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171.
Blumenthal D Weissman JS Wachterman M Weil E Stafford RS Perrin JM Ferris TG Kuhlthau K Kaushal R Iezzoni LI 《Journal of health politics, policy and law》2005,30(3):453-473
Risk adjustment (RA) consists of a series of techniques that account for the health status of patients when predicting or explaining costs of health care for defined populations or for evaluating retrospectively the performance of providers who care for them. Although the federal government seems to have settled on an approach to RA for Medicare Advantage programs, adoption and implementation of RA techniques elsewhere have proceeded much more slowly than was anticipated. This article examines factors affecting the adoption and use of RA outside the Medicare program using case studies in six U.S. health care markets (Baltimore, Seattle, Denver, Cleveland, Phoenix, and Atlanta) as of 2001. We found that for purchasing decisions, RA was used exclusively by public agencies. In the private sector, use of risk adjustment was uncommon and scattered and assumed informal and unexpected forms. The most common private sector use of RA was by health plans, which occasionally employed RA in negotiations with purchasers or to allocate resources internally among providers. The article uses classic technology diffusion theory to explain the adoption and use of RA in these six markets and derives lessons for health policy generally and for the future of RA in particular. For health policy generally, the differing experiences of public and private actors with RA serve as markers of the divergent paths that public and private health care sectors are pursuing with respect to managed care and risk sharing. For the future of RA in particular, its history suggests the need for health service researchers to consider barriers to use adoption and new analytic technologies as they develop them. 相似文献
172.
Health care politics are changing. They increasingly focus not on avowedly public projects (such as building the health care infrastructure) but on regulating private behavior. Examples include tobacco, obesity, abortion, drug abuse, the right to die, and even a patient's relationship with his or her managed care organization. Regulating private behavior introduces a distinctive policy process; it alters the way we introduce (or frame) political issues and shifts many important decisions from the legislatures to the courts. In this article, we illustrate the politics of private regulation by following a dramatic case, obesity, through the political process. We describe how obesity evolved from a private matter to a political issue. We then assess how different political institutions have responded and conclude that courts will continue to take the leading role. 相似文献
173.
Bill M Gill P Curran J Clayton T Pinchin R Healy M Buckleton J 《Forensic science international》2005,148(2-3):181-189
Several years ago, a theory to interpret mixed DNA profiles was proposed that included a consideration of peak area using the method of least squares. This method of mixture interpretation has not been widely adopted because of the complexity of the associated calculations. Most reporting officers (RO) employ an experience and judgement based approach to the interpretation of mixed DNA profiles. Here we present an approach that has formalised the thinking behind this experience and judgement. This has been written into a computer program package called PENDULUM. The program uses a least squares method to estimate the pre-amplification mixture proportion for two potential contributors. It then calculates the heterozygous balance for all of the potential sets of genotypes. A list of "possible" genotypes is generated using a set of heuristic rules. External to the programme the candidate genotypes may then be used to formulate likelihood ratios (LR) that are based on alternative casework propositions. The system does not represent a black box approach; rather it has been integrated into the method currently used by the reporting officers at the Forensic Science Service (FSS). The time saved in automating routine calculations associated with mixtures analysis is significant. In addition, the computer program assists in unifying reporting processes, thereby improving the consistency of reporting. 相似文献
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The influence of crime among the elderly was investigated in this study. The study suggests that crime prevention programs among the elderly should be implemented with some reservations. Since the risks of criminal victimization are low among the elderly, it may not be possible to reduce those rates much further, even with elaborate security programs for the elderly. On the contrary, raising the salience of crime by placing great emphasis on preventive behavior may well foster social isolation among the elderly. 相似文献
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Robert?D.?DavisEmail author Cary?D.?Rostow James?B.?Pinkston Dennis?R.?Combs Dennis?R.?Dixon 《Journal of Police and Criminal Psychology》2004,19(1):17-26
This study reports an analysis of Bartol's (1991) Immaturity Index and Hargrave and associates' (1988) Aggressiveness Index
as a measure of police conduct. The correlations between the supervisory ratings and the Immaturity and Aggressiveness indices
were examined for 1020 law enforcement officers. The results showed that Immaturity Index was related to termination for failure
to complete training and insubordination. The Aggressiveness Index was related to a termination for failure to complete training
and several other problematic police behaviors, but was not found to be specifically linked with acts of aggression. Implications
for using these two indices in law enforcement selection are discussed.
Authors' Note: Cary Rostow, Ph.D. is president of Matrix, Inc., Baton Rouge, Louisiana, and is in private practice in Baton Rouge. Robert
Davis, Ph.D., is executive vice-president and director of science, research, and development for Matrix, Inc., and has a private
practice in Baton Rouge. James B. Pinston, Ph.D., is a clinical neuropsychologist within the department of neurology at the
Louisiana State University Health Sciences Center and School of Medicine in Shreveport, Louisiana. Dennis R. Combs, Ph.D.,
is an assistant professor of psychology at the University of Tulsa. Dennis R. Dixon, M.A., is currently a doctoral student
at Louisiana State University. 相似文献