Quality of life as the criterion for need assessment and community psychology. A "QOL-Contribution" model for resource allocation decisions is proposed that integrates concepts and values from community psychology, need assessment, and quality of life (QOL) studies. QOL is taken as the criterion for establishing the goodness-of-fit between a population and its environment. It is assumed that the characteristics of a given human group interact with the resources and the stressors of its environment, with its level of QOL as the result. The utility and the implications of the model for resource decisions are demonstrated with data from a statewide need assessment. In this application, different life domains, and different program targets within life domains, are prioritized according to their relative contributions to QOL. The findings for mental health and employment illustrate the specificity of the model's application. The model is then restated as the general task, and a unifying theme, for community psychology.


Psychosocial predictors of service utilization among Cuban-American elders. The utilization of service by Cuban-American elders is studied in light of the informal network and sociodemographic hypotheses extant in the current literature. In addition, the effects of psychological variables are assessed. The data from questionnaires administered to 88 Cuban-American elderly give partial support for findings previously obtained with elderly subjects. However, the results suggest that unidimensional hypotheses are inadequate for explaining service utilization. More complex models that account for multidimensional interactions between population-specific variables must be developed to guide future research and practice.


Assessing Hispanic mental health needs: issues and recommendations. This article is based on the premise that culture-specific needs assessment methodologies are necessary to obtain accurate, valid, and reliable results when studies are conducted in culturally different groups. Accordingly, the literature on needs assessment and on Hispanic psychology is reviewed, creating a synthesis prescriptive of the best strategies for the assessment of mental health needs of Hispanic populations. Traditional needs assessment methods are discussed in the context of the types of changes that must be made to render them culturally acceptable and useful with Hispanics. Conceptually, the important issue is that of being sensitive to the interplay between the effectiveness of the methodology and its impact within a given cultural setting.


Culturally sensitive and effective psychologists: a challenge for the 1980s. A random sample of accredited graduate psychology departments and internship programs were surveyed to examine current efforts at integrating ethnic minority content into curricula and training. Additional information was sought on faculty development efforts and needs relative to integration of such content. Of the 121 department chair respondents, 80 affirmed inclusion of ethnic minority content in curricula. Integration was mainly found through provision of elective courses. Seventy internship directors responded, with 45 acknowledging ethnic minority content in their programs. However, only 36% of this content was found in "most of the program." Over 30% of both the departments and internship programs reported no efforts to integrate ethnic minority content into curricula or training. Faculty development efforts in both the academic and applied settings were also found to be minimal. However, the need existed to provide faculty with basic resource materials, guidelines, and approaches, as well as training in integrating ethnic minority content. Department chairs perceived summer institutes for faculty as a mechanism for fulfilling ethnic minority content requirements. Internship directors perceived continuing education programs as most advantageous. Issues regarding the implications of the apparent dearth of ethnic minority content in psychology are discussed.


Sweep-frequency marker generator for blood pressure transducer testing. A circuit which places accurate frequency calibrations on swept-frequency recordings is presented. This circuit is useful in the calibration of direct blood pressure transducers and will have applications in the testing of other biological transducers as well. The design range of 1 Hz to 128 square root 2 Hz is suitable for testing a broad range of biological transducers and systems. The circuit basically measures the periods between successive zero crossings. Pulses are generated that may be recorded on a swept-frequency strip chart record of an individual transducer. A series of sixteen marker pulses indicates 1 Hz, square root 2 Hz, 2 Hz, 2 square root 2 Hz, up to 128 square root 2 Hz. A special wide pulse at 16 Hz distinguishes the marker pulses.


Hospital telemetry monitoring systems.

Hospital telemetry monitoring systems. Hospital cardiac care systems frequently provide multiple-channel cardiac monitoring by telemetry for a second phase of cardiac recuperation from a myocardial infarction. This article describes the engineering and clinical considerations in selecting, designing, and operating telemetry systems in a clinical setting.


The Indian Health Service. A comprehensive health care delivery program.


Health considerations for improving human well-being in the 1980s.


Microcomputers and quantitative methods in the health services administration program: an experiment.


Health administration education: what next?


Primary health care: assessing projects.


Personnel resources and training needs: the education and training of the hospital management in Austria.


Developing the infrastructure of education for a changing environment.


Report of the Board of Directors, AUPHA.


The hypothermic code. CPR controversy revisited.


ARC answers Alicia.

ARC answers Alicia.


Windows of vulnerability.

Windows of vulnerability.


Pitfalls in disaster management.

Pitfalls in disaster management.


EMS volunteers.

EMS volunteers.


Simulation in training.

Simulation in training.


Housing and health. The role of the environmental health practitioner. From a health standpoint, the residential environment is both the dwelling and its associated areas. The dwelling and related area are interrelated both in terms of sanitation problems affecting physical health and other problems affecting mental health. The residential environment certainly represents a complicated public health problem. The issue of inadequate shelter has been addressed throughout history, but the relationship of shelter and health brings it to our attention now. It is estimated that one out of every four persons in our nation lives with some kind of shelter deficiency. The Federal Housing Act of 1949 was instrumental in creating an awareness that the quality of shelter and the surrounding environment has a great influence upon the physical and mental health and well-being of each individual. When the Housing Act of 1949 was passed, the American Public Health Association Committee on the Hygiene of Housing acknowledged the role public health agencies would have in eliminating and preventing health hazards associated with substandard dwellings. It also recognized the need for a formal code to establish minimum standards for the condition and maintenance of dwellings.


Patient rights versus patient care.

Patient rights versus patient care.


Infection control. EMS reacts--and overreacts--to the AIDS panic.


A first response system, rural style.

A first response system, rural style.


Fund raising: opportunity or hassle?

Fund raising: opportunity or hassle?


Fire service EMS training.

Fire service EMS training.


Funding an ambulance service.

Funding an ambulance service.


Basic principles for new role development: a ten-year experience.


GNP role development: what makes the difference?


GNP role development: problems and potentials.


Use of a GNP in the expanded nursing home.


The role of the nurse practitioner.

The role of the nurse practitioner.


Institutional perspectives.

Institutional perspectives.


GNP: the right person at the right time.


GNP effectiveness in a rehabilitation center. Gerontological nurse practitioners have proved to be of immense value to patient care in a moderate sized (124-bed), busy (100 percent capacity), long-term care facility. A program that was established to handle a staffing problem with financial constraints has worked very well in providing extended medical services to a demanding patient load. GNPs have successfully been integrated into the facility with wide acceptance by the hospital staff and the clinic physicians to whom the facility's patients are referred when needed.


Desert Life Health Care Center.

Desert Life Health Care Center.


Quality improvement at Desert Life Health Care Center.


GNP--the bloom of Rose Arbor Manor.

GNP--the bloom of Rose Arbor Manor.


The GNP role in a large, multi-level facility.


GNP: curriculum and training.

GNP: curriculum and training.


Crista Senior Community.

Crista Senior Community.


Projects and demonstrations relating to long-term care.


The AAPC: the beginning years, 1963-1965.


Organizational options and future directions.


Manual for staff doctors, 1983. Japan Hospital Association.


Toward envisioning the future of pastoral counseling and AAPC.


Overview of Japanese health insurance.

Overview of Japanese health insurance.


The situation of Japanese hospitals in the next ten years: preventive medicine, health promotion, and the hospital network.


Time series trend of the clinical departments of general hospitals in Japan.


Efficient hospital management.

Efficient hospital management.


The effect of a low-calorie diet on the quality and quantity of breast milk.


Accounting standards for hospitals.

Accounting standards for hospitals.


Performance-based certification in volunteer administration.


Companies prescribe major revisions in medical benefits programs to cut soaring healthcare costs.


Security problems proliferates along with personal computers.


The importance of management input in the development of information systems security.


White v Turner et al--physician and surgeon.


Re: Clarke Institute of Psychiatry and Catholic Children's Aid Society of Metropolitan Toronto et al.


Psychiatry: the lost horizon. The erosion of human rights.


PINCO: personal information and confidentiality controls. Legislation is required now in order to get proper controls on personal information and confidentiality in the near future when the need for it, particularly in relation to the development of third generation computers, will be more clearly perceived in Britain than it is at the moment. If action is taken now, PINCO controls can be introduced more cheaply and efficiently than will be the case if urgent action has to be taken later.


Castro's medicine. An on-the-scene report.


Deaf patients hear me loud and clear.

Deaf patients hear me loud and clear.


We can't afford to prolong so many hopeless lives.


A $100,000 warning to insurers: don't second-guess M.D.s.


Midwifery: the latest growth industry.

Midwifery: the latest growth industry.


Malpractice reform gets a powerful boost.


How doctors kicked out a hospital board.


Doctor competition: more battles spill over into court.


Could someone be stealing from your hospital?


Malpractice pressure spreads along new fronts.


How PPOs turn doctor against doctor.

How PPOs turn doctor against doctor.


Will this law resolve the informed-consent dilemma?


What the new Congress will do to doctors.


What dying patients fear most.

What dying patients fear most.


Who really cares about saving medical costs? Nobody!


Is this the ultimate step in quality control?


Is any attorney worth a $4.4 million fee?


How a lawyer can poke holes in good medical records.


A self-policing program that works.

A self-policing program that works.


Writing medication orders that won't get you sued.


Will the PPO movement freeze you out?

Will the PPO movement freeze you out?


Medical equipment buyers guide 1983, Part 2: Blood flowmeters, blood pressure instruments, cardiac output meters, ECG-EEG-EMG, pacemakers, scanners, imaging and accessories.


Ultrasonic wheelchair control.

Ultrasonic wheelchair control.


