Medicaid managed care's impact on safety-net clinics in California.

A growing percentage of Medicaid patients are receiving medical care within a managed care system. This policy change has raised concerns about whether safety-net providers can maintain their share of Medi-Cal (California Medicaid) patients. From 1995 to 1997 several of California's counties implemented mandatory Medi-Cal managed care. The majority of California's safety-net primary care clinics experienced a decline in the percentage of their patients insured by Medi-Cal. However, after the overall decline in the number of Medi-Cal beneficiaries was controlled for, the increased penetration of Medi-Cal managed care in a county was not independently associated with a decline in clinics' share of Medi-Cal patients. Despite this fact, it may become increasingly difficult for clinics to maintain their current level of services with declining Medi-Cal enrollment and other anticipated reforms in their funding.

Evaluating needle exchange: a description of client characteristics, health status, program utilization, and HIV risk behavior.

This study was designed to describe demographic and drug use characteristics, health status, and HIV-related risk behavior among clients attending the San Francisco needle exchange program (NEP), and to assess the relationship between NEP utilization and risk behavior. Randomly selected clients were interviewed when they visited the NEP. Participants were of diverse ethnicity, had a mean age of 38.2, and 72% were male. Many reported being homeless (25%), unemployed (34%), uninsured (52%), and having an episode of infectious disease in the past 2 years (36%). Clients who received a higher proportion of their needles from the exchange were less likely to report sharing of needles or rinse water. Clients who attended the exchange more frequently were more likely to clean their skin prior to injecting and less likely to use the same needle repeatedly. Frequency of visiting the NEP was not associated with the likelihood of sharing needles or rinse water. Efforts to evaluate needle exchange in the United States will benefit from descriptive reports from other NEP programs, and the use of nonexchange comparison groups.

Complex behavior induced by egg-laying hormone in Aplysia.

Previous studies have described a pattern of complex behavior that occurs in the marine mollusc Aplysia during egg laying. Egg laying and the behavior are initiated by a burst of impulse activity in the neuroendocrine bag cells of the abdominal ganglion or by injection of bag cell extract. To more precisely identify the factors responsible for inducing the behavior we injected animals with egg laying hormone (ELH), one of the neuropeptides secreted by the bag cells. We found that ELH causes a behavior pattern similar to what occurs during spontaneous egg laying. This includes a temporal pattern of head movements consisting of waves and undulations, followed near the beginning of egg deposition by a transition to head weaves and tamps and inhibition of locomotion. There was also a small decrease in respiratory pumping. Except for respiratory pumping, a similar pattern occurred in a second group of animals injected with atrial gland homogenate, which is presumed to induce bag cell activity, but not in controls. These results further implicate ELH in regulation of the behavior. We discuss possible sites of action of ELH and the neural mechanisms by which the behavior is controlled.

Health care litigation: assuring consistency and proportionality in punitive damages awards.

This article, the ninth in a series on health care litigation, explains possible reforms that could be implemented to prevent juries from awarding unreasonable and unfair amounts of punitive damages. One way to minimize this problem would be to establish a system that promotes consistency in punitive damages awards. Another reform would involve instituting mechanisms to ensure proportionality in punitive damages awards. This article explores the steps involved in establishing a new system, and the benefit to defendants if the punitive damages system is reformed.

Health care litigation: achieving fairness and reasonableness in punitive damages awards.

This article, the eighth in a series on health care litigation, discusses whether due process considerations require that the common-law procedures for awarding punitive damages be modified and whether juries have undue discretion in awarding punitive damages. The authors analyze an important recent United States Supreme Court punitive damages case and examine the changes states may need to make in their punitive damages assessment procedures to conform with the Supreme Court's holding.