Health care policy: lessons from the past and issues of the future

Liberal distributional values, the increasingly powerful capacity of medicine to provide more and better care, and concern about the health hazards of an industrial society fueled the vast expansion of the health care sector during the last 20 years. That growth was facilitated by a growing economy. The current health policy debate at one level reexamines the distributional bases of entitlement programs, and at another seeks alternative resource allocation mechanisms to reduce the cost of health care. This article has two themes. First, distributional and allocational policies are shown to be intrinsically related, so that the health policy debate is fundamentally a clash between liberal and libertarian values. Second, the inexorable social forces driving the health care system are shown to be the aging of the population and the rapid expansion of technology. The resulting dynamics imply the further growth of the health sector, now in the environment of a sluggish economy. Future policies will have to struggle with how to ration scarce health resources and how to reorient the health care sector to the problems of the aged.     

How many physicians are enough?

Although it is difficult to ascertain whether or not the nation faces an oversupply of physicians in the coming decades, there is no doubt that a health care system can be operated more effectively with a taut supply of medical personnel than with a loose supply. The perception of severe specialty and geographic imbalance, which informed national health policy during the 1960s and 1970s, has been modified by evidence of a significant redistribution in the supply. Increasing numbers of practitioners are likely to effect further escalation in the costs of physician services and total expenditures for health care, even if--in conformity with classical laws of supply and demand--individual physicians' incomes and the relative economic advantage of the profession were to decline. Since the objective of improved access has to a considerable extent been realized, the principal benefit of the loosened supply in the future will be to facilitate the initiation of innovative practice modes and alternative health care delivery systems that offer the potential of improved efficiency and quality.     

Purchasing power of U.S. Social Security benefits abroad, 1970-82

This article examines whether the small number of Social Security beneficiaries living abroad enjoy a higher standard of living than they would with the same benefits if they lived in the United States. The article addresses this question using two methods. First, absolute comparisons of U.S. dollar purchasing power abroad are made using "purchasing power parities," a method recently developed to allow international comparisons of real standards of living. Second, the effects of changes in Social Security benefit levels, exchange rates, and rates of inflation on the relative value of benefits abroad are measured. Both methods show considerable instability in purchasing power of Social Security benefits in the 1970's. Although beneficiaries in 1970 generally could live better abroad than in the United States, this advantage eroded considerably during the 1970's, followed by some improvement in 1981-82.     

B. Reviews: general

A HISTORY OF THE ARAB PEOPLES. By ALBERT HOURANI. London, Faber and Faber, 1991. xviii, 551pp. £25 (hb).

STUDIES IN ARAB HISTORY. Edited by DEREK HOPWOOD. (St.Antony's/Macmillan series.) London, Macmillan, 1990. 189pp. 5 plates and 3 figures.

A HISTORY OF THE SELJUKS: ?BRAHIM KAFESOGLU'S INTERPRETATION AND THE RESULTING CONTROVERSY. Translated and edited By GARY LEISER. Carbondale and Edwardsville, Southern Illinois University Press, 1988. 208pp. Genealogical charts, maps in end covers. $29.95.

THE HISTORY OF THE JEWS IN THE LATIN KINGDOM OF JERUSALEM. By JOSHUA PRAWER. Oxford, Clarendon Press, 1988. xv, 310pp. 5 maps.

ARAB HISTORY AND THE NATION STATE: A STUDY IN MODERN ARAB HISTORIOGRAPHY 1820–1980. By YOUSSEF M. CHOUEIRI. (Exeter Arabic and Islamic Series.) London & New York, Routledge, 1989. xix, 238pp. £35.00

THE END OF EMPIRE IN THE MIDDLE EAST: BRITAIN'S RELINQUISHMENT OF POWER IN HER LAST THREE ARAB DEPENDENCIES. By GLEN BALFOUR‐PAUL. Cambridge, Cambridge University Press, 1991. xxiv, 278pp. £30.00.

