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.     

A risk marker analysis of assaulted wives

In the wife assault literature, a number of risk markers have been identified. Using the data of the female respondents to the National Family Violence Survey (n = 699), a multivariate analysis was performed to examine which risk factors best differentiated between women involved in nonviolent relationships, verbally aggressive relationships, relationships exhibiting minor physical aggression and severely violent relationships. High levels of marital conflict and lower socioeconomic status emerged as the primary predictors of an increased likelihood of wife assault. Research implications are discussed.     

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)     

B. Reviews and notes: bibliographies and works of reference

LE MONDE ARABE ET MUSULMAN AU MIROIR DE L'UNIVERSITE FRANÇAISE: REPERTOIRE DES THESES SOUTENUES DANS LES UNIVER‐SITES FRANÇAISES, EN SCIENCES DE L'HOMME ET DE LA SOCIETE, SUR LE MONDE ARABE ET MUSULMAN (1973–1987). By MARIE BURGAT, DANIELLE BRUCHET, JACQUELINE QUILET [& others]. Aix‐en‐Provençe, Institut de Recherche et d'Etudes sur le Monde Arabe et Musulman, 1989–92. 4 vols.

MAPAS, PLANOS Y FORTIFICACIONES HISPANICOS DE MARRUECOS (S.XVI‐XX)/CARTES, PLANS ET FORTIFICATIONS HISPANIQUES DU MAROC (XVIe‐XXe S.). By JUAN BTA. VILAR. 604pp. Text in Spanish. Table of Contents, Preface (by José Antonio Calderon Quijano), and Introduction in Spanish and French. Madrid, Ministerio de Asuntos Exteriores, Secretaría de Estado para la Cooperación Internacional y para Iberoamérica: Dirección General de Relaciones Culturales y Científicas, Agencia Española de Cooperación International, Institute de Cooperación con el Mundo Arabe, 1992. 7210 ptas.

A BIOGRAPHICAL DICTIONARY OF CONTEMPORARY AFGHANISTAN. By LUDWIG W. ADAMEC. Graz, Akademische Druck‐ u. Verlagsanstalt, 1987. vi, 252 pp. Photo section. ÖS 450.‐

TÜRKIYE DI?INDAK? TÜRKLER B?BL?YOGRAFYASI. A BIBLIOGRAPHY OF TURKS OUT OF TURKEY. By ?SMET B?NARK and others. Ankara, T.C. Ba?bakanlik Devlet Ar?ivleri Genel Müdürlü?ü Dokümentasyon Dairesi Ba?kanli?i (Yayin No.5), 1992. 2 vols. lxv, 1379 pp.

GULF CRISIS CHRONOLOGY: DAY‐TO‐DAY COVERAGE OF EVENTS IN THE GULF CONFLICT FROM 2 AUGUST 1990 TO THE 3 MARCH 1991 CEASEFIRE. Compiled by the BBC WORLD SERVICE. Harlow, Longman, 1991. 454 pp. £65.‐

FRAUENFRAGEN IM MODERNEN ORIENT: EINE ERGANZUNGSBIBLIO‐GRAPHIE. WOMEN IN THE MIDDLE EAST AND NORTH AFRICA: A SUPPLEMENTARY BIBLIOGRAPHY. By INGEBORG OTTO & MARIANNE SCHMIDT‐DUMONT. (Biblio., 16.) Hamburg, Deutsches Übersee‐Institut, Übersee‐Dokumentation, Referat Vorderer Orient, 1989. xvi, 126 pp. DM19.‐

THE MIDDLE EAST AND NORTH AFRICA 1993. London, Europa Publications, 1992. xxi, 988 pp. £130.     

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.     

The development of ego defenses in adolescence

This study tested a model for developmental transitions in defense use in adolescence based on an integration of psychoanalytic views of adolescence and Loevinger's theory of ego development. Loevinger's test for ego development and the Defense Mechanism Inventory were administered to 31 male and 35 female adolescents. Results supported several hypothesized developmental transitions: decrease in aggression outward defenses (e.g., displacement), increase in turning against the self, and an unpredicted increase in defenses entailing reversal (repression, denial, and reaction formation). Results failed to support a hypothesized increase in intellectualization and a decrease in projection. Results supported ego development over chronological age as a more valid index of maturity to apply to the investigation of the development of defenses. Implications of these findings are discussed and directions for future research are suggested.This research was partially funded by the Psychology Department at Boston UniversityAffiliations at the time when this study was conducted were Department of Psychology, Boston University, and Departments of Psychiatry at Beth Israel and McLean Hospitals/Harvard Medical School. Now Clinical Psychologist, Outpatient Psychiatry Service, Baystate Medical Center, Springfield, Massachusetts. Received Ph.D. in clinical psychology from Boston University. Research interests include ego defenses, psychotherapy research, gender, and sex roles.