sponsored changes in federal health policy and funding may harbor adverse effects for the health of mothers and children, and for the capabilities of state-level programs to serve them appropriately. Careful monitoring is required to assess the nature, extent, and impact of those changes. This paper examines several monitoring efforts in maternal and child health and recommends additional action at the state level to meet urgent information requirements.
Lessons from Germany: Some Reflections Occasioned by Schulenburg's “Report”
Authors: Glaser William A.
Published: January 2008

Germany created the first national health insurance scheme, and its turbulent history has carried many lessons for all other countries. Health care financing—like all social security financing—redistributes wealth and inevitably is caught up in class politics. Cost-sharing by patients is not a neutral device in social engineering to improve efficiency, but it is a gambit in distributive politics. Health care involves the wealth and power of the doctors, and they become militant and successful forces in social politics. The forces for higher spending are stronger than the forces for restraint. Only exceptional political will by government can control costs.
The Politics of Management in Health Care: A British Perspective
Authors: Haywood Stuart C.
Published: January 2008

This paper discusses the contribution of organizational political perspectives to a better appreciation of policy implementation problems in health care. The context is the efforts of successive British governments to accord a higher priority to community health and long-stay services. The limited success of these policies owes much to continuing medical control of the philosophy of the organization and agenda, in spite of government responsibility for funding and providing health services. More effective policy implementation depends on a recognition of the “naturalness” of organizational politics, rather than treating them as constraints in an otherwise rational, managerial system.
Comprehensive Primary Care at the Neighborhood Level: An Israeli Experiment That Failed
Authors: Lazin Frederick A.
Published: January 2008

This paper is an analysis of the first stage of a demonstration program designed to integrate within neighborhood clinics various health and welfare services that were previously provided separately. The program included the active participation of quasi-public, governmental, private, philanthropic, and university institutions. The purpose here is to understand the failure to achieve the original goals and purposes. The analysis takes an organizational perspective, and should contribute to a better understanding of why programs designed to change existing service-delivery systems are inclined to fail. Although this is a case-study of a demonstration program in Israel, the findings should have relevance and interest for academicians and professionals in other countries.
The Push for Reprivatization of Health Care Services in Canada, Britain, and the United States
Authors: Weller Geoffrey R. , Manga Pranlal
Published: January 2008

Progress towards the equity objective in health has been seriously threatened in recent years by attempts to halt or reverse the direction of postwar policy and reprivatize the health care systems of Canada, Britain, and the United States. This article examines the individuals and groups who advocate reprivatization, analyzes the major concepts involved, and discusses the possible causes of the push for reprivatization. A detailed examination of policy outputs and their likely consequences leads to the conclusion that the push for reprivatization will exacerbate the problems, and that governments would be better advised to pursue policies that would restructure and redesign the supply side of their health systems.
Medicare Revisited: A Look Through the Past to the Future
Authors: Rosenblum Robert W.
Published: January 2008

This paper examines the elderly's out-of-pocket health care expenditures by category of expense, before and after the inception of Medicare. It describes the shifting of out-of-pocket expenses from hospital care to nursing-home care, while physician services and drugs have remained prominent components of out-of-pocket expenditures. Recent corrosive trends in the protection against out-of-pocket liability are discussed and analyzed. The author contends that the raging debate over the Medicare program must include and recognize the concerns of the elderly consumer.
Probable Future Funding Priorities in Maternal and Child Health: A Modified Delphi National Survey
Authors: Loos Greg P. , Smith Roy G. , Roseman Cyril
Published: January 2008

Recent enactment of program consolidation block grants proposed by the Reagan administration has left many observers of public health services wondering about the impact of such a change on categorical programs in maternal and child health (MCH). This study first presents predictions about the future of 23 specific MCH services, derived from a modified Delphi Survey of MCH experts, and then examines the implications of these predictions for future public health.
Regulating Motor Vehicle Safety Maintenance: Can We Make It Cost-Effective?
Authors: Thompson Fred
Published: January 2008

Our analysis suggests that a properly designed and implemented safety inspection program for motor vehicles would probably produce benefits in excess of costs, whereas most existing state programs probably produce costs well in excess of benefits. That these findings are somewhat inconclusive is both regrettable and unnecessary: the data required to carry out a satisfactory evaluation of alternative safety inspection program designs are obtainable. Unfortunately, serious policy-relevant empirical research is costly; for that reason, more conclusive findings may never be available.
Götz Großklaus, Medien-Bilder. Inszenierung der Sichtbarkeit. 2004
Authors: Pompe Hedwig
Published: January 2008

