Fertility,development, and family planning, 1970–1980: An analysis of cases weighted by population

A series of related studies (Freedman and Berelson, 1976; Mauldin and Berelson, 1978; and Tsui and Bogue, 1978) have presented empirical findings based on multiple regression analysis which indicated that family planning program effort (FP), as measured by an index developed by Lapham and Mauldin (1972), was the single most important predictor of (or influence on) fertility reduction in less-developed countries (LDCs). The basic results have been confirmed repeatedly. A more extensive data set was used to extend the analysis to a comparison of results of corss-sectional models circa 1970 and 1980. The study builds upon the results of past studies yet differs from them in several ways. All the variables in the present study were measured at 2 points in time: circa 1970 and circa 1980, allowing a comparison between cross-sectional models for 1970 and 1980. Among the cases included in this multivariate analysis was China, a country usually excluded for lack of data. The analysis was extend to 85 countries. Cases were weighted by population, having the effect of increasing the impact of larger countries such as India and China on the outcome of the analysis. Total fertility rate (TFR) was used as an indicator of fertility. For 1970, family planning program effort had the strongest direct influence on fertility (a result consistent with previous studies). Life expectancy at birth was the other direct influence. The direct influence of life expectancy at birth was less than that of family planning, but the total influence was greater. After life expectancy and family planning, school enrollment and relative educational status of women had the strongest indirect and total influences. The other variables all had a positive influence on fertility. When the total variance attributable was considered, directly and indirectly to each of the independent variables, urbanization, carlorie supply, and per capita gross national product all accounted for less than 5% of the variance in fertility, all of it indirect. Life expectancy, family planning, and school enrollment each explained (directly plus indirectly) more than 10% of the variance in fertility. The pattern differed somewhat for 1980. Calorie supply, per capita gross national product, and relative educational status of women had no influence, direct or indirect on fertility. Also for 1980, life expectancy had a stronger direct influence on fertility than family planning. Overall, life expectancy at birth, family planning program effort, and total school enrollment emerged as the principal influences on fertility.     

Tumbling abrasions. Injuries from ricocheting bullets

Atypical entrance gunshot wounds may be produced by deflected or ricocheting bullets. One special type of atypical entrance wound involves abrasion of the skin at a site that is remote from the point of dermal penetration. These remote abrasions, termed "tumbling abrasions," are produced by bullets that tumble after impact with an intermediate target. Three cases of tumbling abrasions are presented.     

The impact of health maintenance organizations and competition on hospitals in Minneapolis/St. Paul

The Healthcare Educational and Research Foundation (HERF) in Minneapolis undertook a two-year research project to study the effects of health maintenance organizations (HMOs) and competition on the hospital industry in Minneapolis/St. Paul. This article summarizes HERF's major findings surrounding three key questions: (1) do the HMOs in Minneapolis/St. Paul use fewer hospital resources relative to conventional payers?; (2) do recent overall community trends in inpatient use suggest evidence of hospital utilization-reducing effects attributable to HMOs?; and (3) given the highly visible competitive process among Minneapolis/St. Paul providers, do hospital cost and revenue data suggest any evidence of cost-containment? The findings (based on data through 1982) indicate that for comparable patients, Twin Cities HMOs appear to use fewer medical care resources per hospitalized patient. There was, however, no clear evidence of community-wide, utilization-reducing effects directly attributable to the "competitive effect" of HMO introduction and development in the market. In addition, there was no empirical evidence that HMOs (which had enrolled 25 percent of the consumer market by 1982), or other large buyers of inpatient services, have selected hospitals on the basis of price as hypothesized by competition advocates.     

Repeat autopsies on corpses from abroad. A futile effort?

A large number of corpses transferred to Athens and the Piraeus Morgue from abroad have been examined in second autopsies. Lack of information, mistakes in data, useless effort, and disappointment on the part of the forensic pathologists because of the lack of new information revealed are characteristic of these cases. With some exceptions, the second autopsy provided no news for the anxious relatives, who, for the most part, had been prompted by their attorneys or other "well-meaning friends" to demand a second autopsy on the corpses of their loved one (who generally died on board ship abroad). Nevertheless, in 10 of 59 cases, the cause of death was completely different from the determined in the autopsy performed abroad or assumed from the information available. This fact ensures that any corpse from abroad undergoes a careful and thorough examination on its arrival in Greece.     

Wrongful termination lawsuits: the employers finally win a few

Much attention has been given of late to the erosion of the "employment-at-will" doctrine. Exceptions to this doctrine began to emerge when courts held that at-will employees could sue if their termination violated public policy. The at-will doctrine was further eroded by court rulings that a contract requiring good cause in order to terminate could be inferred from employee handbooks, company personnel policies, and circumstances of employment. As the initial flood of wrongful termination lawsuits now reaches the appellate level, some guidance on the standards employers must observe can be drawn from court decisions. The authors examine these decisions as well as the legislative reform being proposed in response to them.     

Practitioner fraud and abuse in medical benefit programs: government regulation and professional white-collar crime

Physicians who defraud and abuse medical benefit programs provide a unique group of lawbreakers for scientific study. They could be considered to epitomize white collar criminals given their exceedingly high socioeconomic status and power as a professional group. Using official reports and documents, as well as interviews with enforcement and program personnel at both state and federal levels, this study examines the problem of physician fraud and abuse in Medicare and Medicaid. Major areas relevant to understanding this phenomenon and its control are presented and policy implications of present knowledge in the area are discussed.