THE ECONOMIC STATUS OF THE ELDERLY: BEWARE OF THE MEAN*

Current discussion contains widely contradictory statements about the economic status of the elderly in the United States. One can read that poverty among the elderly has been eliminated, and that it remains one of the most serious problems facing the country today. This paper discusses different ways of measuring economic status, and attempts to show how authors can reach such divergent conclusions, and support them with readily available data. The U.S. Census data on personal income generally exclude in-kind benefits, and treat family size in a straightforward though unsophisticated manner. This paper shows that alternative treatments of these issues can have significant effects on indices of the economic status of the elderly. Whether or not in-kind benefits are included in the definition of income, which in-kind benefits are included and how they are valued change the conclusions dramatically. Even more important is whether the income data are presented by household or per capita (or with some intermediate divisor, using equivalency scales), since elderly households are the smallest of any age category. This paper makes 3 points. One is that there has been significant progress in the economic status of the elderly over the past several decades, although the extent of the improvement is subject to debate. But the second is that summary statistics about the elderly, such as the above, may conceal more than they reveal. The diversity of the elderly is key. Beware of the mean. Finally, there is no one correct way to measure well-being. Different methodological approaches can be chosen and justified, and the choices made alter the conclusions significantly.     

Moments of greatness: entering the fundamental state of leadership

When we do our best work as leaders, we don't imitate others. Rather, we draw on our own values and capabilities. We enter what author Robert Quinn calls the fundamental state of leadership. This is a frame of mind we tend to adopt when facing a significant challenge: a promotion opportunity, the risk of professional failure, a serious illness, a divorce, the death of a loved one, or any other major life jolt. Crisis calls, and we rise to the occasion. But we don't need to spend time in the dark night of the soul to reach this fundamental state. We can make the shift at any time by asking ourselves-and honestly answering--four transformative questions: Am I results centered? (Am I willing to leave my comfort zone to make things happen?) Am I internally directed? (Am I behaving according to my values rather than bending to social or political pressures?) Am I other focused? (Am I putting the collective good above my own needs?) Am I externally open? (Am I receptive to outside stimuli that may signal the need for change?) When we can answer these questions in the affirmative, we're prepared to lead in the truest sense. Of course, we can't sustain the fundamental state of leadership indefinitely. Fatigue and external resistance pull us out of it. But each time we reach it, we then return to our everyday selves a bit more capable, and we usually boost the performance of the people around us. Over time, we create a high-performance culture--and that can be sustained.     

Estimating healthcare resource use associated with the treatment of metastatic melanoma in eight countries

Objectives Studies reporting healthcare resourse use (HRU) for melanoma, one of the most costly cancers to treat, are limited. Using consistent, robust methodology, this study estimated HRU associated with the treatment of metastatic melanoma in eight countries.

Methods Using published literature and clinician input, treatment phases were identified: active systemic treatment (pre-progression); disease progression; best supportive care (BSC)/palliative care; and terminal care. HRU elements were identified for each phase and estimates of the magnitude and frequency of use in clinical practice were obtained through country-specific Delphi panels, comprising healthcare professionals with experience in oncology (n?=?8).

Results Medical oncologists are the key care providers for patients with metastatic melanoma, although in Germany dermato-oncologists also lead care. During the active systemic treatment phase, each patient was estimated to require 0.83–2 consultations with a medical oncologist/month across countries; the median number of such assessments in 3 months was highest in Canada (range?=?3.5–5) and lowest in France, the Netherlands and Spain (1). Resource use during the disease progression phase was intensive and similar across countries: all patients were estimated to consult with medical oncologists and 10–40% with a radiation oncologist; up to 40% were estimated to require a brain MRI scan. During the BSC/palliative care phase, all patients were estimated to consult with medical oncologists, and most to consult with a primary care physician (40–100%).

Limitations Panelists were from centers of excellence, thus results may not reflect care within smaller hospitals; data obtained from experts may be less variable than data from broader clinical practice. Treatments for metastatic melanoma are continually emerging, thus some elements of our work could be superseded.

Conclusions HRU estimates were substantial and varied across countries for some resources. These data could be used with country-specific costs to elucidate costs for the management of metastatic melanoma.     

The effect of legal status on immigrant wages and occupational skills

Native and foreign-born workers with a high school degree or less education work in different types of occupations. This article exploits the 1986 Immigration Reform and Control Act to examine whether legal status causes immigrants to work in occupations that use skills similar to those of natives. Legal status decreases the manual skill intensity of immigrants’ occupations by about two percentiles. It increases communication skill intensity by a similar amount. This reduces the skill gap between Mexican-born and native-born American workers by 11–15%.     

Goldsmith-Banking: Mutual Acceptance and Interbanker Clearing in Restoration London

During the second half of the 17th century, London's goldsmith-bankers formed a system of banking through mutual debt acceptance and interbanker clearing. Widespread acceptance of bank notes, orders, and bills created positive externalities for member bankers and promoted the use of bank supplied media of exchange during the Financial Revolution in England. Mutual acceptance by goldsmith-bankers arose endogenously as a dominant strategy Nash equilibrium. The bilateral clearing of these acceptances produced incentive compatible co-monitoring between goldsmith-bankers. The responsiveness of co-monitoring is supported by statistical analysis of the accounts of the Restoration era goldsmith Edward Backwell. Systemic cohesion was further reinforced by the screening of new members through apprenticeship.     

Book reviews

New Technology and Industrial Relations R. Hyman & W. Streeck Oxford, Basil Blackwell, 1988.

Strategic Planning: Development and Implementation. Bonita H. Melcher & Harold Kerzner Blue Ridge Summit, PA, TAB Books, 1988, 404 pp., £23.65.

Science and Corporate Strategy: Du Pont R & D, 1902-1980 D.A. Hounshell & J.K. Smith New York, Cambridged University Press, 1988.

Sharpbenders: The Secrets of Unleashing Corporate Potential Pete H. Grinyer, David G. Mayes & Peter McKiernan Oxford, Basil Blackwell, 1988, 287 pp., £25.00.

Small and Medium Size Enterprises and Regional Development Maria Giaoutzi, Peter Nijkamp & David J. Storey (Eds.) London, Routledge 1988, 314 pp.