In der zu besprechenden Sammelausgabe sind sieben Kapitel dem Titelthema gewidmet, das achte ist die erweiterte Fassung eines Lexikonartikels „Interkulturelle Medienwissenschaft“ von 2003 und dient der methodischen Orientierung der Leser. In diesem systematischen Abriß skizziert Götz Großklaus das forschungsorientierte Konzept einer erst noch „zu entwickelnden ‚Interkulturellen Medienwissenschaft‘“ (S. 219), die sich aber heute schon selbstbezüglich im Umfeld des „Inter“ bewegt: „Die neue ‚Epoche‘ ist bestimmt durch neue kommunikative Formen der Inter-Kulturalität, der Inter-Medialität, der Inter-Textualität“ (S. 227f.). Aktuelle Medientheorie wird also selbst verstanden als Effekt von evolutionären Bewegungen und medial bewirkten Epochenzäsuren. Die „vier ‚Leitmedien‘“: „Das Bild (Ikon), die Sprache (Mündlichkeit), die Schrift (Alphabet/Text), die Zahl (Ziffer)“ (S. 219) und ihre Wechselbeziehungen werden in den Ensembles historischer und gegenwärtiger kultureller Praktiken sichtbar.
Harald Saller, Ein neues Editionskonzept für die Schriften Notkers des Deutschen anhand von De interpretatione. 2003
Authors: Sonderegger Stefan
Published: January 2008

In der vorliegenden Studie, einer sorgfältig ausgearbeiteten Dissertation aus der Schule von Ernst Hellgardt (München), wird ein zuerst im Jahr 2001 programmatisch vorgestelltes Editionskonzept am Beispiel der lateinisch-althochdeutschen Schrift De interpretatione des Aristoteles/Boethius in der übersetzend-kommentierenden Bearbeitung des frühmittelalterlichen St. Galler Klosterlehrers und Fachschriftstellers Notker III. Labeo oder Teutonicus (um 950–1022) verwirklicht. Das Buch ist, nach einem Vorwort, in zwei Hauptabschnitte „II Herleitung des Editionskonzepts“ (S. 3–68) und „III Textbeispiel“ (S. 69–240) gegliedert; es folgen eine zusammenfassende Schlußbetrachtung („IV Schluß“, S. 241–244) sowie „V Siglen und Literaturverzeichnis“, Register und Anhang (Kapitel-Konkordanz zu De interpretatione).
Bettina Jung, Das Nürnberger Marienbuch. Untersuchungen und Edition. 2004
Authors: Oswald Marion
Published: January 2008

Von Marias Gestalt geht seit dem frühen Christentum ungebrochen eine Faszination aus, die sich in unterschiedlichen Formen der Diskursivierung niederschlägt. Die Mysterien von Unbeflecktheit, immerwährender Jungfräulichkeit und Gottesmutterschaft sind dabei nicht allein Thema lateinischer apokrypher, exegetischer und liturgischer Traditionen, sondern auch volkssprachiger Dichtungen. Es handelt sich allerdings vielfach um Texte, die ohne eine lange Tradition lateinisch geprägter, ritualisierter religiöser Kommunikation nicht denkbar wären. Sie lassen eine strikte Unterscheidung von religiöser und literarischer Rede nicht zu und entziehen sich insofern einer literaturwissenschaftlichen Zuordnung, die von modernen funktionalen und ästhetischen Maßstäben ausginge.
Bernd Bastert (Hg.), Karl der Große in den europäischen Literaturen des Mittelalters. Konstruktion eines Mythos. 2004
Authors: Geith Karl-Ernst
Published: January 2008

