Mental health services in a single payer system: Lessons from Canada and principles for an American plan.

Reviews the advantages of financing mental health care in the US along the lines of the Canadian single-payer system and argues that the pillars of the Canadian system (accessibility, comprehensiveness, portability, public administration, and universality) are standards a restructured US system could achieve. The merits of including mental health coverage in a basic benefits package are also discussed. The authors believe limits on reimbursement for psychologists in Canada should not keep US psychologists from supporting single-payer proposals because (1) the professional Zeitgeist in the US in 1992 is very different from that of Canada in the late 1960s and (2) Canadian psychologists could have participated but failed to achieve professional consensus on the merits of inclusion in the national health program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The ontological basis of strong artificial life

In 1973, the United States Congress enacted legislation requiring physicians to initiate Peer Review Organizations to monitor utilization and quality of hospital and physician services in the federally funded Medicare program. A hardly noticed provision of the statute intimated the desirability of formulating guidelines for medical treatment. What was originally intended to simplify and universalize general standards by which quality of care could be objectively measured has more recently escalated into formalized projects, subsidized by government, to create "practice parameters". The impetus to define clinical conditions and methods of treatment for specific medical conditions (practice parameters) and standards of practice to avoid or defend malpractice claims (risk management protocols) are part of the movement in the United States for tort reform. If the vague "reasonable man" standard of care in negligence law can be supplanted by a scientifically developed, particularized medical practice standard, it is anticipated that spurious claims and defensive medical practice will be discouraged, quality improved, iatrogenic injury and malpractice litigation diminished. Many U.S. states undertook tort reform in the last decade. A few have embarked on medical-legal reform. One state is conducting a five-year medical liability project that calls for the development of practice parameters and risk management protocols in four medical specialties. The parameters will have the effect of law and may be introduced as evidence in medical malpractice trials. How the parameters are established, their effect on the strategies of litigation, the resultant trial problems in the introduction of evidence and in the burden of proof and their potential for acceptance by a significant number of jurisdictions-are the issues to be explored in this paper.     

Principles of surgical management of ovarian carcinomas

Most comparisons of the relative effectiveness of cost containment in the Canadian and U.S. health systems trace Canada's greater success to its single-payer approach. However, these studies ignore the substantial variation that exists in hospital and personal health care spending among both the American states and the provinces and territories of Canada. Four American states have adopted all-payer hospital rate setting; one other uses competitive bidding. All five show rates of growth in per capita hospital spending comparable to (and in some cases, lower than) the Canadian jurisdictions. Hospital spending, as a percentage of state gross domestic product (GDP), declined or remained constant in four of the five states. In four out of the five, growth in per capita spending on personal care, as a percentage of GDP, remained or fell below the national average. By contrast, in Canada, per capita spending on both hospitals and personal health care increased as a percentage of GDP in ten out of eleven jurisdictions. In each of the U.S. states, government played a central role in structuring the terms of payment and thus strengthened the hand of purchasers over providers. This strategy, rather than specifically a single-payer or universal health insurance approach, seems to be the key to limiting the growth in health costs to the growth in state or national income.     

Medical necessity in Canadian health policy: four meanings and ... a funeral?

Four meanings of medical necessity have emerged, evolved, and dominated past and current health policy debates about the appropriate level of service coverage under Canada's health insurance program. To explore the shift in definition, provincial government and national health care association position papers responding to federal legislative and policy reviews of Canada's health insurance program from 1957 to 1984 were examined, as were more current reports on medical necessity. Four meanings of medical necessity predominated: "what doctors and hospitals do"; "the maximum we can afford"; "what is scientifically justified"; and "what is consistently funded across all provinces." These meanings changed with time as different stakeholder associations and governments redefined the concept of medical necessity to achieve different policy objectives for health service coverage under Canada's health insurance program.     

