Medical care of individuals residing in substance abuse and recovery homes: an analysis of need and utilization

The current study examined medical care need and utilization patterns among a substance abusing and recovering population (n = 876), investigating factors such as employment and drug use categories (e.g., pharmaceutical use, cocaine use, heroin use, alcohol use). It was found that those who were unemployed needed and utilized greater medical care than those who were employed. Results indicated that heroin, cocaine, and/or alcohol use was not predictive of medical care need or utilization, whereas pharmaceutical drug use was predictive of medical care need and utilization. Trauma and risky use of substances were not significant predictors of medical care need or utilization whereas the suicide severity composite was significant. Potential implications for misuse of medical services (e.g., to obtain pharmaceutical drugs of use) and federal medical care expenditure allocation are discussed.     

Comparing Justice and Labor Department lawyers: ten years of occupational safety and health litigation

Federal regulatory programs are strongly influenced by the outcome of litigation seeking to challenge or to enforce those programs. Competition exists between the Department of Justice and numerous federal agencies for control of that litigation. This article proposes several measures for comparing litigation conducted by the Justice Department with that done by the agency whose program is being-litigated. It then uses case data to compare the Justice Department's and the Labor Department's handling of litigation under the Occupational Safety and Health Act from 1972 through 1980. The findings show relatively little difference attributable to the identity of the litigator in the types or numbers of cases brought, the appeal rates, or the success rates. This suggests that further research, including other measures of difference, are needed to discern whether who controls the litigation matters as much as theory predicts it might and the lawyers involved believe it does.     

No room at the inn: a snapshot of an American emergency room

The emergency rooms of American hospitals have frequently become the principal suppliers of nonurgent primary care to the under- and uninsured. Canvassing published reports and using original data obtained from a representative urban hospital, Erik Olson examines the demographics of the American emergency room and analyzes its finances. The costs of providing primary care are shifted, to the extent possible, to those who can pay. The result is escalating health care costs and a deterioration of quality of care due to overcrowding, leading some hospitals to close their emergency rooms and others to turn away ambulances or "dump" patients who still require critical care. Mr. Olson explains that state antidumping laws and the federal COBRA statute have been ineffective at stemming these practices in the face of severe economic pressure to continue them. Pointing out that emergency rooms are an excessively expensive method of treating uninsured nonemergency patients, he proposes a system of primary care clinics created through a public/private partnership between municipalities and existing private health care providers. The partnership is designed to maintain a high standard of care at the clinics. As an incentive to stimulate the appearance of such clinics, a tax would be imposed on private health care providers; the tax on a given provider would be reduced to the extent that provider subsidizes a local primary care clinic that offers universal coverage, regardless of insurance status. Because the existence of such clinics would reduce inefficient use of hospital emergency rooms, in the long run hospitals should find it less expensive to finance local primary care clinics than to continue to sustain unreimbursed expenses due to improper use of their emergency departments.     

Governance and Growth: A Simple Hypothesis Explaining Cross-Country Differences in Productivity Growth

Cross-country evidence shows that a subset of developing countries isgrowing very rapidly, taking advantage of opportunities to ``catch-up'' atthe same time that other developing countries are growing slowly. We arguethat this is due to differences in the quality of governance. Inparticular we show that productivity growth is higher in better-governedcountries.     

Court compliance as a predictor of postadjudication recidivism for domestic violence offenders

This study evaluated pre- and postadjudication behavior of 220 male defendants convicted of a domestic violence-related offense using court records and police department data. Our goal was the identification of possible predictors for continued criminal behavior that could pose a risk of further harm to victims. Factors identified as significant predictors of defendant recidivism were having two or more court reports of noncompliance with domestic violence treatment, two or more warrants issued by the court for noncompliance, and two or more reports to law enforcement of new criminal activity involving the defendant. Law enforcement reports were the strongest predictor of recidivism, with an odds ratio of 7.7 and confidence interval of 3.0-19.7. These results illustrate the importance of monitoring multiple dimensions of defendant behavior while under court supervision and of communicating information on noncompliance with victims and advocates to assist in safety planning efforts.     

The Kurds in Iraq

The following briefs are edited versions of papers presented at the annual meeting of the Middle East Studies Association in Anchorage, Alaska, November 8, 2003. The editors were Hakan Yavuz and Michael Gunter, whose papers are included below. Why Kurdish Statehood is Unlikely , Michael M. Gunter, professor of political science, Tennessee Technological University, Cookeville, Tennessee Transnational Networks: New Opportunities and Constraints for Kurdish Statehood , Denise Natali, visiting research fellow, Washington Kurdish Institute (WKI); director of WKI's transnational project Turkey and Kurdistan‐Iraq, 2003 , Robert Olson, professor of Middle East and Islamic history, University of Kentucky Could a Kurdish State Be Set Up in Iraq? , Nihat Ali Özcan, author of PKK (Kurdistan ýpçi Partisi) Tarihi, Ideolojisi ve Yönetimi (Ankara: Asam, 1999) Kurdish Reality in an Emerging Iraq , Khaled Salih, University of Southern Denmark Provincial Not Ethnic Federalism in Iraq , M. Hakan Yavuz, associate professor of political science, University of Utah