Physicians as gatekeepers: illness certification as a rationing device

Illness or disability is often used as an eligibility criterion by public programs that distribute money, services, privileges, and exemptions. Physicians then play a central role in the allocation process. But physicians are caught between a large pool of applicants who want some benefit, on the one hand, and an organization with limited resources to distribute, on the other hand. Three conflicts are engendered in this gatekeeping role: the tension between trusting and mistrusting information provided by the patient, the tension between erring on the false positive side and the false negative side in diagnostic decision-making, and the tension between doing everything possible for each patient and allocating limited resources among several needy clients. Several non-medical factors influence the ultimate outcome of this allocation process, which, in theory, rests on clinical decision-making: the specificity and restrictiveness of the formal definitions of illness and disability used by a program; the structure of the determination process; the overall policy of the organization on distribution of benefits; and the ability of the organization to use administrative review, direct incentives, and written standards to control the certifying behavior of physicians.     

Electronic gatekeepers: Locking out the marketplace of ideas

The Hutchins Commission was concerned that the small minority of the people controlling the press as an instrument of mass communication could misuse their gatekeeping power. Due to new communication technologies the abundance of media outlets has increased choices available to the public far beyond anything commission members could have envisioned. This, in turn, has led to the development of a second layer of electronic gatekeepers between information originators and the public. The effect these electronic gatekeepers will have on the evolution of the press will be as great as, if not greater than, that of the human gatekeepers who were the commission's focus. This article suggests there will be an increasing equation of the public interest with what the public is interested in, a reduction in people's knowledge of public affairs and a decrease in the exposure of individuals to new ideas or ideas that contradict their existing beliefs. The article concludes by questioning whether government regulation is capable of addressing these concerns.     

法人类学作为独立学科的诞生及其他

法人类学是一门独立的学科。作为一门独立的学科,法人类学究竟是什么时候诞生的?从以前有关法人类学诞生的界定来看,似乎给人以法人类学与人类学同时诞生或者法人类学先于人类学诞生的暧昧叙述。事实上,法人类学诞生在19世纪末的德国,是从民族学和历史学中分离出来的。波斯托和科勒是创始时期的杰出代表,而马林诺夫斯基的“功能观点”是法人类学在理论上成熟的重要标志。     

Nexus between fiscal imbalances,green fiscal spending,and green economic growth: empirical findings from E-7 economies

Economic Change and Restructuring - The green economy is viewed as a cost-effective means of achieving sustainability around the globe, and a recent study inferred the nexus between the fiscal...     

Medicare's fiscal problems: an imperative for reform

Many observers have noted that Medicare expenditures will significantly outstrip projected revenues over the course of the next 25 years. This paper examines the economic and demographic assumptions behind forecasts of Medicare hospital insurance and supplementary medical insurance expenditures and revenues and analyzes various strategies for closing the impending gap. It is argued that the present forecasts already assume considerable success in controlling hospital costs and physician payments, making substantial further savings unlikely. Shifting more of the burden onto the elderly through increased cost sharing or higher premiums also will not solve the program's fiscal problems over the long term. The remaining alternative--imposing higher income or payroll taxes on the under-65 population--is also unlikely to be a welcome solution. The authors argue that, eventually, the nation must choose between some form of a two-tier system of benefits or a Canadian-style national health insurance system.     

传销犯罪独立成罪的合理性及模式——兼评《刑法修正案（七）》

我国传统的传销定罪模式将非法经营罪作为传销的基础犯罪,这不符合传销行为多样性、客体多重性和目的多样性的特点.传销犯罪在我国刑法典中应当独立成罪,这有利于实现传销罪名与罪质的统一、扩大传销犯罪的惩治范围、实现与<禁止传销条例>的协调和避免不必要的国际贸易摩擦.在传销犯罪的立法模式上,<刑法修正案(七)>(草案)-稿采取的是预备式立法,二稿和<刑法修正案(七)>采取的是概括式立法.两稿在立法模式上仍存在一定不足,应综合采用概括式立法和预备式立法.     

Testing the impact of fiscal policies for economic recovery: does monetary policy act as catalytic tool for economic Survival

Economic Change and Restructuring - This study seeks to evaluate the efficacy of macroeconomic revamping policies operationalized after the pandemic by fiscal and monetary regulators to fight the...     

质疑独立担保无效说

独立担保是社会发展的产物,但在我国担保法上和司法实践中却被认定为无效担保。对独立担 保的效力的绝对否定有无理论缺陷和实践弊端,应如何正确确定独立担保的效力与后果,对此作 了分析并提出了相应的立法建议。     

Independent Neuropsychological Evaluations

Unlike clinical practice, entering the realm of independent neuropsychological evaluations and similar types of nonclinical evaluations is an area of professional practice for which most neuropsychologists have little to no training. Many ethical and professional issues and challenges arise with such frequency in this type of work that it would be difficult to justify not being prepared for them. For the practitioner looking for guidance and standards of professional conduct in this arena, there are few comprehensive resources that address the range of issues raised by these types of evaluations and/or a clear standard by which to assess their competence. The purpose of this article is to provide a primer (and/or refresher) to acquaint the practitioner with some of the more salient issues associated with conducting these types of assessments and to review the pertinent literature that is evolving in relation to best practices in this area.     

Medicare program; data, standards and methodology used to establish fiscal year 1992 budgets for fiscal intermediaries and carriers--HCFA. Final notice

This notice is published in accordance with sections 1816(c)(1) and 1842(c)(1) of the Social Security Act which require us to publish the final data, standards and methodology used to establish budgets for Medicare intermediaries and carriers. It announces that we are adopting as final without revision proposed data, standards, and methodology used to establish Medicare fiscal intermediary and carrier budgets for the fiscal year (FY) 1992, beginning October 1, 1991. It also contains our response to public comments on the proposal.     

Medicare program: data, standards and methodology used to establish fiscal year 1993 budgets for fiscal intermediaries and carriers--HCFA. Final notice

This notice is published in accordance with sections 1816(c)(1) and 1842(c)(1) of the Social Security Act which requires us to publish the final data, standards and methodology used to establish budgets for Medicare intermediaries and carriers. It announces that we are adopting as final, and responds to comments about, the data, standards, and methodology we proposed to use to establish Medicare fiscal intermediary and carrier budgets for the fiscal year (FY) 1993, beginning October 1, 1992.     

Medical and dental services fiscal year 1998--DoD. Notice

Notice is hereby given that the Deputy Chief Financial Officer in a memorandum dated September 26, 1997 established the following reimbursement rates for inpatient and outpatient medical care to be provided in FY 1998. These rates are effective October 1, 1997.     

Medicare program: data, standards, and methodology used to establish fiscal year 1994 budgets for fiscal intermediaries and carriers--HCFA. Final notice

This notice is published in accordance with sections 1816(c)(1) and 1842(c)(1) of the Social Security Act which require us to publish the final data, standards, and methodology used to establish budgets for Medicare intermediaries and carriers. In this notice, we respond to the comments received in response to our notice of October 5, 1993 and we announce the adoption of the proposed data, standards, and methodology that we used to establish the Medicare fiscal intermediary and carrier budgets for fiscal year (FY) 1994, beginning October 1, 1993, as final and without revision.