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Human beings have two apparently conflicting fundamental rights. On the one hand, individuals have a right to health care as the United Nations declared in 1948. On the other hand, individuals have a right to liberty; that is, the freedom to make one's own health related choices, even poor ones. One goal of this essay is to show how to reconcile these two apparently conflicting core American values. This reconciliation is important, because a universal health care system that is fair and just must account for individual rights in tandem with attempts to address matters of social justice. In order for this reconciliation to occur, matters of individual responsibility, social responsibility, and social justice must be central to health care reform. / by Jennifer Lynn Mantoni. / Vita. / Thesis (M.A.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

This thesis examines the relationship of monetary policy and investment in a theoretical framework in which monetary and real economic forces are intrinsically interlinked. The full shift from a money, real dichotomy in historical economic thought to the notion of money being an essential determinant of economic outcomes is traced to the work of Keynes, partly in the Treatise (1930), but more completely in the General Theory (1936). The treatment of monetary forces in economic growth models is examined. It is found that the money, investment relationship, with close money, real interaction, is appropriately pursued in the approach to monetary theory adopted by those who could broadly be characterised as Post Keynesian. The operation of monetary forces through the banking system is examined using this theoretical backdrop. A symbolic model is developed of the influence channels implied by the theoretical analysis, using the South African monetary system as the specific focus. The symbolic model is expressed in a form which enables empirical examination. South African data are compiled and used to determine the nature and statistical significance of hypothesised relationships. The implications of the theoretical analysis and empirical examination are drawn out both for monetary theory within the Post Keynesian mould, and for the conduct of monetary policy, in South Africa in particular. / Economics / D. Litt. et Phil. (Economics)

Cette thèse est composée de 3 essais. Le 1er essai traite de la problématique du risque de pertes extrêmes dans le secteur bancaire dans un contexte du problème d'agence entre les actionnaires et les top managers des banques. Pour pouvoir inciter les banques à ne pas prendre le risque de pertes extrêmes, il est proposé d'appliquer la régulation des fonds propres sous forme d'une politique de recapitalisations obligatoires, dont les paramètres sont choisis pour inciter les actionnaires à rémunérer leurs managers de la manière à les détourner des stratégies au risque de pertes extrêmes.Le 2ème essai développe le design de la supervision bancaire qui vise à éliminer le problème d'aléa moral au sein d'une banque, tout en assurant un coût minimum de supervisions. Les banques, dont la situation financière commence à se dégrader, doivent être soumises à des audits aléatoires. Les banques, dont la valeur de l'actif s'est dégradée considérablement, doivent être mises sous tutelle pour un redressement financier. Les auditeurs externes peuvent être impliqués dans le processus de supervision, mais ne doivent pas complètement remplacer les régulateurs. Le 3ème essai étudie comment la capacité d'emprunt de l'entreprise non-financière affecte sa politique d'investissement en présence des coûts d'émission de la dette. Il est montré que les entreprises, dont la capacité d'emprunt est moyenne, ont intérêt à réaliser un investissement plus important par rapport aux entreprises dont la capacité d'emprunt est relativement faible/forte. Cela est entièrement dû à l'effet des coûts fixes d'émission de la dette, qui émerge dans le contexte dynamique d'investissement. / This dissertation consists of 3 self-contained theoretical essays.Essay 1 brings into focus the problem of "manufacturing" tail risk in the banking sector. This work shows that, in order to prevent banks from engaging in tail risk, bank capital regulation should account for the internal agency problem between bank shareholders and bank top managers. It is proposed to design bank capital requirements in the form of incentive-based recapitalization mechanism which would induce bank shareholders to shape executive compensation in such a way as to prevent top managers from engaging in tail-risk.Essay 2 deals with the problem of moral hazard in bank asset management. It proposes the concept of incentive-based bank supervision aimed at preventing moral hazard at a minimum cost to the regulator. It is shown that the intensity of supervision efforts should be gradually adjusted to the bank's financial health: banks in the mild form of distress should be subject to random audits, whereas deeply distressed banks should be placed under temporary regulatory control. To prevent double moral hazard, external auditors involved in supervision should be offered the optimal incentive contract.Essay 3 examines the impact of credit rationing (debt capacity) on corporate investment in the setting with costly debt financing. It is shown that, when credit constraints are binding, the firms with intermediate levels of debt capacity will establish larger investment projects than the firms with relatively low or high debt capacity. This non-monotonicity of investment on debt capacity arises due to the effect of the lump-sum debt issuance costs in the dynamic context of investment.