Der 1200. Jahrestag der Krönung Karls des Großen zum römischen Kaiser hat der wissenschaftlichen Beschäftigung von Historikern, Literaturwissenschaftlern und Kunsthistorikern mit Person, Taten und Nachleben dieser großen mittelalterlichen Herrschergestalt einen neuen Anstoß gegeben. In Kongressen, Ausstellungen und anderen Veranstaltungen (Feiern) wurde seiner gedacht und seine Gestalt, sein Wirken und Nachwirken vergegenwärtigt. In Biographien und Sammelbänden wurden unter verschiedenen Schwerpunkten unterschiedliche Aspekte der historischen Herrscherfigur und ihrer Umgestaltung durch Historiographie, Literatur und Kunst behandelt. In diesem Zusammenhang ist auch das vorliegende Buch entstanden. Der Herausgeber hat aus dem bei der eigenen Arbeit empfundenen Bedürfnis heraus, ein Werk konsultieren zu können, das „so profund wie kompakt über das ausgedehnte Feld der europäischen Karlsliteratur informieren würde“ (S. VII), die Initiative ergriffen und Fachleute für die verschiedenen europäischen Ausprägungen der Karlsliteratur gewonnen, deren Beiträge den hier anzuzeigenden Band ergaben.
Anne Stephan-Chlustin, Artuswelt und Gralswelt im Bild. Studien zum Bildprogramm der illustrierten Parzival-Handschriften. 2004
Authors: Baisch Martin
Published: January 2008

In der vorliegenden Studie, einer Mainzer Dissertation, widmet sich Anne Stephan-Chlustin anhand illustrierter Handschriften von Wolframs von Eschenbach Parzival dem für die Kulturgeschichte zentralen Forschungsthema ‚Text und Bild‘. Analysegegenstand sind die Handschriften G (München, Bayerische Staatsbibliothek: Cgm 19) und Gk (München, Bayerische Staatsbibliothek: Cgm 18) aus dem 13. Jahrhundert, die aus der elsässischen Werkstatt Diebold Laubers stammenden Handschriften m (Wien, Österreichische Nationalbibliothek: Cod. Vindob. 2914), n (Heidelberg, Universitätsbibliothek: Cpg. 336) und o (Dresden, Sächsische Landesbibliothek: Ms M 66) und Gx (Bern, Burgerbibliothek: Cod. AA 91), welche alle im 15. Jahrhundert angefertigt wurden. Die Untersuchung setzt zwei Schwerpunkte: „Der erste gilt nach einer Darstellung von Überlieferung, Datierung, Aufbewahrung, Schrift, Texteinrichtung und Ausstattung der Codices der Charakterisierung des künstlerischen Ausdrucks der Bilder dieser Handschriften“ (S. 4). Dabei beschäftigt sich die Autorin zum einen mit Technik, Zeichen- und Malstil und Koloristik, zum andern mit der Darstellungsweise in den Kategorien Person, Tier, Architektur, Landschaft und Komposition. Zielpunkt der Vollständigkeit anstrebenden Untersuchung ist „die Herausarbeitung der stilistischen Merkmale der verschiedenen Bildversionen der Parzival-Handschriften“ (S. 4).
Volker Fritz Brüning, Bibliographie der alchemistischen Literatur. Bd. 1: Die alchemistischen Druckwerke von der Erfindung der Buchdruckerkunst bis zum Jahr 1690. 2004
Authors: Hoffmann Volker
Published: January 2008

Brünings Bibliographie hätte wie John Fergusons Bibliotheca Chemica (1906) ein Jahrhundertwerk der alchimistischen Referenzliteratur werden können; die dilettantische und fehlerhafte Ausführung des anspruchsvollen Vorhabens hat das Gegenteil bewirkt. Dabei ist Brünings Konzeption bestechend. Die bisherigen Verzeichnisse – meist Sammlungen – waren überwiegend alphabetisch geordnet (Young/Ferguson 1906; Ferguson/Ferguson 1943. 1955; Duveen/Duveen 1949, neu 1965; von Bernus/Stöckinger, bearbeitet von Telle 1997). Alan Pritchards verdienstvolle Bibliographie (1980) ist ausnahmsweise nach Ländern und Themen gegliedert. Ansätze zu einer chronologischen Übersicht bieten nur zwei Nachschlagewerke. Die Katalogaufnahme der riesigen Bestände der Wellcome Historical Medical Library erfolgt nach Zeiträumen (Inkunabeln [1954], Bücher vor 1641 [1962], Bücher 1641–1850 [1966, 1976, 1995 – es fehlt noch S bis Z]), innerhalb dieser Abteilungen wird jedoch wieder alphabetisch gereiht. Ebenfalls nach Zeiträumen geordnet, hier 1472–1623 und 1624–1790, verfährt der Katalog der Sammlung Mellon (2 Bde. für die gedruckten Bücher, 1968).