More on least squares estimation of the transition matrix in a stationary first-order markov process from sample proportions data

Miller suggested ordinary least squares estimation of a constant transition matrix; Madansky proposed a relatively more efficient weighted least squares estimator which corrects for heteroscedasticity. In this paper an efficient generalized least squares estimator is derived which utilizes the entire covariance matrix of the distrubances. This estimator satisfies the condition that each row of the transition matrix must sum to unity. Madansky noted that estimates of the variances could be negative; a method for obtaining consistent non-negative estimates of the variances is suggested in this paper. The technique is applied to the hypothetical sample data used by Miller and Madansky.I am indebted to a referee for his thoughtful suggestions on content and style.     

Outpatient benefits for mental health services in Medicare. Alignment with the private sector?

Revision of Medicare's benefit for outpatient mental health care is long overdue. The Omnibus Reconciliation Act of 1987 expands the covered limit to $2,200 (from the $500 set in 1966) but retains the 50% coinsurance requirement for beneficiaries. There are several strong arguments supporting further changes in the benefit to reduce the coinsurance and include psychologists as covered providers. These are need among the elderly, changes in Medicare's inpatient reimbursement system, and innovations in treatment. Outpatient mental health care is a very small portion of Medicare expenditures, amounting to less than .1% of total costs. Using data from the Bureau of Data Management and Strategy at the Health Care Financing Administration (HCFA), it was estimated that $41.8 million was paid by HCFA for outpatient mental health care in fiscal year 1984. This article estimates the costs to Medicare and beneficiaries of reducing the coinsurance to 20% and including psychologists as eligible providers.     

Parental Perceptions of Services Provided for Children with Autism in Jordan

Providing formal support for children with autism and their parents is important and mandatory to improve children’s abilities and enhance the capabilities of parents. The present study attempted to investigate the perceptions of parents of children with autism regarding the services provided in Jordan. A questionnaire consisting of five sections was designed and distributed to a sample of 60 parents of children with autism (5–18 years old) among four special education institutions in Jordan. The questionnaire addressed five domains: demographics, type and number of received services, methods and difficulties of obtaining services, parents’ satisfaction, and parents’ perceived needed services. The results revealed that the service delivery system with which parents interacted was composed of multiple places and providers, but had several difficulties. Parents participating in this study expressed an average satisfaction with the received services. Issues pertaining to the cost of services, parents-professional partnerships, and overall quality of services were seen by parents as sources of low satisfaction. On the other hand, parents expressed the need for early intervention, family counseling, and community awareness services. Further suggestions and implications are presented in the study.     

Side-effect actions,acting for a reason,and acting intentionally

What is the relation between acting intentionally and acting for a reason? While this question has generated a considerable amount of debate in the philosophy of action, on one point there has been a virtual consensus: actions performed for a reason are necessarily intentional. Recently, this consensus has been challenged by Joshua Knobe and Sean Kelly, who argue against it on the basis of empirical evidence concerning the ways in which ordinary speakers of the English language describe and explain certain side-effect actions. Knobe and Kelly's argument is of interest not only because it challenges a widely accepted philosophical thesis on the basis of experimental evidence, but also because it indirectly raises an important and largely neglected question, the question of whether or in what sense an agent can perform a side-effect action for a reason. In this article, I address this question and provide a positive answer to it. Specifically, I argue that agents act for a reason whenever they perform side-effect actions as trade-offs. Thus, I claim that there are three distinct types of rational action: actions performed as ends in themselves, actions performed as means to further ends, and side-effect actions performed as trade-offs. Given this multiplicity of types of rational action, the question of whether or not actions performed for a reason are necessarily intentional is in need of refinement. The more specific question that lies at the heart of this article is whether or not side-effect actions performed as trade-offs are necessarily intentional. I conclude that, contrary to what Knobe and Kelly suggest, the question remains open.