bluuebunny/crossref_metadata_2025 huggingface dataset:
Illusions of Necessity: Evading Responsibility for Choice in Health Care
Authors: Evans Robert G.
Published: January 2008

Discretionary power is commonly defended by denial of its existence, the allegation of inevitability. Objective external conditions and forces are claimed to dictate policy decisions with tangible distributional effects. In health policy, such forces include the aging of the population, the extension of technology, and the demands of ethical standards. Taken together, these forces create relentless upward pressure on costs, to levels which society “cannot afford,” necessitating sacrifice of the interests of the “less eligible.” Yet quantitative analysis of these forces does not sustain the argument; in each case the source of cost escalation is not external pressure but the way in which the health care system itself reacts. Less costly and equally effective options are demonstrably available, but would threaten provider interests and broader ideologies. A spurious cloak of inevitability serves to promote and justify political choices.
Paying for the Medicare Program
Authors: Munnell Alicia H.
Published: January 2008

Although the hospital insurance (HI) trust fund acted as a source of strength for the old-age, survivors, and disability insurance program during its recent financial crises, projections by HCFA and CBO reveal that the Medicare program will experience financing problems of its own within the next decade. No one would argue that Medicare's financing problems should be solved simply by raising more money. However, the prospect of insolvency in the HI trust fund and the increasing strain on general revenues from the Supplementary Medical Insurance trust fund require policymakers to survey the options for increasing Medicare revenues while cost-control devices are being developed. Indeed, even if cost-control efforts are completely successful, additional revenues may be needed in the future to finance new initiatives in the Medicare program. Therefore, this paper will look briefly at current efforts to regain control of soaring hospital and physician costs and then examine some of the more feasible options for increasing Medicare revenues.
Doctors and Allocation Decisions: A New Role in the New Medicare
Authors: Cassel Christine K.
Published: January 2008

The role of the physician in the allocation of health care resources has come under renewed scrutiny in recent years. Doctors have always had to face the reality of scarce resources and to do their work in the context of social injustices. With the advent of Medicare and Medicaid came the rhetoric of universal access and the “right to health care.” At the same time the field of bioethics was emerging and contributing ideas about other kinds of rights, such as the right to die with dignity. Physicians during this time did not see their role as that of gatekeeper, but rather as advocate for the best care for each individual patient. The 1980s has brought a new awareness of limited resources and the necessity for a rationale for allocation of resources. These social and professional shifts have confronted physicians with the need for yet another shift in their ethical stance. If they are to take part in allocation decisions, for the continued well-being of their patients and of the public health, they will need a new perspective on biomedical ethics. This role can be an ethical one for physicians providing certain criteria are met: (1) there must be universal access to a basic minimum level of care, (2) physicians' levels of income must not be directly related to treatment choices, (3) there must be a closed financial system within which meaningful trade-offs can be made, and (4) there must be an ethically acceptable framework for decision-making.
Competition versus Regulation: Some Empirical Evidence
Authors: Merrill Jeffrey , McLaughlin Catherine
Published: January 2008

In response to dramatic rises in health care costs, policymakers have been debating the relative merits of regulatory and competitive strategies as a means of containing costs. One major activity espoused by proponents of competition is the growth of health maintenance organizations (HMOs) which, in their opinion, will result in the market better determining efficient levels of utilization and costs. Extending this argument, the larger the percent of the population in a market area who enroll in HMOs, the greater the market-forcing effect of HMOs in reducing overall hospital expenditures; that is, if HMOs are providing lower-cost care, then the fee-for-service system will be forced to reduce costs in order to be competitive. The authors studied the 25 largest SMSAs from 1971-1981, and controlling for environmental conditions in each market, they examined the impact of both HMO growth and regulatory activity on costs and utilization. They conclude that neither competition nor regulation had a significant impact in reducing overall hospital costs. While there may have been some impact in specific communities, no generalizable effect could be observed. However, the authors did find that increases in costs and utilization were essentially driven by supply factors such as the number of hospital beds or medical specialists in a given community.
The Competitive Impact of Health Maintenance Organizations on Hospital Finances: An Exploratory Study
Authors: Feldman Roger , Dowd Bryan , McCann Don , Johnson Allan
Published: January 2008

In this study we explore whether HMO-induced competition has contained expenditures in Minneapolis/St. Paul hospitals. Specifically, we assessed the impact of HMOs on revenue, cost, and net income per admission in Twin Cities hospitals from 1979 to 1981. Some HMOs have obtained negotiated discounts from hospitals. We found that hospitals which gave larger discounts did not have lower costs per admission. This finding suggests that discounts do not force hospitals to operate more efficiently. In addition, hospitals with a large share of patients from HMOs or government Medicare and Medicaid programs did not have lower costs per admission than other hospitals during the years from 1979 to 1981. This finding casts doubt on the claim that discounts are justified by lower costs for HMO or government patients. Finally, neither HMO market share nor discounts had an adverse effect on hospital profits. During the three years studied, hospital profits in the Twin Cities showed an upward trend.
Medicaid Myths: Trends in Medicaid Expenditures and the Prospects for Reform
Authors: Davidson Stephen M. , Cromwell Jerry , Schurman Rachel
Published: January 2008

