Health affairs
-
One essential component of health system reform is to bring the number of physicians in line with the needs of the population. The physician supply policies of prepaid group practice health maintenance organizations have been cited as one model to achieve this goal. Planning for physician supply should be an explicit public-sector activity and should not be left to the private sector, because some areas are not sufficiently populated to support competing providers under a managed competition scheme. A new model for planning for physician supply should include the following strategies: (1) erecting barriers to entry into medical practice; (2) encouraging early retirement; (3) restructuring economic incentives; (4) reallocating physicians to underserved areas in the United States and abroad; and (5) creating new areas of professional responsibility for physicians.
-
This paper identifies five research dilemmas in associating violence with substance abuse: (1) difficulty in establishing causal linkages; (2) problems associated with the legal status of substances; (3) ecological and individualistic fallacies; (4) measurement issues and problems with data sources; and (5) research design problems. The author then discusses social context and the role of rational choice as frameworks to explain the interaction among drugs, alcohol, and violence.
-
This DataWatch estimates the costs and monetary value of lost quality of life due to death and nonfatal physical and psychological injury resulting from violent crime. In 1987 physical injury to people age twelve and older resulting from rape, robbery, assault, murder, and arson caused about $10 billion in potential health-related costs, including some unmet mental health care needs. It led to $23 billion in lost productivity and almost $145 billion in reduced quality of life (in 1989 dollars). ⋯ Considering only survivors with physical injury, rape cost $60,000, robberies $25,000, assaults $22,000, and arson $50,000. Costs are almost $2.4 million per murder. Lifetime costs for all intentional injuries totaled $178 billion during 1987-1990.
-
The cost of firearm injuries in the United States in 1990 was an estimated $20.4 billion. This includes $1.4 billion for direct expenditures for health care and related goods, $1.6 billion in lost productivity resulting from injury-related illness and disability, and $17.4 billion in lost productivity from premature death. While these are the best available national estimates, it is likely that they underestimate the economic impact of firearm injuries because they are based on relatively old data and on many assumptions necessitated by data gaps. The need for better data and improved estimates, and their policy relevance, are discussed.