A multidimensional approach to homosexual identity.

The existing developmental stage models of homosexual identity do not consider the diversity of human sexual experience. The stage models stem from an essentialist perspective, in which the process of homosexual identity formation is largely a matter of becoming aware of one's underlying, or real, sexual orientation. Once homosexual orientation is identified, the only legitimate outcome is to develop homosexual identity and eventually incorporate that identity as one aspect of the total self. In this paper, we are concerned with those people for whom the stage models are inadequate in describing their experience of sexual identity development. The social constructionist perspective holds that the process of identity formation is a continual, two-way interactive process between the individual and the social environment, and that the meanings the individual gives to these factors influence the development of self-constructs and identity. Sexual identity develops within this contextual framework and, because it is influenced by continual interaction, is fluid over time and experience, throughout one's life. Our model does not rely on the existing developmental models of homosexual identity; rather, our model looks at desire, behavior, and identity as three separate constructs related to sexual identity. We posit that from the social constructionist viewpoint, there is in fact no true endpoint to sexual identity development.

Is your organization operationally ready to be a Medicare PSO?

Providers that wish to form a provider-sponsored organization to contract directly with Medicare need to assess their operational capabilities to determine whether such a plan can be successful. Areas that need to be examined include administrative and financial expertise, contract management capabilities, clinical and administrative medical management, information management, and continuum of care components. While many of the operational capabilities required to operate a PSO may be appropriately provided by an unrelated third party, some capabilities can be delivered most effectively by the PSO itself.

Contact capitation: an alternative for specialist capitation.

Because many specialists do not see capitation as a viable payment option, the most common strategy for paying specialists remains discounted fee-for-service. A transitional form of capitation for specialists, however, is growing in popularity--contact capitation. Unlike traditional capitation, which pays a per-member-per-month amount based on utilization levels, contact capitation payments are made to physicians when they have the first "contact" with new patients. Many specialists find contact capitation attractive because of its similarity to fee-for-service payment. But, unless some adjustments are made, contact capitation rates may underpay certain specialists.

Affiliation: to be or not to be independent?

In recent years, healthcare providers have expended a great deal of energy on merger, affiliation, and acquisition activities. Before entering into any of these arrangements, however, healthcare executives should answer the question: "Does my organization need to join with others to survive and thrive?"

Managing the transition to capitation.

Although most experts believe that capitation and financial risk-sharing among providers will become key components of the U.S. healthcare system, providers may not feel the full effect of this shift for several years. In the interim, providers must operate under an activity-based payment system that rewards them for the volume of patients seen, while preparing for the transition to a fixed, per-capita payment system that will reward them for the efficiency with which services are provided. Preparation for the move to capitation will involve implementation of the systems necessary to negotiate managed care contracts, enhance quality and efficiency, and take responsibility for the health of a defined population.

Advanced pricing strategies for hospitals in contracting with managed care organizations.

This article provides both a conceptual overview of pricing health care services and two pricing strategy examples. The overview addresses the underlying concepts of pricing, the factors that influence it, and the risk continuum of pricing approaches. The pricing strategy examples highlight some of the issues and considerations involved in pricing services in a changing health care market. Because the payors of health care will continue to shift economic risk to the providers of health care, the examples emphasize the importance of managing risk.

Morphological and electrophysiological changes produced by electrical stimulation in cultured neuroblastoma cells.

Electric fields, which were equivalent to those generated by medical devices, were applied to cultured neuroblastoma cells (mouse and human) to test for morphological damage and to establish damage thresholds. Each of two methods of applying fields permitted flow of electrical current and minimized exposure of cells to electrode-breakdown products. One method consisted of a pair of parallel wires in a Petri dish by which current was delivered within a fixed volume of flowing tissue-culture media. With the other method, the cells were held in a confined geometrical chamber and current was applied via agar bridges. Under a given set of stimulation parameters, damage was found to be variable from cell to cell. By changing the strength of the electric field (frequency and duration of stimulation held constant), thresholds of several V/cm were found above which cell damage could be reliably produced. Depending on the intensity of the field, damage took the form of cell lysis or damage to neurites. Intracellular recordings from the mouse neuroblastoma cells revealed a correlation between a decline in resting transmembrane potential and stimulus intensity. Human neuroblastoma cells were less susceptible to damage than were the mouse neuroblastoma cells, given the same strength of applied electric fields.

Hidden costs make planning critical for trauma centers.

Hospitals seek trauma center designation to enhance prestige, improve market share, increase financial return, enhance their teaching function, and support their mission. Unfortunately, for most hospitals, trauma centers create significant increases in capital and operating costs. The best way to determine the direct financial effect of trauma center designation is to focus on the additional patients who will be treated at the hospital and the associated costs and revenue.