Medicaid expenditures, which had reached more than $32 billion by 1981, have grown substantially throughout the program's history. As a result, the conventional wisdom is that Medicaid expenditures represent a significant public-policy problem. Using other measures, however, it can be shown that the program is much less of a problem than it appears to be. By 1981, spending for Medicaid represented only 12.7 percent of total state spending and had contributed only 14.2 percent to the overall growth in state expenditures since 1965. Moreover, considering only the funds which states raise from in-state sources, the median share of state budgets accounted for by Medicaid was just 5.6 percent, and only 7 states spent as much as 9 percent of their own money on the program. These figures suggest that the marginal reductions in Medicaid expenditures which would result from typical program changes are likely to be so small that rational state officials might be unwilling to incur the political opposition of powerful provider groups or the resistance of large state bureaucracies by proposing substantial reforms. The major exceptions are the few states with very large programs where even small proportional savings would amount to millions of dollars. We conclude that, given its present federal-state form and the current distribution of expenditures, it is unlikely that major reforms will be enacted because the stakes are too small for most states and the federal interest is too diffused.
The AIDS Epidemic and Gay Bathhouses: A Constitutional Analysis
Authors: Rabin Judith A.
Published: January 2008

Some legal scholars propose that the right of privacy articulated by the United States Supreme Court should be extended to protect homosexual activity. In light of the advent of AIDS, should that extension include constitutional protection for homosexual men who frequent gay bathhouses? The author argues that although the government has the power to close the baths in the name of public health, it should not do so without careful and conscious balancing against the privacy rights infringed upon by its actions. Balancing the tension between public health policy and individual rights applies not only to the specific situation of the baths, but also to insurance companies' aim to test all single, young, male life and health policy applicants for exposure to the putative AIDS virus; to potential health department releases of names of those testing antibody-positive for HTLV-III; to the military's rumored plans to discharge all personnel suspected of having AIDS; and to school districts seeking to exclude children with AIDS.
Analysis, Advice, and Congressional Leadership: The Physician Payment Review Commission and the Politics of Medicare
Authors: Oliver Thomas R.
Published: January 2008

In 1985, Congress established the Physician Payment Review Commission (PPRC) to help formulate changes in the system used by Medicare to pay for physician services. The recommendations of the PPRC and subsequent legislative action led to fundamental reform. As a new type of advisory body, the PPRC enabled Congress to establish an agenda for physician payment reform and set it into law despite initial resistance from the executive branch. Four key factors contributed to the influence of the commission: (1) an institutional design that enhanced and integrated congressional policy formulation; (2) the quality of the information generated for legislative deliberation; (3) the open, consensual process the commission used to translate that information into policy recommendations; and (4) the strategic packaging of the proposals for reform. In the process leading to enactment of the new payment system, the commission skillfully bridged the traditionally segmented roles of neutral analyst and political advisor for legislators pursuing Medicare reform. Implementation of physician payment reform has been largely an administrative responsibility, in which the PPRC has played a minimal role. The complexity and ambiguity of some of the legislative provisions have left room for administrative officials and interest groups to maneuver according to their priorities. Thus, despite congressional efforts to design a tightly controlled system, a considerable amount of work remains to assure its technical and political success.
Improving the Current System for Supplying Organs for Transplantation
Authors: Horton Raymond L. , Horton Patricia J.
Published: January 2008

The United States currently relies on a voluntary, altruistic system for supplying organs for transplantation. It is now generally recognized that this system, as currently operated, produces a seriously inadequate supply of organs. A number of scholars have argued that some type of (generally unspecified) market system is necessary. Two articles appearing in the Journal of Health Politics, Policy and Law have proposed relatively specific market systems for increasing the supply of organs. In this paper we argue that market systems are at best premature. In particular, there is little to suggest that any type of market system for organs will be permitted in the United States in the foreseeable future. We present data that strongly suggest that the current voluntary, altruistic system has not been developed to its full potential and offer a number of specific suggestions for improving the system.
The Proposed Market for Human Organs
Authors: Spurr Stephen J.
Published: January 2008

During the last decade there have been enormous advances in the transplantation of vital human organs-in particular, the kidney, lung, heart, liver, pancreas, and small intestine. Unfortunately, efforts to provide the benefits of these operations to patients have been severely hindered by limitations in the supply of organs-limitations that are a consequence of regulation prohibiting the use of market incentives to increase the supply.

