major trend reversals in most social welfare programs; legal services for the poor, housing finance, health care for the poor, school lunches, student aid, food and nutrition programs, to name a few, were particularly targeted. Notably absent from the list in the beginning were programs for the aging, especially Social Security and veterans programs. Only as the economic situation tightened this past year did the Reagan administration begin to touch the social insurance system, and even then it proceeded with much caution. How did the special public concern for the aging come about and how pervasive has it been as a matter of public policy? The politically privileged position of the elderly is marked both by change and continuity. On the one hand, aged, native white men had secured substantial benefits from the Civil War pensions through the late nineteenth century. But the pensions did not cover most women or nonwhites. And when the Civil War veterans and their dependents died the extended coverage lapsed so that by 1920, there was virtually no coverage. By the time of the development of the Social Security insurance system in 1935, the aging were one of the poorest groups in American society. Thus, it is only in the relatively recent past that
{"title":"Age and dependency: children and the aged in American social policy.","authors":"J. Axinn, M. Stern","doi":"10.2307/3349853","DOIUrl":"https://doi.org/10.2307/3349853","url":null,"abstract":"major trend reversals in most social welfare programs; legal services for the poor, housing finance, health care for the poor, school lunches, student aid, food and nutrition programs, to name a few, were particularly targeted. Notably absent from the list in the beginning were programs for the aging, especially Social Security and veterans programs. Only as the economic situation tightened this past year did the Reagan administration begin to touch the social insurance system, and even then it proceeded with much caution. How did the special public concern for the aging come about and how pervasive has it been as a matter of public policy? The politically privileged position of the elderly is marked both by change and continuity. On the one hand, aged, native white men had secured substantial benefits from the Civil War pensions through the late nineteenth century. But the pensions did not cover most women or nonwhites. And when the Civil War veterans and their dependents died the extended coverage lapsed so that by 1920, there was virtually no coverage. By the time of the development of the Social Security insurance system in 1935, the aging were one of the poorest groups in American society. Thus, it is only in the relatively recent past that","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"51 1 1","pages":"648-70"},"PeriodicalIF":0.0,"publicationDate":"1985-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79910751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
values and health care, no work addresses the divided Germany that was forced into existence following the conclusion of World War II. The omission is surprising since the resultant individualistic West and the Communist East provide the researcher with a "natural experiment" in history, one in which a third of the world's oldest and perhaps most sophisticated health care system itself became an experiment in the application of Marxist/socialist ideology. Examining this experiment has distinct advantages over other comparisons of health care under Communist versus non-Communist governments. If one compares health care services .before and after a Communist takeover, one is unable to examine how the former society and its health care system would have evolved over time had a political upheaval not taken place. Alternately, if one compares a Communist and a non-Communist system in two countries during the same period, the problem of periodicity is solved but the problem of comparability is increased. Inevitably, there are differences of language, culture, history, medical institutions, forms of insurance, and other relevant variables. Happily, the German experience comes as close as is humanly possible to what Campbell (1969) calls a quasi experiment, in which
{"title":"Values and structure in the German health care systems.","authors":"D. Light","doi":"10.2307/3349852","DOIUrl":"https://doi.org/10.2307/3349852","url":null,"abstract":"values and health care, no work addresses the divided Germany that was forced into existence following the conclusion of World War II. The omission is surprising since the resultant individualistic West and the Communist East provide the researcher with a \"natural experiment\" in history, one in which a third of the world's oldest and perhaps most sophisticated health care system itself became an experiment in the application of Marxist/socialist ideology. Examining this experiment has distinct advantages over other comparisons of health care under Communist versus non-Communist governments. If one compares health care services .before and after a Communist takeover, one is unable to examine how the former society and its health care system would have evolved over time had a political upheaval not taken place. Alternately, if one compares a Communist and a non-Communist system in two countries during the same period, the problem of periodicity is solved but the problem of comparability is increased. Inevitably, there are differences of language, culture, history, medical institutions, forms of insurance, and other relevant variables. Happily, the German experience comes as close as is humanly possible to what Campbell (1969) calls a quasi experiment, in which","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"42 1","pages":"615-47"},"PeriodicalIF":0.0,"publicationDate":"1985-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88164979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
groups and communities within Australia's scattered population has been problematic for more than a century. When modern scientific medicine was developing its present form, in the 1880s, Australia was composed of six self-governing colonies of the United Kingdom. Half of the population was dispersed in an agricultural and extractive economy supporting a few regional service towns, but commercial, financial, and governmental activities were concentrated in the seaboard capital cities. Numerous small hospitals were established by voluntary initiative in the country towns and voluntary initiative, often aware of a British model if not appealing directly to it, was responsible for a considerable part of the hospital services in the urban metropolitan areas. Dispersed voluntaryism may have worked in the United Kingdom, where landed wealth also was dispersed, but it was not adequate to the Australian situation, where hospital boards quickly fell into the habit of seeking subsidy from the colonial government for their institutions. The trouble with the subsidy was that it created political and financial obligations on governments to maintain institutions over whose establishment and expansion they had no control. The system