[pt] Elaborado dentro de um programa muito bem definido, o projeto na Arquitetura Moderna tem como uma de suas premissas não só edificar, mas também organizar móveis e objetos nos espaços, pretendendo ensinar como morar, ou seja, doutrinar os usuários sobre a forma correta de utilizar a máquina de morar. O Conjunto Residencial Marquês de São Vicente, prédio situado na Gávea, Zona Sul do Rio de Janeiro, foi pensado pelo arquiteto Affonso Eduardo Reidy dessa forma e construído com a certeza de que atenderia a esse programa, a certeza dos idealistas. Partindo de tal constatação, realizamos uma série de visitas aos apartamentos e entrevistas com os moradores deste prédio, com objetivo de proceder a uma análise morfológica das configurações espaciais feitas por eles a fim de construirmos o discurso do senso comum para, em seguida, relacioná-lo ao projeto original, o discurso da racionalidade. Ou seja, procuramos conhecer o outro lado da história, i. e., saber como os outros - nesse caso os moradores - construíram esse espaço no seu imaginário. / [en] Conceived within the scope of a very well defined intellectual movement, the project, in modern architecture, aimed not only to build, but also to organize furniture and objects in living spaces. They intended to teach how to live, to indoctrinate the users about the correct way of using the living machine. The Marquês de São Vicente condominium, located in Gávea borough, Rio de Janeiro, was developed in this way by the architect Affonso Eduardo Reidy and built with the conviction that it would accomplish that program, as the idealists conceived of it. Starting with this premise, we visited many apartments in the complex and interviewed the residents of one of the buildings so as to develop a morphologic analysis of the existing configuration thet had been done by them, tho know the common sense discourse, so that it could be related with the original project and, afterwards, with the discourse of reason. In other words, we tried to know the other side of history, i.e., to learn how the others - the residents - built that room in their own imaginary.

Made available in DSpace on 2016-04-26T20:48:48Z (GMT). No. of bitstreams: 1 Cristiano Serrao.pdf: 265704 bytes, checksum: ddff2ca9e6d556d812ab50127beca2f2 (MD5) Previous issue date: 2005-05-10 / This paper s objective is to study the Brazilian crisis of the year of 2002. We believe that, as this is a recent event, there is room to new perceptions and interpretations. This paper will propose a new view on this crisis, based on the Credit Rationing Theory. Initially, we will do a brief review of the Credit Rationing Theory. We will focus on the key aspects of that theory, specially the ones that will allow us to apply such theory in the case study that we are working on. After that, we will analyze the historical context that led Brazil to that crisis. Initially, this study will be focused on the increase of the size of the flows that transited through Brazilian Financial Account in the period that precedes the crisis. We will also take a look in the historical context itself, and analyze the external influence in this crisis. Afterwards, this paper will study the Mark-to-Market crisis, which was the starting point of the Brazilian crisis of 2002. This event was responsible to raise doubts about the sustaintability of Brazilian public debt. Additionally we will study the dynamics of Brazilian public debt in the crisis period, which, in our opinion, had a highly relevant role in such event. / Essa dissertação pretende lançar um olhar mais detalhado à crise brasileira de 2002. Acredito que esse evento, por ser ainda recente, ainda não foi compreendido em toda a sua magnitude, e esse trabalho tem o objetivo de lançar uma interpretação plausível para o mesmo. Para isso, utilizaremos o instrumental teórico da Teoria do Racionamento de Crédito. Inicialmente, iremos fazer uma revisão da Teoria do Racionamento de Crédito, nos atendo aos pontos que serão úteis na aplicação dessa teoria ao caso prático. Em seguida, iremos expor os principais condicionantes da crise brasileira de 2002, nos atendo inicialmente ao movimento de flexibilização da conta Financeira brasileira nos anos que antecedem a crise. É dada especial ênfase à Conta de Investimento em Carteira. É também analisado o contexto histórico no qual a crise está inserida. O passo seguinte foi investigar em que medida essa crise foi originada também por motivos externos, ao comparar a piora dos indicadores de risco-país não só do Brasil, mas dos demais países emergentes também. A dissertação, por fim, irá se deter no período de crise em si. Iremos analisar a Crise da Marcação a Mercado , que foi o ponto inicial da crise brasileira de 2002, estudando suas origens e impactos na credibilidade da dívida pública brasileira. Segue-se a análise da dinâmica da dívida pública brasileira no período de crise, o que na nossa opinião possui um poder explicativo muito forte com relação ao evento em questão.