The Pavement Enterprise at Michigan Technological University

A project-based student Enterprise program was established at Michigan Technological University as part of an effort, funded by the National Science Foundation, related to reform of engineering education. The Enterprise program represents a separate degree track available in all departments of the College of Engineering. The Pavement Design, Construction, and Materials (Pavement) Enterprise was established in the Department of Civil and Environmental Engineering in conjunction with the Thompson Scholars program. The Thompson Scholars program is an asphalt-paving-industry-supported scholarship program. The Pavement Enterprise is composed of a team of students that work in a businesslike setting on projects related to the asphalt paving industry. In addition to their project activities, students are required to participate in paid summer internships in associated industries and organizations. An Advisory Board composed of industry and government leaders meets three times a year to provide advice, guidance, and feedback to the students and associated faculty. The team project activities of the Pavement Enterprise prepares graduates for careers in the pavement engineering field with knowledge and skills well beyond their peers in the traditional civil engineering curriculum. These team projects incorporate “active learning” techniques into the program. The performance of the Pavement Enterprise is demonstrated using student attrition as well as a peer review. Lessons learned in the operation of the program are presented for those institutions considering a similar program.     

The new politics of U.S. health policy

Following the demise of comprehensive health care reform in 1994, some reformers are seeking comfort in the successful "incremental" strategy for enacting Medicare that emerged out of President Harry Truman's failed campaign for national health insurance in 1948-50. But despite similarities between the Truman and Clinton health security efforts, overall contexts of government and politics are much less hospitable to governmentally funded reforms today than they were after Truman's defeat. Back then, market transformations and political dynamics were both pushing toward expanded access to health services and insurance coverage. Today, by contrast, both push in the opposite direction. The private insurance market is fragmenting, federal budgetary constraints stymie new programs, and the deficit dominates debate over existing programs. Equally important, a stable pro-reform coalition like that of Truman's day has yet to emerge, while a new and fiercely conservative corps of Republicans is championing coherent programmatic alternatives based on antigovernment premises. Although passage of the Kassebaum-Kennedy health insurance reform bill in 1996 unleashed a wave of enthusiasm about incremental health care reform, formidable political, fiscal, and technical obstacles continue to stand in the way of even relatively modest incremental solutions.     

Interpersonal trust as a factor in communication.

A written questionnaire given to individuals in a large government research laboratory, inquired about attitudes about changes in a research program, attitudes of trust toward each other, reports as to whether they had discussed the new program, and estimates of each other's attitudes about the program. The data support the hypothesis that "a communicator, B, who lacks trust in the recipient of his communication, A, tends to be motivated to conceal his own attitudes about an issue, X, in communicating with A. The accuracy of A's perceptions is impaired accordingly." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A crash research program for peace.

A letter raising questions and requesting information about encouraging nonphysical sciences (social and biological) to solve the problems of "our very survival," about the position of the government represented on a huge research program of a "crash" nature sponsored by the United Nations at a cost of several billions of dollars "for the purpose of scientifically investigating the phenomenon of war," and an indication of reasons that would favor an affirmative vote on the research proposal was sent to head representatives of each of the 81 nations in the United Nations. 26 replies were received. Replies were classified as negative (6), favorably inclined (2), favorable (3), "can not evaluate" (5), and "being considered" (10). Statements excerpted from the replies are presented. A major reason for not supporting the proposed program was "a skepticism concerning the value of its outcome." Results are briefly discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Replacing retrenchment with dynamism through a program of career alternatives.

The current crisis in higher education needs to be redefined from an "external" problem of lack of government funding to an "internal" problem resulting from the age and tenure distribution of the current faculty. Sufficient money will not be available both to preserve the status quo and to meet new educational responsibilities. Rather, an internal response must be found in order to avoid "retrenchment" which will compromise essential academic values. An immediate and necessary step is to gain increased academic and financial flexibility through a program of career alternatives to restore choice and direction to our universities through internal "dynamism." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Advocates for Educational Services for All Children need improved research and conceptual bases.