Electrical safety in medical environments.


Medical equipment buyers guide 1983, Part 3: ECG transmitters/receivers, electronic thermometers, patient scales, pumps, infusion and autotransfusion devices, syringes, transient/surge protectors, ultrasonics.


Technology for hospitals.

Technology for hospitals.


Electronic balance calibrates pipettes.

Electronic balance calibrates pipettes.


Medical equipment buyers guide, Part 4: Balances and microbalances, blood cell counters, blood chemistry, blood coagulation, blood gas, blood pH, ECG analyzers, heart rate meters, hematocrit, recorders.


Medical equipment buyers guide, Part 5: Biofeedback, catheters and catheterization, electrodes for ECG, EEG, EMG, ENG, patient monitors, stimulators, defibrillators.


Recording films.

Recording films.


Acquisition of a laboratory information system.


The doctor's dilemma: the rights of the critically ill.


All but one Mobile hospital ER bars indigents on weekends.


Spine-injured moving from nursing homes into life's mainstream.


How to rebuild your P & P manual.

How to rebuild your P & P manual.


Deducting the cost of smoking cessation programs under Internal Revenue Code Section 213.


Going the distance.

Going the distance.


Space is tight, costly for new technology.


Computer advances make hospital systems more vulnerable to break-ins.


Patient monitors getting 'smarter'.

Patient monitors getting 'smarter'.


Vendors bet on different strategies to overcome NMR's cost problems.


Bonnabel serves haute technology.

Bonnabel serves haute technology.


Interest in satellites starts to soar.

Interest in satellites starts to soar.


Planning now for the possibility of layoffs can temper turmoil, trauma.


IRS may let nonprofit hospitals take advantage of 'profit sharing' plan.


'Group boycott' claim fails, but buying contract still faces antitrust challenge.


Conflicting market forces promise erratic behavior in interest rates.


Hospitals that start their own PPOs ease sting of discounts, survey finds.


Emergicenters serve HMO enrollees.

Emergicenters serve HMO enrollees.


States may ax emergicenters' growth.

States may ax emergicenters' growth.


Total recall.

Total recall.


Lifemark shuns freestanding centers.

Lifemark shuns freestanding centers.


Think of the patients.

Think of the patients.


Pressure to pare length of stay may pose liability pitfalls for hospitals.


Healthcare entices venture capital firms.


Competition is heating up hospitals' desire for market research projects.


FTC plans new probe of nursing homes.

FTC plans new probe of nursing homes.


Parkside is 'for-profit' in name only.

Parkside is 'for-profit' in name only.


Profits can bloom from unused land.

Profits can bloom from unused land.


Hospital's circular, pod design hits snags, but 'pros far outweigh cons'.


26% predict compensation hike; 27% foresee stability or decline.


Purchasing group spurs formation of consortium of drug wholesalers.


Freestanding centers seeking slice of radiology, computer businesses.


Shuttle cars hit some bumps, but other design elements run smoothly.


Competitive Memphis hospitals use television to focus on bigger market.


Hospitals should address specific markets in their direct mail efforts.


Scared hospitals cower behind rate setting to fend off prospective pay.


Chairman's in middle of cost debate.

Chairman's in middle of cost debate.


DC opens hospital doors to non-M.D.s.

DC opens hospital doors to non-M.D.s.


Case-strapped hospital, county clash.

Case-strapped hospital, county clash.


HealthWest's team uses management specialties to cook up new ventures.


Ex-administrator hauls board to court over its 'capricious' act of firing him.


Compensation. Hospitals pare pay hikes, but real income hits record high.


Choosing partners for a marathon dance.

Choosing partners for a marathon dance.


Playing the ratings game.

Playing the ratings game.


AMI and Lifemark forge $1 billion merger deal.


Education to the nth degree.

Education to the nth degree.


One market's loss, another market's gain.


Bar code meeting recommends task force, creates a council.


Hospital or hotel? There may be a choice.


Health care delivery: a system in transition. Health Industry Manufacturers Association.


A 'maverick' speaks--again.

A 'maverick' speaks--again.


'Phased' EtO plan is needed, says AHA.

'Phased' EtO plan is needed, says AHA.


Group sees FTC as pivotal in walk-in clinics' growth.


The Standards Laboratory and clinical standard solutions.


FECs: a fast track market. National Association of Freestanding Emergency Centers.


A market marked by optimism: more and better products for treating pressure sores.


Issuers wrap up variable-rate packages.

Issuers wrap up variable-rate packages.


QAS Microbiology Program--monitoring antimicrobic disc susceptibility tests.


Decisions related to automation in microbiology. The selection of instruments for the microbiology laboratory poses unique problems. The author of this article recommends useful steps in this process.


Selecting instrumentation and reagents for the coagulation laboratory. The selection of appropriate instrumentation and reagents for the coagulation laboratory is a difficult task for pathologists who do not devote a significant portion of their time to hemostatic problems. In this article, the authors outline a systematic approach to evaluating instruments and reagents. Using this approach, an informed individualized decision can be made.


Pathology through the looking glass.

Pathology through the looking glass.


Selecting equipment and reagents: a personal experience and process. The selection of laboratory equipment and reagents, whatever the section of the laboratory, is not a momentary decision. In this article the author shares his personal experience which emphasizes an ongoing process involving collaboration with the entire staff. Emphasis is placed on assessing the medical needs of the institution and the unique characteristics of the laboratory personnel, space, and financial resources. The author asserts that the process must be personalized to make a satisfactory selection of instrumentation and reagent systems.


The plight of clinical pathology: contributing factors.


Hospital corporations and multi-hospital arrangements. There has been a recent trend toward consolidation of hospitals into multi-institutional systems. This article states reasons for this trend and explains how it influences the health care field. The author also describes his own company which, being the largest of such systems, affects a proportionally large number of pathologists and is a major trend-setter. Pathologists would be well advised to familiarize themselves with this phenomenon. This article is based on a lecture given last year to the American Pathology Foundation.


Manpower supply and demand in pathology. Recently physicians, the federal government, and medical specialty societies have shown increasing interest in manpower needs in medicine and in the medical specialties. Since 1976 the Joint Task Force on Pathology Manpower of the American Society of Clinical Pathologists, the College of American Pathologists, and the Association of Pathology Chairmen has completed and published three reports on pathology manpower supply and demand. The results of these studies agree with a recently completed study by a federally mandated commission. These studies show pathology manpower in the early 1980s is in good balance between supply and demand. They also indicate this equilibrium will continue until 1990 unless unanticipated changes in supply and demand take place.


Blood bankers send out AIDS alert.

Blood bankers send out AIDS alert.


Marketing the hospital laboratory.

Marketing the hospital laboratory.


Candidate methods for hematology quality control.


How one hospital laboratory system marketed its clinical laboratory services. The authors of this article describe their successful experience, not only with the merging of two hospital laboratories, but with marketing their services to the offices of physicians on their medical staffs.


Avoid conflict: know the legal implications. This article addresses many of the legal ramifications of marketing hospital laboratory services to clients other than hospital patients.


Your role in the diagnosis and management of AIDS.


NME emphasizes committed volume.

NME emphasizes committed volume.


Microbiological safety cabinetry.

Microbiological safety cabinetry. This article presents a brief history of the safety cabinet, with emphasis on the Class II Laminar Flow Biological Safety Cabinet. The why, what, how, and when of cabinet operation, purchase, certification, HEPA filters, and cabinet working techniques are explained thoroughly.


Nosocomial patient-related laboratory abuse. Improper and excessive use of laboratory procedures constitute a significant waste of money. This article describes a number of common forms of laboratory abuse and attempts to alleviate the headaches with a dash of humor.


Innovations in patient education. Instructional classes in a psychiatric hospital.


Health education programs for childhood asthma.


Using digital subtraction angiography.

Using digital subtraction angiography.


Designing patient education in an office practice.


Planning a family asthma program.

Planning a family asthma program.


Helping your patient live with epilepsy.


A guide to job-related employment interviewing.


A comparison of results-oriented and trait-based performance appraisals.


How to judge your day care options.

How to judge your day care options.


Employee control is an important option in variable work schedules.


Does the polygraph provide valid information about an applicant? The polygraph: a questionable personnel tool.


Resolution 8219: Reimbursement for patient education services. American Public Health Association.


Clubhouse in the city.

Clubhouse in the city.


Assessing adolescent health needs: a factor analytic approach. Advances in technology are rapidly expanding health educators' resources for presenting information tailored to meet individual health needs and interests. A self-administered questionnaire was given to 510 youths in grades 6 through 9 to ascertain adolescents' health concerns and thus develop more appropriate educational programs. Smoking, diet and weight control, physical fitness, and general health items were included. Factor analysis methods identified ten concerns; smoking, weight control, exercise effects, peer approval of appearance, preparatory health behaviors, planning and maintaining a personal health program, feeling good about oneself, communication issues, comparisons with others, and resistance to negative peer influences. Sex and grade were significantly associated with particular responses. Recommendations include the value of addressing each area of the content domain as it relates to health lessons to ensure that information is relevant to the needs and interests of individual adolescents.


Prenatal education for the Spanish speaking: an evaluation. A Spanish-language prenatal health-education program of classes in four topic areas was conducted for randomly selected pregnant women. The topics included newborn care, labor and delivery, family planning, and dental health care. A questionnaire was administered to the participants after they had attended all four sessions and at the end of their 36th week of gestation. A matched group of control women received the same questions soon after entering the program and before attending any classes. Women attending the health-education classes demonstrated significantly greater knowledge of the subjects covered than did those not taking the classes. Insights gained from the study suggest potential approaches for working with such a population with respect to cultural considerations, evaluation question construction, and question selection.


