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We study changes in age-specific diabetes-related mortality and annual health care utilization. We find that half of the estimated 16% increase of diabetic mortality falls within employable age groups. We estimate that disease combination-specific increase in case fatality has resulted in premature diabetic mortality costing $3.2 billion annually. The estimated annual direct cost of treating high-risk diabetics reaches $36 billion, of which Medicare and Other Federal Programs compensate 54%. Respiratory conditions among diabetics comprise the same proportion of high-risk diabetics as do the disease combinations including coronary heart diseases. Treating of general diabetic conditions has become more efficient as indicated by the estimated declines in per unit health care costs.

The Epidemiologic Transition can help us understand a fundamental puzzle about aging. The puzzle stems from two seemingly contradictory facts. The first fact is that death rates from noninfectious degenerative maladies – the so-called diseases of aging – increase as people age. It seems to be at odds with the historical fact that for nearly a century in which people were aging more than ever before, the aggregate rates of such diseases have been decreasing. In what sense can both be true? Crucial to resolving the puzzle are the age-profiles of such diseases in cohorts that grew up in the different regimes of the Transition. For each cohort, noninfectious diseases had increased with age, resulting in an upward-sloping age profile, which affirms the first fact. As the regimes were transitioning from the Malthusian to the modern one, however, the profiles of successive cohorts had been shifting downward: death rates from noninfectious diseases were shrinking at each age, signifying the newer cohorts’ greater aging potentials. The shifting profiles had been renewing the cohort mix of the population, shaping the century-long descent of such diseases in aggregate, giving rise to the historical fact. The profiles had shifted early in the cohorts’ adult years, associating closely with the newer epidemiologic conditions in childhood. Those conditions appear to be a circumstance under which aging potentials of cohorts could be misgauged, including in one troubling episode in the first half of the nineteenth century when the potentials had reversed.

Using micro data on virtually all of the drugs and diseases of over 500,000 people enrolled in Puerto Rico's Medicaid program, the impact of the vintage (original FDA approval year) of drugs used to treat a patient on the patient's three-year probability of survival, controlling for demographic characteristics (age, sex, and region), utilization of medical services, and the nature and complexity of illness are examined. It is found that people using newer drugs during January–June, 2000, were less likely to die by the end of 2002, conditional on the covariates. The estimated mortality rates are strictly declining with respect to drug vintage. For pre-1970 drugs, the estimated mortality rate is 4.4%. The mortality rates for 1970s, 1980s, and 1990s drugs are 3.6%, 3.0%, and 2.5%, respectively. The actual mortality rate is about 16% (3.7% vs. 4.4%) lower than it would have been if all of the drugs utilized in 2000 had been pre-1970 drugs. Estimates for subgroups of people with specific diseases display the same general pattern.

This study proposes targeted modernization of the Department of Defense (DoD's) Joint Forces Ammunition Logistics information system by implementing the optimized innovative information technology open architecture design and integrating Radio Frequency Identification Device data technologies and real-time optimization and control mechanisms as the critical technology components of the solution. The innovative information technology, which pursues the focused logistics, will be deployed in 36 months at the estimated cost of $568 million in constant dollars. We estimate that the Systems, Applications, Products (SAP)-based enterprise integration solution that the Army currently pursues will cost another $1.5 billion through the year 2014; however, it is unlikely to deliver the intended technical capabilities.

Purpose – To explore how home care social worker perceptions of their organizations' dominant goals and means affect direct service home care professionals' care delivery and meeting of patient needs for persons with Alzheimer's disease.

Methodology/approach – The study used a convenience sample of 34 home care social workers in the New York City metropolitan area and an extensive literature review.

Findings – The study found that literature indicates a dissonance between effective, evidence-based research psychosocial Alzheimer's disease interventions and Medicare home health policy which does not cover their use. Furthermore, interviews indicated home care social workers' different strategies to cope with organization demands, which affect their perceptions and care delivered to patients. The coping strategies are characterized using a modified version of Merton's (1957) adaptation model – conformist, innovator, and rebel.

Contribution to the field – The study is the first to use the voice of home care social workers to explore how perceptions of organizational dominant goals and means affect direct service home care professionals' care delivery and meeting of patient needs. The study asserts the need for a home care-based policy model drawing on the Hospice Medicare Benefit (HMB) to address Alzheimer's disease more cost-effectively with a more positive quality of life manner, thus limiting the adverse consequences of the evolving epidemic.