Introdução: Triagem para admissão em unidades de terapia intensiva (UTIs) é realizada rotineiramente e é comumente baseada somente no julgamento clínico, o que pode mascarar vieses e preconceitos. Neste estudo, foram avaliadas a reprodutibilidade e validade de um algoritmo de apoio a decisões de triagem em UTI. Também foi avaliado o efeito da implementação de um instrumento de auxílio à tomada de decisão para a priorização de vagas de UTI nas decisões de admissão em UTI. Foi avaliada, ainda, a acurácia da predição prognóstica dos médicos na população de pacientes em deterioração clínica aguda. Métodos: Para o primeiro objetivo do estudo, um algoritmo computadorizado para auxiliar as decisões de priorização de vagas em UTI foi desenvolvido para classificar pacientes nas categorias do sistema de priorização da \"Society of Critical Care Medicine (SCCM)\". Nove médicos experientes (experts) avaliaram quarenta vinhetas clínicas baseadas em pacientes reais. A referência foi definida como as prioridades classificadas por dois investigadores com acesso ao prontuário completo dos pacientes. As concordâncias entre as prioridades do algoritmo com as prioridades da referência e com as prioridades dos experts foram avaliadas. As correlações entre a prioridade do algoritmo e o julgamento clínico de adequação da admissão na UTI em contexto com e sem escassez de vagas também foram avaliadas. A validade foi ainda avaliada através da aplicação do algoritmo, retrospectivamente em uma coorte de 603 pacientes com solicitação de vagas de UTI, para correlação com desfechos clínicos. Para o segundo objetivo do estudo, um estudo prospectivo, quaseexperimental foi conduzido, antes (maio/2014 a novembro/2014, fase 1) e após (novembro/2014 a maio/2015, fase 2) a implementação de um instrumento de auxílio à tomada de decisão, que foi baseado no algoritmo descrito acima. Foi avaliado o impacto da implementação do instrumento de auxílio à tomada de decisão na ocorrência de admissões potencialmente inapropriadas na UTI em uma coorte de pacientes com solicitações urgentes de vaga de UTI. O desfecho primário foi a proporção de solicitações de vaga potencialmente inapropriadas que foram admitidas na UTI em até 48 horas após a solicitação. Solicitações de vaga potencialmente inapropriadas foram definidas como pacientes prioridade 4B, conforme diretrizes da SCCM de 1999, ou prioridade 5, conforme diretrizes da SCCM de 2016. Foram realizadas análises multivariadas com teste de interação entre fase e prioridades para avaliação dos efeitos diferenciados em cada estrato de prioridade. Para o terceiro objetivo do estudo, a predição prognóstica realizada pelo médico solicitante foi registrada no momento da solicitação de vaga de UTI. Resultados: No primeiro objetivo do estudo, a concordância entre as prioridades do algoritmo e as prioridades da referência foi substancial, com uma mediana de kappa de 0,72 (IQR 0,52-0,77). As prioridades do algoritmo evidenciaram uma maior reprodutibilidade entre os pares [kappa = 0,61 (IC95% 0,57-0,65) e mediana de percentagem de concordância = 0,64 (IQR 0,59-0,70)], quando comparada à reprodutibilidade entre os pares das prioridades dos experts [kappa = 0,51 (IC95% 0,47-0,55) e mediana de percentagem de concordância = 0,49 (IQR 0,44-0,56)], p=0,001. As prioridades do algoritmo também foram associadas ao julgamento clínico de adequação da admissão na UTI (vinhetas com prioridades 1, 2, 3 e 4 seriam admitidas no último leito de UTI em 83,7%, 61,2%, 45,2% e 16,8% dos cenários, respectivamente, p < 0,001) e com desfechos clínicos reais na coorte retrospectiva, como admissão na UTI, consultas com equipe de cuidados paliativos e mortalidade hospitalar. No segundo objetivo do estudo, 2374 solicitações urgentes de vaga de UTI foram avaliadas, das quais 1184 (53,8%) pacientes foram admitidos na UTI. A implementação do instrumento de auxílio à tomada de decisão foi associada com uma redução de admissões potencialmente inapropriadas na UTI, tanto utilizando a classificação de 1999 [adjOR (IC95%) = 0,36 (0,13-0,97), p = 0,043], quanto utilizando a classificação de 2016 [adjOR (IC95%) = 0,35 (0,13-0,96, p = 0,041)]. Não houve diferença em mortalidade entre as fases 1 e 2 do estudo. No terceiro objetivo do estudo, a predição prognóstica do médico solicitante foi associada com mortalidade. Ocorreram 593 (34,4%), 215 (66,4%) e 51 (94,4%) óbitos nos grupos com prognóstico de sobrevivência sem sequelas graves, sobrevivência com sequelas graves e nãosobrevivência, respectivamente (p < 0,001). Sensibilidade foi 31%, especificidade foi 91% e a área sob a curva ROC foi de 0,61 para predição de mortalidade hospitalar. Após análise multivariada, a gravidade da doença aguda, funcionalidade prévia e admissão na UTI foram associadas com uma maior chance de erro prognóstico, enquanto que uma predição de pior prognóstico