Markets for organs could take various forms: sales by living donors; sales of future interests in organs, to be removed on the death of the donor; and sales of organs of a recently deceased person by the family of the deceased. Two additional issues relate to the design of a market: the geographic scope of the market and rules of liability for the sale of diseased or defective organs.
The Struggle for the Soul of Health Insurance
Authors: Stone Deborah A.
Published: January 2008

The politics of American health insurance is a struggle over which vision of distributive justice should govern: the solidarity principle or the logic of actuarial fairness. Actuarial fairness is central to American private health insurance. It is both an antiredistributive ideology and a method of organizing mutual aid by fragmenting communities into ever-smaller, more homogeneous groups, leading ultimately to the destruction of mutual aid. This fragmentation is accomplished by fostering in people a sense of their differences and their responsibility for themselves, rather than their commonalities and interdependence. Actuarial fairness developed as a business strategy for gaining market share. Medical underwriting, which is far more extensive than commonly known, is the information technology used for implementing actuarial fairness. Despite significant changes in the political context of health insurance which are leading toward restraints on underwriting, the logic of actuarial fairness is so deeply embedded in the structure of competitive markets in insurance and so deeply consonant with social divisions in American society that eradicating it will take more than any current reform proposals contemplate.
Black America: From Community Health Care to Crisis Medicine
Authors: McBride David
Published: January 2008

This study traces the major policy shifts in medical care that have affected disadvantaged African-Americans and the response of this community's medical leadership to these changes. Since World War II policy has passed through three major phases. The first—engagement—ran from the mid-1960s through the mid-1970s. During this phase a community health policy orientation prevailed as national government targeted resources to health care programs for needy blacks and other poor Americans. From the late 1970s to the mid-1980s the period of submersion occurred: black community health professionals and political leaders experienced a newfound inclusion in health policy debate, but, at the same time, broader policy-making circles in government and health care reduced medical resources for the inner-city poor. Finally, in the third phase—crisis recognition—a network developed of community health advocates who seek to reorient the health system so that it addresses needs within urban America's “New Ghettos.”
The Politics of Antismoking Legislation
Authors: Jacobson Peter D. , Wasserman Jeffrey , Raube Kristiana
Published: January 2008

To understand why some states have enacted relatively stringent laws to control smoking in public places while others have not, we examined the political evolution of tobacco control initiatives in six states: New York, Minnesota, Florida, Illinois, Texas, and Arizona. Taken together, the case studies demonstrate the difficulties inherent in enacting strong statewide tobacco control legislation. More important, several unmistakable themes emerge from these case studies, shedding light on the barriers to greater legislative success. These themes include the manner in which the legislative debate is framed by antismoking advocates and the tobacco industry, the relative dearth of leadership provided by medical and health organizations, the role of public opinion, and the complex interaction that exists between statewide antismoking legislation and local antismoking ordinances. Understanding how these issues affect legislative outcomes may help antismoking advocates enact future statewide tobacco control initiatives. It may also present lessons applicable to future battles over other public health legislation.
Restructuring Federalism: The Impact of Reagan Policies on the Family Planning Program
Authors: McFarlane Deborah R. , Meier Kenneth J.
Published: January 2008

Through fiscal cutbacks and structural changes, Reagan's federalism assaulted the ethos of public health. In assessing the effects of Reagan policies on a basic public health program, family planning services, we find a substantial decrease in spending for this program, a reduction in the numbers of patients served, and increased variation among the states in the provision of services to low-income women. These effects are comparable with findings from other studies on the impact of Reagan's federalism upon social programs and have manifold implications for public health.
The Racial Integration of Health Facilities
Authors: Smith David Barton
Published: January 2008

No published measures of racial integration in health facilities in the United States exist. This article reviews the problems with possible sources of data. It then derives estimates of the degree of integration in nursing homes and hospitals from the 1985 National Nursing Home and National Hospital Discharge surveys. Nursing homes were less racially integrated than hospitals. Health facilities in the South were more integrated than in any other region of the country. There was little difference in the degree of racial segregation of publicly financed patients and those whose care was financed from private sources. Data on nursing homes in Pennsylvania illustrate in more detail some of the consequences of such patterns of segregation. The article discusses some of the reasons for the lack of easy access to such information and makes recommendations for addressing it.
Lay Participation in Health Care Decision Making: A Conceptual Framework
Authors: Charles Cathy , DeMaio Suzanne
Published: January 2008

Lay participation in health care decision making has attracted increasing interest in Canada, with numerous provincial government reports advocating this initiative. Interest stems from a number of factors. Among them is a growing recognition that patient preferences ought to be incorporated into decision making that involves individual treatment choices. Another factor is the desire to increase public accountability for decisions on the allocation of health care resources, in order to make providers more accountable to the communities they serve. There is, however, still considerable confusion over what lay participation really means. In addition, little consideration has been given to whether and how lay participation can lead to better decision making and the criteria by which it should be judged. This article presents a framework based on decision-making domains, role perspectives, and levels of participation and is intended as an initial step toward providing greater conceptual clarity regarding the key dimensions and goals of lay participation in health care decision making.
The Political Economy of National Health Insurance
Authors: Bowler M. Kenneth , Kudrle Robert T. , Marmor Theodore R.
Published: January 2008

