'Learn from Daqing': More dark clouds for workers in state-owned enterprises

Now that China has joined the World Trade Organization, workers employed in the already hard-hit state-owned sector of the economy face the certain prospect of massive new lay-offs. Already, in the early months of 2002, China has seen its largest labor demonstrations since 1949. Not surprisingly, these took place at struggling state-owned enterprises that have recently dismissed thousands of workers. These workers have expressed a great deal of anger at their situation and show little faith in the Communist Party-approved union's--the All China Federation of Trade Unions--ability to protect their interests. For this reason, they have formed an independent trade union, even though the Chinese government has declared such unions illegal. This article provides a context in which to understand these increasingly serious tensions and argues that, without a fundamental change in direction on the part of the Communist Party, China is sure to witness further and more explosive labor problems in the near future.     

Technology transfer at land-grant universities

Improvement in the ability of universities in the United States to transfer technology to the private sector is seen as a factor in strengthening American competitiveness. To better understand the university's role in this process, a survey of formal university programs in technology transfer was performed through personal interviews at four midwestern land-grant universities. There are six basic types of programs in place: technical assistance, affiliate, licensing, business development, incubators and research parks, and information networks. For purposes of classifying these programs, we used the model developed by Janis et al. (1) It was found that, of the six modes of technology transfer, two could be considered active, three semi-active and one passive.     

Life on the atoll: Singapore ecology as a neglected dimension of social order

Based on field interviews in Singapore in 1985, 1997, and 2003, this article addresses the issue of how island ecology helps explain the remarkable low rates of crime that are often attributed mainly to cultural and government policies. Understanding crime and control on this most densely populated Southeast Asian atoll must begin with how people are dispersed over the limited spatial area. Ecology also influences how styles of some crimes are defined and controlled. Several of Donald Black's propositions are given further consideration.     

The who, what, and why of risk adjustment: a technology on the cusp of adoption

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.     

"Medical necessity" determinations--a continuing healthcare policy problem

To promote an understanding of the implications of current structures and processes for medical necessity determinations that affect everyone, directly or indirectly, the American Health Lawyers Association will devote its biannual Public Interest Colloquium (to be held in February 2005) to the topic. In preparation for the colloquium, the author summarizes the history and current importance of the topic, identifies stakeholders in the system and their interests, and sets forth a preliminary list of issues to be considered by the colloquium participants, focusing on potential elements of an ideal system for making medical necessity determinations.