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This article addresses the issue of Chinese state engineering of an urban middle class in Beijing. Its major argument is that urban dwellers with closer ties to the public sector & better access to traditional forms of welfare have benefited comparatively more than other groups from the redistribution & privatization of public assets & from policies to improve consumption in urban areas. The author investigates in particular the impact of urban housing reform on this process of polarization, the increasing residential segregation of the professional middle class & the effects of this process on neighborhood politics, the emergence of self-conscious communities of interests, & the self-organization of autonomous activist groups. Adapted from the source document.

This study uses data on Medicaid physician fees in 1993 and 1998 to document variation in fees across the country, describe changes in these fees, and contrast how they changed relative to those in Medicare. The results show that 1998 Medicaid fees varied widely. Medicaid fees grew 4.6 percent between 1993 and 1998, lagging behind the general rate of inflation. This growth was greater for primary care services than for other services studied. Relative to Medicare physician fees, Medicaid fees fell by 14.3 percent between 1993 and 1998. Medicaid's low fees and slow growth rates suggest that potential access problems among Medicaid enrollees remain a policy issue that should be monitored.

This study presents findings from a national survey of physicians working in the emerging career of hospital medicine. It finds that female hospitalists earn significantly less annually than male hospitalists, despite similar work schedules and commitments; that these similarities in work and differences in pay remain even for male and female hospitalists who are married and have children; and that female hospitalists maintain positive feelings toward their work careers despite assuming multiple work and nonwork roles simultaneously. The results present a unique picture of female physicians' career experiences in toto. They have implications for how health care organizations and managers should think about the contemporary female physician (e.g., her career development needs and workplace challenges); for female physicians' need to gain greater equity vis-à-vis men within the profession; and for the kinds of questions researchers should raise around physician gender in their work.

From 1982 - 1994, median physician income rose at an average of 5.9% in nominal terms, and 2.1% in inflation-adjusted dollars. The year 1994 marks the first time nominal earnings went down. This decline comes at a time when the market for physician services is in flux because of the growth of managed care. By 1995 more than 83% of all patient care physicians had at least one managed care contract, up from 61% in 1990 and 43% in 1986. A key driver of managed care is cost containment; evidence suggests that managed care has cut reimbursements and restricted access to physician services. The 1994 physician income numbers, however, may be the first evidence that managed care has had a widespread effect on physicians' earnings in particular and on health spending in general.

Data from a national representative physician survey conducted in 1995 is used to: 1. document the prevalence of capitation, 2. analyze the geographic, specialty, and practice characteristics of capitated practices, and 3. examine the degree to which physician earnings are at risk. It is found that capitation is widespread, and physician involvement with capitated contracts increased sharply between 1994 and 1995. Physicians with capitated contracts are bearing significant amounts of risk. Among practices with contracts, nearly 20% of all revenues are capitated. Furthermore, only a small proportion of practices may be making use of reinsurance or stop-loss provisions that would limit downside losses.

In light of rising expenditures for physicians' services and the scheduled decreases in the amounts Medicare pays for such services, we identified the sources of change in the volume and intensity of Medicare physicians' services. We found that the per capita volume and intensity of physicians' services used by Medicare beneficiaries increased more than 30% between 1993 and 1998. Our analyses indicated that, at most, half of this increase was due to measurable changes in the demographic composition, places of residence, prevalence of health conditions, and managed care enrollment of beneficiaries. The other half was due to a general increase in the use of care across beneficiary categories.

This study examines how the volume of privately insured services provided in hospital inpatient and outpatient departments changes in response to reductions in Medicare physician payments. We hypothesize that physicians consider relative payment rates when choosing which patients to treat in their practices. When Medicare reduces its payments for surgical procedures, as it did in the late 1980s, physicians are predicted to treat more privately insured patients because they become more lucrative. We use data from 182 hospitals for seventeen major procedures groups, covering a forty-five-month period between 1988 and 1991 that encompasses a twenty-four-month period before the reduction in Medicare fees and twenty-one months after the reduction. Our findings are consistent with the predictions for a number of procedure groups, but not for all of them. One implication of the findings is that societal savings from Medicare fee reductions are overstated if one does not also consider spillover effects in the private insurance market.

Objective: To assess adequacy of reimbursement for childhood vaccinations in two rural regions in Colorado, the authors measured medical practice costs of providing childhood vaccinations and compared them with reimbursement. Methods: A \"time-motion\" method was used to measure labor costs of providing vaccinations in 13 private and public practices. Practices reported non-labor costs. The authors determined reimbursement by record review. Results: The average vaccine delivery cost per dose (excluding vaccine cost) ranged from $4.69 for community health centers to $5.60 for private practices. Average reimbursement exceeded average delivery costs for all vaccines and contributed to overhead in private practices. Average reimbursement was less than total cost (vaccine-delivery costs + overhead) in private practices for most vaccines in one region with significant managed care penetration. Reimbursement to public providers was less than the average vaccine delivery costs. Conclusions: Current reimbursement may not be adequate to induce private practices to provide childhood vaccinations, particularly in areas with substantial managed care penetration.

This article addresses the relationship between legislative success and failure and participation in bureaucratic policy making. It specifically examines the hypothesis that the parties upon which regulations are expected to impose costs participate more extensively in the rule-making process than the expected beneficiaries of regulations do. The analysis focuses on the submission of comments on a regulation, promulgated by the Health Care Financing Administration, that reformed the way in which the Medicare program pays for physician services. The results provide little evidence that physician specialties that expect decreases in payment under the new system submitted more comments than specialties that expect increases in payment. This finding is contrary to expectations drawn from prospect theory, research on benefits, costs, and political participation, and the conventional wisdom on participation in rule making. More broadly, it highlights the need for additional research on the use and influence of participatory instruments, which potentially enhance the extent to which bureaucratic agencies are accountable to elected officials and their constituents