National health insurance (NHI) is discussed as a redistributive issue (that is, conflict over it is characterized by stable coalitions with important ideological differences). Discussion of policy alternatives has been intensified, but obscured, by a rhetoric which insists that the medical care system is in crisis. Both rhetoric and discussion point to three problem areas: cost, quality, and distribution of care. Three kinds of NHI proposals exist–minimal intervention measures (e.g., AMA's Medicredit proposal), major government action (e.g., Kennedy-Corman), and mixed strategies (e.g., CHIP). While these have different potentials for mitigating the problem areas discussed, none can provide complete solutions. Rather, the goal of NHI is to avert financial catastrophe for families and individuals. The emergence of Democratic majorities in Congress and a Democratic White House increases the chances that some NHI plan will be adopted. Political analysis suggests that, short of aggressive leadership committed to a comprehensive scheme, a “middle ground” solution will be the outcome.
The Hospital Support Game Revisited
Authors: Smith David B. , Homer Carl G.
Published: January 2008

This paper updates a well-known case study in which Ray Elling examined the failure of community health planning in a medium-sized American city. During the period described by Elling, the city's hospitals had managed to resist efforts to rationalize the system by marshalling the support of their respective constituents. This political gamesmanship gave way in the late sixties and early seventies to greater cooperation and a significant consolidation of the hospitals. The authors hypothesize that an important factor influencing this development was the change in medical technology. The effects on the community's health care delivery are also discussed.
Health Services Research for Decision-Makers: The Use of the Delphi Technique to Determine Health Priorities
Authors: Moscovice Ira , Armstrong Patricia , Shortell Stephen , Bennett Roger
Published: January 2008

In an effort to make health manpower training programs and health services research and policy analysis activities more responsive to health care needs in Washington State, a Delphi process was used to obtain perceptions of critical health problems from knowledgeable persons in the health services field.

The technique revealed a reasonable agreement among respondents that the following items, in order of priority, were the ten most important problems facing the citizens of Washington State.
From Shared Cost to Block Funding and Beyond
Authors: Van Loon R. J.
Published: January 2008

This paper takes as its starting point recent major changes in arrangements between the federal and provincial governments in Canada concerning the sharing of costs for health insurance programs. The switch from a shared cost (conditional grant) to a modified block funding system was motivated by federal desires to limit and make predictable their expenditures, by provincial desires to increase the flexibility of their allocation of funds and by a mutual desire to limit any growth of health care costs as a proportion of GNP. Concerns related directly to improving medical care delivery were insignificant.

The changes will effectively centralize responsibility for program financing and program delivery, thus providing a powerful incentive for provincial governments to apply very strong measures to control costs. For reasons largely external to the relationship between public sector insurers and the suppliers of medical services, these attempts are unlikely to be successful in the short run. The probable impact of this difficulty on government and members of the health care delivery system is assessed.
Federal Influence on State Health Policy
Authors: Buntz C. Gregory , Macaluso Theodore F. , Azarow Jay Allen
Published: January 2008

This paper reports on research that was intended to demonstrate the impact of federal programs on state health policy goals. The sample included four Public Health Service programs (Health Planning and Resources Development, Nurse Training, Cooperative Health Statistics and the Community Mental Health Centers program) in six states (Colorado, Maryland, Michigan, Oregon, South Carolina, and Texas).

The authors conclude that, in general, states' political environments tailor program implementation to suit state preferences.
Politics and Economics of Hospital Cost Containment
Authors: Raphaelson Arnold H. , Hall Charles P.
Published: January 2008

Voluntary and regulatory efforts toward hospital cost-containment have accelerated with rapid increases in those costs and under pressures of national health insurance. Possible causes of hospital cost inflation are examined in the context of market analysis and with reference to the nature of hospitals as institutions facing special combinations of economic and political conditions and pressures. Some details of voluntary experiments and state regulatory efforts are examined in order to assess the elements of experience to date and their relationships to causes of hospital cost inflation. Federal proposals for a regulatory cap on costs are also discussed along with a view of how such proposals are related to probable causes of hospital cost inflation and of the relevance of other experience.
Rationales for Public Health Insurance Coverage of Geriatric Day Care: Issues, Options, and Impacts
Authors: Weissert William G.
Published: January 2008

America's long-term care system has been widely criticized for many shortcomings. It relies too heavily upon institutional services, it is too costly, it forces inappropriate levels of care upon patients by offering too few options, in too many instances it offers inferior quality care, and it places too much emphasis on caring for physical ills without concern for enhancing patients' quality of life. Alternative modes and settings now under consideration could solve one or more of these problems, but the choices would be constrained by financial and technical barriers. Different choices have profoundly different consequences for costs and numbers and types of patients served. This paper considers different roles and their consequences for one alternative: geriatric day care. The issues raised apply to other alternatives.
Invisible Hand or Fatherly Hand? Problems of Paternalism in the New Perspective on Health
Authors: Weale Albert
Published: January 2008