THE LETTERS OF T.E. LAWRENCE. Edited by MALCOLM BROWN. Oxford, Oxford University Press, 1991. xi, 564pp. £8.95 (pb).

A PRINCE OF OUR DISORDER: THE LIFE OF T.E. LAWRENCE. By JOHN H. MACK. Oxford, Oxford University Press, 1990. xxvi, 561pp. £9.95 (pb).

UN GRAND RABBIN SEPHARADE EN POLITIQUE 1892–1923. Presented and edited by ESTHER BENBASSA. Mesnil‐sur‐l'Estrée, CNRS, 1990. 263pp.

THE SUPREME MUSLIM COUNCIL: ISLAM UNDER THE BRITISH MANDATE FOR PALESTINE. By URI M. KUPFERSCHMIDT. Leiden, Brill, 1987.

AFTER THE EAGLES LANDED: THE YEMENITES OF ISRAEL. By HERBERT S. LEWIS. Boulder, Westview Press, 1989. xix, 277pp., photographs, glossary.

LAND BEFORE HONOUR: PALESTINIAN WOMEN IN THE OCCUPIED TERRITORIES. By KITTY WARNOCK. (Women in Society: A Feminist List.) London, Macmillan Educational Press, 1990. 199pp.

PEASANT POLITICS IN MODERN EGYPT: THE STRUGGLE AGAINST THE STATE. By NATHAN BROWN. New Haven and London, Yale University Press, 1990. 280pp. 2 maps. £25.00.

SOCIETY AND STATE IN THE GULF AND ARAB PENINSULA. By KHALDOUN HASAN AL‐NAQEEB. London and New York, Routledge, 1990. xvii, 206 pp. £35

THE TURBULENT GULF. By LIESL GRAZ. London, I.B. Tauris, 1990. xi, 312pp. £17.95.

IRAN: THE KHOMEINI REVOLUTION (COUNTRIES IN CRISIS). Edited by MARTIN WRIGHT. Contributors: Nick Danziger, Martin Howe, Baqer Moin, Reza Navabpour, Sir Anthony Parsons, Vahe Petrossian, Amit Roy and Martin Wright. London, Longman, 1989. 128pp. Maps, ills. £6.95.

ISRAEL AND THE PALESTINIANS (COUNTRIES IN CRISIS). Edited by MARTIN WRIGHT. Contributors: Paul Cossali, Roger Hardy, Lawrence Joffe, Noah Lucas, David McDowall, Elfi Pallis, Martin Wright. London, Longman, 1989. 131pp. Maps, ills. £6.95.

MAJOR POLITICAL EVENTS IN IRAN, IRAQ AND THE ARABIAN PENINSULA 1945–1990. By TREVOR MOSTYN. New York & London, Facts on File, 1991. xii, 308pp. £14.95.

WOMEN AT WORK IN THE GULF: A CASE STUDY OF BAHRAIN. By MUNIRA A. FAKHRO. London, Kegan Paul International. 184pp. £45.00

THE POLITICAL ECONOMY OF TURKEY: DEBT, ADJUSTMENT AND SUSTAINABILITY. Edited by TOSUN ARICANLI and DANI RODRIK. Basingstoke, Macmillan, 1990. 275pp. £40 (hb).

AFGHANISTAN: A COUNTRY LAW STUDY. By GHOLAM H. VAFAI. Washington, Library of Congress, 1988. 63pp.

RESISTANCE AND CONTROL IN PAKISTAN. By AKBAR S. AHMED. London & New York, Routledge, 1991. xxiii, 207pp. £12.99 (pb).

MASTERING ARABIC: By JANE WIGHTWICK and MAHMOUD GAAFAR. (Macmillan Master Series.) London, Macmillan, 1990. 370pp.

FROM CODE‐SWITCHING TO BORROWING: A CASE STUDY OF MOROCCAN ARABIC. By JEFFREY HEATH. (Library of Arabic Linguistics, monograph 9.) London, Kegan Paul International, 1990. 328pp.

