Medicare coverage, Medicare costs, and medical technology

One possible approach to containing Medicare costs involves explicit changes in Medicare's coverage policy with respect to medical technology. This paper first describes the development and diffusion of medical technology in general and then describes how technologies are identified, assessed, and approved for payment by Medicare. Currently, cost is neither a criterion nor an explicit issue in coverage decisions, although coverage policy is an integral part of payment policy. A combination of policies to reduce the rates of adoption and use of certain technologies is needed--including cost considerations in technology assessments for coverage decisions, limiting diffusion of technology to certain providers and sites, limiting utilization to certain indications, and tightening administrative processes. Finally, the interaction between coverage policy and DRG payment needs to be explored more thoroughly.     

Placing Indigenous Rights to Self-Determination in an Ecological Context

In this paper the author focuses on Australian land management and in particular on the environmental management issues that could have been prompted by the High Court recognition in 1996 (in Wik Peoples v. The State of Queensland ) that native title to land and pastoral leaseholdings can co-exist. Drawing on themes of self-determination and co-existence, the paper looks at more specific topics such as aboriginal title to land—what has been called land rights or native title in Australia—and some implications of that for land, sea and resource management. Central to this analysis are competing theories of Aboriginal land management and links between Aboriginal traditional knowledge and conservation of species. These are illustrated through the marine mammal, the dugong. The Australian debates lead to the Canadian debates and then to Scandinavia and the role of the Sami people in protection and management of the Arctic region. Issues of indigenous self determination inevitably provide an overall theme to these discussions. As a matter of global concern, the paper asks, but does not decide, whether indigenous peoples may manage fragile eco-systems more effectively than outsiders. It maintains that what is important in this context is a broader question. This concerns how culturally inclusive land and resource management can emerge from recognition of indigenous land and human rights and how comparative developments can provide crucial cross-jurisdictional information for future developments and opportunities in the interests of environmental conservation.     

AN EXPLORATORY STUDY OF SUPERVISED ACCESS AND CUSTODY EXCHANGE SERVICES

The detrimental effect of parental conflict in protracted child custody and visitation disputes is well established in the literature. However, little is known about the impact of parental conflict on children when visitation takes place in a protected setting. Part of a larger study that examined the broader issues related to parental and child involvement in a supervised access and custody exchange service, this article specifically explores the influence of parental participation on child well-being. This exploratory effort reveals that children's level of adjustment remained stable over 6 months of participation while visitation returned to court-ordered levels and interparental contact was precluded by staff intervention.     

Corporate Incubators: Industrial R&D and What Universities can Learn from them

The explosive growth of incubation has seen a concurrent and significant increase in research on and knowledge of the incubation phenomenon. However, instead of comprehensively differentiating between non-profit and for-profit incubators, research has described a whole array of partly overlapping archetypes, thus missing out on important aspects. This article first offers two arguments validating a framework of what non-profit university incubators can learn from for-profit corporate incubators before presenting the framework itself. While corporate incubators are for-profit organizations with which to enhance a corporation’s technology development, university incubators try to leverage technological insights from the university in a similar manner. In accordance with their respective missions, organizational structures, incubator processes and resource flows, it is possible to transfer lessons learned from two corporate incubator archetypes—the fast-profit incubator and leveraging incubator—to the world of university incubator. Our empirical findings are based on in-depth case studies of 25 companies through 52 semi-structured interviews with managers of corporate incubators of large technology-intensive corporations in Europe and the U.S., two EU incubator benchmarking surveys and five interviews with the heads of technology transfer offices of two top technology universities.     

INITIATING A COMPARABLE WORTH WAGE POLICY IN MINNESOTA: NOTES FROM THE FIELD

As of January 1986, Minnesota has progressed farther than any other state in implementing acomparable worth (pay equity) wage policy, with two laws requiring pay equity, one covering state employees and a second covering employees of all types of jurisdictions. This article presents a discussion of Minnesota's importance as a case study, a definition of comparable worth, the history and politics o f pay equity policy in Minnesota, and an analysis of Minnesota's role in a national campaign to change wage policy. The article shows that implementation has been more straight-forward in state government than for the 1,583 local jurisdictions, many of which had less-developed personnel systems than did the state. The passage of the local pay equity law ushered in a new stage in this policy, where the issue Is no longer controlled by a small number of legislators, bureaucrats, and lobbyists.     

THE USE OF MANDATORY SENTENCING LEGISLATION AS SYMBOLIC STATEMENTS

Mandatory sentencing legislation often results in laws which use provisions and set penalties in order to make strong symbolic and political statements. Thus, in addition to protecting society, they are powerful vehicles for expressing moral outrage. This is especially evident in mandatory sentencing for drug and alcohol offenses. The present research examines the consequences of that practice on one state's criminal justice system. Interviews with key actors along with examinations of official documents, newspaper publicity and media campaigns illustrate the political decisions and symbolic statements which pervade driving-while-intoxicated (DWI) legislation. The process is studied from before the lawls enactment through its subsequent outcome.     

CLIENT AND COUNSELLOR PERCEPTIONS OF THE PROCESS AND OUTCOMES OF FAMILY COURT COUNSELLING IN CASES INVOLVING DOMESTIC VIOLENCE

The Family Court of Australia provides conciliation counselling to couples who are involved in disputes regarding their children following separation. In cases where domestic violence is involved, the appropriateness of providing counselling has been seriously questioned. This study is an extension of earlier work completed by the authors that specifically examined client satisfaction with counselling in cases involving domestic violence. This article examines client and counsellor perceptions of the counselling process and its outcomes.