{"title":"Formula funding and regional planning of health services in Australia.","authors":"N. Hicks","doi":"10.2307/3349854","DOIUrl":"https://doi.org/10.2307/3349854","url":null,"abstract":"groups and communities within Australia's scattered population has been problematic for more than a century. When modern scientific medicine was developing its present form, in the 1880s, Australia was composed of six self-governing colonies of the United Kingdom. Half of the population was dispersed in an agricultural and extractive economy supporting a few regional service towns, but commercial, financial, and governmental activities were concentrated in the seaboard capital cities. Numerous small hospitals were established by voluntary initiative in the country towns and voluntary initiative, often aware of a British model if not appealing directly to it, was responsible for a considerable part of the hospital services in the urban metropolitan areas. Dispersed voluntaryism may have worked in the United Kingdom, where landed wealth also was dispersed, but it was not adequate to the Australian situation, where hospital boards quickly fell into the habit of seeking subsidy from the colonial government for their institutions. The trouble with the subsidy was that it created political and financial obligations on governments to maintain institutions over whose establishment and expansion they had no control. The system","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"127 1","pages":"671-90"},"PeriodicalIF":0.0,"publicationDate":"1985-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89001327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The general public, physicians, and policy makers have all come to accept constraints on public expenditures for medical care as a reasonable means to redirect resources to competing sectors of national life, and to reflect changing political and social values. "Rationing" of facilities and services by explicit and implicit methods seems inevitable; the poor and disabled must not bear the brunt of stringency. The politics of competition and altered power relationships among providers offer new opportunities for system-wide reform.
{"title":"Cost containment and the quality of medical care: rationing strategies in an era of constrained resources.","authors":"D. Mechanic","doi":"10.2307/3349843","DOIUrl":"https://doi.org/10.2307/3349843","url":null,"abstract":"The general public, physicians, and policy makers have all come to accept constraints on public expenditures for medical care as a reasonable means to redirect resources to competing sectors of national life, and to reflect changing political and social values. \"Rationing\" of facilities and services by explicit and implicit methods seems inevitable; the poor and disabled must not bear the brunt of stringency. The politics of competition and altered power relationships among providers offer new opportunities for system-wide reform.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"25 1","pages":"453-75"},"PeriodicalIF":0.0,"publicationDate":"1985-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73875542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health survey data are an important and efficient source of information for policy makers and administrators. But caution is warranted: surveys do not show cause-and-effect relations, and they are no substitute for randomized controlled experimentation in predicting behavior. The variety of surveys--governmental and private--is increasing, and both methodology employed and interpretation of results can be improved in suggested ways.
{"title":"Cognitive aspects of health surveys for public information and policy.","authors":"S. Fienberg, E. Loftus, J. Tanur","doi":"10.2307/3349850","DOIUrl":"https://doi.org/10.2307/3349850","url":null,"abstract":"Health survey data are an important and efficient source of information for policy makers and administrators. But caution is warranted: surveys do not show cause-and-effect relations, and they are no substitute for randomized controlled experimentation in predicting behavior. The variety of surveys--governmental and private--is increasing, and both methodology employed and interpretation of results can be improved in suggested ways.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"16 1","pages":"598-614"},"PeriodicalIF":0.0,"publicationDate":"1985-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73895585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Questions relating to symptoms are an important ingredient in many surveys of health status. Yet, the understanding of mechanisms for the recall of pain, and the cognitive aspects of memory for pain and other symptoms, have eluded investigators. Even within limits imposed by current imperfect knowledge of the physiology of pain, more collaborative research on recall would improve the completeness and accuracy of clinical diagnostic interviews, insurance adjudications, morbidity statistics, and health survey interviews.
{"title":"Recalling pain and other symptoms.","authors":"S. Fienberg, E. Loftus, J. Tanur","doi":"10.2307/3349849","DOIUrl":"https://doi.org/10.2307/3349849","url":null,"abstract":"Questions relating to symptoms are an important ingredient in many surveys of health status. Yet, the understanding of mechanisms for the recall of pain, and the cognitive aspects of memory for pain and other symptoms, have eluded investigators. Even within limits imposed by current imperfect knowledge of the physiology of pain, more collaborative research on recall would improve the completeness and accuracy of clinical diagnostic interviews, insurance adjudications, morbidity statistics, and health survey interviews.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"4 1","pages":"582-97"},"PeriodicalIF":0.0,"publicationDate":"1985-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72777946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Inadequate insurance, whether private or public, can impose ruinous private hardship and unexpected public burdens. "Who are the underinsured?" is both a definitional and an empirical question. Data from the National Medical Care Expenditure Survey, applied under various concepts of risk and expense, reveal that over a quarter of the nonelderly population is inadequately protected against the possibility of large medical bills. The private burdens of the underinsured are widely distributed across the population.