In the last 10 years or so, a growing body of research has highlighted the importance of social movements as the mechanism through which fields change or new fields emerge. This article contributes to this body of research by studying how an organization was able to promote institutional change from the center of a field by channeling the legitimacy generated by local religious movements. Data comes from the archives of a special commission within the Catholic Church that developed rules for adjudicating miracles performed by candidates to sainthood. The social movement is composed of candidates and their supporters who mobilized local communities using miracles. The period of the analysis was the aftermath of the Protestant Schism, when long-established practices and beliefs were fundamentally challenged. By approving miracles that created ties between individuals that spanned across kinship and social status boundaries, the commission was able to channel legitimacy into the wounded core of the Church. At the same time, receiving Rome’s approval reduced the competition the candidate’s supporters faced from other religious activists. The noncontentious interaction that occurred between the two actors gave birth to the field of modern sainthood. The main implication for organization theory is that, even in the absence of conflict, a new environment and ideology can emerge endogenously from the center of a field and transform both the organization and the social movement.

Purpose – To assess labeling and social control of clients in contemporary mental health care organizations.

Methodology/approach – Fifteen months of observation in two multiservice mental health care organizations, interviews with workers and clients, and analysis of organizational documents.

Findings – The organizations used a variety of organizational labels, both official and informal, which served distinct purposes in organizational life and which did not always agree in their construction of the client. Official mental illness diagnosis was a bureaucratic label, while informal labels determined the types of social control to which clients were subjected. Clients who were informally labeled severely mentally ill were subject to integrative social control, while exclusionary social control was applied to those informally seen as not being severely mentally ill. Unlike in classic studies of mental health care, looping processes, in which client behaviors are viewed as symptoms, do not reliably predict the types of labels or social control applied to clients.

Implications – It is important for a sociology of diagnosis to contextualize official diagnosis in the repertoire of organizational labels applied to clients in mental health care, recognizing that it plays a limited but important role in organizational life. Informal labels, which at time conflict with official diagnosis, play a more prominent role in the management of everyday organizational life.

When decision makers encounter new assurance services that can be customized for individual clients, they must include them in their pre-existing categorization of assurance, a cognitive task known as postclassification. This paper draws upon three literatures (classification research in accounting, theory of assurance, and cognitive psychology) in order to suggest how this task might be modeled and studied empirically, using the example of SysTrust™. The role of a necessary condition for successful postclassification called the category use effect (Ross, 2000), in which decision makers are reminded of pre-existing categories when they learn to use new categories, is explained.

Purpose – This chapter presents a case for reframing medical sociology to focus on diagnosis as a pivotal category of analysis via an extended literature review of the diagnosis as a tool of medicine.

Methodology/approach – Conceptual overview.

Practical implications – By reviewing the range of social functions served by diagnosis, and the similarly wide assortment of social forces that shape diagnostic categories, this chapter pushes social scientists and theorists to consider diagnosis as a cornerstone to the understanding of health, illness, and disease.

Originality/value of paper – Building on Brown's earlier call for a sociology of diagnosis, this chapter sets forth potential parameters for this field. It defines how the study of diagnosis is dissipated across myriad areas of scholarship, including medicalization, disease theory, ethics, classification theory, and history of medicine. Extirpating diagnosis and revealing it for specific discussion provides an opportunity to study topics such as illness experiences, health social movements, and disease recognition from a different and rich perspective.

Through the example of a “regulatory ranking” – an index produced with the aim to regulate the pharmaceutical market by pushing companies in the direction of providing greater access to medicine in developing countries – this chapter focuses on indexing and ranking as infrastructural processes which inscribe global problem spaces as unfolding actionable territories for market intervention. It foregrounds the “Indexal thinking” which structures and informs regulatory rankings – their aspiration to align the interests of different stakeholders and to entice competition among the ranked companies. The authors detail the infrastructural work through which such ambitions are enacted, detailing processes of infrastructural layering/collage and patchwork through which analysts naturalize/denaturalize various contested categories in the ranking’s territory. They reflect on the consequences of such attempts at reconfiguring global topologies for the problems these governance initiatives seek to address.