SPECIALIZATION OF NURSING HOME CARE AND OUTCOMES1

Implications of nursing home specialization for health outcomes were examined. The formal hypothesis tested in this study was that facilities specializing in the treatment of certain kinds of residents, as reflected in a critical mass of such residents, are more likely to experience better health outcomes over time compared to facilities that do not specialize in the treatment of such residents. Activities of Daily Living (ADLs), survival, and several diagnosis‐specific outcomes were analyzed for residents. Multivariate state‐dependence and logistic regression models were estimated for residents of six diagnostic sub‐groups. Specialization was empirically defined in terms of concentration of residents with certain diagnoses within nursing facilities. Empirical results indicate that specialization has some positive effects on some outcomes. For instance, facilities specializing in the care of Alzheimer's disease patients appear to produce comparatively better outcomes with respect to restraint use and accidents. Residents with diagnoses of hypertension or ischemic heart disease in specialized facilities also fare better in terms of survival. Residents with a diagnosis of cerebrovascular disease in specialized facilities were found to experience worse outcomes with respect to most of the outcomes modeled in this study, however. Overall, specialization only appears to make a difference in the outcomes of residents with certain medical conditions for some health outcomes. Regression results also indicate that basic measures of frailty such as functional deficiencies, incontinence, and behavioral problems largely contribute to detrimental effects irrespective of the diagnostic group or the outcome considered.     

DEREGULATION OF PARAPROFESSIONALS AND HEALTH CARE COST CONTAINMENT: THE CASE OF DENTISTRY

The author argues that the development of satisfactory market models in dentistry and other health care areas is crucial to a realistic examination of various deregulation proposals. He argues that such examinations cannot rely on the logic of economics alone, but must be rooted in empirical analyses well-founded in theory. Using expanded function dental auxiliaries as an example, the author demonstrates the complexities of the issues involved and the relevance of political economy models.     

THE EFFECT OF THE CHILD-CARE CREDIT ON LOW-AND MIDDLE-INCOME TAXPAYERS' PURCHASES OF CHILD CARE

The child‐ and dependent‐care credit in the Internal Revenue Code is intended to encourage the consumption of commercial day‐care services. This research finds, through econometric analysis of tax returns from 1983 and 1987, that reducing child care's after‐tax price increases child‐care consumption by low‐ and middle‐income taxpayers who purchase commercial child‐care services.     

CHARTING A COURSE THROUGH THE HEALTH CARE POLICY MAZE

Health Policy: Development, Implementation and Evaluation in Australia. By H eather GARDNER (ed.)
The Price of Health: Australian Governments and Medical Politics 1910–1960. By J ames A G illespie
Federalism and Health Policy: The Development of Health Systems in Canada and Australia. By G wendolyn G ray
The President's Health Security Plan. By W hite H ouse D omestic C ouncil
Hospitals in Transition: The Resource Management Experiment. By T im P ackwood , J ustin K een and M artin B uxton     

LATCHKEY CHILDREN AND AFTER-SCHOOL CARE: A FEMINIST DILEMMA?

Many children of working parents regularly care for themselves after school. Questionable findings about the danger of children's self-care (latchkey) arrangements are being used in an effort to obtain public funding for after-school care. The use of this evidence poses a dilemma for feminists and others. Arguing that latchkey children are at risk may improve the chances of receiving funds for child care. But it could also lead to unintended negative consequences for women. Emphasizing the risks of self-care could result in greater social opposition to working mothers. From a feminist perspective, the best argument for after-school care would be one that focuses on the special needs and circumstances of working parents, and does not rely on suspect data that suggest negative consequences of self-care for children's development.     

新晋商·新山西·新跨越 世界晋商大会

8月20日,由中共山西省委、省政府,全国工商联,中国侨联主办的首届世界晋商大会在山西太原隆重召开,共有来自42个国家和地区,65个代表团1500多位晋商应邀参加。这是全球晋商的一件大事,对于山西进一步扩大对外开放、推动转型跨越发展具有重要意义。首届世界晋商大会精彩纷星,内容深刻;特别是在恳谈会议、开幕大会和六个论坛上,嘉宾代表话发展、谈投资、论晋商精神、议晋商人才,为与会者提供了丰盛的思想盛宴。     

LONG TERM CARE REGULATION IN THE STATES: A SYSTEMIC PERSPECTIVE

In recent years there has been growing interest in differing state roles in the regulation of the health care industry. Most of this attention has stressed the impact of regulatory policy with only superficial attention directed towards understanding the extent to which states can be counted on to act effectively in the area of health care regulation. Using the regulation of nursing homes as a focus, this study evaluates a variety of sociocultural, political, and economic conditions for their impact on the development of various regulatory policies. The findings suggest that the development of certificate of need legislation and reimbursement controls were not related to significant changes ir, states' budgets for Medicaid services or in bed/population ratios. Instead, regulatory efforts were more closely linked to the sociopolitical environments surrounding the policy arena. While these factors provide some indication of the potential for strong state action in the regulatory arena, ultimately the use of state regulatory policies will depend quite centrally on the innovative tendencies of the state, its organizational capacity for addressing policy issues, and the nature and extent of interest group politics.