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141.
Concern over the rising cost of medical care has focused policy attention on methods of paying physicians. Unfortunately, limits placed on fees paid by public medical care financing programs, Medicare and Medicaid, adversely affect those programs' primary objective: making office-based physicians' services available to the poor and the elderly at affordable prices. This suggests that a second policy instrument, controls on physicians' private charges, may be needed. The Economic Stabilization Program (ESP) provides the only recent U.S. experience with a system which constrained both physicians' private charges and public payments. Using Medicare and Medicaid claims data for a large sample of California physicians, we simulate what physicians' private charges and supplies of services to Medicare assignment and Medicaid patients would have been in the absence of ESP. The simulations suggest that without ESP, private charges would have been higher and the quantities of services provided to poor and elderly patients lower than were actually observed. We believe, therefore, that the ESP experience supports the argument that controls over both public and private fees are needed in order to simultaneously contain costs of and maintain access to physicians' services by Medicare and Medicaid beneficiaries.The research for this paper was supported by Contract No. 600-76-0054 from the Social Security Administration, USDHEW. We wish to thank our colleagues Judith Feder, John Holahan, William Scanlon, and Judith Wagner for their helpful comments. James Bluck provided excellent research assistance. The findings and opinions expressed in this paper are solely those of the authors, and do not necessarily reflect the positions of either The Urban Institute or The Department of Health, Education, and Welfare. 相似文献
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The purpose of this article is twofold: (1) to summarize the theoretical frame-work, methodological orientation, and gender-differentiated findings of our ongoing study of the personality context, prospective and concurrent, for depressive symptoms at age 18; and (2) to report new longitudinal relations between preadolescent play constructions (at age 11) and depressive tendencies reported seven years later. Eighty-seven 18-year-olds completed the Center for Epidemiological Studies Depression Scale (CES-D). Seven years earlier, at age 11, the subjects were observed in a play construction situation. Six psychologically coherent, reliable play composite variables were generated from the codings of videotapes and related longitudinally, in a hierarchical polynomial regression design, to the later CES-D scores. Among preadolescent girls, concern with morality and loss foretold, linearly, depressive experiences. The quadratic regression function explained additional variance: relative to girls receiving intermediate CES-D scores, girls earning loworhigh scores were seen as more overcontrolling of impulse, more angry, and more concerned with loss. Among preadolescent boys, only curvilinear relations were obtained. Relative to boys receiving intermediate CES-D scores, boys earning loworhigh CES-D scores were seen during preadolescence as more undercontrolling of impulse, more angry, and more concerned with loss as theme. The implications of these findings are discussed.This study was supported by National Institute of Mental Health Grant MH 16080 to Jack Block.Received Ph.D from University of California at Berkeley in 1984. Major research interests include socio-emotional development in adolescence, developmental psychopathology, and cross cultural perspectives on development.Received Ph.D from Stanford University in 1950. Major research interests include logitudinal analyses of personality and cognitive development, personality theory, and personality assessment. 相似文献
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This preliminary note reports clinical interviews at the Oregon State Penitentiary with 22 children, ages 5 through 15, visiting their imprisoned fathers. A majority of these children were found to be socially isolated. All the children placed a high value on the prison visits, but also demonstrated a variety of conflicted feelings about their incarcerated father. These findings highlight the need for more data on children and families of imprisoned parents and for consistent and well-conceptualized policies of family visitation. 相似文献
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This study is designed to evaluate the correlation between fatal vehicle crashes (FVC) and consumption of alcohol and/or drugs among drivers. Between 1996 and 2000 in Hong Kong, a total of 197 FVC cases of deceased drivers were investigated. The blood and/or urine samples of the victims were examined for the presence of alcohol and drugs. The 197 cases were then classified into two groups: single-vehicle crashes (SVC) and multiple-vehicle crashes (MVC). Out of the 106 cases for the latter group, alcohol and/or drugs were detected in 22 cases (21%) while the remaining 84 cases (79%) were regarded as no significant finding. As for the 91 cases in SVC group, 51 cases (56%) were positive for alcohol and/or drugs. The findings indicate that a driver consuming alcohol and/or drugs has a higher risk of being involved in a FVC. The most frequently detected drugs for SVC group (11 cases) were: 46% central nervous system (CNS) stimulants (including designer drugs like MDMA); 36% cannabis; 18% benzodiazepines and 9% ketamine. The detected drug for the only case in the MVC group was a CNS stimulant. The number of cases with ketamine, methamphetamine and MDMA detected has increased in recent years as these party drugs have gained popularity in Hong Kong. 相似文献
149.
In Hong Kong, ecstasy tablets are more commonly known as "Fing Tau Yuen", literally meaning "Shake Head Pills". The tablets contain mainly amphetamine-type stimulants (ATS) including 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), methamphetamine (MA) and/or ketamine. Adulterant such as caffeine was also detected in the tablets. This paper reports a study on the impurity profiles of ecstasy tablets from 89 seizures in Hong Kong from 2002 to early 2004. Tablet samples were extracted by diethyl ether under alkaline condition and then analyzed by gas GC-MS. The chromatograms obtained were compared. A total of 19 identified impurities were selected as markers for impurity profiling. They are different precursors, intermediates and by-products. The data matrices were examined by hierarchical cluster analysis (HCA), and then the ecstasy tablets were classified into different groups. Cluster analysis of ecstasy tablets is shown to be capable of providing intelligence on clandestine laboratory networks. 相似文献
150.