This study estimates the cost of osteoporosis in California, including health care services and the value of lives lost prematurely to the disease. Costs are estimated for diagnoses of "osteoporosis" and for the proportion of spine, forearm, hip and other fractures that are caused by the disease. The additional costs resulting from a secondary diagnosis of osteoporosis are also included. Osteoporosis accounted for over $2.4 billion in direct health care costs in 1998, and over $4 million in lost productivity resulting from premature death. Most of the cost results from hip fractures and other fractures. In fact, only 15% of costs are for people with a diagnosis of "osteoporosis" per se, and, of this group, most of the costs are associated with a secondary, not a primary diagnosis. The disease is largely a diagnosis of older white women: three-quarters of the hospitalization costs are incurred by women, 80% of those hospitalized are white, and three-quarters are over age 65 years. As would be expected, Medicare pays for most of the hospital care -- almost three-fourths of the total. Nursing home care represents the largest cost for people with osteoporosis, accounting for 59% of the money spent treating the disease.

In this classic book, Professor Victor Fuchs draws on his deep understanding of the strengths and limitations of economics and his intimate knowledge of health care institutions to help readers understand the problems every nation faces in trying to allocate health resources efficiently and equitably. Six complementary papers dealing with national health insurance, poverty and health, and other policy issues, including his 1996 presidential address to the American Economic Association, accompany the original 1974 text.

Health professionals, policy makers, social scientists, students and concerned citizens will all benefit from this highly readable, authoritative, and nuanced discussion of the difficult choices that lie ahead.

A growing body of evidence suggests that managed care can reduce overall health care costs but provides little insight into how this could happen. One possibility is that managed care influences the adoption of new medical technologies. In examining the relationship between health maintenance organization (HMO) activity and market-level availability and use of magnetic resonance imaging (MRI), we find that high HMO market share is associated with low levels of MRI availability and use. This suggests that managed care may be able to reduce health care costs by influencing the adoption and use of new medical equipment and technologies.

Signs of a managed care backlash in California are increasing. This paper reports and interprets the recently completed work of the California Managed Health Care Improvement Task Force, focusing on the managed care backlash and the state's regulatory response. Although cost containment was a contributing factor, the causes of and solutions to the backlash differ among consumers, physicians, health care workers, politicians, and health plans. The recommendations of the task force could improve the market for health insurance. However, lasting solutions to the profound problems causing the backlash will require fundamental cultural and systemic change.

Zouping offers important general lessons for the study of China's rural transformation. The authors in this volume, all participants in a unique field research project undertaken from 1988 to 1992, address questions that are far from simple and about which there is some controversy.

The questions are grouped around two issues. The first is the role of local governments as economic actors. What is this role, how have they played it, and how can we explain their behavior? Have they dominated rural economies through public ownership of industry and local planning, or has the role of local governments diminished with the rise of market transactions and private ownership? The second issue is market reform and inequality. Have rural cadres enjoyed income advantages in the new market environment? Has the provision of such collective services as education and health care declined, leading to new forms of inequality?

The chapters on the role of local government all point to a single conclusion: one cannot explain the rapid development of Zouping without reference to the role of local governments and of local government officials as economic actors. Scholarly writings about the "transitional economies" have often ignored or distorted this aspect of China's reform experience. On the second issue, changes in inequality owing to market reform, the authors present mixed findings but contribute rich new data to the research on this issue.

Signs of a managed care backlash in California are increasing. This paper reports and interprets the recently completed work of the California Managed Health Care Improvement Task Force, focusing on the managed care backlash and the state's regulatory response. Although cost containment was a contributing factor, the causes of and solutions to the backlash differ among consumers, physicians, health care workers, politicians, and health plans. The recommendations of the task force could improve the market for health insurance. However, lasting solutions to the profound problems causing the backlash will require fundamental cultural and systemic change.

Objective: To determine whether physician gender and patient gender influence the process of communication and parent and child satisfaction during pediatric office visits. DESIGN: Content analysis of videotaped pediatric office visits.

Setting: University-based pediatric primary care practice.

Subjects: Videotaped communication between 212 children, ages 4 to 14 years, parents, and physicians. Thirty-eight percent were child health supervision visits, and 62% were for the management of minor or chronic illnesses.

Main Outcome Measures: An established coding system of physician-patient communication and measures of parent and child satisfaction with medical care.

Results: Female physician visits were 29% longer than those of male physicians (P .001). Compared with male physicians, female physicians engaged in more social exchange (P .01), more encouragement and reassurance (P .01), more communication during the physical examination (P .05), and more information gathering (P .01) with children. Male and female physicians engaged in similar amounts of discussions regarding illness management. Children were more satisfied with physicians of the same gender (P .05), while parents were more satisfied with female physicians (P .05).

Conclusions: Children communicate more with female than with male physicians and show preferences for physicians of the same gender. These findings are consistent with communication patterns in adult patients and may have a significant influence on gender disparities in health care. Efforts at improving the process and outcome of medical care should address gender differences.