Patient education in the hospital health-care setting. The implementation of patient education within the hospital setting can be justified for a variety of reasons. The rationale for implementing patient education can be justified in terms of escalating emphasis on consumerism and informed participation on the part of the health-care recipient, the support of federal legislation, the support of hospital regulatory bodies, the support of third-party insurance carriers and private foundations, increased cooperation and compliance on the part of the patient, reduced stress levels for the hospitalized patient, and the improvement of staff-patient relationships. All of these serve as a database that justifies the integration of patient education within hospital care services. Patient education is the responsibility of the existing health-care system. In many instances, patient education is still not being approached in a serious manner. Therefore this paper attempts to provide a number of reasons health-care professionals functioning within the hospital setting should implement this process.


Helping families manage mental illness.

Helping families manage mental illness.


Professional disclosure in the counseling profession: a review of the literature. Professional disclosure is a vehicle by which clients can become informed about the services they may receive in a professional setting, including those in the allied health fields. This paper reviews the literature on professional disclosure from the viewpoints of shaping client expectations, promoting counselor accountability, and being ethically responsible. A written professional disclosure statement can be provided that satisfies these requirements.


Home treatment for families.

Home treatment for families.


Curbing the exploitation of children.

Curbing the exploitation of children.


Center for people in a new environment.

Center for people in a new environment.


Appraisal scales that measure performance outcomes and job results. The major deficiency with most common graphic performance-appraisal scales is their emphasis on retrospective evaluation and documentation, rather than on communication and education. So charges author Roger Plachy, management consultant, who advocates instead the use of the Performance Outcome Appraisal Scale (POAS) or the Jobs Results Appraisal Scale (JRAS). The focus of the POAS is away from the employee and toward behavior outcomes so as to minimize personal defensive reactions and to emphasize a performance standard or level of management expectation for the job responsibility or dimension. A conceptual difference separates POAS from other rating scales--that is, it is based on the belief that although the product of the procedure is a job plan and performance appraisal, the nature of the process is communication. The emphasis is not on judging behavior, but on teaching employees to think in terms of which job performance outcomes are really important to the organization. The JRAS is identical to the POAS in structure, but it starts with the desired job results as defined in the job description, rather than with performance outcomes.


Learning the hard way how to sell wellness services to the corporate market.


Motivating change: one alternative to the health hazard appraisal.


More competition, antitrust laws will not lead to better care.


Deinstitutionalization: may work for some, but still has problems.


Involuntary patient treatment left to California M.D.'s.


APA against D.C. bill to allow psychologists hospital privileges.


Threat of more malpractice suits may be facing psychiatrists.


AMA Commissioner, former President speaks on JCAH proposed medical staff standard. Interview by Barbara Herrington.


Commitment criteria expansion recommended, but can state hospitals handle more patients?


Court rules that danger warnings must be given.


Doctors taking own advice, institutional survey shows.


Treating victims of AIDS poses challenge to psychiatrists. Part 1.


Use of MH benefits may be tied to coinsurance more than Rand found, economists suggest.


'AIDS panic' brings lonely life to patients, gays.


California seeks funds to probe PPO possibility.


Social support networks seen as essential to withdrawn, isolated patients.


Survey challenges claims of lower costs by investor-owned hospitals.


Characteristics of mental health service utilizers, costs described in U.S. Public Health Service report.


Court approves forced medication if rights protected.


The implicit assumptions of television research: an analysis of the 1982 NIMH report on television and behavior. The authors analyze some of the assumptions underlying most current research on television. They emphasize the dependence on (1) an individual rather than an institutional level of analysis; (2) a model of research utilization that pays little explicit attention to where sources of leverage lie for changes in programming; (3) extremely simple models of the selection processes associated with different levels of television viewing; and (4) uncritical appraisals of the consequences of effects that many would call small or modest. These issues are illustrated by a general discussion of the NIMH report on Television and Behavior and specific discussion of "mainstreaming" and the effects of television violence. In 1972, POQ's editors invited Leo Bogart to prepare an extended review article of the Surgeon-General's Study of Television and Social Behavior (POQ 36:491-521). When the 10-year follow-up study was released by NIMH in 1982, the editors asked Thomas D. Cook, a distinguished psychologist noted for his research on television, to perform the same function.


NIMH finds rate of cuts slowing in state hospitals.


The homeless of New York.

The homeless of New York.


A radiology manager's view of marketing.


Applying the FELT system: upgrading and utilization of radiology personnel. In summary, the need for a strong foundation cannot be over emphasized. The staff quality and team atmosphere within a department of radiologic services are essential to the success of a program; the results we experienced at Dover General Hospital could not have evolved if either of these factors were not attained. Once a program has passed the FELT System criteria, it should be presented and implemented as soon as possible. Once in place, it should be reviewed periodically, and input by all affected staff will be helpful in the evaluation. Modification may be necessary as the department grows and technology changes, but the basic system should never change if the FELT System has been utilized. It is my opinion that the FELT System process is a managerial tool that can be utilized at any program at any level of management. Positive reinforcement inherent in the FELT System is essential to the growth and success of the decision-making process.


1983 Statistical Resources Committee survey/Part 1. American Hospital Radiology Administrators.


DSM-III and structural diagnosis of borderline patients. This study compared diagnoses arrived at through a structural interview developed by Kernberg which assesses levels of personality organization with those arrived at using DSM-III criteria of signs and symptoms among a group of hospitalized patients. Complete agreement was reached in 61 percent of the cases. Among the cases in which there was disagreement, 39 percent could nevertheless be considered to be compatible within the two systems, while the remaining cases were not. Discussion is directed to the different facets of clinical material addressed with each of these two diagnostic approaches, their discrepancies, and the underlying relationship between the two systems.


Draft recommendations for evaluation of radiation exposure in diagnostic radiology examinations.


Opening the door on a locked psychiatric unit. A therapeutic milieu on acute locked psychiatric units is difficult to establish and maintain. The stigma of being on a locked unit and the absence of a sufficiently compelling goal around which patients can mobilize as a group are two factors that contribute to this difficulty. By opening the door under specific conditions, we were able to affect both these factors significantly. In this article, we describe the issue of feasibility, the technical devices employed, and seven months' experience with this system.


The William C. Menninger Memorial Lecture 1983. The National Association of Private Psychiatric Hospitals and its golden anniversary in American psychiatry.


Japanese productivity: adapting to changing comparative advantage in the face of lifetime employment commitments. This article examines one of the possible sources of Japan's productivity growth--industrial policy. The policy actively encourages the transfer of resources, including labor, out of what are considered to be declining industries and sectors, and into industries and sectors considered to be expanding. At the same time, job security is guaranteed for a significant proportion of the labor force, and the article seeks to explain how Japanese "lifetime employment" can be maintained in the presence of the country's industrial policy.


Budget cuts and human services: one community's experience.


Human service cutbacks and the mental health of the poor.


The right to die and substituted judgment in Texas.


The private sector moves in: the union response.


THRM forum: influence and the medical record practitioner.


Implementing productivity improvements.

Implementing productivity improvements.


Measuring productivity in medical record departments.


Establishing objective performance standards.


Monitoring system and realistic work standards: keys to improving transcription productivity.


A labor productivity monitoring system in the medical record department.


Medical record work standards: some practical aspects.


Workload and staffing in the medical records department at Church Hospital.


Group therapy with patients in the waiting room of an oncology clinic.


Medical record department productivity standards: a case study.


Skills and tactics in hospital practice.


The most common emerging model for localizing "quality assurance" in the hospital organization.


State investigations of disabled or impaired physicians and the right to inspect medical records.


Alliances: linkages to walk tightrope between autonomy and efficiency.


Guidelines can resolve turf battles between local and corporate boards. The relationship of a local board that is a member of a multihospital system with the corporate board of the system is a confusing one for trustees. This article provides a model for the distribution of power between corporate and local boards of hospitals that are owned or leased by a multihospital corporation.


Contract management: legal issues in delegation and supervision. Whatever the justification, the decision of a hospital board to enter into a management agreement is a significant one not to be undertaken without careful deliberation. An important component in that decision is consideration of the managerial functions to be delegated, and this process raises potential legal issues for the hospital trustee. This article examines those issues, identifies questions that a hospital board should address, and suggests some steps that trustees can take to minimize problems.


Six cardinal rules to help boards solve top management problems. The board, administration, and medical staff have distinct roles to play in hospital leadership. Only when each group knows and sticks to its proper role can a hospital hope to meet its major objectives.


General economic recovery signals productivity increases for hospitals.


Maintaining familiarity within a nursing home.


Blue Cross clearinghouse helps locate SNF beds.


New computers simplify nursing home management.


Choosing the right telephone system.

Choosing the right telephone system.


Hospital costs state by state.

Hospital costs state by state.


Known welfare fraud is only "tip of iceberg".


New health center bridges care gap.

New health center bridges care gap.


Self-help group aids adult child and parent.


DoD survey of community hospitals sparks concern.


Resident allocation could be improved.

Resident allocation could be improved.


Prenatal, postnatal services seen important in preventive medicine.


HHS renews proposal on infant 'protection'.


Research training commitment vital.

Research training commitment vital.


Critics claim rules harm dialysis care.

Critics claim rules harm dialysis care.


VA, DoD in agreement on sharing guidelines.


Blood shortage fails to materialize.

Blood shortage fails to materialize.


Reforms for FEHBP proposed.

Reforms for FEHBP proposed.


U.S. Medicine interviews William R. Gemma.


Koop says physicians misjudging 'Baby Doe'.


