HMOs for Medicaid: the road to financial independence is often poorly paved.

During the 1980s both the federal government and the private sector articulated policies to encourage the development and participation of health maintenance organizations (HMOs) in the Medicaid program. However, the policies, intended to save costs, limited the ability of new HMOs to achieve financial independence. New plans that emphasize Medicaid participation have few, if any, options on benefit design or in setting capitation rates. Relative to fee-for-service Medicaid programs, their costs to provide services may be quite high, as they have neither the buying power not the ability to impose discounts. As a consequence, plans must focus their financial planning efforts on targeting and attaining a stable enrollment base and on controlling the amount of services provided, tasks that are difficult for all HMOs. Achieving a stable enrollment base is particularly hard because Medicaid eligibles have few incentives to enroll and once enrolled often lose their Medicaid eligibility. Traditional HMOs control the amount of services provided through physician selection, financial incentives on physicians, and monitoring and utilization review. Lack of information and the difficulty inherent in attracting sufficient provider participation limit the first two strategies, so new plans often adopt organization structures that rely heavily on monitoring activities. Unfortunately, management information systems for HMOs are often the weakest link. We discuss the tasks and present data on financial planning, on putting financial plans into operation, and on monitoring progress toward financial independence for a set of ten demonstration projects sponsored by the Robert Wood Johnson Foundation.     

A STUDY OF CLIENT SATISFACTION WITH 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 situations where domestic violence has occurred, the appropriateness of providing counselling to such couples has been seriously questioned This study examines the experience of clients attending counselling at the family court. Two groups of clients are studied—one group who reports domestic violence as a significant issue and a comparison group who does not report domestic violence. The results indicate that the two groups do not differ in their expressed level of satisfaction with the counselling they have received and that both groups consider counselling to have been helpful in resolving their issues. The preliminary results of this study have implications for the provision of postseparation counselling/mediation to couples when domestic violence has occurred.     

关于成人网络游戏玩家与未成年网络游戏玩家的比较研究

尽管网络游戏日益流行,但一直没有关于成人游戏者与未成人游戏者的比较性调查。为此,我们对EverQuest(简称EQ,中文名称为“无尽的任务”,是由美国索尼在线娱乐公司开发的知名网络游戏——译者注)游戏者(n=540)的相关特征进行了网上问卷调查。该调查主要考察了游戏玩家基本的人口学特征、游戏的频率、玩游戏的历史、游戏的偏好及玩游戏的代价等。结果表明未成年的游戏者多为男性,相较于成年游戏者,他们更不喜欢变换角色性别,更愿意牺牲学习和工作的时间。在游戏偏好的比较中,成年与非成年游戏群体的最大区别在于更多的未成年人认为他们喜好…