foi associada a uma menor chance de erro prognóstico. O grau de expertise do médico solicitante não teve efeito na predição prognóstica. Discussão/Conclusão: Neste estudo, um algoritmo de apoio a decisões de triagem em UTI demonstrou boa reprodutibilidade e validade. Além disso, a implementação de um instrumento de auxílio à tomada de decisões para priorização de vagas de UTI foi associada a uma redução de admissões potencialmente inapropriadas na UTI. Também foi encontrado que a predição prognóstica dos médicos solicitantes foi associada a mortalidade hospitalar, porém a acurácia foi pobre, principalmente devido a uma baixa sensibilidade para detectar risco de morte / Introduction: Intensive care unit (ICU) admission triage is performed routinely and is often based solely on clinical judgment, which could mask biases. In this study, we sought to evaluate the reliability and validity of an algorithm to aid ICU triage decisions. We also aimed to evaluate the effect of implementing a decision-aid tool for ICU triage on ICU admission decisions. We also evaluated the accuracy of physician\'s prediction of hospital mortality in in acutely deteriorating patients. Methods: For the first objective of the study, a computerized algorithm to aid ICU triage decisions was developed to classify patients into the Society of Critical Care Medicine\'s prioritization system. Nine senior physicians evaluated forty clinical vignettes based on real patients. Reference standard was defined as the priorities ascribed by two investigators with full access to patient\'s records. Agreement of algorithm-based priorities with the reference standard and with intuitive priorities provided by the physicians were evaluated. Correlations between algorithm prioritization and physician\'s judgment of appropriateness of ICU admission in scarcity and non-scarcity settings were also evaluated. Validity was further assessed by retrospectively applying this algorithm to 603 patients with requests for ICU admission for association with clinical outcomes. For the second objective of the study, a prospective, quasi-experimental study was conducted, before (May 2014 to November 2014, phase 1) and after (November 2014 to May 2015, phase 2) the implementation of a decision-aid tool for ICU admission triage, which was based on the aforementioned algorithm. We assessed the impact of the implementation of the decision-aid tool in potentially inappropriate ICU admissions in a cohort of patients referred for urgent ICU admission. Primary outcome was the proportion of potentially inappropriate ICU referrals that were admitted to the ICU in 48 hours following referral. Potentially inappropriate ICU referrals were defined as priority 4B patients, as described by the 1999 Society of Critical Care Medicine (SCCM) guidelines and as priority 5 patients, as described by the 2016 SCCM guidelines. We conducted multivariate analyses and evaluated the interaction between phase and triage priorities to assess for differential effects in each priority strata. For the third objective of the study, physicians\' prognosis and other variables were recorded at the moment of ICU referral. Results: On the first objective of the study, agreement between algorithm-based priorities and the reference standard was substantial, with a median kappa of 0.72 (IQR 0.52-0.77). Algorithm-based priorities demonstrated higher interrater reliability [overall kappa of 0.61 (95%CI 0.57-0.65) and median percent agreement of 0.64 (IQR 0.59-0.70)] than physician\'s intuitive prioritization [overall kappa of 0.51 (95%CI 0.47-0.55) and median percent agreement of 0.49 (IQR 0.44-0.56)], p=0.001. Algorithm-based priorities were also associated with physicians\' judgment of appropriateness of ICU admission (priorities 1, 2, 3 and 4 vignettes would be admitted to the last ICU bed in 83.7%, 61.2%, 45.2% and 16.8% of the scenarios, respectively, p < 0.001) and with actual ICU admission, palliative care consultation and hospital mortality in the retrospective cohort. On the second objective of the study, of 2374 urgent ICU referrals, 1184 (53.8%) patients were admitted to the ICU. Implementation of the decision-aid tool was associated with a reduction of potentially inappropriate ICU admissions using the 1999 [adjOR (95% CI) = 0.36 (0.13-0.97), p = 0.043] or 2016 [adjOR (95%CI) = 0.35 (0.13-0.96, p = 0.041)] definitions. There was no difference on mortality between phases 1 and 2. On the third objective of the study, physician\'s prognosis was associated to hospital mortality. There were 593 (34.4%), 215 (66.4%) and 51 (94.4%) deaths in the groups ascribed a prognosis of survival without disabilities, survival with severe disabilities or no survival, respectively (p < 0.001). Sensitivity was 31%, specificity was 91% and the area under the ROC curve was 0.61 for prediction of mortality. After