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.     

Independent instances of "souvenir" Asian skulls from the Tampa Bay area

In the summer of 1984, police in Pinellas County, Florida, confiscated six identically colored imported Asian skulls (in a shipping case) from a private citizen. In May 1988, in nearby Hillsborough County, police confiscated a very similar skull from another private citizen, who allegedly had found it in an abandoned house. Aside from slight color differences between the six found in Pinellas County and the one found in Hillsborough County, the skulls are virtually identical in their osteological characteristics and condition and in the vital statistics derived from each. Each skull is as clean and dry as those typically sold by commercial scientific supply outlets in the United States. Each is edentulous (primarily premortem), between approximately 20 and 60 years of age at death, and morphologically Asian. Five of the seven are morphologically male, one is morphologically female, and one is a mosaic with respect to gender-related features. Police, medical examiners, coroners, and forensic anthropologists should be aware of such "souvenir" specimens, in the event that they encounter similar skulls. Discriminant function analyses for race and sex yield considerably conflicting results, which underscores the need for using extreme caution when interpreting forensic science estimates based on such techniques.     

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.     

Causes of death in hospitalized intravenous drug abusers

The authors reviewed at autopsy the causes of death of 274 patients with evidence of intravenous drug abuse who had been admitted to a large public hospital. There were 127 who died from diseases unrelated to intravenous drug abuse, and in 41% of these, chronic alcoholism was implicated. Deaths from overdose syndromes and drug-related organ pathology comprised only 11% of all cases. The mean age at death was 39 years. There was a male/female ratio of 3.6:1. Half of all patients died from infection--72 from acquired immunodeficiency syndrome (AIDS) alone. These findings indicate that persons hospitalized with a history of intravenous drug abuse usually die from causes other than overdose and that AIDS and chronic alcoholism are significant problems. Emphasis should be placed upon detecting "hidden" intravenous drug deaths to provide more accurate statistical information.     

The metropolitan character of urbanization in Mexico, 1900-1988

The author analyzes trends in urbanization in Mexico during the twentieth century, with a focus on the impact of rapid industrialization since 1982. Sections are included on the interrelations among economic development, industrialization, and urbanization; stages, levels, and measures of urbanization; the development of the city system in Mexico; and stages in the growth of Mexico City. (SUMMARY IN ENG)     

Are you ready for the cure?

The Clinton health-care plan will soon be unveiled. Here is an inside look at what it contains so far.