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.     

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.     

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)