Dissatisfaction with the financing of U.S. health care is widespread. The system is inefficient, inequitable, and increasingly perceived to be unaffordable. Because only incremental reform is deemed politically feasible, inordinate attention is devoted to treating the institutional symptoms rather than diagnosing systemic problems that require major surgery. As an alternative, we propose a voucher system for universal health care, an efficient, fair, and relatively simple approach that might elicit broad support. We recognize that change is not imminent, but such a proposal can stimulate discussion and provide a readily available model when the political climate becomes hospitable for endorsing meaningful reform.

The key features of the voucher system are the following:

• Universality
• Free Choice of Health Plan
• Freedom to Purchase Additional Services
• Funding by an Earmarked Value-Added Tax
• Reliance on a Private Delivery System
• End of Employer-Based Insurance
• Elimination of Medicaid and Other Means-Tested Programs
• Phasing Out of Medicare
• Administration by a Federal Health Board
• Establishment of an independent Institute for Technology and Outcomes Assessment

Mortality rates in the United States fell more rapidly during the late nineteenth and early twentieth centuries than in any other period in American history. This decline coincided with an epidemiological transition and the disappearance of a mortality "penalty" associated with living in urban areas. There is little empirical evidence and much unresolved debate about what caused these improvements, however. In this article, we report the causal influence of clean water technologies -- filtration and chlorination -- on mortality in major cities during the early twentieth century. Plausibly exogenous variation in the timing and location of technology adoption was used to identify these effects, and the validity of this identifying assumption is examined in detail. We found that clean water was responsible for nearly half the total mortality reduction in major cities, three quarters of the infant mortality reduction, and nearly two thirds of the child mortality reduction. Rough calculations suggest that the social rate of return to these technologies was greater than 23 to 1, with a cost per person-year saved by clean water of about $500 in 2003 dollars. Implications for developing countries are briefly considered.

The Encyclopedia of Psychological Assessment is a landmark reference work and constitutes a definitive resource for academics, practitioners and students working in any field of applied psychological science.

Psychological assessment is a key component of psychological work. Devices of scientific assessment are necessary for adequate describing, diagnosis, predicting, explaining or changing the behavior of all subjects under examination. This double-volume collection offers complete coverage to facilitate action in each of these areas and will consequently be invaluable to psychologists in any applied setting.

The two volumes of the Encyclopedia of Psychological Assessment contain a series of 235 entries, organized alphabetically, and covering a variety of fields. Each entry includes a general conceptual and methodological overview, a section on relevant assessment devices, followed by links to related concepts in the Encyclopedia and a list of references.

The Encyclopedia of Psychological Assessment offers a truly international perspective, both in terms of the selected authors and chosen entries. It aims to provide an integrated view of assessment, bringing together knowledge dispersed throughout several methodological and applied fields, but united in terms of its relevance for assessment. It is an essential purchase for any library with an existing collection or concern with the field of psychological science in general.

The articles presented in this issue are discussed within the context of the general literature on coping and coping style. The focus of this special issue was to determine if these articles are both consistent with extant research and advance the field. We identify at least two general definitions of coping, as used in these articles. We refer to one definition as reflecting one's "coping style." This is largely a descriptive concept and closely related to one's enduring behavioral traits. It is closely related to other personality characteristics such as introversion-extroversion, stability, etc. The other definition of "coping" in the literature is much more specific to stressful environments and to the changes noted in one's behavior and cognitions during times of stress, than the first definition. We refer to this broad stress response as one's "coping response." Coping response, unlike coping style, includes both a cognitive and an affective component. We conclude that it may be advantageous to differentiate between these two broad definitions in future research. We also conclude that the articles in this issue provide information that advances the field's understanding of coping styles and coping responses. Copyright 2003 Wiley Periodicals, Inc. J Clin Psychol, 2003.

Coping is a complex process. It is variously described as a situational and as a trait-like response, as a response to stress and as a disposition to respond to change. In this article, we review the current research on coping within the context of considering the contributions of the articles presented in this series. We present two broad views of coping, the more general one under the title of "coping response" defines coping as containing emotional, behavioral, and cognitive qualitites. It is generally considered to be a stress-specific pattern by which an individual's perceptions, emotions, and behaviors prepare for adapting and changing. The more narrow view of coping is described here as "coping style" and represents a more observable but general style of interacting. In this usage, coping is a trait-like variable that is activated when an environment changes in some way. It resembles other personality qualities and describes dispositions to respond in certain ways. In this article, we consider the implications and extant knowledge about coping within these two definitions, with special consideration to the prediction of treatment processes and outcomes. The articles in this series are discussed both in terms of extant research on these two views of coping and in terms of their contributions to the available literature on coping and coping responses. Copyright 2003 Wiley Periodicals, Inc. J Clin Psychol, 2003

Elderly Floridians use much more medical care and have much lower mortality rates than do their peers in other regions of the country. After demographic and other variables are controlled for, the differential between Florida and the rest of the United States is 25 percent for utilization and 10 percent for mortality among whites ages 65-84. This paper summarizes the facts about Floridian exceptionalism and reviews various possible explanations: physician inducement of utilization, differences in preferences, selective migration into and out of the state, climate, and social interactions, among others. Readers are invited to suggest their own explanations and their policy recommendations, if any.

We compared results of safety climate survey questions from health care respondents with those from naval aviation, a high-reliability organization. Separate surveys containing a subset of 23 similar questions were conducted among employees from 15 hospitals and from naval aviators from 226 squadrons. For each question a "problematic response" was defined that suggested an absence of a safety climate. Overall, the problematic response rate was 5.6% for naval aviators versus 17.5% for hospital personnel (p0.0001). The problematic response was 20.9% in high-hazard domains such as emergency departments and operating room. Problematic response among hospital workers was up to 12 times greater than that among aviators on certain questions.

CONCLUSION: Although further research on safety climate in health care is warranted, hospitals may need to make substantial changes to achieve a safety climate consistent with the status of high-reliability organizations.

Attendance at 12-step self-help groups is frequently recommended as an adjunct to professional substance use disorder (SUD) treatment, yet patient dropout from these groups is common. This study assessed the prevalence, predictors, and treatment-related factors affecting dropout in the first year following treatment for 2,778 male patients. Of these, 91% (2,518) were identified as having attended 12-step groups either in the 90 days prior to, or during, treatment. At 1-year followup 40% had dropped out. A number of baseline factors predicted dropout. Importantly, patients who initiated 12-step behaviors during treatment were less likely to drop out. Further findings suggest patients at highest risk for dropout may be at lower risk if treated in a more supportive environment. Clinicians may decrease the likelihood of dropout directly, by screening for risk factors and focusing facilitation efforts accordingly, and indirectly, by increasing the supportiveness of the treatment environment, and facilitating 12-step involvement during treatment.

The ethical case for the social insurance model will be strengthened as people realize that most health problems have at least in part a genetic basis. The efficiency case will benefit from recognition that employment-based insurance has high administrative costs but provides no advantages to society as a whole. The desire to exert more direct control over rising expenditures will provide an additional reason to introduce some form of national health insurance.

The timing of such a change, however, will depend largely on factors external to health care. Major changes in health policy are political acts undertaken for political purposes. This was true when Bismarck introduced national health insurance to the new German state in the 19th century. It was true when England adopted national health insurance after World War II; and it will be true in the United States as well. National health insurance will probably come to the United States after a major change in the political climate, the kind of change that often accompanies a war, a depression, or large scale civil unrest. Until then, the major effect of the new plans will be to make young and healthy workers better off at the expense of their older, sicker colleagues.