The competitive solution and the health care problems of today

Mark Pauly claims that a "competitive" health care system will solve the health care cost crisis. This article examines how well the competitive solution deals with the five central problems of the health care system: (1) almost universal lack of adequate health insurance for nursing homes and home care; (2) Medicaid's penurious approach to payment for health services for the poor; (3) the emergence of a dual health care system, especially for children; (4) the entrenched waste and inefficiency of the health care system; and (5) consumers' inability to judge the quality of health care. The competitive solution does not eliminate any of these problems--and may not even improve some of them.     

Fracture incidence among elderly people in institutional care: linking injury surveillance data with a postal code-based register of residential and nursing homes

Fracture prevention strategies will be most cost-effective if targeted at groups of frail elderly people who are at particularly high risk of falls and fractures. Elderly people living in residential and nursing homes are one potential target population, but fracture incidence in this setting remains poorly defined in many countries. We have used the All Wales Injury Surveillance System (AWISS) in a population-based study of people aged over 65 living in the city of Cardiff. We linked a postal code-based register of all care homes in the city with injury data from Cardiff’s only Accident and Emergency department. Cardiff has 47,520 residents aged over 65, and 1,874 (3.9%) live in residential or nursing homes. Fracture incidence was 25/1,000/year overall, and 5/1,000/year for hip fracture. During 1997, the care home residents suffered 162 fractures, 82 of which were of the hip; an incidence of 86/1,000/year overall, 44/1,000/year for hip fracture. Even after adjustment for the age and sex profile of the care home population, fracture incidence remained 2.3 times higher and hip fracture incidence 3.6 times higher than in the general elderly population. Such figures support the potential cost-effectiveness of strategies that prevent fractures in care homes, and are of special interest to those planning intervention studies in this setting.     

Elderly Consumers' Knowledge Related to Medigap Protection Needs

Elderly consumers’ knowledge of Medicare coverage and the major factors they considered in purchasing supplementary health insurance were examined. Perceptions of the financial consequences of being hospitalized also were investigated. The findings based on a sample of Florida residents indicated that many older people may be ill-prepared to correctly assess their medigap protection needs and to choose wisely among alternative insurance policies if they decide to purchase supplementary coverage. Inadequate knowledge may result in unfulfilled expectations about protection when medical expenses are incurred, vulnerability to questionable insurance sales appeals and methods, and purchase of uneconomic duplicate coverage.     

Causal linkages between psychographic and demographic determinants of outshopping behaviour

This article explores determinants of rural to rural outshopping in the Central Western region of NSW, Australia. The results of this study indicate significant psychographic and demographic variables associated with outshoppers to another rural trading area. These outshoppers tend to be more socially active, innovative, have one to two children living at home and are younger than those people who tend to shop in their local trading area.

Regression analysis is used to develop a causal relationship between psychographic variables, demographic variables and outshopping.     

"Ethics and Geography –Impact of Geographical Cultural Differences on Students Ethical Decisions"

Conceptually, entrepreneurship is seen as the engine that drives a robust economy, promotes a favorable quality of life, and assures the availability of the attributes needed for meaningful living. However, like many popular concepts in this world, its limitations are normally not well acknowledged. A grouping of entrepreneurial ventures which has recently come into existence deals with the personal fiscal issues associated with the end-of-life phase of the human cycle. While generally praised as humanitarian services for society, that are assuredly within legal bounds, these activities have potentially significant negative implications. When examined from an ethical perspective, some questionable practices became apparent. Three such undertakings in particular have to do with the terminally ill and are examined in this paper. The first, viatical transactions, is defined as the transfer of a life insurance policy's ownership to someone who does not have an insurable interest in the life of the insured individual. The second, creative tax shelters for wealthy people involved in estate planning, involves hiring unrelated parties, particularly those who are young and in failing health, to do the dying for the principal. The third, mind games, involves curtailing the use of medical resources for the dying. The justification for this is rationing scarce medical resources.     

Evaluation of a home injury prevention program in a WHO Safe Community

The objective of this study was to evaluate the effect of a community-based injury prevention program on home injuries. Unintentional injuries occurring in private homes and during leisure time account for 70-80% of injuries treated in public health care. A quasiexperimental design was used for the study, with cross-sectional preand post-implementation measurements in the program area and in a neighboring control community. Children and the elderly were two main target groups of the intervention program, which was based on a participative strategy for community involvement. The study was based on defined total populations. The total relative risk for home injury occurrence decreased in the study area, whereas it increased in the control area. Regarding age and gender, there was a decrease for females and males in the study area and a slight increase in the control area. For males, the youngest and oldest age groups showed no decrease, whereas females showed a decrease among the youngest and those aged 60-79. No decrease was observed in the control area. The study showed that the Safe Community approach had a general effect on the incidence of home injuries.     

Entrepreneurship's requisite areas of development: A survey of top executives in successful entrepreneurial firms

Precisely what does one “need to know” in order to become a successful entrepreneur? When should we first begin teaching this knowledge? How should this knowledge be conveyed? These questions and others were answered by 100 leading entrepreneurs and chief executive officers in America's fastest-growing entrepreneurial firms. Questions such as those listed above are rapidly taking on increased importance not only for enhancing U.S. national competitiveness, but also around the world. For instance, eastern block countries wish to understand these questions as they attempt to establish free market economies and foster the entrepreneurial spirit, while developing countries need answers as they turn more toward entrepreneurship as a viable vehicle for promoting economic development and improved living standards for their citizens.This research develops a theoretical framework suggesting four primary areas in which successful entrepreneurs must be developed. Specifically, these areas are content, skills and behavior, mentality, and personality. The first three areas, content, skills and behavior, and mentality are referred to as areas of creative knowledge. This is because new knowledge is brought into existence during the creation and subsequent management of growing business entities.The study analyzes the responses of 100 chief executives from Inc. magazine's list of the nation's most successful publicly held entrepreneurial firms for the years 1979–1989. A list of requisite areas of knowledge in terms of content, skills, and mentality is developed. Personality characteristics necessary for entrepreneurial achievement are also delineated. Examples of essential domains of knowledge include finance/cash management, engineering, accounting, etc. in the area of content. Leadership, communication, and human relations are some of the skills and behaviors deemed essential. Creativity, opportunistic thinking, vision, and positive thinking are examples of required mentality attributes. Self-motivation, propensity for risk-taking, and deep-seated ethical values are required in terms of personality characteristics.After determining the areas of knowledge required for successful entrepreneurship, the study goes further to determine (1) if the executives believe the knowledge can in fact be taught, (2) the priority level of importance of the knowledge, and (3) suggested methods for conveying or teaching such knowledge.The results of the study represent a first attempt in the U.S. for systematically determining, from successful entrepreneurs, the knowledge believed important for engendering successful entrepreneurship. The results will help the designers of entrepreneurship education curricula in deciding which areas might be included in such curricula and which should receive greater emphasis. Finally, while the results could very well be different in other cultures and countries, they could represent a starting point for further analysis in other parts of the world as governments, academicians, and business communities attempt to foster the entrepreneurial spirit as a means of economic development and improvement of local standards of living.