A week in the life of a hospital

The same urgency and intellect that America's teaching hospitals apply to saving lives is now also going into saving the institutions themselves. All across the country, academic medical centers are trying to figure out how to marry progress with profits. At the Duke University Medical Center, TIME visits the front line in the war between money and medicine.     

A decade of decline: a longitudinal look at big city and big county strategies to cope with declining revenues

Many local governments have now endured a decade of fiscal decline due to periodic reductions in external funding (federal and state and slowdowns in the rate of growth of the state and local government sector. This research examines the extent to which six large jurisdictions (three cities, three counties) under fiscal duress avoided political conflict and prevented further fragmentation of their authority between 1978 and 1987. The results showed that local officials generally chose retrenchment strategies (revenue, expenditure, and borrowing) with the least anticipated political opposition; but where hard choices had to be made (personnel reductions), they were made without hesitation. The timing of politically unpopular choices to coincide with downward trends in the private sector reduced the level of political fallout, even in heavily unionized, socioeconomically diverse communities. The results also showed that local officials strongly endorsed, rather than opposed, strategies that further fragmented their authority (privatization, intergovernmental cooperative agreements), because these approaches produce significant personnel and capital savings in the short term. Finally, the results indicated that the long-term cumulative effects of short-term decremental decisionmaking on the quality of life (as measured by drops in bond ratings) were negative in only one-third of the jurisdictions.     

Science and technology in the transition: A review article

David A. Dyker (ed.), The Technology of Transition: Science and Technology Policies for Transition Countries. Budapest: Central European University Press, 1997, ix + 292 pp., £37.50.

Mark Steven Frankel & Jane Cave (eds), Evaluating Science and Scientists: An East‐West Dialogue on Research Evaluation in Post‐Communist Europe. Budapest: Central European University Press, 1997, x + 226 pp., £37.50 h/b, £15.99 p/b.

Paul J. J. Welfens & George Yarrow (eds), Telecommunications and Energy in Systemic Transformation: International Dynamics, Deregulation and Adjustment in Network Industries. Berlin/Heidelberg: Springer‐Verlag, 1997, xi + 501 pp., DM178.00.