multivariable analysis, severity of illness, performance status and ICU admission were associated to an increased likelihood of incorrect classification, while worse predicted prognosis was associated to a lower chance of incorrect classification. Physician\'s level of expertise had no effect on predictive ability. Discussion/Conclusion: In this study, a ICU admission triage algorithm demonstrated good reliability and validity. Moreover, the implementation of a decision-aid tool for ICU triage was associated with a reduction of potentially inappropriate ICU admissions. It was also found that physician\'s prediction was associated to hospital mortality, but overall accuracy was poor, mainly due to low sensitivity to detect mortality risk

Made available in DSpace on 2016-04-25T18:40:39Z (GMT). No. of bitstreams: 1 Gilberto de Souza Oliveira.pdf: 829463 bytes, checksum: cedc06d34a48cf6b7aa1b457064ce388 (MD5) Previous issue date: 2009-05-11 / This thesis begins with a systematic analysis of the electrical sector in Brazil and the main risks inherent to such sector. Then, it discusses certain information of the five largest publicly-held electric power distribution companies, based in the State of São Paulo, namely: Bandeirante Energia S.A.; Companhia Paulista de Força e Luz.; Companhia Piratininga de Força e Luz.; Elektro Eletricidade e Serviços S.A.; Eletropaulo Metropolitana Eletricidade de São Paulo S.A. It presents all the mandatory disclosure of financial statements under the Brazilian corporate law, as well as those required by the Granting Authority ANEEL, subsequently it presents a collection of indicators for analysis of financial statements, as well as the calculation methodology and interpretation and, finally, it presents a selection of indicators used in the study of five companies. The study is aimed to evaluate the economic and financial performance of these companies during the period from 2000 to 2007, focusing on two distinct stages: (i) the rationing of electricity period that lasted from June 2001 to February 2002, which had a huge impact on the financial statements for such periods, and (ii) the post rationing period, which was impacted by new standards established by the Federal Government in connection with the creation of a new model for the Brazilian energy sector, during the years 2004 and 2005. This thesis uses the evolutionary analysis, which evaluates the development of indicators for each of the five companies, checking the performance of their economic situation, financial performance, profitability and allocation of cash generated and consumed between two thousand and two thousand and seven / Esta dissertação inicia com a descrição da sistemática de funcionamento do setor elétrico no Brasil e os principais riscos inerentes ao setor. A seguir, discorre sobre as informações principais das cinco empresas distribuidoras de energia elétrica, de capital aberto, sediadas no Estado de São Paulo, que são: Bandeirante Energia S.A.; Companhia Paulista de Força e Luz; Companhia Piratininga de Força e Luz.; Elektro Eletricidade e Serviços S.A.; Eletropaulo Metropolitana Eletricidade de São Paulo S.A. Apresenta todas as demonstrações contábeis de divulgação obrigatória por força da legislação societária Brasileira e aquelas de exigência do poder concedente a ANEEL, na seqüência expõe uma coletânea de indicadores para análise das demonstrações contábeis, assim como a sistemática de cálculos e interpretação e apresenta a seleção destes indicadores utilizados no estudo das cinco empresas. O estudo objetiva avaliar o desempenho econômico e financeiro dessas empresas no período de 2000 a 2007, com ênfase em duas fases distintas: a) O racionamento de energia elétrica que vigorou de junho de 2001 a fevereiro de 2002, e impactou fortemente os balanços destes dois exercícios, e b) A fase pós racionamento que foi influenciada pelas normas editadas pelo Governo Federal para a criação de um novo modelo para o Setor Elétrico Brasileiro durante os anos de 2004 e 2005. O método utilizado foi a análise evolutiva, em que se avalia a evolução dos indicadores de cada uma das cinco empresas, verificando o desempenho de sua situação econômica, financeira, rentabilidade e a destinação do caixa gerado e consumido no período de 2000 a 2007