Hospitals' joint clinical trials could raise policy influence.


The role of hospitals in the strategy for health for all by the year 2000.


Financial, staffing setbacks continue to plague hospital.


Perspectives. Can doctors and hospitals MeSH?


Teaching hospital and community: development of a comprehensive health care plan.


The health service in a big city: planning initiatives.


Management and delivery of health care in Colombo, Sri Lanka.


Nursing in urban settings: are we responsive to the needs?


Primary health care in urban areas: WHO's dilemma.


Primary health care in the State of Mexico.


New trends in Western Europe for hospital planning.


Design of a hospital within a health plan: the Altebrat Programme.


Summary of Group 4: Innovations in the planning, management and delivery of health care in big cities.


Environmental psychology and hospital design.


Summary of Group 2: Design for efficiency, economy and humanity in hospitals.


Physician supply, protective pricing and implications for hospital medical staffs.


Psychiatric malpractice: liability for suicide and attempted self-destruction. One of the many observations of changes in doctor-patient relationships is in regard to psychiatric problems. First, patients have become more sophisticated in their comprehension of these problems and have become more willing than previously to talk about these conditions and simultaneously to be managed for these problems by primary care physicians--sometimes in preference to a psychiatrist. Secondly, primary care physicians have changed their perceptions of patients' psychiatric problems. They have developed a greater comprehension of these problems--particularly as they relate to somatic complaints. One result of this has been that physicians are now able to detect these problems and to intervene before the problem reaches serious proportions. One of these psychiatric disasters is suicide, and it is to this subject that this article is devoted. Obviously, it is a subject as applicable and important to the primary care physician as it is to the psychiatrist, as both encounter patients in situations and with conditions that have the potential for leading to self-destruction.


Social issues in perinatal screening for sickle cell anemia. We are living in a time of fascinating scientific achievement in the biomedical field of genetics. The revolutionary methodologies of this biomedical technology produce new ideas and new options for the quality of our life. While this paper is focused on prenatal testing for sickle cell anemia, it simultaneously illustrates the general complexity of public health issues and points out that some emerging scientific values may be more harmful than beneficial to the public because they are inappropriate priorities and do not deal with problems that truly affect the public's health. Special attention is given to issues of ethical significance demonstrating that scientific objectives have been emphasized and that beneficence and respect for persons are principles that have been neglected in Prenatal Sickle Cell interventions. Lastly, this paper advocates social policy to protect the at risk groups from what may become irresponsible public health paternalism.


New York City's Poison Control Center: a systematic approach to a complex problem. A pooling of public and private resources has created a regional poison control system which provides information and education to the medical and lay communities of metropolitan New York City. An overview of the poisoning problem on a national scale is followed by a description of the operations by the Center, and a special volunteer effort.


Reaching women problem drinkers through a multimedia information campaign.


Training employees and supervisors to increase use of EAPs by women.


Women alcoholics in management: issues in identification.


Women in the workplace: an overview of NIAAA's Occupational Alcoholism Demonstration Project.


Affecting attitudes and assumptions about women and alcohol problems.


Treatment services for youth. A comprehensive treatment approach.


Job analysis and placement in vocational rehabilitation.


Teaching principles of geriatrics through a home health care rotation. To provide pharmacy students with ambulatory geriatric training, the University of Georgia School of Pharmacy developed a clinical rotation in home health care. This one-week experience in which students encounter patients in the home environment is offered as part of the four-week required clinical clerkship. While in the home setting the student is exposed to the various medical, social, and economic problems of the elderly and in turn provides the patient with nondispensing pharmaceutical services such as drug use review, drug histories, and patient education. The patients' medication regimens are discussed prospectively and retrospectively at daily conferences with the clinical preceptor and student peers. Students have evaluated the program as valuable in improving their communication skills and their knowledge of drugs and diseases of the geriatric patient.


Evaluating risk taking propensity as a predictor of the outcome dimensions of medication history taking. Medication history taking is a commonly discussed factor in the role of the pharmacist. Effective and efficient interviewing skills are important since they can be influential in affecting the quality of the medication history. Level of risk taking has been related to many factors which affect personal interaction. The objective of this study was to relate level of risk taking to the successful outcome of the medication history interview. Outcome dimensions of the medication interview were defined as successful completion and unsuccessful completion. Senior pharmacy students were observed and rated relative to the performance criteria of effectiveness and efficiency in acquiring patient medication histories over an eight-week period in an ambulatory medicine clinic. A significant Kendall Coefficient of Concordance indicated that the judges involved applied essentially the same standards in ranking the subjects. Subjects were administered a six-item questionnaire, the Choice Dilemmas Questionnaire (CDQ), which measured their risk taking propensity. There were significant differences in mean levels of risk taking between the groups rated as high and low in terms of effectiveness and efficiency. Effective and efficient interviewers, who successfully completed interviews, were significantly higher in risk taking propensity. Tetrachoric r indicated the CDQ was efficient in distinguishing the criterion groups.


'Wrongful birth' lawsuits raise complex social issues.


A thoroughbred plant.

A thoroughbred plant.


Reagonomics: a change in thinking needed.


Lighting those visual display terminals--in the cause of the operator's comfort.


On understanding changing marketplaces, and changing tactics for getting things built.


Health spin-off from work in radio-astronomy.


Scheme to save hospitals millions a year.


Business communication, Part 3: Successful meeting a business rarity.


Electricity load management.

Electricity load management.


Medicare threat to hospital system.

Medicare threat to hospital system.


One chef's crusade for interesting food in hospitals.


Nurses launch attack on Richmond Report.


The chasm between admin and nursing.

The chasm between admin and nursing.


Are staff the casualty in the casualty ward?


Individualized instruction and evaluative rationale. Students of radiologic technology must be competent both academically and in clinical practice, and as professionals they will be held accountable for the quality of their practice. Evaluation and accountability are inseparable elements in their education.


States approve Medicare deal.

States approve Medicare deal.


South Australia report. Now is the time for tough, crucial decisions.


Introduction to computer hardware and internal representation. This article begins with a discussion of some of the electronics basic to computers. From this somewhat "atomic" level, it proceeds to describe various sections of the computer itself and the representation of numbers and other data inside the computer. Finally, multiple-user systems are reviewed.


Coming to terms with occupancies.

Coming to terms with occupancies.


AHA fears Medicare 'exodus'.

AHA fears Medicare 'exodus'.


Psych wards: a report from the inside.

Psych wards: a report from the inside.


Westmead solves records problem.

Westmead solves records problem.


Are modern health service information trends really threatening ethical standards?


Soaring atria bring sunlight and space into a high-tech hospital.


Staff management and motivation.

Staff management and motivation.


Patient use of CCTV.

Patient use of CCTV.


Housing designed for special needs.

Housing designed for special needs.


Accident and health premiums 1982.

Accident and health premiums 1982.


The missing link in cost containment.

The missing link in cost containment.


What price fringe benefits?

What price fringe benefits?


Challenges.

Challenges.


Taking control of health care costs.

Taking control of health care costs.


Recombinant DNA research: actions under the guidelines--NIH. Notice of actions under NIH guidelines for research involving recombinant DNA molecules. This notice sets forth actions taken by the Director, National Institute of Allergy and infectious Diseases (NIAID), by authority of the Director. NIH, under the June 1983 NIH Guidelines for Research Involving Recombinant DNA Molecules (48 FR 24556).


Dealing with employees' personality conflicts.


Five steps to making performance appraisal writing easier.


Privacy Act of 1974; system of records--PHS. Notification of establishment of a new Privacy Act system of records 09-25-0154, "Biomedical Research: Records of Subjects in Cancer Research. In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to establish a new Privacy Act system of records 09-25-0154, "Biomedical Research: Records of Subjects in Cancer Studies of the Division of Resources, Centers and Community Activities," HHS/NIH/NCI. We are also proposing routine uses for this system. The Division of Resources, Centers and Community Activities (DRCCA) in the National Cancer Institute (NCI) will use this system of records to support research on the causes and prevention of cancer.


Revised federal allotments to states for social services expenditures pursuant to Title XX--Social Services Block Grant Act; promulgation for fiscal year 1984--HHS. Notification. The Federal allotments of +2.5 billion to States for social services under Section 2003 of the Social Security Act (Act) which were published in the Federal Register November 26, 1982 (47 FR 53502) were based upon the authorization set forth in Section 2003 of the Act at that time and were contingent upon Congressional appropriations actions for the fiscal year. Public Law 98-135, enacted October 24, 1983, amended Section 2003 of the Act, by increasing the authorization to +2.7 billion for Fiscal Year 1984 and each succeeding fiscal year. The allocation of this authorized amount for Fiscal Year 1984 is shown in Column 1 of the table below, and it too is contingent upon Congressional appropriations actions. Public Law 98-139, enacted October 13, 1983 appropriates +2.675 billion for allocation to the States under Section 2003 of the Act for Fiscal Year 1984. The allocation of this appropriated amount is shown in Column 2 of the table below. Accordingly, the promulgation made in 47 FR 53502, November 26, 1982, is rescinded and the promulgation, as revised, is set forth in Column 2 of the table below.


Privacy Act of 1974; annual publication of records--NIH. The National Institutes of Health (NIH) is publishing this document to establish changes to notices of systems of records which have been revised following a comprehensive review of all systems of records maintained by NIH. None of these changes requires a report of altered system to be sent to the Congress and the Office of Management and Budget. The notices are complete and accurate as of August 26, 1983. Furthermore, we are summarizing additions of new systems which have been published since the last annual publication, establishment of new routine uses, and deletions of old systems terminated since the 1982 publication. We are also publishing a complete list of all systems of records which NIH currently maintains.


