Escalating health care spending: is it desirable or inevitable?

This study analyzes changing trends in U.S. health spending and concludes that although the long-term growth trend has been a good predictor of future spending, periodic differences in the growth trend are important. Of particular concern is the rapid acceleration in health spending beginning in 1998. If left unchecked, the current growth rate will result in almost 24 percent of GDP spent on health by 2011. The authors question whether such unconstrained spending levels are either desirable or inevitable, and they offer a guide to how the United States might develop a long-term cost-containment strategy that is both effective and sustainable.

An examination of factors in the withdrawal of managed care plans from the Medicare+Choice program.

Participation of health maintenance organizations (HMOs) in the Medicare+Choice program, expected to rise rapidly after passage of the Balanced Budget Act of 1997, has gone in just the opposite direction. Because plans have left in such large numbers, Congress has taken remedial measures to remove restrictions and increase payments. To date these efforts have failed. This paper uses plan organizational characteristics, market position, and financial performance to quantify the reasons why some HMOs exited at the end of 1998. The findings suggest HMO participation in Medicare+Choice will continue to fall unless major changes are made to the overall Medicare program and the method of paying HMOs.

Single-pixel demonstration of innovative adaptive optics by use of a charge-transfer membrane light modulator.

We have constructed and demonstrated a single-pixel implementation of an all-optical membrane-based spatial light modulator as a compact optical wave-front error correction device. High rates of response of as much as 20 kHz in an open-loop configuration were obtained. The device was then used in an adaptive-optics servo to compensate successfully for a 1-kHz sinusoidal phase error with a peak-to-peak excursion of approximately pi/7 rad. A small-signal servo gain of the order of 10 was inferred from the closed-loop measurements.

Optical real-time defect-enhancement diagnostic system.

We have demonstrated an all-optical diagnostic system that enhances the observation of defects in periodic structures. This real-time technique employs a spatial light modulator as a smart-pixel array for information processing in the Fourier transform plane of a lens. The system also includes a phase-conjugate mirror for autoalignment and for correction of optical wave-front aberrations that are imparted on the object light by the smart-pixel processor and its associated optical train.