{"title":"Who are the underinsured?","authors":"P. Farley","doi":"10.2307/3349844","DOIUrl":"https://doi.org/10.2307/3349844","url":null,"abstract":"Inadequate insurance, whether private or public, can impose ruinous private hardship and unexpected public burdens. \"Who are the underinsured?\" is both a definitional and an empirical question. Data from the National Medical Care Expenditure Survey, applied under various concepts of risk and expense, reveal that over a quarter of the nonelderly population is inadequately protected against the possibility of large medical bills. The private burdens of the underinsured are widely distributed across the population.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"2015 1","pages":"476-503"},"PeriodicalIF":0.0,"publicationDate":"1985-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78927968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A parliamentary committee of inquiry was convened in response to growing concern--among the general public and the scientific community--about new techniques in human fertilization and research in embryology. The committee had to enter that jurisprudential minefield, the theoretical relation between morality and the law. When issues arise in which there is no historical tradition, the voice of morality may be genuinely confused and uncertain. But the law, unlike moral opinion, cannot be contradictory; it must be definite, unambiguous, and universally applicable.
{"title":"Moral thinking and government policy: the Warnock Committee on Human Embryology.","authors":"M. Warnock","doi":"10.2307/3349845","DOIUrl":"https://doi.org/10.2307/3349845","url":null,"abstract":"A parliamentary committee of inquiry was convened in response to growing concern--among the general public and the scientific community--about new techniques in human fertilization and research in embryology. The committee had to enter that jurisprudential minefield, the theoretical relation between morality and the law. When issues arise in which there is no historical tradition, the voice of morality may be genuinely confused and uncertain. But the law, unlike moral opinion, cannot be contradictory; it must be definite, unambiguous, and universally applicable.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"65 1","pages":"504-22"},"PeriodicalIF":0.0,"publicationDate":"1985-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83747965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The past 25 years have seen the development of a wide variety of sample surveys dealing with the nature and distribution of illness and disability, and with the utilization of health care services. The sample survey is currently the most widespread and influential instrument for judging the health status of the nation and for guiding health policy. The knowledge, beliefs, and attitudes of survey respondents "subjectively" affect what the survey seeks to "objectively" measure. Even as statistical sampling has been refined, so is it important to reexamine what the cognitive sciences have to offer for survey interview structure and content.
{"title":"Cognitive aspects of health survey methodology: an overview.","authors":"S. Fienberg, E. Loftus, J. Tanur","doi":"10.2307/3349847","DOIUrl":"https://doi.org/10.2307/3349847","url":null,"abstract":"The past 25 years have seen the development of a wide variety of sample surveys dealing with the nature and distribution of illness and disability, and with the utilization of health care services. The sample survey is currently the most widespread and influential instrument for judging the health status of the nation and for guiding health policy. The knowledge, beliefs, and attitudes of survey respondents \"subjectively\" affect what the survey seeks to \"objectively\" measure. Even as statistical sampling has been refined, so is it important to reexamine what the cognitive sciences have to offer for survey interview structure and content.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"61 1","pages":"547-64"},"PeriodicalIF":0.0,"publicationDate":"1985-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83811160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The impact upon health of changes in public policy regarding health services has not been systematically assessed. The long-term, and largely irreversible, effects of reduced support for health services to children present special challenges to collaborative research between clinical and public health approaches. Preliminary evidence from such a collaborative study of a variety of illnesses and interventions is persuasive of real benefit from prompt access to medical care.
{"title":"Motherhood and apple pie: the effectiveness of medical care for children.","authors":"B. Starfield","doi":"10.2307/3349846","DOIUrl":"https://doi.org/10.2307/3349846","url":null,"abstract":"The impact upon health of changes in public policy regarding health services has not been systematically assessed. The long-term, and largely irreversible, effects of reduced support for health services to children present special challenges to collaborative research between clinical and public health approaches. Preliminary evidence from such a collaborative study of a variety of illnesses and interventions is persuasive of real benefit from prompt access to medical care.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"13 1","pages":"523-46"},"PeriodicalIF":0.0,"publicationDate":"1985-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80712718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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