This article examines the charge that the “New Perspective” on health (as exemplified by the Lalonde Report in Canada, by Prevention and Health in the United Kingdom) represents an abandonment of liberal principles in favor of a collectivist and paternalistic role for the state. It looks first at the problems confronting modern health policy, and at the reasoning behind the New Perspective's approach. It then explores whether and how the charge of paternalism applies to that approach, and just what such a charge implies. The article concludes with a discussion of the “liberal paternalist” viewpoint towards health policy, a viewpoint that combines respect for individual liberty with an interest in taking effective public action to improve the health status of modern populations.
A Guide to Benefit-Cost Analysis, as Seen Through a Controlled Experiment in Treating the Mentally Ill
Authors: Weisbrod Burton A.
Published: January 2008

The study reported on here is the first benefit-cost analysis of a controlled (random assignment) experiment in the mental health field. It compares, in terms of an unusually wide variety of tangible and intangible forms of benefits and costs, a traditional, hospital-based approach to treating the mentally ill with a nontraditional community-based approach.

The research reported here supports the hypothesis that hospitalization of the mentally ill is, except for emergencies, less effective than community-based treatment of approximately equal cost. The research also confirms the hypothesis that the forms taken by the social costs of alternative programs can be so different that it is easy to mistake a change in the form of costs for a change in their level. Finally, this study highlights the fact that benefit-cost analysis, despite advances at both the conceptual and empirical levels, remains a mixture of science and art.
Public Hospitals on the Brink: Their Problems and Their Options
Authors: Brown E. Richard
Published: January 2008

This article defines the differences among public community hospitals, and examines the problems faced by those that serve primarily the poor. The article analyzes the impacts of (1) the tradition of local fiscal responsibility, (2) third-party funding arrangements, (3) public hospitals' bases of political support, and (4) problems in governance and administration. Three broad policy options for public hospitals are considered in the light of these impacts.
Health Care in Canada: Patterns of Funding and Regulation
Authors: Evans Robert G.
Published: January 2008

During the 1970s the share of health care expenditure in Canadian GNP remained roughly stable, in the range of 7-71/4 percent of GNP, in marked contrast to its escalation in most other countries (the U.S. in particular) and to previous Canadian experience. The shift to a stable pattern coincided with the completion of the Canadian system of universal comprehensive public hospital and medical care insurance. This paper explores how and why the public insurance system served to contain cost escalation. It then discusses the inadequacy of expenditure experience per se as a basis for health system evaluation–the same data will support claims of both “underfunding” and “spiralling costs.” More serious questions involve the influence of alternative patterns of health care funding and delivery on the effectiveness and efficiency of care provision, and the resulting distributional patterns of care and income. A brief sketch is given of the present situation and future possibilities of Canadian health care under these heads.
Hospital Capital Formation in the 1980s: Is There a Crisis?
Authors: Cohodes Donald R.
Published: January 2008

Access to capital will be a serious problem for a subset of our nation's hospitals in the 1980s. Without adequate capital to modernize or maintain life-safety codes, certain facilities may have no other choice than to close their doors. The consequences of closure are far-reaching and long-lasting. The hospitals that exit from the market may be forced out as a result of their location or payor mix, and not as a consequence of their inefficiency. Allowing capital formation in the hospital industry to be determined by the market criteria of bottom-line performance may lead to a serious contraction of the field, to increased financial hardships for the hospitals that remain, to reduced service provision, and to plant deterioration.
The Economics of Safety Deregulation: Lives and Dollars Lost Due to Repeal of Motorcycle Helmet Laws
Authors: Hartunian Nelson S. , Smart Charles N. , Willemain Thomas R. , Zador Paul L.
Published: January 2008

Between 1976 and 1980, 28 state legislatures in the United States repealed or weakened their motorcycle helmet-use laws. This paper estimates the number of excess deaths attributable to this deregulatory activity, and the associated economic costs to society. Because of data limitations, no attempt was made to estimate the excess nonfatal injuries and associated costs.

We applied a variant of log-linear contingency-table analysis to the monthly counts of motorcycle fatalities in the 48 contiguous states over the period 1975 through 1980. This analysis produced estimates of the total number of deaths, in each of 36 age-sex groups, that could be attributed to changes in the helmet laws. We then estimated the direct and indirect economic costs associated with fatalities in each age-sex group. Our findings indicate that 516 excess deaths occurred in 1980 in the 28 states that weakened or repealed their helmet laws. This represented 24 percent of the total motorcycle fatalities occurring in those states. Women and younger cyclists of both sexes comprised a disproportionate share of excess deaths. The economic costs to society that are associated with the excess fatalities resulting from the repeals of helmet laws total at least $180 million.
Report from Germany: Current Conditions and Controversies in the Health Care System
Authors: Schulenburg J.-Matthias Graf
Published: January 2008

This paper presents a structured survey of the West German health care and health insurance system, and analyzes major developments of current German health policy. In order to make the analysis more accessible to a largely American audience, brief historical remarks, comparisons with U.S. experience, and considerable data and tabular information are provided.