ARISTOTELIAN LOGIC AND THE ARABIC LANGUAGE IN ALFARABI. By SHUKRI B. ABED. Albany, State University of New York Press, 1991. xxv, 201pp.

OGHUSICA AUS IRAN. By GERHARD DOERFER, WOLFRAM HESCHE, JAMSHID RAVANYAR. Wiesbaden, Harrassowitz, 1990. ix, 146pp. DM 56.‐

ABBASID BELLES LETTRES. Edited by Julia Ashtiany, T.M. Johnstone, J.D. Latham, R.B. Serjeant and G. Rex Smith. (The Cambridge History of Arabic Literature, Vol.II, 1.) Cambridge, Cambridge University Press, 1990. xiii, 517pp.

PENSEE MYTHIQUE, IDEOLOGIE ET ASPIRATIONS SOCIALES DANS UN CONTE DES MILLE ET UNE NUITS. By PATRICE COUSSONNET. (Supplément aux Annales Islamologiques—Cahier no. 13). Cairo, Institut français d'archéologie orientale, 1989. 67 pp. 6 plates.

THE MEADOWS OF GOLD: THE ABBASIDS. By MAS'UDI. Tr. and ed. by PAUL LUNDE and CAROLINE STONE. London and New York, Kegan Paul International, 1989. x, 469pp. £30.00

POESlA ESTRÓFICA (CEJELES Y/O MUWA??AHAT) ATRIBUIDA AL MlSTICO GRANADINO A?‐?u?TARI (SIGLO XIII d.C.).(Preedición, traducción, estudio e índices.) By F. CORRIENTE. Madrid, CSIC, Instituto de Filología, Departamento de Estudios Árabes, 1988. [6], 379pp.

ISLAM, THE STRAIGHT PATH. By JOHN L. ESPOSITO. Oxford University Press, 1988. viii, 230pp. £6.95.

TRADITIONAL ISLAM IN THE MODERN WORLD. By SEYYED HOSSEIN NASR. London, KPI, 1987. x, 335pp.

IN A CALIPH'S KITCHEN: MEDIAEVAL ARABIC COOKING FOR THE MODERN GOURMET. By DAVID WAINES. London, Riad el‐Rayyes Books, 1989. 119pp. 44 colour plates. £14.00.     

Reviews

Terry L. Thompson & Richard Sheldon, eds, Soviet Society and Culture: Essays in Honor of Vera S. Dunham. Boulder, CO: Westview Press, 1988, xiii+290 pp., £21.00.

Michael Rywkin, Soviet Society Today. New York: M.E. Sharpe, 1989, xii+243 pp., $35.00 h/b, $12.50 p/b.

David Lane, Soviet Society Under Perestroika, London: Unwin Hyman, 1990, xv+401 pp., £40.00 h/b, £12.95 p/b.

Catherine Merridale, Moscow Politics and the Rise of Stalin: The Communist Party in the Capital, 1925–32. London: Macmillan, 1990, xv+328 pp., £47.50.

Roger Pethybridge, One Step Backwards, Two Steps Forward: Soviet Society and Politics under the New Economic Policy. Oxford: Clarendon Press, 1990, xi+453 pp., £48.00.

Francois Heisbourg, ed., The Strategic Implications of Change in the Soviet Union. London: Macmillan, 1990, vi+227pp., £40.00.

Neil Fodor, The Warsaw Treaty Organisation: a Political and Organizational Analysis. London: Macmillan, 1990, 235 pp., £40.00.

Gerald Segal, The Soviet Union and the Pacific. Boston, MA: Unwin Hyman, 1990, xiii+236 pp., £30.00 h/b, £10.95 p/b.

Philip S. Gillette & Willard C. Frank, Jr, eds, The Sources of Soviet Naval Conduct. Lexington, IN: Lexington Books, 1990, xvii+297 pp., $39.95.

Sylvia Woodby & Alfred B. Evans, Jr, eds, Restructuring Soviet Ideology: Gorbachev's New Thinking. Boulder, CO: Westview Press, 1990, 226 pp., £22.50.