Telecommunications technology: equipment, transmission, & management.


How to introduce your main speaker.

How to introduce your main speaker.


The care and feeding of speakers.

The care and feeding of speakers.


Privacy Act of 1974; annual publication of systems of records--PHS. This preamble summarizes significant changes to systems of individually identifiable records which have occurred since the 1982 annual publication. Notices of modified systems of records currently maintained by HRSA follow this preamble. The notices include modifications for the purpose of clarity, timeliness, and correctness, as of August 19, 1983. None of the modifications being made at this time meet the OMB criteria for a new or altered system report, or a period of public comment.


Federal old-age, survivors and disability insurance computation of benefits under totalization agreements--SSA. Notice of proposed rulemaking. Section 233 of the Social Security Act (the Act) authorizes the President of the United States to enter into Social Security agreements with foreign countries which permit the establishment of entitlement to benefits under title II of the Act by combining periods of coverage under the United States (U.S.) system and the system of the foreign country with which the U.S. has such an agreement. This process is called "totalization." We have gained a considerable amount of experience under the rules (Section 404.1918) for computing a totalization benefit while implementing the three agreements now in effect. That experience has shown that those rules are difficult to administer and that they can cause some undesirable results for benefit applicants. The rules also make it difficult to negotiate and implement additional agreements. In order to avoid administrative problems and other undesirable results we are proposing a new U.S. totalization benefit computation method which uses neither foreign earnings nor foreign coverage.


Designation of health manpower shortage areas (HMSAs); clarification of "non-federal" as used in practitioner counts--HRA.


Privacy Act of 1974; annual publication of systems of records--FDA. FDA is publishing this document to meet requirements of Pub. L. 97-375, the Congressional Reports Elimination Act. This new statute amends the Privacy Act (5 U.S.C. 552a, section 3(e)(4] to limit republication to revised system notices only. FDA has reviewed each of its system notices and has revised many of its system notices this year to enhance specificity and clarify the effects of reorganization. These revisions are minor and have no affect on the public's need-to-know. Therefore, FDA is not republishing any of its system notices at this time.


Mayo Clinic and Medical School Biodynamics Research Unit. The facilities that make up the Mayo Biodynamics Research Unit include the dynamic spatial reconstructor (DSR), which when fully operational will generate raw data at 200 million samples per second. Processing of these data will require a computer capable of several billion arithmetic operations per second.


Standard setting requirements for medical and nonmedical facilities where SSI recipients reside--Office of Human Development Services. Final rule. On March 1, 1983, the Office of Human Development Services (HDS) published in the Federal Register (48 FR 8453) a final rule with a 60 day comment period to amend 45 CFR Part 1397, Standard Setting Requirements for Medical and Nonmedical Facilities Where SSI Recipients Reside. (These requirements are known as the "Keys amendment" regulations). In response to comments, we have made one change in this final rule to allow States the option of charging a fee for providing copies of standards, procedures or other information on these facilities.


Leasing versus buying equipment.

Leasing versus buying equipment. For the upgrading of equipment that is necessary in radiologic practice, leasing is more convenient and less expensive than buying. Changes in tax laws, embodied in the Economic Recovery Act of 1981, have increased tax benefits of this arrangement.


Privacy Act of 1974; system of records--PHS. In accordance with the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to add a new routine use to system of records 00-37-0013. "Health Resources Utilization Statistics, HHS/OASH/NCHS." This system of records is maintained in the National Center for Health Statistics (NCHS) for the purposes of collecting statistics on the utilization of health services, processing and analyzing the data, and publication of the statistical findings. NCHS is proposing to add a new routine use to permit disclosure of information to a contractor. PHS invites interested persons to submit comments on or before January 11, 1984.


AMA, government officials skeptical of 'convenience medicine' facilities.


Has the law altered your role in the informed consent process?


The difficult patient: changing your approach to treatment.


Continuing education and the geographically isolated therapist. The relationship between therapists' geographic location and three program planning variables in continuing education was studied using the descriptive survey method. The findings suggested that learning needs were high in evaluation related competencies and that family responsibility and lack of appropriate programs were major barriers to participation. The overwhelming preference in delivery systems was the one or two day workshop. The study concluded that there were few significant differences between urban and rural therapists in relation to the variables studied indicating restraint rather than innovation in programming for the geographically isolated therapist.


Males in occupational therapy.

Males in occupational therapy.


A holistic view of middle management.

A holistic view of middle management.


A community model for arthritis rehabilitation. Arthritis is a widespread chronic disease which can result in severe disability. Arthritis is best managed by a triad of treatment, education, and research. A community model for arthritis rehabilitation, with emphasis on the team approach, is described and illustrated. Central to the design of the model is an arthritis centre which demonstrates exemplary treatment and has a commitment to develop education and research programs. Primary arthritis care is the responsibility of the health professionals in each community, and the arthritis centre provides the support and resources for their programs. The model is suggested as a prototype for the management of other major chronic diseases.


Patients, staff cooperate to find most effective way to run unit.


A wheelchair seatbelt for elderly patients. This article describes the design, materials, use and adaptations of a seatbelt designed to support an elderly patient sitting in a standard adult size wheelchair. The seatbelt was designed in response to a growing need for positioning of the many disabled, elderly patients now found in acute-care hospitals. To-date the seatbelt has been used successfully by four different patients.


Evaluating a hospital pharmacy computer system.


Automating the medical records department at HUP.


Time accounting systems: a case history.


"Frustration zones.".

"Frustration zones.".


Hospital disaster plans on trial as Hurricane Alicia hits Houston.


Hospitals seen to have effect on community child car safety.


EPs seen to be stepping into 'surgical vacuum' in trauma.


Providing ED indigent care in Detroit may serve as model for other cities.


Fear of death and physical illness: a personal construct approach. The Threat Index, Templer's Death Anxiety Scale, and the Collett-Lester Fear of Death Scale were administered to 100 respondents in an attempt to assess their personal orientation toward death. Each respondent was a member of one of the following groups: people with no known illness; people attending their family physician for a checkup; rheumatoid arthritics; diabetics; or people recently treated for cancer. Hierarchical multiple regression analyses indicated that older respondents were significantly less death anxious, less fearful of their own death, and more integrated (that is, showed less self-death discrepancy) than younger respondents. Further analyses revealed no differences between any of the groups on fear of death or death anxiety, indicating that the current state of an individual's health was not related to his or her death orientation. Instead, correlational and regression analyses suggested that anxiety and fear were much more likely to be influenced by a respondent's level of actualization and, to a lesser extent, level of integration. The expected additive effects of actualization and integration did not emerge, a finding that was at variance with previous research.


Emergency medical personnel training: II. Components of training. Nationwide Emergency Medical Technician (EMT) training programs at both basic and advanced levels are in flux, confronting similar challenges in design and implementation. There currently exist the 81-hour Department of Transportation course of instruction as the basis for EMT-Ambulance (EMT-A) certification and the National Standard Training Curriculum (NSTC) 15-module course for training the EMT-Paramedic (EMT-P). The National Registry of EMTs has established examination and recertification guidelines as well as requirements for both levels of training. The two national training courses reflect a difference in disease focus (ie, trauma vs cardiac) and thus a difference in care rendered by the two EMT levels. Variations in both EMT-A and EMT-P training programs at the state level in areas such as length of training and requirements for certification point out a need for greater consistency in training of emergency medical personnel. Evaluation of current training programs based on the NSTC has resulted in updating the EMT-P curriculum. The proposed curriculum includes new course material with behavioral and performance objectives. An ongoing system of training, evaluation, and incorporation of new techniques found clinically relevant is recommended.


Death education for oncology professionals: a personal construct theory perspective. Using observations from a psychosocial training program for oncology professionals, this article illustrates how one can model, while training the student, the very methods he or she can adopt in working with patients and families. One starts with an elicitation of the student's (patient's) operative personal constructs and then devises strategies to elaborate, integrate, loosen, tighten, preempt, or take other action, as needed. The very means used to promote movement within the student's own death-related constructs can be adopted for use by him or her in the clinical situation. As the helper's pathways of action and thought with regard to this domain become more comprehensive and as the helper becomes more skilled at moving freely along them, he or she becomes more perceptive and resourceful to those in need.


Training robots or thinkers?

Training robots or thinkers?


Criteria for selecting paramedic trainees. The experience of training more than 700 paramedics and the detailed records of 221 paramedic students were reviewed to determine possible criteria for selecting individuals who could complete successfully a paramedic course. Individuals over 35 years of age who had not taken competitive examinations or college courses within the last 15 years faired poorly. Review of total college hours, college grade point average (GPA), science hours, and science GPA showed no difference between the group that passed paramedic school and the group that failed. Fire department rookie school grades and emergency medical technician-basic (EMT-A) grades correlated well with success or failure in paramedic school. Psychological screening was important in ruling out serious psychiatric disturbances but was of uncertain help in predicting early burnout.


Concerns about death among severely ill people. Personal construct psychology was used to generate a set of questions about concerns about death among severely ill people. Answers to these questions were provided by content analyses of the responses of a large group of ill people to an open-ended question about their current experiences. Comparison of their responses with those of a similar group of well people indicated that they expressed more concerns about death. More death-related concerns were reported by those ill people who were facing surgery rather than those who were not, those whose illnesses were acute rather than chronic, and those who were interviewed while in the hospital rather than at home. Gender, age, marital status, and educational attainment were all considered predictors of death-related concerns; but none was found to be significant, nor were concerns about death observed to vary according to illness type. The psychological states found to accompany greater death-related concerns among ill people proved to represent both the adaptive and the dislocative processes of mourning. People who were not ill, but who had greater death-related concerns than other well people, on contrast, showed signs only of the more dislocative processes. Some of the implications of these findings for thanatological counseling of severely ill people are discussed.


