The Department of Health and Human Services issues proposed regulations on physician incentive payments by hospitals

Hospitals tempted to operate their own physician incentive plans are reminded that, under OBRA 1986, they are precluded from paying physician incentives of any kind to reduce or limit Medicare or Medicaid covered services. In light of the proposed regulations and the guidance of the preamble, hospitals should review their incentive plans to determine whether physicians providing direct patient care are receiving prohibited payments. Further, supervising physicians who are receiving incentives for certain hospital departments may not influence direct care over patients served by those departments, even through other physicians. Some risk may also exist if incentives are based on a formula that considers patients of the supervising physician's medical group. Finally, it may be useful to develop a utilization and quality of care review program specifically designed to assure that patient undertreatment does not occur as a result of any supervising physician incentive program.     

From underworld to underground

In the West economically motivated crime is usually perceived as a matter for the police while the performance of the economy is a matter for the political authorities. This paper argues that the growth and evolution of the modern underground economy has made such a distinction obsolete. Not only have the frontiers between the legitimate and the criminal sectors of the economy blurred, but the distinction between the explicitly criminal and the merely informal aspects of the modern underground economy has become largely meaningless. Given the tremendous growth of underground activity, this means that the issue must now be addressed not just on the enterprise level, as a police matter, but on the level of the economy as a whole, by economic policy makers. This in fact is something that many developing countries long ago realized. The paper therefore asks whether developing countries have been any more successful in using monetary, fiscal and balance of payments policy to mitigate the adverse social and economic impact of widespread underground economic activity than have Western countries who have relied mainly on the sanction of criminal law. It concludes that both approaches are deficient in so far as they neglect the degree to which modern underground activity can no longer be seen as a manifestation of deviant economic behavior so much as a virtual economic insurgency against the status quo distribution of income and wealth and the codes of economic behavior which accompany it. However dramatic are the financial manifestations of the spread of enterprise crime, ultimately the challenge it poses must be addressed as the political and ideological level.     

Migrating women: Mexican women in the United States

"This analysis considers some aspects of the international migration of Mexican women, seen under the light of two recent statistical sources: the [U.S.] 1990 census and the 1993-1994... International Migration Survey at the Mexican Northern Border. The joint analysis of migrations and migrant inventories reveals the hidden scope of feminine exile, as well as some of its peculiarities, and offers numerical answers to two questions: How does sex differentiate Mexican immigrants in the United States? How does the migration affect work, marriage, child-bearing, etc. of Mexican women? The results suggest the need to address migration no longer as an action of individuals, but of families (most immigrants are married), and to place the mother or the wife at the gravity center of the household migratory space." (SUMMARY IN ENG)     

Population: malady or symptom?

The 1994 International Conference on Population and Development (ICPD) opened the dawn of a new era in discourse over population. A newfound consensus was reached between North and South which was not there during the two previous world population conferences in Bucharest and Mexico. While consensus was reached at the 1994 ICPD on the need for action, however, debate over population is far from settled. Causes of population growth, the links between population growth and economic development, and environmental degradation remain controversial topics. The authors analyze the basis of the ICPD consensus at the local, national, and global levels. They also compare the development discourse to the political discourse over population. Both discourses emphasize different aspects of a far more complex reality. The question is which discourse to choose as a basis for drawing policy recommendations. The emerging view on the way to Cairo was that consensus would be achieved on the basis of development discourse. Success on the action plan rests upon the belief that more contraceptives, more health services, and more schools will be enough to reduce fertility rates. The political discourse, however, is better than the development discourse as a basis for policy making because it stresses the need for integration rather than running the risk of exclusion. The political discourse is also more demanding.