Nikolai N. Petro, ed., Christianity and Russian Culture in Soviet Society. Boulder, CO: Westview Press, 1990, xi+244pp., £17.95 p/b.

David A. Dyker, Yugoslavia: Socialism, Development and Debt. London: Routledge, 1990, xi+201 pp., £30.00.

Agnes Heller & Ferenc Fehér, From Yalta to Glasnost. The Dismantling of Stalin's Empire. Oxford: Basil Blackwell, 1990, viii+288 pp., £35.00.

Elemer Hankiss, East European Alternatives. Oxford: Clarendon Press, 1990, xiv+319 pp., £35.00.

George Blazyca & Ryszard Rapacki, eds, Poland into the 1990s: Economy and Society in Transition. London: Pinter, 1991, x+148 pp., £27.50.

Michael D. Kennedy, Professionals, Power and Solidarity in Poland: A Critical Sociology of Soviet‐Type Society. Cambridge: Cambridge University Press, 1991, xiv+421 pp., £45.00, $59.50.

Graham Smith, ed., The Nationalities Question in the Soviet Union. London: Longman, 1990, x+389 pp., £22.50 h/b, £12.95 p/b.

James Muckle, Portrait of Soviet School under Glasnost. Basingstoke: Macmillan Press, 1990, ix+205 pp., £35.00.

Piers Beirne, ed., Revolution in Law: Contributions to the Development of Soviet Legal Theory, 1917–1938. Armonk, NY: M. E. Sharpe, 1990, xiii+202 pp., $49.95.

Richard M. Connaughton, The Republic of the Ushakovka: Admiral Kolchak and the Allied Intervention in Siberia, 1918–20. London: Routledge, 1990, ix+193 pp., £30.00.

Vitaut Kipel & Zora Kipel, eds, Byelorussian Statehood—Reader and Bibliography. New York: Byelorussian Institute of Arts and Sciences, 1988, 398 pp.     

Genetic markers in human bone: I. Deoxyribonucleic acid (DNA) analysis.

Deoxyribonucleic acid (DNA) was isolated from a number of spongy and compact human bone tissue specimens, and the yield was estimated on a "per milligram of starting tissue" basis. DNA was, in addition, isolated from a number of corresponding blood and bone tissue specimens. Spectrophotofluorometry and ethidium bromide visualization on minigels were used to estimate the quantity and degree of degradation of DNA. The DNA from several blood-bone pairs is shown to give concordant restriction fragment length polymorphism (RFLP) typing results by two different typing protocols with five different single-locus probes. DNA from several additional blood-bone pairs is shown to give concordant results for human leucocyte antigen (HLA)-DQ alpha phenotypes following polymerase chain reaction (PCR) amplification and hybridization to specific allele-specific oligonucleotide (ASO) probes, and for the variable numbers of tandem repeats (VNTR) length polymorphisms 3' to the human apolipoprotein B (APOB) gene following PCR amplification with specific primers and analysis of the products by electrophoresis and ethidium bromide visualization.     

Pitfalls in the diagnosis of drug smuggler's abdomen

Narcotics "body packing" can be detected in abdominal X-rays by the ring shadow caused by air trapped in the packs. In a series of 82 cases admitted for abdominal X-ray in Helsinki, Finland, in 1982 through 1988, we encountered 9 (11.0%) true positives, 3 (3.6%) false positives, and 1 (1.2%) false negative. The false positives were due to the constipation often associated with the narcotics abuse. The false negative X-ray diagnosis was attributable to an inexperienced radiologist. False negatives may also be associated with packets containing marijuana, packs with few wrappings, aluminum-foil coated packs, and machine-packed narcotics. Searching for trapped air in radiographs, repeated X-raying by an experienced radiologist, use of computed tomography, or combined urinary drug screening may be applied to diminish false findings and to avoid unnecessary arrest for the purpose of fecal screening over several days.