The paradoxical politics of provider reempowerment

The recent decline, indeed perhaps dismantling, of managed care is sometimes treated as both consequence and cause of the political reempowerment of medical providers, whose professional dominance managed care had challenged. Drawing evidence from Round III of the Community Tracking Study of the Center for Studying Health System Change, this article reviews the politics of four "arenas" of managed care regulation--prompt payment, mandated benefits, external appeals, and financial solvency--and concludes that the power of providers is contingent on patterns of coalition and conflict that differ across the discrete arenas. The zero-sum connotations of the "de" and "re" empowerment of providers under managed care fail to capture the subtlety of providers' search for fresh cultural, economic, and political resources in shifting policy contexts.     

Perceptions of responsibility for clinical risk management: evidence from orthopaedics practitioners, practice managers and patients in an Australian capital city

The article describes a study of the perceptions of three groups--patients, orthopaedic surgeons and the surgeons' practice managers--concerning three types of legal risk associated with the duty of care: failure to follow up, failure to warn and failure to diagnose. The study found there is cause for concern about doctors' follow-up and documentation of patient care. Doctors may be unaware of the Australian courts' propensity to emphasise practitioner responsibility rather than patient autonomy. A further important result is the considerable disparity between the surgeons' views and the views of their practice managers about the duty of care. The article draws out implications for improved risk awareness and suggests further research.     

Occupational safety and health in Poland in the 1990s: A regulatory system adapting to societal transformation

The societal transformation underway in Poland createda fundamental challenge to the occupational health and safety system, as the ideological and administrative principles on which it was founded vanished along with the communist-dominated regime. This paper examines the regulatory reform in Poland during the 1990s: its structural elements, implementation record and future prospects. Drawing on five case studies of privatized firms, a mailed questionnaire, and policy and institutional analysis, we find that Poland had considerable success in developing an effective regulatory system for managing occupational health hazards in privatized sector while also achieving considerable socioeconomic progress. The fundamental legitimacy of the regulators and regulatory process, the availability of information about firms and regulatory intents, and the capacity for case-specific decision making, are among the key explanatory factors. The case-specific implementation in Poland is consistent with models advocated by several authors in relation to other industrialized European economies (termed variously as negotiated compliance, tit-for-tat, cooperation-deterrence), despite a uniquely Polish context related to the continuing legacy of the communist era. The study also shows how in Poland a good fit between regulatory institutions and policies on the one hand, and their social context on the other hand, contributes to the effectiveness of the regulatory system.     

Contraceptive behavior in adolescence: A decision-making perspective

The contraceptive behavior of adolescent girls was viewed from a decision-making perspective. A semistructured interview protocol was used in interviewing 120 girls aged 12–19 in three clinics (Teen Family Planning, Prenatal, Pediatric Acute Care) at Michael Reese Hospital and Medical Center on (1) demographic in formation; (2) sexual and obstetric history; (3) contraceptive and sexual knowledge, attitudes, and practices; (4) environmental pressures; (5) personality factors; and (6) decision-making style. We found that the girls were generally poor contraceptors. They viewed the costs of contraception (in terms of safety) to be high; and they positively valued physical intimacy, opportunities for which come up unexpectedly and sporadically. These factors, along with their ambivalent views toward pregnancy and childbearing seemed to encourage their risk-taking behavior. Once pregnancy occurred, it was carried to term because of the strong internal and external pressures they felt to have and keep the baby. The peer-led intervention program that we are developing based on the survey findings will focus on (1) the teenagers' lack of accurate and complete knowledge about birth control and conception, (2) their limited sense of options concerning birth control and pregnancy outcomes, and (3) their poor understanding of and lack of insight into what motivates their behavior.This study is part of the investigation being conducted by the YADMAC (Young Adult and Adolescent Decision Making About Contraception) Project at Michael Reese Hospital and Medical Center, 2959 South Cottage Grove, Chicago, Illinois 60616. The authors are all members of the YADMAC research team.Received Ph.D. from the University of Chicago. Current interests are human sexuality and reproductive behavior. Currently at Department of Psychology, St. Xavier College.Received M.D. from the University of Michigan. Current interests are liaison child psychiatry and adolescent sexuality.Received Ph.D. from the University of Chicago. Current interests are early adolescent development issues.Current interests are puberty and sex differences.B. A. candidate in social work, Roosevelt University. Current interests are adolescent sexuality and contraceptive behavior.     

Et Tu, Counselor: may an in-house attorney file a qui tam action against the attorney's employer?

Most corporations probably do not consider their in-house counsel to be potential qui tam threats. That may be a naive assumption. Case law provides an illustrative view of the legal ramifications involved when an attorney brings a qui tam suit. In general, there is no prohibition on attorneys who wish to bring these actions. Nevertheless, a corporation can take preventive steps to eliminate the likelihood of attorney qui tam actions. In addition, the corporation can take advantage of state professional ethics laws to mount a defensive action against the attorney who files any such action.     

Image analysis of gunshot residue on entry wounds. II--A statistical estimation of firing range.

A statistical investigation of the relationship between firing range and the amount and distribution of gunshot residue (GSR), used automated image analysis (IA) to quantify GSR deposit resulting from firings into pig skin, from distances ranging between contact and 45 cm. Overall, for a Ruger .22 semi-automatic rifle using CCI solid point, high velocity ammunition, the total area of GSR deposit on the skin sections decreased in a non-linear fashion with firing range. More specifically there were significant differences in the amount of GSR deposited from shots fired at contact compared with shots fired from distances between 2.5 and 45 cm; and between shots fired from a distance of 20 cm or less, with shots fired at a distance of 30 cm or more. In addition, GSR particles were heavily concentrated in the wound tract only for contact and close range shots at 2.5 cm, while the particle distribution was more uniform between the wound tract and the skin surfaces for shots fired from distances greater than 2.5 cm. Consequently, for future scientific investigations of gunshot fatalities, once standards have been established for the weapon and ammunition type in question, image analysis quantification of GSR deposited in and around the gunshot wound may be capable of providing a reliable, statistical basis for estimating firing range.