The German statutory health insurance scheme is known as a very comprehensive and generous one. However, under the pressure from rapidly expanding health care expenditures and a severe economic recession, the German governments under Helmut Schmidt and his successor Helmut Kohl imposed a number of cost-containment measures, namely a change in the mode of remuneration for physician services, certain regulations of the drug market, and increased cost-sharing. Cost-sharing is especially favored by the new conservative-liberal government. The article concludes with a summary of striking similarities between the American and German health care schemes, and an outlook on proposals for reform which are currently under investigation by the German government.
The New Israeli Health Care Reform: An Analysis of a National Need
Authors: Ellencweig Avi Yacar
Published: January 2008

This paper describes the current situation of health care services in Israel. Major problems are discussed and analyzed in terms of the dualism of the main health organizations (the Ministry of Health and the General Sickness Fund), the multiplicity and discontinuity of health care delivery, quality-of-care problems, and the uneven geographical distribution of facilities. A proposal for a reform of the health care system is outlined, and its principles enumerated. This reform, suggested by the Ministry of Health, reflects a new approach of separating the direct provision of care from the executive functions of planning and control of services. The Ministry's proposal is analyzed, and its implications are discussed in relation to the American health care system.
Local Complexity and Central Bureaucracy in Finnish Health Care Planning
Authors: Ståhlberg Krister
Published: January 2008

The 1972 Primary Health Care Act in Finland has generally been considered very successful. In many respects this may be true. From an administrative point of view, however, this act has not worked satisfactorily. Data are given on the bureaucratic inertia introduced by the new planning system mandated by the act, and some general criticism is offered of the claims of success made by public health officials.
Worker Injuries: The Effects of Workers' Compensation and OSHA Inspections
Authors: Robertson Leon S. , Keeve J. Philip
Published: January 2008

Detailed analysis of work exposure and worker attributes failed to explain changes in injury claims in three plants, each in a separate state, during 1973-1980. When relative exposure to hazard and worker attributes are controlled, changes in injury rates are largely explained by increases in Workers' Compensation greater than inflation and by inspections made by the Occupational Safety and Health Administration (OSHA). Rises in Workers' Compensation greatly increased the claims for injuries, while OSHA citations substantially decreased objectively verifiable injuries in the year following an inspection. Data on days lost due to injury in 167 industrial groupings in 20 states also indicate significant reductions of workdays lost in correlation with OSHA inspections, when increases due to Workers' Compensation are controlled. The results thus appear to be generalizable. Previous studies of OSHA failed to adequately control for Workers' Compensation effects, and thus underestimated the effects of OSHA.
Reducing Public Expenditures for Physician Services: The Price of Paying Less
Authors: Gabel Jon R. , Rice Thomas H.
Published: January 2008

The purpose of this paper is to examine how physicians respond to changes in payment levels from government insurers. Our analysis focuses on two issues: controlling overall program expenditures, and assuring full access to care for program clients. We review evidence from natural experiments in which payment levels were increased, frozen, or decreased. These studies show that freezing or reducing payment levels is not effective in controlling program expenditures, because physicians responded by increasing the quantity and complexity of services provided. Furthermore, when government programs freeze or reduce their payment levels, physicians are less likely to treat the clients of these programs. We conclude that policymakers must seek alternative strategies for controlling program expenditures.
The Life and Death of a Field Experiment: A Case Study of Health Care Research in a Hostile Environment
Authors: Yesalis Charles E. , Levitz Gary S.
Published: January 2008

This paper discusses the effects of powerful confounding events on the evaluation of an innovative health care payment program—an experiment with capitation payment for pharmacy services for Medicaid recipients. The research, conducted at the University of Iowa from 1975 to 1982, used a sophisticated experimental design; it was funded by the National Center for Health Services Research, the Health Care Financing Administration, and the State of Iowa, representing an investment of over two million dollars. Despite this investment, and the interest of many at the national level, events in the research environment during this period may well have distorted the conclusions of the research. Thus this case study highlights the problems of conducting evaluation research. particularly social experiments, on innovative programs perceived as threatening to the status quo.
State Rate-Setting and Its Effects on the Cost of Nursing-Home Care
Authors: Holahan John
Published: January 2008