Presents a rebuttal to the position statement "Advocacy for the Appropriate Educational Services for All Children" jointly sponsored by the National Coalition of Advocates for Students and the National Association of School Psychologists. Arguments focus on the conceptual weaknesses of the position. Advocacy for an alternative system to classification and placement in special education is based on false assumptions, including those regarding the relationship between psychoeducational assessment and program effectiveness. The position's weaknesses preclude its usefulness as a basis on which to advocate reform in systems that serve the handicapped and even less so in those that serve all children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coordinated systems of community-based health care delivery: a vehicle for health care reform

The need for health care reform in this country continues to be high on the public agenda. Deficits in the access of United States citizens to needed health care services continues, despite recent efforts at health care reform. In addition, the health status of children in this country is of paramount concern. Significant threats to the health of this nation's children have spurred several proposals for reducing the cost of health care while improving the quality of outcomes. A sample of these proposals is analyzed. An example of a health care program which exemplifies one such proposal for health care reform is then discussed. Findings of a recent research project that is relative to the benefits of such a program are provided.     

Ultrasonic examination in soft-tissue and long-bone injuries of the limbs

Compulsory sterilization, where jail sentences will be imposed on couples if both partners remain unsterilized after the birth of their 3rd child, will be introduced in India, and it is thought that such a program will fail. Indian officials justify compulsory sterilization on the grounds that the country's survival is at stake. This argument, however, is not self-evident. Coercion entails potential moral and political consequences. Preliminary evidence on the effects of a combination of income redistribution, lowered infant mortality, improved literacy, and readily available family planning services and information show that such "packages," however slow and costly, may make smaller families an attractive alternative to the poorest family. The Indian government seems to be looking for a "short-cut," which will require complicated record keeping and readily available health facilities. If India were ready for the successful introduction of compulsory sterilization, it would also be ready for "development" since much the same structure would be required.     

Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance

Decentralization has long been advocated as a desirable process for improving health systems. Nevertheless, we still lack a sufficient analytical framework for systematically studying how decentralization can achieve this objective. We do not have adequate means of analyzing the three key elements of decentralization: (1) the amount of choice that is transferred from central institutions to institutions at the periphery of health systems, (2) what choices local officials make with their increased discretion and (3) what effect these choices have on the performance of the health system. This article proposes a framework of analysis that can be used to design and evaluate the decentralization of health systems. It starts from the assumption that decentralization is not an end in itself but rather should be designed and evaluated for its ability to achieve broader objectives of health reform: equity, efficiency, quality and financial soundness. Using a "principal agent" approach as the basic framework, but incorporating insights from public administration, local public choice and social capital approaches, the article presents a decision space approach which defines decentralization in terms of the set of functions and degrees of choice that formally are transferred to local officials. The approach also evaluates the incentives that central government can offer to local decision-makers to encourage them to achieve health objectives. It evaluates the local government characteristics that also influence decision-making and implementation at the local level. Then it determines whether local officials innovate by making choices that are different from those directed by central authorities. Finally, it evaluates whether the local choices have improved the performance of the local health system in achieving the broader health objectives. Examples from Colombia are used to illustrate the approach. The framework will be used to analyze the experience of decentralization in a series of empirical studies in Latin America. The results of these studies should suggest policy recommendations for adjusting decision space and incentives so that localities make decisions that achieve the objectives of health reform.     

我国钨企业现代企业制度改造的思考

在政府的引导下 ,按照市场规则 ,通过参股、控股、交叉持股形成大型集团公司应是目前我国钨企业现代企业制度改造的较好方式 ,它将给我国钨业带来全新的面貌。     

Medical legal aspects of clinical monitoring

Modern laboratory technology has spawned a plethora of techniques for measuring and monitoring drug concentrations and body constituents; but the availability and frequent over-use of these determinations, some of which are exotic and require specialized personnel and expensive apparatus have further escalated the already high cost of medical care in several ways. The specter of medical malpractice suits has compelled the physician to practice defensive medicine including ordering unnecessary monitoring procedures, particularly for drug levels. Further impetus has been superadded by the courts and state legislatures; for example, phenylketonuria (PKU) determinations are mandatory in almost all states. Court rulings have held that "common knowledge" not expert testimony, may be all that is necessary to hold the doctor culpable for not ordering a test; nor is expert testimony necessarily required if the Physicians Desk Reference (PDR) or drug company insert recommends that certain tests or monitoring procedures be performed and the doctor fails to comply. (PSRO) programs will force further conformity, leave less to the discretion of the physician and place the government in an ever more regulatory role. Professional societies should take cognizance of the impropriety and danger of the government dictating diagnosis and treatment and should launch a vigorous program to scrutinize pending regulatory legislation and to make official and informed representations to appropriate legislators.     

