The MacArthur Treatment Competence Study. II

This article reports the development and psychometric properties of three standardized and objectively scored measures, the MacArthur Treatment Competence Research Instruments. They were designed to assess abilities related conceptually to four legal standards for competence to consent to treatment: understanding, appreciation, rational manipulation (reasoning), and expressing a choice. Scoring reliability, internal consistency, intertest correlations, and test-retest correlations were examined with data from samples of hospitalized patients with schizophrenia, major depression, and ischemic heart disease, as well as matched non-ill community samples. The results indicate very good interscorer reliability and provide guidance for the use of the instruments and interpretation of their results in future research on patients' decisional abilities in treatment contexts.     

State Medicaid reform under Section 1115 demonstration authority

Given the complexity of federal Medicaid law and the limitations it imposes on state flexibility, it is likely that states will continue to ask the Secretary to grant waivers under Section 1115 to allow them to pursue new approaches to health care reform. The results of currently operational Section 1115 projects involving statewide managed care systems will be useful in evaluating the Medicaid reform measures currently under discussion in other states and at the federal level. In particular, the ability of the states to control Medicaid and indigent care costs and to utilize federal dollars more efficiently should prove important in evaluating a block grant approach to federal Medicaid funding. Moreover, Section 1115 project results that bear on the sufficiency of various Medicaid capitation rate methodologies will also be of value as more states expand the use of managed care arrangements for their Medicaid populations.     

The Department of Health and Human Services issues proposed regulations on physician incentive payments by hospitals

Hospitals tempted to operate their own physician incentive plans are reminded that, under OBRA 1986, they are precluded from paying physician incentives of any kind to reduce or limit Medicare or Medicaid covered services. In light of the proposed regulations and the guidance of the preamble, hospitals should review their incentive plans to determine whether physicians providing direct patient care are receiving prohibited payments. Further, supervising physicians who are receiving incentives for certain hospital departments may not influence direct care over patients served by those departments, even through other physicians. Some risk may also exist if incentives are based on a formula that considers patients of the supervising physician's medical group. Finally, it may be useful to develop a utilization and quality of care review program specifically designed to assure that patient undertreatment does not occur as a result of any supervising physician incentive program.     

From underworld to underground

In the West economically motivated crime is usually perceived as a matter for the police while the performance of the economy is a matter for the political authorities. This paper argues that the growth and evolution of the modern underground economy has made such a distinction obsolete. Not only have the frontiers between the legitimate and the criminal sectors of the economy blurred, but the distinction between the explicitly criminal and the merely informal aspects of the modern underground economy has become largely meaningless. Given the tremendous growth of underground activity, this means that the issue must now be addressed not just on the enterprise level, as a police matter, but on the level of the economy as a whole, by economic policy makers. This in fact is something that many developing countries long ago realized. The paper therefore asks whether developing countries have been any more successful in using monetary, fiscal and balance of payments policy to mitigate the adverse social and economic impact of widespread underground economic activity than have Western countries who have relied mainly on the sanction of criminal law. It concludes that both approaches are deficient in so far as they neglect the degree to which modern underground activity can no longer be seen as a manifestation of deviant economic behavior so much as a virtual economic insurgency against the status quo distribution of income and wealth and the codes of economic behavior which accompany it. However dramatic are the financial manifestations of the spread of enterprise crime, ultimately the challenge it poses must be addressed as the political and ideological level.     

Migrating women: Mexican women in the United States

"This analysis considers some aspects of the international migration of Mexican women, seen under the light of two recent statistical sources: the [U.S.] 1990 census and the 1993-1994... International Migration Survey at the Mexican Northern Border. The joint analysis of migrations and migrant inventories reveals the hidden scope of feminine exile, as well as some of its peculiarities, and offers numerical answers to two questions: How does sex differentiate Mexican immigrants in the United States? How does the migration affect work, marriage, child-bearing, etc. of Mexican women? The results suggest the need to address migration no longer as an action of individuals, but of families (most immigrants are married), and to place the mother or the wife at the gravity center of the household migratory space." (SUMMARY IN ENG)     

A. reviews: general

WARFARE IN THE LATIN EAST, 1192–1291. By CHRISTOPHER MARSHALL. (Cambridge Studies in Medieval Life and Thought, fourth series, 17.) Cambridge, Cambridge University Press, 1992. xiv, 290pp. 7 figures, 9 plates.

