Thomas J. Burns

Health insurance, neighborhood income, and emergency department usage by Utah children 1996–1998

BackgroundIt is estimated that approximately half of emergency department (ED) usage in the U.S. and other developed countries is for non-urgent conditions and that this usage is related to availability, social, and economic factors. We examined pediatric ED usage in a U.S. state with respect to income, health insurance status, types of medical conditions, and whether introduction of managed care affected utilization by Medicaid children.MethodsEmergency department usage rates were calculated from 1996 through 1998 using Utah ED data for children with commercial health insurance, Medicaid, for uninsured children, and by income group estimating neighborhood household income from Zip code of residence. We analyzed usage following the July 1996 transition of Utah Medicaid to managed care.ResultsChildren with Medicaid had approximately 50% greater ED utilization rates than children with commercial health insurance or uninsured children. The majority of usage for Medicaid and uninsured children was for non-traumatic conditions. Only 35% of total ED usage was for non-emergent or non-urgent conditions and this was related to both Medicaid and low household income. Children lacking health insurance were more likely to be discharged against medical advice (OR = 2.36, 95% C.I. 1.88–2.96). There was no reduction in Medicaid ED usage following the transition to managed care.ConclusionUsage of ED services is related to both health insurance status and income. Children lacking health insurance and Medicaid children have excessive usage for conditions which could be treated in a primary care setting. That managed care does not reduce Medicaid ED usage is consistent with findings of other studies.

Change Scores, Composites and Reliability Issues in Cross-National Development Research

While a number of researchers of world development examine social change using composite measures as indicators, there is a relative paucity of research on the reliability of these change score composites over time. We construct two development composites based simply on factor analysis, one economic and one social, and then perform reliability analysis on these two development composites at two discrete points in time (i.e. 1970 and 1985) and their change over the 15-year period defined by their beginning and ending points. Despite evidence of reliable beginning and ending points, change in composites over time yield markedly different patterns of reliability. We conclude that if composite indicators of development are used in cross-national research to assess change, the reliabilities of their change should be addressed directly in addition to the reliabilities of their beginning and ending points. The risk of not doing so is faulty inferences with respect to theory.

Epistemology, culture and rhetoric: some social implications of human cognition

The paper examines linkages between individual cognition and emergent social processes. We consider theoretical and empirical work in cognitive psychology, and the ways individuals process information in a social context, and then progress to more macro-level cultural phenomena. Legitimacy of an argument is likely to be judged against the backdrop of semantic networks, but these networks arise in, and are modified in, a social context. Organization of information in semantic networks is partially a function of position in the stratification system. We examine ways in which political priorities on the material level do and do not parallel information prioritization rules on the individual level. Cultural similarities can be seen as similarities in ways of prioritizing information. Because of linkages between the organization of information and social organization, objective social and cultural changes occur concomitantly with subjective changes in cognitive networks, especially as they are mediated by prioritizing summary symbols.

Metatheorizing Structural Human Ecology at the Dawn of the Third Millennium

While its processes have been unfolding for centuries, some aspects of human interaction with the natural environment are unprecedented. In recent centuries, the world has experienced unparalleled technological change, wealth accumulation and population growth and concentration; these have led to extraordinary levels of other problems, particularly environmental degradation. Focusing on mismatches between the adaptive cycle and the organization of the world economy, we examine material and cultural changes that lead to social and ecological devastation. We apply our theoretical framework to one of the largest ecological and social catastrophes since the Industrial Revolution—the Irish Potato Famine of the 1840s. There are a number of lessons, particularly in terms of the relations of production and humankind’s connection with the natural environment. It is now as important as ever to learn from past mistakes and modify current modes of theory and analysis as history moves into the Third Millennium.