Bereavement and personal constructs: old theories and new concepts. This paper reviews several traditional and current theories regarding the nature of bereavement and argues that conceptualizing grieving in personal construct terms can clarify and extend existing work in this area. In particular, it is contended that a personal construct view of the importance of "core role" (self) structure helps explain Bowlby's theory of "defensive exclusion" of the reality of the death: because an individual's perceived relationship with a significant other helps define his or her core role, loss of the relationship through death directly challenges the most central dimensions of the bereaved person's construct system. Implications of this cognitive theory of bereavement are detailed, and several testable hypotheses are put forward.


Involving constituents in agency priority setting: a case study. Many government agencies have "constituents" who believe the agencies should hear and consider their needs and desires in establishing program priorities. This article describes how one involves interested constituents (consumers, industry, medical professionals, and state organizations) in the agency's annual priority-setting process. This participation has produced a number of beneficial results-some expected and some unexpected.


Examining EMT education: a shift in emphasis. This article examines several aspects of EMT education in the United States. It deemphasizes the instructor's total dependence on objectives and examination results and encourages EMT educators to begin looking at the actual instructional process itself. This concept is encouraged through attainment by individual training programs of AMA accreditation (EMT-Paramedic level only), development of a spirit of collegiality and of inquiry about the practice of teaching, and utilization of formalized primary training and continuing education courses on improving instruction technique.


Need and possibilities for research.

Need and possibilities for research.


Reducing stress factors in EMS: report of a national survey. The existence of stress, coping with stress, and the effects of stress in Emergency Medical Services (EMS) are highly current and hotly debated subjects. This article describes in part the results of a national survey of 25 EMS systems in 24 large metropolitan areas. The portion of the survey reported here focused on sources of stress and programs available to promote more effective coping with stres. Results are discussed generally and in terms of the services' organizational affiliations.


Employee counseling services evaluation system: design, issues and conclusions. Employee Counseling Services (ECS) programs have emerged as an effective method for dealing with employees whose job performance has deteriorated due to personal problems such as alcoholism or drug abuse. It is estimated that 18% of any work force is effected by such problems at any given time and that these employees cost industry billions of dollars annually in lost productivity, abuse of sick leave, etc. One of the critical concerns of this emerging field is the need for comprehensive evaluation that can demonstrate the cost-effectiveness and cost-benefits of ECS programs. This paper will describe the model Federal ECS developed at the U.S. Department of Health and Human Services as well as the components of the evaluation system designed to determine its effectiveness. The system is the first of its kind and will be a valuable contribution to the field. The paper then raises issues and develops conclusions about designing such an evaluation within the context of a large bureaucracy.


From programs to systems: implications for program evaluation illustrated by the Community Mental Health Centers Program experience. Many approaches can be used to develop understanding of service programs. These approaches vary in how much they rely on technical vs. political procedures, who controls them, purpose, scope of content, and generality of results. Only some of these approaches are usually considered program evaluation. This diversity is illustrated by a description of the history of 10 program evaluation-like approaches to understanding as they operated during the 18-year life of the federal Community Mental Health Centers (CMHC) Program. When services were funded in federal categorical programs, information-gathering approaches focused narrowly on the program and its activities. It now appears that more widely useful information would result by shifting from the evaluation of "programs" to comparative analysis and evaluation of service systems.


Constructs and coping: physicians' responses to patient death. This paper explores the relationship between physicians' personal orientations toward death and their responses to patient death. A group of 25 pediatric residents were asked to complete the Threat Index and to respond to vignettes depicting personal death. Consistent with predictions derived from personal construct theory, particular death orientations were associated with various behavioral and psychophysiological reactions. Residents with high death threat and anxiety were more likely to adopt avoidance and denial strategies and to experience fewer psychophysiological symptoms when faced with a patient's death. Implications of these findings for further research and treatment are discussed.


But I thought you said. . .

But I thought you said. . .


Product selection, bioequivalence, and therapeutic equivalence: the generic drug market. Pharmacists are continually faced with drug product selection decisions. When is a generic drug product equivalent to the innovator product and, thus, a suitable candidate for generic substitution? The FDA policy has been that only drug products that are therapeutic equivalents are candidates for product selection decisions. This paper outlines the regulatory and scientific framework for the FDA's policies and requirements for generic drug products. The history and current status of the Drug Efficacy Study Implementation (DESI) project is described. Originally begun in 1966 as a review of about 3,400 drug products, the review in mid-1983 is more than 90% complete, but its impact has already affected more than 7,000 marketed drug products. The therapeutic equivalence policy and the manner in which decisions on therapeutic equivalence are communicated are reviewed. Regulatory policies for the approval of generic drug products are reviewed and specific litigation challenging the rights of generic drug manufacturers to produce generic "look-alikes" and challenging the FDA's policy that a generic drug product is a new drug requiring an approved New Drug Application for marketing is discussed. The conclusion reached is that the evaluation of regulatory requirements and science is leading to a point where all generic drug products will be known to be safe, effective and therapeutically equivalent, and pharmacists can be optimistic about the quality of products in the generic drug market.


National drug formularies: lessons from Latin America. Although pharmaceuticals comprise up to 40% of the health care budget in developing countries, the majority of the population does not have access to many of the essential drugs needed to treat prevalent diseases. This situation demands the development of a national formulary of essential drugs for the public sector. The approach used in developing countries is to select drugs of choice for the treatment of prevalent morbidities and avoid therapeutic duplication, unacceptably dangerous drugs, or drugs of unproven efficacy. Drugs are selected based on a review of the prevalent morbidities, health care worker training, patient characteristics, and efficacy/risk information resulting from scientifically sound studies. An added component to the formulary is the inclusion of concise, unbiased prescribing information for each drug selected. A number of product selection guidelines were proven to be effective in establishing and maintaining an essential drug formulary for developing countries. These guidelines include: 1. Selection of drugs with proven efficacy and acceptable risk; 2. Selection of minimum number of drugs needed to treat the prevalent diseases; 3. Inclusion of new products only if they are found to have distinct advantages over products currently in use; 4. Inclusion of combination products only when they provide true benefit over single ingredients; 5. Selection of drugs with clear "drug of choice" indications for prevalent diseases; 6. Evaluation of the administrative and cost impact of products; and 7. Selection of drugs with established high quality.


Collaboration and work sharing of drug information services in the United Kingdom. The United Kingdom Drug Information Network has been developed in recent years to form an effective service. The structure of the health service is discussed and the organization of drug information services within this framework is outlined. A number of collaborative and work sharing exercises have been undertaken between regional services and thus are reviewed together with future trends for the service.


Socialized medicine countries ration access, foreign market specialist says.


Right to medical care: rethinking both the nature and the scope of public responsibility.


Chairman of President's commission relates personal experiences to ethics questions.


Emergency medical personnel training: I. An historical perspective. The status of Emergency Medical Technicians has evolved from an undefined role with few rules, regulations, or standards to an established health care profession and a nationally administered program. The evolution of this profession received major impetus from the 1966 report by the National Academy of Science/National Research Council that provided recommended training standards. Development of a training course curriculum for basic life support (BLS) followed. The need for coordinated training of Emergency Medical Technical Technicians was recognized, and funds became available to aid in the national standardization of education, examination, certification, and recertification procedures for EMTs. Concomitant with the attempt to standardize BLS training, advanced life support (ALS) programs grew in number. By 1977 the National Standard Training Curriculum became available and was soon followed by a national certification exam. As states have the option to accept or reject the federal standards embodied in the national training course, there remains variation among programs offered by each state. Because of the difference in need for specific emergency services among the states at a time of increased professional mobility, arguments still exist regarding the desirability of federally mandated training and certification programs.


The ethics dilemma.

The ethics dilemma.


Hatch believes federal government does inadequate job as arbiter of ethical issues.


Top HHS health official says meeting true medical needs can fulfill ethical obligations.


Waxman says equitable access should be used as guide in health policy of future.


AMA judicial chairman sees emergency of hospital ethics panels as an inevitability.


Bioethicist on hospital association staff sees upsurge in medical ethics problems.


Florida reaches public policy crossroads on health care issues.


Laboratory fume hood noise.

Laboratory fume hood noise.


The cost of conserved energy as an investment statistic.


Hospital privileges war flares up again--this time in D.C.


Family health and psychosocial responses to cardiovascular disease.


"Disproportionate" care for the poor at heart of urban hospitals' plight.


Family responsibility could go beyond nursing homes.


Let the medical staff be a "medical" staff, AMA house says.


HRSA fiscal 1984 program guide.

HRSA fiscal 1984 program guide.


Health care in the USA: 'It just sort of happens'.


Suspected cheating holds up release of foreign medical test scores.


Appropriations bill funds HRSA programs near fiscal 1983 levels.


Consumer groups demand say in government nursing home review.


Creative computing: the faith factor.

Creative computing: the faith factor.


Creative computing: pleasing all the people.


Creating computing: quiet revolution led by the other SAS.


Health and illness beliefs and practices among the old order Amish.


Computers on roll call.

Computers on roll call.


High level wellness: a quality of life.

High level wellness: a quality of life.


A design center for disabled people.

A design center for disabled people.


In touch with the tots.

In touch with the tots.


Why the NHS watchdogs must stay alert.

Why the NHS watchdogs must stay alert.


Multi-choice acid test.