Nous analysons un type W de système de l’Assemble-à-commande avec des délais de livraison aléatoires, l'arrivée aléatoire de la demande et des ventes perdues, en temps continu. Nous formulons le problème en tant que processus de décision Markov à l'horizon infini. Nous nous éloignons de l'approche standard en caractérisant une région de l'espace d'état où toutes les propriétés de la fonction de coût tiennent. Nous caractérisons la politique optimale dans cette région. En particulier, nous montrons que, dans l'intérieur de la région récurrente, les composants sont toujours produits. Nous caractérisons également la politique d'allocation de composants optimale qui spécifie si une demande de produit arrivant devrait être remplie. Notre analyse révèle que la politique d'allocation optimale est contre-intuitive. Par exemple, même lorsqu'un produit domine l'autre, en termes de coût/taux de vente perdue, sa demande peut ne pas avoir une priorité absolue par rapport à la demande de l'autre produit. Une telle caractéristique n'a pas été observée dans de nombreux paramètres intégrés de production/inventaire où l'allocation d'inventaire suit une priorité fixe pour satisfaire les exigences. Nous montrons également que la structure de la politique optimale reste la même pour les systèmes à production par lots, les temps de production répartis par Erlang et la demande de produits non unitaire. Enfin, nous proposons des heuristiques efficaces qui peuvent être utilisées comme substitut à la politique optimale ou peuvent être utilisées comme une politique de départ pour les algorithmes communs utilisés pour obtenir une politique optimale dans le but de réduire leur temps de calcul. / We analyze a W-configuration assemble-to-order system with random lead times, random arrival of demand, and lost sales, in continuous time. We formulate the problem as an infinite-horizon Markov decision process. We deviate from the standard approach by first characterizing a region (the recurrent region) of the state space where all properties of the cost function hold. We then characterize the optimal policy within this region. In particular, we show that within the interior of the recurrent region components are always produced. We also characterize the optimal component allocation policy which specifies whether an arriving product demand should be fulfilled. Our analysis reveals that the optimal allocation policy is counter-intuitive. For instance, even when one product dominates the other, in terms of lost sale cost and lost sale cost rate (i.e., demand rate times the lost sale cost), its demand may not have absolute priority over the other product’s demand. Such a feature has not been observed in many integrated production/inventory settings where inventory allocation follows a fixed priority in satisfying demands. We also show that the structure of the optimal policy remains the same for systems with batch production, Erlang distributed production times, and non-unitary product demand. Finally, we propose efficient heuristics that can be either used as a substitute for the optimal policy or can be used as a starting policy for the common algorithms that are used to obtain the optimal policy in an effort to reduce their computational time

This dissertation studies Oregon primary care physicians' attitudes toward health care reform. Two models of reform are examined: one, health care rationing such as that proposed by the Oregon Health Plan (OHP); and, two, support for national health insurance (NHI). This work examines the necessity for changing the present health care system, traced from the early origins of the medical profession to the present day health care "crisis." The high cost of health care is examined and an overview of the OHP is provided, including citations from John Kitzhaber, M.D., author of the plan. Overall, Oregon primary care physicians overwhelmingly supported health care rationing policies. Just under 75 percent of the physicians expressed support for health care rationing policies such as that proposed by the Oregon Health Plan. However, just under 48 percent of the same physicians expressed support for national health insurance (NHI). Internal medicine physicians were most supportive of health care rationing policies and OB/GYN physicians were least supportive. Conversely, pediatricians were most supportive of NHI and OB/GYN physicians were least supportive. Regression analyses explained 11.5 percent of variation in support for health care rationing policies and 20.9 percent of their support for national health insurance (NHI). While strong support measures were found for health reform such as that proposed by the Oregon Health Plan (OHP), no similar measures of support for NHI emerged. Almost universal support for health care reform such as the OHP was found among primary care physicians across the state, however similar patterns were not found for NHI. It appears from the research's findings that attempts to change the health care system that include the physician's ability to ration care would be more successful than a more systematic change such as would occur under a national health insurance program. This dissertation points out that physicians represent strong supporting forces and/or opposing forces for health care reform. Their attitudes toward such reform must be considered if successful change is to occur in the U.S. health care system.