State regulation of managed care: fragments of reform

State legislatures consider numerous bills to regulate managed care organizations. After identifying the legal, political, and economic barriers to state reform efforts, the paper assesses recent types of state regulation, particularly mandated benefits and disclosure requirements. Two prerequisites to future reform, coalition building and the diffusion of information about managed care, are analyzed.     

Who should manage care? The case for providers

Health care professionals should be the ones to make allocation decisions in the managed care setting because they are in the best position to assess outcomes, cost effectiveness, and quality of care.     

Variation of Isometric Response Force in the Rat

Hungry, unrestrained rats (N = 7) were rewarded for pressing a response beam in excess of 11 different force requirements. Changes in peak force production as a function of peak force requirement were examined by analyses of the first four moments of distributions of peak response forces: constant error, the within-subject standard deviation, skewness, and kurtosis. Results were similar to those previously obtained with human subjects: Constant error was positive at low and negative at high force requirements, the within-subject standard deviation increased as a negatively accelerating function of force requirement, and skewness and kurtosis were positive at low force requirements and decreased to negative values at the highest increments. Additional analyses of response kinetics indicated that rats, like humans, meet increasing force requirements by altering the rate of rise of force. The performance similarities suggest that common processes are engaged by the human and rat motor control systems to solve the problem of generating forces that are appropriate to the prevailing environmental constraints.     

A classroom demonstration of self-monitoring, reactivity, and interobserver agreement

A brief classroom demonstration designed to introduce students to the concepts of self-monitoring, reactivity, and interobserver agreement is presented. The demonstration provides students with opportunities to monitor their own behavior, record the behavior of others, and calculate interobserver agreement percentages. Results of using the demonstration with students from two classes are presented.     

Children's capacity to agree to psychological research: knowledge of risks and benefits and voluntariness

A series of studies investigated the capacity of children between the ages of 7 and 12 to give free and informed consent to participation in psychological research. Children were reasonably accurate in describing the purpose of studies, but many did not understand the possible benefits or especially the possible risks of participating. In several studies children's consent was not affected by the knowledge that their parents had given their permission or by the parents saying that they would not be upset if the children refused. In contrast, other studies found that children were much more likely to stop their participation if the experimenter said explicitly that she would not be upset if they stopped. We suggest that experimenters should pay more attention to describing the possible risks and benefits of participation in research, and that they should also make it clearer to children that they are free to stop once they have begun.     

Being skeptical about the medical humanities

In this paper the author challenges the prevailing view that contemporary writing in the medical humanities is serving the needs of the various health care disciplines. The current medical humanities literature assumes that physicians are the appropriate target group. This is most notably the case within health care ethics literature. There appears to be an unexamined assumption that physician-centric approaches to clinical ethical decision-making are the standard by which appropriate ethical practice is judged. The author challenges this assumption and addresses the problems that this approach engenders. The medical humanities literature appears to reinforce hierarchical, patriarchal arrangements which are themselves not morally neutral.