Multi-choice acid test.


Health builders.

Health builders.


Individual can beat the system.

Individual can beat the system.


Record bonding.

Record bonding.


Nursing homes: new strategy for an old problem.


Partners for priorities.

Partners for priorities.


An NHS home of their own.

An NHS home of their own.


Supplies coordination: goodbye to all this.


How long can NHS ignore quality control?


Creative computing: is it time to pull the plug on the older systems?


Residential homes: private lives.

Residential homes: private lives.


A case for the personnel officer.

A case for the personnel officer.


File under V for vital.

File under V for vital.


Nursing homes: desirable residences?

Nursing homes: desirable residences?


A sharper eye on private homes.

A sharper eye on private homes.


Where they crawl in and skip out.

Where they crawl in and skip out.


Health in the Philippines. Lessons in primary care.


Let the consumer speak.

Let the consumer speak.


The big boys take on Reagan's young Turk.


Health promotion: bringing in the outsiders.


The big car park clampdown.

The big car park clampdown.


Women's Royal Voluntary Service: more than just tea and sympathy.


Smears: are we ready to pay the price?

Smears: are we ready to pay the price?


Contracting out: new brooms to sweep NHS clean.


Cover for the healthier family.

Cover for the healthier family.


Screen test that can save a life.

Screen test that can save a life.


Contracting out: pushing private polish.


Can your computer keep a secret?

Can your computer keep a secret?


London health planning. Who speaks for the capital?


Trouble on the picket line.

Trouble on the picket line.


Systems for safety.

Systems for safety.


Buddy, can you spare a hospital contract?


Antenatal care: mothering instincts.

Antenatal care: mothering instincts.


Performance indicators: adding up the score.


Just what are we trying to achieve?

Just what are we trying to achieve?


When will the players get involved?

When will the players get involved?


Reaching for the healing gun.

Reaching for the healing gun.


Services in the Bible belt.

Services in the Bible belt.


Health promotion: regional review sets the targets.


Showdown for health vigilantes.

Showdown for health vigilantes.


The problem staff nurse.

The problem staff nurse.


Youth employment scheme: more than spare pairs of hands.


Who can they turn to?

Who can they turn to?


Training's October revolution?

Training's October revolution?


Out of the DHSS shadows.

Out of the DHSS shadows.


Confined with care.

Confined with care.


Life and death on the sectarian front line.


Data: a new game without frontiers.

Data: a new game without frontiers.


Keeping tabs on 'the casuals'.

Keeping tabs on 'the casuals'.


Manpower planning.

Manpower planning.


Whose turn to carve the joint?

Whose turn to carve the joint?


Resource allocation in Wales: sharing the cash in the valleys.


Lifting the language barrier.

Lifting the language barrier.


In case of fire, follow the computer.

In case of fire, follow the computer.


Management after Nodder.

Management after Nodder.


A man with mental health in mind. Interview by Sally Burningham.


Who is counting the human factor?

Who is counting the human factor?


Data and paramedical services: massaging the figures.


Patients who live on the hill.

Patients who live on the hill.


How statistics can plot areas of need.

How statistics can plot areas of need.


Unit management. Staff who came in from the cold.


A cottage conversion.

A cottage conversion.


Appraisal schemes could do better.

Appraisal schemes could do better.


Their lives in whose hands?

Their lives in whose hands?


Waste disposal. Down in the dumps.

Waste disposal. Down in the dumps.


Taking stock of supplies security.

Taking stock of supplies security.


Manpower planning. All clued up but nowhere to go?


Everything you wanted to know about priority scaling.


Catering for our colons.

Catering for our colons.


Youth training for the NHS: a step towards positive policies?


The quality of nursing care--an element in the nursing manpower decision.


District training reviews: how regions can help districts to develop their training and education functions.


Characteristics of NHS administrators.

Characteristics of NHS administrators.


Why Brent has resisted the manpower targets.


An interview with Ada Maddocks, Chairman, TUC Health Services Committee.


Manpower targets--a manpower planner's viewpoint.


The two nations within the NHS.

The two nations within the NHS.


Why not share supply prices?

Why not share supply prices?


Is a hospital a seller of goods or a provider of health care services?


Inflation for hospital supplies at 6%.

Inflation for hospital supplies at 6%.


Detailed 'how-to' book helps admitters bill third parties.


A profile of today's hospital director of materials management. Part II.


Who gets the bill when third-party payers all want to pay last?


An interview with: Robert Ross, C.P.P.

An interview with: Robert Ross, C.P.P.


Protecting patients and staff and reducing liability in the psychiatric unit.


The problem of privatisation.

The problem of privatisation.


Against centrism: planning and development in the NHS.


Management Advisory Service: the Oxford and South Western Region-wide experiment.


IHSA presidential address 1983.

IHSA presidential address 1983.


Supplies--how best to deliver the goods?


Reform of mental health law grounds for admission.


Autopsy on the report of a working party.


The best of both worlds?

The best of both worlds?


Modern approaches to incineration practice.


What is hospital waste?

What is hospital waste?


Safety and environmental issues with waste disposal in hospitals.


Home health care provides way to shorten hospital stays.


Medical community urged to remember commitment to serve all life.


Pediatric health festival promotes preventive care.


Circuit rider librarian provides services to small hospitals.


Survival strategies for not-for-profit hospitals.


Clinical setting enhances bioethics education.


Societal trends, Church beliefs support NFP methods.


ER physician's documentation of services provides protection in malpractice suit.


Proof of reasonable care defends hospital in case based on res ipsa loquitur theory.


Critical designs.

Critical designs.


In Title VII investigation EEOC may subpoena hospital information despite consent decree.


Appellate court allows reimbursement for amortized land use costs.


How should Catholic health facilities regard written directives for treatment?


Medical art--an exact science.

Medical art--an exact science.


Paramedics to the rescue.

Paramedics to the rescue.


SI conversion--proceed with caution.

SI conversion--proceed with caution.


Maidstone DGH phase one.

Maidstone DGH phase one.


Caring in an isolated community.

Caring in an isolated community.


Transplant surgery comes of age.

Transplant surgery comes of age.


The PPO perspective.

The PPO perspective.


Tolsma expects HHS secretary Margaret Heckler to support health education, announces new risk survey initiatives. Interview by Lawrence M. O'Rourke.


Pharmacists and health education: an evaluation of a stop-smoking project involving pharmacists.


Health education in pre-retirement education--a question of relevance.


Market place rubella antibody testing.

Market place rubella antibody testing.


Promoting health, preventing disease: what should the NHS be doing now?


Question: Could you list some options for getting rid of, or selling, used equipment or supplies?


Marshall W. Kreuter, U.S. Health Education Director, praises Pittsburgh health education center as 'classic example of good community networking'.


Make discipline a positive experience.

Make discipline a positive experience.


Housekeeping supply decisions involve materials management.


Multiple goals: a career necessity.

Multiple goals: a career necessity.


Quality assurance has many sides.

Quality assurance has many sides.


Delegation--the key to effective time management.


The other victims of alcoholism.

The other victims of alcoholism.


Thoughts from a hospital gift shop manager ... "genuine fulfillment".


Join up with nutrition!

Join up with nutrition!


Job sharing: two heads are better than one!


Corporate restructuring: a new hospital strategy.


Planning for profit!

Planning for profit!


Successful staffing is team building.

Successful staffing is team building.


Medical staffs can help protect endangered species.


AIDS poses legal questions for hospital managers.


Survey of hospital medical staffs--Part 1. Net data reveal surprises in size, composition, committee structure, and participation in governance. From 1973 to 1982: Medical staff size has grown by an average of 55 percent. The number of medical staff committees in the average hospital has nearly doubled. Nearly 30 percent more hospitals have made physicians voting members of their governing boards.


Results of survey--unit-dose repackaging. A survey was conducted to determine drugs that hospitals frequently package in unit-dose. There were 116 responses, identifying 606 line items of tablets or capsules, liquids, and more or less than one dosage unit being packaged. In all three categories there were 108 drugs packaged by four or more hospitals. These results have been shared with the respective manufacturers, to use in marketing these drugs in unit-dose packages.


MeSHing hospitals and physicians provides mutual benefits.


Advent of multis presents challenges for managers.


ASHET's long-range objectives reviewed.

ASHET's long-range objectives reviewed.


Twenty-four hour pharmacy service in hospitals with less than 300 beds--Part 4.


Operational characteristics of hospital pharmacies in Indiana--1976 vs. 1981. The operating characteristics and services provided by hospital pharmacies in Indiana were determined. Survey questionnaires were mailed to the pharmacy director for each of the 120 licensed hospitals in Indiana; 62 responded. Pharmacy departments were open an average of 106.3 hours weekly, 51 pharmacies maintained patient profiles, and 29 pharmacies used unit-dose for all beds. Involvement in preparing I.V. solutions was reported by 67.7% of the pharmacies. The mean number of total pharmacy staff (FTEs) reported was 17.1. The ratio of staff FTEs per patient day was larger for pharmacies using a unit-dose distribution system. The most commonly provided clinical services were drug consultation with nursing, drug utilization review, and inservice education. Ratios of average dollar drug inventory and operating expenses per patient day indicated that larger hospitals were more effective with inventory control, but had higher expenses per patient day.