Review of The student personnel program.

Reviews the book The student personnel program by M. D. Woolf and Jeanne A. Woolf (see record 1954-06582-000). Subtitled, Its development and integration in the high school and college, this book is an "attempt to picture a comprehensive student personnel program" (p. v) and draws heavily on the authors' twenty-six years of educational experience. Most professional workers will find much of interest in it. Most will also be bothered by a number of shortcomings. Virtually all phases of the student personnel program are dealt with. After a short introductory chapter on the expanding role of the personnel worker, there are chapters on counseling, group methods, student government, discipline, housing, remedial services, measurement, orientation, faculty advising, training of personnel workers, and administration of the program. Unfortunately, there is no readily discernible framework, no integrating philosophy which might have given added meaning to the extensive content. Taken as a whole, the defects of this book seem to stem from two principal sources. In the first place, there is the previously mentioned apparent confusion about whether this is a scholarly book or one primarily reporting on experiences. Both are valuable and necessary, but they need to be carefully amalgamated, not cut and patched together. Secondly, there is the lack of a carefully thought out and explicitly stated philosophy of student personnel work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment: A Report of the Commission of Inquiry Into the Non-Medical Use of Drugs.

The Commission of Inquiry into the Non-Medical Use of Drugs was established May 29th, 1969. The interim report prepared by the Commission and tabled in parliament on June 19th, 1970, has resulted in the creation of the Non-Medical Drug Directorate within the National Department of Health and Welfare. However, other than providing some funds for research, no comprehensive program has been developed by the directorate to deal with abuse and addiction problems. Furthermore the government has indicated that the final direction of federal programs will not be determined until the Commission of Inquiry into the Non-Medical Use of Drugs has made its final report and until a discussion of their recommendations has been held. This commentary presents the views of the Canadian Psychological Association regarding the report on "Treatment" only and will be followed by a commentary on "Cannabis" and the "Final" reports. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Reinventing government.

Reviews the book, Reinventing government by David Osborn and Ted Gaebler (1992). This is a "must read" book for any consultant who works with or for government. The focus is on how government operates, the means of governing. Osborn and Gaebler point out that government cannot be run like a business, because they are fundamentally different institutions; their missions, motives and procedures being quite opposite. However, the differences between them do not mean that government cannot be more entrepreneurial, and that idea gets to the heart of the book. Control needs to be replaced by flexibility and adaptability. This can only happen if the environment is characterized by "entrepreneurship", which means "shifting economic resources out of an area of lower productivity into an area of higher productivity and greater yield". The authors propose 10 principles of new government, and the meat of the book is found in the ten chapters which expand on these ideas and offer a variety of examples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sustaining curricular change at Sherbrooke through external, formative program evaluations

In this case study, the authors discuss external, formative program evaluation as a means to monitor and sustain ongoing curricular change and to prepare for periodic accreditation reviews. The Faculty of Medicine at Sherbrooke (in Quebec, Canada), following a major curricular reform begun in the mid-1980s, held three external, formative program evaluations in 1988, 1991, and 1994, using expert judgment and "connoisseur" models of evaluation. The authors present the goals of the evaluations (e.g., to evaluate the implementation of intended curricular changes) and the 17-step process used (e.g., "involve as many faculty and students as possible before and during the visit"), and describe the preparation for the evaluations, the selection of the external evaluators (e.g., a chief medical officer from the World Health Organization, a high-profile basic sciences teacher, the chairman of the previous accreditation team, and others), and on-site activities and reporting. Recommendations from the evaluators and the subsequent actions taken (and in a few cases, not taken) by the school are presented and discussed in terms of program planning, curricular content, basic sciences, problem-based learning and tutors' training, assessment of students, resource constraints, clerkships, community orientation, students' self-directedness, and medical humanism. The three evaluations helped guide and support the major curricular undertakings and encouraged continued changed and refinements. They also had a significant effect on the curriculum itself, on the faculty, and on the socioeducational climate of the school.