MINORITES RELIGIEUSES DANS L'ESPAGNE MEDIEVALE [ = Revue du Monde Musulman et de la Méditerranée, 63–4]. Aix‐en‐Provence, Edisud, 1992. 292 pp. 150FF.

THE TRANSMISSION OF KNOWLEDGE IN MEDIEVAL CAIRO. By JONATHAN BERKEY. Princeton, Princeton University Press, 1992. x, 238pp. $39.50.

PRAGMATISM IN THE AGE OF JIHAD: THE PRECOLONIAL STATE OF BUNDU. By MICHAEL A. GOMEZ. Cambridge, Cambridge University Press, 1992. xiii, 252 pp. £35.00.

THE CHURCH OF THE EAST AND THE CHURCH OF ENGLAND. A HISTORY OF THE ARCHBISHOP OF CANTERBURY'S ASSYRIAN MISSION. By J.F. COAKLEY. Oxford, Clarendon Press, 1992. £45.00.

WOMEN, ISLAM AND THE STATE. By DENIZ KANDIYOTI. London, Macmillan, 1991. 271pp. + index.

MARRIAGE ON TRIAL: A STUDY OF ISLAMIC FAMILY LAW. By ZIBA MIRHOSSEINI. (Society and Culture in Modern Middle East Series.) London, I.B. Tauris, 1993. 200 pp. + notes and index.

WOMEN IN THE MIDDLE EAST: PERCEPTIONS, REALITIES AND STRUGGLES FOR LIBERATION. Edited by HALEH AFSHAR and MARY MAYNARD. Basingstoke, Macmillan, 1993. xiv, 250pp.

WRITING WOMEN'S WORLDS: BEDOUIN STORIES. By LILA ABU‐LUGHOD. Berkeley, Los Angeles and Oxford, University of California Press, 1993. xxiii, 266 pp., bibliography. $30.00 (hb), $12.00 (pb).

NASSER'S BLESSED MOVEMENT: EGYPT'S FREE OFFICERS AND THE JULY REVOLUTION. By JOEL GORDON. Oxford, Oxford University Press, 1992. vii, 254 pp.

WAR AND PEACE IN ISRAELI POLITICS: LABOR PARTY POSITIONS ON NATIONAL SECURITY. By EFRAIM INBAR. Boulder and London, Lynne Rien‐ner, 1991. 184pp., appendices. £21.95.

TURKEY AND THE WEST: CHANGING POLITICAL AND CULTURAL IDENTITIES. Edited by METIN HEPER, AYSE ÖNCÜ and HEINZ KRAMER. London/New York, Tauris, 1993. xiv, 289 pp.

TURKEY'S NEW GEOPOLITICS: FROM THE BALKANS TO WESTERN CHINA. By GRAHAM E. FULLER and IAN O. LESSER, with PAUL B. HENZE and J.F. BROWN. Boulder and Oxford, Westview Press, 1993. xv, 197pp.

THE SOCIALIST MOVEMENT IN TURKEY, 1960–1980. By IGOR P. LIPOVSKY. Leiden, Brill, 1992. ix, 190pp. $48.75.

ISLAM IN MODERN TURKEY: RELIGION, POLITICS AND LITERATURE IN A SECULAR STATE. Edited by RICHARD TAPPER. London/New York: Tauris, 1991. v, 314 pp.

SIBAWAYH THE PHONOLOGIST: A CRITICAL STUDY OF THE PHONETIC AND PHONOLOGICAL THEORY OF SIBAWAYH AS PRESENTED IN HIS TREATISE AL‐KITAB. By A.A. AL‐NASSIR. London and New York, Kegan Paul International, 1993. xx, 130 pp.

AL‐MADKHAL ILā TAQWīM AL‐LISāN WA‐TA'LīM AL‐BAYāN. By IBN HISHāM AL‐LAKHMī. Edited by JOSÉ PÉREZ LÁZARO. (Fuentes Arábico‐Hispanas, no. 6.) Madrid, Consejo Superior de Investigaciones Científicas & Insti‐tuto de Cooperatión con el Mundo Árabe, 1990. 2 vols. 219; 599pp.