An end to a consensus on health care in the Federal Republic of Germany?

Over the past fifteen years the national government in the Federal Republic of Germany has animated the political debate about rising health care expenditures. However, it has only provided health policy leadership by shifting the burden of financing health and medical care to others. This paper presents three cases that illustrate the political and institutional constraints inherent in the German policy process that limit the proposal and implementation of appropriate policy solutions to rising health care costs. Cost controls have been inhibited because of the near-universal entitlement of national health insurance, the access all social groups have to advanced medical care, and policies targeted at providers rather than users of health services. The paper also underscores the past and future importance of regional policy coalitions in shaping national health policy.     

The polymorphism of transferrin by ultrathin-layer isoelectric focusing. Tf phenotypes and TfC subtypes in the population of Padua

The distribution of Tf phenotypes in the population of Padua was investigated by ultrathin-layer isoelectric focusing. In our sample (n = 618) nine phenotypes, Tf C₁, C₂, C₃, C_3?1, C_2?1, C_3?2, C₁B, C₂B and C₁D, were observed and the following frequencies calculated: TfC₁ = 0.77837; TfC₂ = 0.1804; TfC₃ = 0.03641; TfB = 0.0040; TfD = 0.0008. These gene frequencies have been compared to those found in other populations. Analysis of 101 mother-child pairs was in agreement with an autosomal codominant mode of inheritance.     

How the spending patterns of cities change: Budgetary incrementalism reexamined

Do city governments generally behave in keeping with the assumptions underlying the incremental model when they allocate their resources among competing activities? That is to say, do they try to maintain everyone's historical “fair share” of the budget in order to minimize disputes among rival participants in the decision process? Earlier studies have lacked sufficient data to address this question. However, with data from 105 West German cities, the present study is able to provide an answer. The resource allocation behavior of many of those cities seems to conform with the incremental model's assumptions. Yet for other cities, major changes in expenditure patterns from one year to the next are common. The differences in the variability of expenditure patterns across the cities studied are far from random. They are systematically associated with certain characteristics of the municipal environment. These associations, in turn, offer plausible hints about the process that leads to change in cities' spending patterns.     

The Prevalence of Mental Illness Among Inmates in a Rural State

A limited number of recent empirical studies suggest that inmates suffer from high rates of serious mental illness. Different explanations are offered depending on the type of institution: jail or prison. The literature is based largely on urban samples and does not offer comparisons of rates across types of institution within a single study. The present study examined a random sample of 213 jail and prison inmates in a rural state using the Diagnostic Interview Schedule (III-R). Among jail inmates there was little evidence of high rates of serious mental illness, suggesting the criminalization of mental illness may not be as evident in rural settings as urban areas. Among prison inmates, however, high rates of mental disorders were found, supporting previous findings in urban and rural jurisdictions. Implications of the findings are discussed in the context of a consolidated correctional system.     

Causes of death of patients in an institution for the developmentally disabled

The causes of death of 53 severely to profoundly developmentally disabled patients who died in an intermediate care facility were reviewed. Respiratory disease, predominantly pneumonia and aspiration, accounted for 72% of deaths. Seven patients died of nonrespiratory causes, and in 8 patients, no cause of death could be determined, even after a complete autopsy or investigation. The median age at death was 20 years. The weights of these patients' organs at autopsy were lower than those for normal individuals of the same age. The lifespan of these severely impaired individuals continues to be significantly shortened, even with improved methods of care.