Tension, compression, and shear: directions, stresses, and outcomes of health care cost control

"Control" of health care costs is often portrayed as a struggle between external, "natural" forces pushing costs up and individuals, groups, and societies trying to resist the inevitable. This picture is false. Control includes strenuous efforts by some to raise costs, and by others to resist those increases, and/or to transfer costs to someone else. But all such forces originate in the purposes and interests of individuals and groups. Health care cost control is a struggle among conflicting interests over the priorities of a society, and claims of "inevitability" are simply part of the political rhetoric of that struggle. International experience supports certain conclusions. First, there is no basis for the claim that limits on expenditure growth must threaten the health of (some members of) a society. Second, there is a substantial variety of experience with cost control. Failure in the United States is often presented as evidence of the impossibility of control, but most other countries have succeeded. Finally, control requires the direct confrontation of interests, with substantial build-up of stress. Advocates of expansion are more successful if they can transform compressive forces into efforts to shift the burden onto someone else. Pressures from providers in every country for "privatization" and/or payment by users reflect this recognition of economic interest.     

Pitfalls in state-authorized treatment of minors

Recently a federal court in Georgia ruled that several physicians and several state officials could be sued for state-authorized treatment of a minor over his father's objection. State authorization protects providers only if it is properly obtained and the authorizing official has the power to grant the authorization in the existing circumstances.     

Euthanasia: a challenge for the forensic toxicologist

People die daily in the hospital. Mostly, they die because their illnesses were no longer treatable (natural death). Unfortunately, some people die an unnatural death, in particular, as the result of euthanasia. In contrast to the situation in most countries, in the Netherlands euthanasia is accepted by the courts under strict conditions. It can be very difficult for the legal authorities to establish whether a person has died from natural causes or from suicide, euthanasia, or murder. In addition to the pathologist and the lawyer, the toxicologist also has a number of problems in showing whether euthanasia has been carried out. These can consist of the following analytical problems: (a) interactions--the patients involved have frequently been receiving a large number of toxic and nontoxic drugs simultaneously; (b) identification--not all drugs administered are included in general screening procedures; (c) metabolites--a large number of metabolites may have accumulated toward the end of a long therapeutic regimen; and (d) determination--determination of quaternary muscle relaxants and their various metabolites, as well as other drugs, can be problematic. There are also toxicokinetic problems; because of poor kidney and liver function, low serum albumen, general malaise, and interactions between these factors and other drugs, the kinetics of a given drug can differ from normal. This makes it all the more difficult to determine whether the patient died from an accumulation of medication or from a so-called "euthanetic" drug mixture.(ABSTRACT TRUNCATED AT 250 WORDS)     

2 fatalities due to hyperthermia in infancy. A contribution to forensic medicine case reports of death caused by heat

Two infants aged 4 1/2 and 8 months are reported to have been exposed to overheating by an electric blanket and a heating fan in bed for a period of up to approx. 19 hours. Dehydration complicated the effects of overheating. Due to the case history in combination with the autopsy and histological findings as well as the absence of toxicological findings the following diagnosis could be established: "Death from exhaustion as a consequence of long-lasting heat effect and dehydration." The necessity of thorough investigations in causes of death during infancy is shown by means of the two cases above. If possible, the rectal temperature should already be taken by the coroner. The public should get informed about the risks caused by the use of electric cushions, heating fans as well as floorboard heating.     

Religious influence on parental attitudes toward the use of corporal punishment

Certain Biblical passages if interpreted literally can be understood as advocating the use of corporal punishment in disciplining children. The purpose of this research was to determine if persons affiliated with religious denominations which emphasized a literal belief in the Bible would demonstrate less appropriate attitudes with regard to discipline than their counterparts who were affiliated with religious denominations which do not subscribe to a literal interpretation of the Bible. The sample consisted of 881 persons who were members of denominations classified as literal or nonliteral believers. Statistically significant differences were noted on the Physical Punishment Scale of the Adult Adolescent Parenting Inventory with persons, regardless of gender or their level of education, who were members of churches subscribing to a literal belief in the Bible preferring the use of corporal punishment over alternate methods of discipline as compared to their nonliteral counterparts.     

A risk marker analysis of assaulted wives

In the wife assault literature, a number of risk markers have been identified. Using the data of the female respondents to the National Family Violence Survey (n = 699), a multivariate analysis was performed to examine which risk factors best differentiated between women involved in nonviolent relationships, verbally aggressive relationships, relationships exhibiting minor physical aggression and severely violent relationships. High levels of marital conflict and lower socioeconomic status emerged as the primary predictors of an increased likelihood of wife assault. Research implications are discussed.     

Technology-transfer strategies of DOE's conservation programs

This paper examines the process by which R&D results funded by the Office of Conservation and Renewable Energy (CE) of the US Department of Energy (DOE) have generated commercial applications. It looks at examples of technology-transfer procedures and activitees across three of CE's component offices that correspond to the major energy end-use sectors: transportation, buildings, and industry. On the surface, the conservation programs would appear to have little strategic consistency and, therefore, lack the clear leadership many seek in a technology-transfer program. However, as an alternative to strategic consistency, one may tailor the technology-transfer approach of each program to its unique circumstances. This paper presents case studies of such tailoring, in which the diversity of approaches mirrors the complexity of the energy end-use markets and the private-public interests that must be negotiated to successfully commercialize energy-saving innovations. The paper discusses the lessons learned about the conditions requiring adaptive design and the structures and practices that have been proven effective.     

Underlying patterns in a current economic development model

Public officials may subjectively use a variety of elements, including economic characteristics and political considerations, in their selection of locations and allocation of resources for economic development. Policy capture is a method that determines the impartial weighting of a broad number of elements which influence these decision makers as they operationalize programs. Non-political criteria that may influence the selection of sites for local economic development provide the basis of the analysis conducted in this paper. Public officials at various levels of responsibility assessed the chances of creating jobs for disadvantaged residents (employment success) for a variety of hypothetical areas chosen as an enterprise zone. Their responses give insight into policy decisions. There is a comparison of both individual responses and groups of respondents to the hypothetical data as well as to actual zones that were recently selected. Concluding remarks will discuss these results and the application of this method for enterprise zones and other policy analyses.We wish to acknowledge the extensive helpful suggestions of the editor and two anonymous reviewers.