Psychiatric pharmacy in a partial hospital program. Psychiatric pharmacy practice in a partial hospital program (PHP) is described. The program's objectives are: (1) to provide a transitional setting in which to assist persons with psychiatric disorders to reenter the community after hospitalization; (2) to provide more structured and intensive therapy than is available in an outpatient setting; and (3) to diagnose and treat early psychiatric symptoms, providing an alternative to hospitalization. The pharmacist conducts medication history interviews, co-directs a weekly medication group, participates in weekly medication clinic, provides individual consultation, teaches pharmacy students, participates in health care group, and provides inservice education to the staff. Clinical pharmacy services in a psychiatric partial hospital program increase knowledge of psychotropic drug efficacy and side effects in PHP staff, increase learning about these medications in PHP clients, and can result in safer and more effective use of medication.


Hospital formulary system/drug product selection: similar or not? Following a brief review of the origin of antisubstitution and drug product selection laws, the legal basis of the hospital formulary system is compared with that of drug product selection. By understanding the differences in the two, the pharmacist can better understand application of the law in these areas to pharmacy practice.


Preventing burnout: an alternative approach. Burnout is a potentially serious dilemma which any practicing pharmacist may encounter. Various suggestions have been proposed to prevent burnout. An alternative approach is presented which involves the pharmacist in a nontraditional role. Pharmacists participate in a 3-month rotation within the Idaho Drug Information Service and Regional Poison Control Center. Pharmacists involved in this rotation believe it is extremely important for expanding their professional roles and preventing burnout.


A comparison of the practices used for distribution of controlled substances in Massachusetts hospitals with those reported nationally. A survey questionnaire concerning the procedures used to distribute controlled substances was mailed to 100 randomly selected Massachusetts hospital pharmacies. The tabulated results were compared to a similar study surveying 285 short-term medical and surgical hospitals nationwide. Of the 58 responding hospitals, 47 (81%) reported controlling either all or some Schedule III Controlled Substances in a manner similar to that used for the distribution and accountability of Schedule II drugs. A total of 42 (72%) reported maintaining the same systems for Schedule IV agents. In contrast, only 24 (42%) of those respondents reported controlling Schedule V drugs in a manner similar to Schedule II Controlled Substances. Similar to the findings of a nationwide study, many of the responding Massachusetts hospitals reported selective inclusion of those Schedule III, IV, and V drugs possessing an increased risk of illicit diversion into a more controlled distribution system. In conclusion, many Massachusetts hospitals distribute and account for controlled substances in a manner similar to that used nationwide.


Twenty-four hour pharmacy service in hospitals with less than 300 beds--Part 5.


Financial management.

Financial management.


Managing organizational productivity.

Managing organizational productivity.


Selection and economical use of hospital legal counsel.


Doing a job on right-to-know legislation.


Capital offense. New York's health care in the crunch.


Ambulatory care: can hospitals compete?

Ambulatory care: can hospitals compete?


Analyzing strategic cost in a high-inflation economy.


Creating competitive advantage with computer technology.


MBO--is it passé?

MBO--is it passé?


Post mortem on a classic battle: doctor versus hospital.


An application of simulation modeling to surgical intensive care bed need analysis in a university hospital.


Linking strategy, performance, and pay.

Linking strategy, performance, and pay.


Continuing relationships and lifestyle in a quality setting.


The living environment: an interior that speaks of home.


A supportive community begins with the family.


Leadership and commitment set the direction.


Making every day a challenge.

Making every day a challenge.


Homelike care means quality assurance.

Homelike care means quality assurance.


Caring for the resident as a total person.


The way to a man's (or woman's) heart is ...


Who are the real nursing home consumers?


Comfort brings well-being.

Comfort brings well-being.


Integration of clinical engineering into the hospital organization.


The myth of food service specification resolved.


The living environment: personal dignity through physical design.


Information resource management--a costing perspective.


Inactivation of bacteria and viruses by steam, hot air, ethylene oxide and chemicals.


A fanciful tale and a not-so-fanciful tale.


Orientation or orientation program. Is it worth it?


Management effectiveness achieved through integrated supply, processing, and distribution organizational structure.


Auckland Hospital, New Zealand: the central sterile supply department.


The eleven blade is missing.

The eleven blade is missing.


Inservice: management concepts.

Inservice: management concepts.


Negligence: a primer on a principal problem.


Management: theory.

Management: theory.


Saint Marys Hospital, Rochester, Minnesota.


OSHA evaluates the EtO exposure standard.


Bar codes.

Bar codes.


Developing future CS managers today.

Developing future CS managers today.


Computers: are they for you?

Computers: are they for you?


To train or not to train: analyzing human performance.


Streamlining equipment maintenance record-keeping.


Paper/plastic pouch heat seals.

Paper/plastic pouch heat seals. Little or no differences were found in overall performance quality between solid 3/8" wide seals and a triple 11/16" wide seal provided they are made on the same material, on the same machine, and at equivalent temperature and dwell settings. This test demonstrated that actual voids in a solid seal are of no consequence. Seal design appears to have little bearing on strength and quality. Remember, this test was not of competitive products. Its only purpose was to test the intrinsic qualities of each type of seal. Consistency of manufacture, materials, and QC testing should be the criteria for selecting a paper/plastic peel pouch. Performance in your hospital should be the ultimate test.


Biological sterilization indicators.

Biological sterilization indicators.


Mercy Hospital Medical Center, Des Moines, Iowa.


Starting a newsletter. It's your idea and nobody else's!


Al Hada Hospital, Saudi Arabia.

Al Hada Hospital, Saudi Arabia.


Motivation.

Motivation.


Safety.

Safety.


The growth of CS in Great Britain.

The growth of CS in Great Britain.


Increasing patient charge recovery rates.


Product recalls.

Product recalls.


New Year's resolutions for CS.

New Year's resolutions for CS.


Reinforcement.

Reinforcement.


The demand for health after a decade.

The demand for health after a decade.


Is competition the answer?

Is competition the answer?


Demand for health: a generalised Grossman model. The demand for health and medical care is analysed within a generalised Grossman-type health investment model. Its underlying assumptions are shown to differ from those employed earlier in a manner which avoids some of the criticisms levelled at Grossman's model. The comparative static predictions of the generalised model are examined; and it is demonstrated that most previous health investment models are derivable from it. Also, the present model is applicable to a new, wider range of problems thus increasing the scope of economic explanations of health behaviour.


Personal hygiene.

Personal hygiene.


Unions and hospitals: some unresolved issues. This article investigates the impact of unions on the wages of hospital workers. Our OLS findings agree with previous OLS studies--unions increase registered nurses' (RNs) wages by five percent and by about eight to ten percent for other hospital workers. By contrast, we find (after correcting for selectivity bias in hospital unionization status) a direct union effect of about twenty percent on RN wages and in excess of thirty percent on wages of other hospital workers. While the results based on selectivity bias adjustments make us uneasy, we do not reject them out-of-hand. We also find indirect union effects (up to five percent) by other unionized occupations within a hospital and up to ten percent by other unionized hospitals in the local labor market. Prospective reimbursement programs have a negative impact on the wages of hospital workers but are only significant for non-unionized occupations. Our three empirical tests of monopsony all reject the view that monopsony is a factor in hospital wage-setting. Even considering the large union effects (based on selectivity bias adjustment), we conclude that unions have been a minor contributor to hospital cost inflation.


The potential for using excise taxes to reduce smoking. We examine the potential for reducing cigarette smoking through increases in cigarette excise taxes by estimating the price elasticity of demand for cigarettes. Using information on individual smoking behavior from the 1976 Health Interview Survey, we estimate the adult price elasticity of demand for cigarettes to be -0.42. We find that price has its greatest effect on the smoking behavior of young males and that it operates primarily on the decision to smoke rather than via adjustments in the quantity of cigarettes smoked. An excise tax increase would discourage smoking by successive cohorts of young adults, and those reduced smoking levels would be reflected in aggregate smoking as these cohorts mature.


Increasing the federal excise tax on cigarettes.


Rational purchase of medical care and differential insurance coverage for diagnostic services.


Breast cancer screening and health service costs.


Health as an unobservable: a MIMIC-model of demand for health care. This paper develops a model to analyze the demand for health care. It differs from current practice in that (1) it deals explicitly with the complex relation between income, health, health insurance, and the demand for health care, and (2) 'health' is treated as an unobservable variable. We present the Maximum Likelihood estimates of an eleven-equation, simultaneous multiple-indicator, multiple-causes (MIMIC) model, containing two simultaneously determined unobservables and, in total, nine 'indicators'. Data used stem from a health-care survey among 8000 households in The Netherlands. The results show, among other things, that health and permanent income have mutual, positive impacts. Both age and education have important direct and indirect (via permanent income) effects on health. The estimated impact of the availability of health care on individual demand confirms similar results based on aggregated data.


Schooling and health: the cigarette connection. Schooling is significantly correlated with health status, but is the relationship causal? This paper tests the hypothesis that schooling causes differences in an important health-affecting behavior: cigarette smoking. The most striking result is that for persons with 12 to 18 years of completed schooling, the strong negative relation between schooling and smoking observed at age 24 is accounted for by differences in smoking behavior at age 17, when all subjects were still in the same grade. Causality from schooling to smoking, and by implication from schooling to health, is rejected in favor of a 'third variable' hypothesis.


Physician-induced demand: an empirical analysis of the consumer information gap. The hypothesis of physician-induced demand is examined empirically in a model where variation in consumer information affects health-care utilization. A theoretical framework is posited under which demand-inducing physicians will provide more services, ceteris paribus, to their medically uninformed patients. Using data from the CHAS-NORC National Survey of Access to Medical uninformed patients. Using data from the CHAS-NORC National Survey of Access to Medical Care 1975-1976, physician office visit demand equations are estimated. The key finding is that medical professionals and their families are as likely, if not more likely, to visit physicians as other people, controlling for sociodemographic factors, price factors, access to care factors and perceived health status.