The paper uses data from nursing-home cost reports to analyze the effectiveness of different approaches to nursing-home reimbursement. Our research has produced considerable evidence on the effect of states' efforts to reduce the rate of increase in nursing-home costs. First, homes in states with flat-rate reimbursement systems were found to have lower rates of increase than homes in other states, while there were no consistent differences between the results of prospective and retrospective systems. Second, efficiency incentives, inflation-projection methods, and the level of ceilings on rates appear to be very important, regardless of the general reimbursement method. For example, prospective systems with weak efficiency incentives, generous inflation adjustments, and high percentile ceilings have lesser cost-containment effects than prospective systems with stringent inflation allowances and low percentile ceilings. There is also evidence that the inherent weakness of the cost-containment incentives in retrospective systems can be offset by low percentile ceilings and efficiency bonuses.
Marie-Sophie Masse, La description dans les récits d'Antiquité allemands fin du XIIe-début du XIIIe siècle. Aux origines de l'adaptation et du roman. 2004
Authors: Kern Manfred
Published: January 2008

Die von der Université d'Amiens mit dem prix de thèse bedachte Untersuchung von Marie-Sophie Masse gehört zu einem Forschungsgebiet, das es in allen philologischen Disziplinen zu neuer Konjunktur gebracht hat. Im Unterschied zu einer medientheoretisch perspektivierten Studie wie jener Haiko Wandhoffs wählt Masse einen traditionelleren, philologisch und narratologisch orientierten Zugang, und sie tut dies mit nicht geringer Fortune. Interesse verdient ihre Arbeit auch deshalb, weil sie der germanistischen Mediävistik den Diskussionsstand der französischen Philologie zur Kenntnis bringt und vice versa in deren Kontext die altgermanistische Forschung entsprechend plaziert.
Elisabeth Rothmund, Heinrich Schütz (1585–1672): Kulturpatriotismus und deutsche weltliche Vokalmusik. „Zum Auffnehmen der Music / auch Vermehrung unserer Nation Ruhm“. 2004
Authors: Braun Werner
Published: January 2008

Wie grundsätzlich jeder Komponist des 17. Jahrhunderts schrieb Heinrich Schütz auch weltliche Werke, die aber als Gelegenheitskompositionen für den kurfürstlichen Hof in Dresden weitgehend ungedruckt blieben und unter Kommunikationsverbot standen. So erklären sich die frühen starken Verluste. Im günstigen Fall blieben die Worttexte übrig. Vorliegende germanistische Aufarbeitung bereichert auch die Musikwissenschaft. Der schon im Titel herausgestellte „Kulturpatriotismus“ korrigiert darüber hinaus nationalistische Tendenzen der älteren Forschung: Es ging um einen angestrebten kulturellen Gleichstand mit Italien. Daß Schütz – anders als sein Kollege Johann Hermann Schein – die eigene Dichtung bloß als Notbehelf auffaßte (vgl. S. 140), öffnete ihm den Weg zu Martin Opitz.
Ralph Häfner, Götter im Exil. Frühneuzeitliches Dichtungsverständnis im Spannungsfeld christlicher Apologetik und philologischer Kritik (ca. 1590–1736). 2003
Authors: Mulsow Martin
Published: January 2008

Das Materialobjekt der vorliegenden Arbeit, einer Berliner Habilitationsschrift aus dem Jahre 1998, bildet mit dem frühneuzeitlichen Dichtungsverständnis ein in fast allen seinen Facetten und Beziehungen bereits eingehend erforschtes Thema, zu dem auch die ‚produktive‘ beziehungsweise ‚aemulative‘ Rezeption der spätantiken, heidnischen und frühchristlichen, Gelehrsamkeit durch die „christliche Dichtung“ im Zeitalter des „christlichen Humanismus“ (S. XVIIf. und passim) gehört. Das Formalobjekt der Studie soll durch die beiden im Untertitel genannten Faktoren gewonnen werden, die Häfner zufolge für das Dichtungsverständnis des 17. und frühen 18. Jahrhunderts konstitutiv waren, philologiegeschichtlich ausgedrückt, in der Zeit zwischen dem jüngeren Scaliger und Johann Albert Fabricius: zum einen eine philologische Textkritik, die durch das Vorbild der spätantiken Polymathie geprägt war, zum anderen der dieser Textkritik inhärierende und nie aufgegebene christlich-apologetische Grundzug. Häfner möchte erstens zeigen, daß das „aemulative Element“ dieses Rezeptionsgeschehens „ganz wesentlich durch die Überlieferungsformen des ‚alten‘ Textes selbst bedingt“ war (S. XXIII), das heißt, daß in diesem Zusammenhang der zeitgenössischen Philologie des überlieferten Textes eine zentrale Funktion zukam. Zweitens geht es ihm darum, am Leitfaden der wechselnden Verhältnisbestimmungen von biblischer Poesie und je zeitgenössischer ‚christlicher‘ Dichtung die grundlegende Bedeutung darzulegen, welche die Differenz zwischen zwei konträren Wissensarten, nämlich Offenbarungswissen von heilsgeschichtlicher Relevanz und Wissen bloß menschlichen Ursprungs, für das Poesieverständnis des untersuchten Zeitraums hatte. Denn der systematische Ort der Poesie im Kanon der Disziplinen und damit der ihr zugebilligte oder für sie beanspruchte Erkenntnis- und Wahrheitsgehalt habe sich „jedesmal aus einer Bestimmung des spannungsreichen Verhältnisses zwischen philologischer Kritik und prophetischem Wissen“ ergeben (S. XXV).
Isolde Schaad, Vom Einen. Literatur und Geschlecht. Elf Porträts aus der Gefahrenzone. 2004
Authors: Fues Wolfram Malte
Published: January 2008

Vom Einen. Oder nicht eigentlich von Zweien? Isolde Schaad zitiert Hannah Arendt: „Mann und Frau können […] nur gleich menschlich sein, indem sie voneinander absolut verschieden sind.“ Das besage, „was die Frauenbewegung anstrebt“ (S. 100). Wenn Mann und Frau absolut verschieden sind, wissen sie nichts voneinander, auch nichts von ihrer Verschiedenheit. Um sie zu erfahren, müssen Mann und Frau sie aufheben, sie in eine Bezugnahme verwandeln, deren Form von ihrem Inhalt verneint und verworfen wird. Ihre gemeinsame Menschlichkeit, in der allein Mann und Frau sich als Mann und Frau wahrnehmen und begreifen können, liegt also in einer Übereinkunft, deren Scheitern ihre Notwendigkeit immer von neuem bestätigt und hervorruft.
Michael Braun, „Hörreste, Sehreste“. Das literarische Fragment bei Büchner, Kafka, Benn und Celan. 2002
Authors: Schöttker Detlev
Published: January 2008

Kaum eine literarische Form erfreut sich bei Schriftstellern und Literaturwissenschaftlern so großer Beliebtheit wie die des Fragments. Das Unabgeschlossene als Erscheinungsform von Texten und das Unvollendbare als deren philosophische Entsprechung gelten als Inbegriff der Moderne, seitdem Friedrich Schlegel im Athenäum meinte, „viele“ Werke der „Neuern“ seien schon bei der Entstehung „Fragmente“, und Hofmannsthal einhundert Jahre später seinen Lord Chandos in einem fingierten Brief gestehen läßt, ihm sei „völlig die Fähigkeit abhanden gekommen, über irgend etwas zusammenhängend zu denken oder zu sprechen“. Solche Bekenntnisse haben Schriftsteller im 20. Jahrhundert unablässig wiederholt, während die Literaturwissenschaft Belege über Belege gesammelt hat, um die Auffassung der Modernität des Fragmentarischen zu bestätigen und geschichtlich einzuordnen.
Content Analysis of an LIS Job Database: A Regional Prototype for a Collaborative Model
Authors: Du Yunfei , Stein Barbara , Martin Robert S.
Published: January 2008

Digital libraries are increasingly serving a worldwide audience. Persons of different cultural backgrounds can hold diverse perceptions of what constitutes an effective, efficient and satisfying information-seeking experience, and digital library design therefore grows more complex when its user population traverses cultural boundaries. This paper reviews the state of research on cross-cultural digital library usability and identifies reasons for lack of progress in the field. An improved framework is proposed to support the discussion and evaluation of subjective cultural factors in a deeper, more systematic fashion. The cognitive theory of Howard Gardner, multiple intelligences theory, is explored as one potential framework for exploring cross-cultural digital library usability. Each component of Gardner's theory is introduced, placed in a cultural context, and then briefly reviewed in terms of its potential application to digital libraries. Alternative frameworks, particularly the cultural dimensions theory of Geert Hofstede, are also introduced. Multiple intelligences theory is found to be helpful for understanding the nature of cultural variables, but not readily translatable into operational design principles for digital libraries. Combining multiple intelligences cognitive theory with cultural theory and global HCI design principles may prove a useful direction for future research.
Information Environment of Artisans in Botswana
Authors: Mooko Neo , Aina L. O.
Published: January 2008

A survey of 439 artisans in Botswana was carried out with a view to determining their information needs, information seeking behaviour and sources of information used for meeting their daily needs. The study reveals that about 70% of the respondents were 21–40 years old. The artisans were involved in a variety of vocations, dressmaking, welding and hair dressing being the most prominent. A significant number of the artisans (11.7%) had no formal education. The greatest job-related information needs were in finding sources for raw materials (55.6%), locating government tenders (46.2%) and improving their knowledge (44%). Health (59.9%) and sports (32.1%) were the major general areas of information needs. The artisans sought information mainly through informal conversations (65.8%) and listening to radio (62.6%). The most used information sources were radio (50.3%), colleagues (49%) and newspapers (47.4%). Only 28% of the respondents were computer literate. The paper recommends that the government of Botswana should provide continuing education programmes for the artisans, as this would improve their skills in their vocations, as well as their computer literacy competence. Also, information providers, such as libraries should be involved pro-actively in the provision of information to artisans. They should also equip the artisans with information literacy competence.