Blue Cross/Blue Shield-sponsored prepaid individual practice

The HMO is no longer a fledgling idea in the Blue Cross/Blue Shield System. There are 45 Blue Cross/Blue Shield Plans throughout the country which sponsor a total of 54 HMO programs with about 1,040,000 members. Among those 54 programs are staff models, group models, Individual Practice Associations (IPAs), and other structures. This analysis is confined to the Minnesota affiliate corporation, "HMO Minnesota."     

New York's Blue Cross and Blue Shield, 1934-1990: the complicated politics of nonprofit regulation.

The story of New York Blue Cross is one of complex interaction with state and federal regulators and also with hospitals, the medical profession, commercial insurers, and the public, who make up the regulatory environment. Negotiation, cooperation, and adaptation among parties whose goals and assumptions were partly parallel characterize the relationships. As we can see from New York Blue Cross's origins and its role in the development and administration of certificate-of-need legislation, Medicare, insurance practice and regulation, and hospital rate setting, this story does not represent the capture of government by a special interest, nor the gradual souring of a public interest organization, nor disinterested and distant government regulation.     

Comment on Kartell v. Blue Shield of Massachusetts, Inc.: an antitrust analysis of Blue Shield's reimbursement schemes

In Kartell v. Blue Shield of Massachusetts, Inc., the First Circuit held that Blue Shield's reimbursement practice known as the "ban on balance billing" did not constitute an unlawful restraint of trade in violation of the antitrust laws. Underlying the First Circuit's decision was deference to what it viewed as efforts by Blue Shield and by the Commonwealth to promote cost containment. This Comment argues that, to the contrary, under an appropriate analysis of antitrust law, the practices employed by Blue Shield did constitute unreasonable restraints of trade on the physicians' service industry in Massachusetts, given Blue Shield's market dominance in the Commonwealth. The Comment also argues that such inhibition of the competitive functioning of this industry is unwise, and that costs should instead be contained by effectuating the antitrust laws and encouraging the development of competitive forces within this industry.     

Walking the Thin Blue Line

ABSTRACT

While the proportion of female officers in law enforcement is increasing, upper level administrative positions continue to be held overwhelmingly by male officers. This paper attempts to provide a fuller depiction of the barriers women may encounter within police departments resulting from the dynamics associated with the ‘tokenism’ phenomenon. It is concluded that tokenism-combined with factors such as family commitments and organizational structures-plays a large role in determining upward mobility, serving to reduce the frequency of the promotion of women to higher rank/supervisory positions in police departments.     

A cure for the Blues: resolving nonprofit Blue Cross conversions

This Article analyzes the issues involved in converting nonprofit Blue Cross organizations to for-profit status. These issues have arisen in the context of litigation regarding the "reorganization" of Blue Cross and Blue Shield of Missouri ("BCBSMo"). BCBSMo had reorganized by creating and transferring a majority of its business to a new for-profit subsidiary. Missouri consumer groups and state regulators characterized the "reorganization" as a conversion requiring BCBSMo to transfer its assets to a foundation dedicated to charitable health purposes. BCBSMo, however, denied that it had any obligation to leave behind its assets in the nonprofit sector. The BCBSMo litigation raises issues common to most conversions of nonprofit healthcare organizations, particularly conversions of nonprofit Blue Cross plans. This Article provides a road map for state regulators and the public to follow in ensuring that the public interest is fully protected in such conversions.     

Capture and culture: organizational identity in New York Blue Cross.

This article explores the changing corporate culture of New York's Blue Cross and Blue Shield plan in its first fifty years. As the plan grew, corporate culture evolved over four sequential phases: the plan first had the character of an experiment, then that of a movement, a business, and, most recently, a corporate agglomerate. Accompanying this evolution has been an identity crisis, as the need to adapt to a turbulent environment has challenged the plan's settled understanding of its core values, namely, voluntarism, community, and cooperation.     

Seeking common ground: a history of labor and Blue Cross.

In recent years, voluntary health insurance costs have become a major source of friction in labor-management negotiations. What was once a "fringe" has led to job actions, strikes, and intensive bargaining. We examine the history of labor's participation in New York Blue Cross from the 1930s to the recent past and show that labor's participation in the plan was crucial to Blue Cross's success in the plan's early decades. By the late 1950s, serious tensions developed over rate increases and the participation of labor in Blue Cross governance. Ultimately, the issue was one of the control over what was provided by the plans and who would pay for the costs of care. We posit that labor was never able to achieve an important role in the control of the third-party payer, and in the antilabor environment of the 1980s this proved detrimental to labor's interests.     

Feeling Blue: Officer Perceptions of Public Antipathy Predict Police Occupational Norms

American Journal of Criminal Justice - Recent protests against law enforcement have spurred claims by practitioners and editorialists that public antipathy toward the police may influence police...     

Black and Blue Bloods: Protecting Police Officer Families from Domestic Violence

Officer‐involved domestic violence (OIDV) is a national problem, with police officer families having higher rates of domestic violence than non–police officer families. OIDV is also an underresearched problem with few studies or proposed solutions. Many victims of OIDV do not report their abuse precisely because their abuser is a police officer, whom they fear is in a unique position to protect him/herself from any legal consequences. Often, OIDV complaints are not investigated properly in a nonbiased manner. While a handful of police agencies around the country have developed specific policies and procedures to deal with OIDV, Washington State has enacted legislation that requires its police agencies to adopt OIDV‐specific policies. The International Associations of Chiefs of Police (IACP), an organization that addresses various issues confronting law enforcement, has also developed a model policy on OIDV. This Note proposes that, in light of the Washington legislation and the model policy proposed by the IACP, each state should enact a statute that requires its police agencies to develop policies on OIDV. This Note also outlines a specific set of procedures that such statutes should, at a minimum, require its police agencies to adopt, ranging from educating police officers on domestic violence to developing guidelines on responding to and investigating OIDV complaints.     

Examining exclusionary conduct of HMOs and PPOs: a case comment on Northwest Medical Laboratories v. Blue Cross and Blue Shield of Oregon.

As the climate of the health care industry has changed to one of cost-containment and competition through the growth of HMOs and PPOs, health care providers have become the subjects of antitrust litigation. One such case, Northwest Medical Laboratories v. Blue Cross and Blue Shield of Oregon, involved a medical laboratory and a radiology center who claimed that they were victims of an illegal group boycott after defendant's pre-paid health plan denied them preferred provider status. The Oregon Court of Appeals, using the traditional antitrust analysis applied to other industries for decades, failed to consider the intricacies that exist within the health care industry. This result led to an inaccurate market share computation and an inadequate rule of reason analysis. This Comment examines the shortcomings of the Northwest Medical opinion and argues that, in applying the antitrust laws to the health care industry, courts in future cases must recognize and respect the unique features of the business of providing health care.     

Sharing governmental authority: Blue Cross and hospital planning in New York City.

Hospital planning in New York has been since the 1930s an intensely political process with high stakes. The leaders of Blue Cross and their allies used the hospital planning process in the city and the state as a means to extend and protect corporate authority in what they took to be the public interest. When Blue Cross was established in the 1930s, its leaders used the mechanisms of formal planning as part of their solution to pressing problems in the organization and distribution of hospital services. In the decade after World War II, Blue Cross had an immense impact on hospital planning in New York as a result of its growth and its underwriting policies. Conflicts between Blue Cross and state regulators beginning in the 1950s led to a new formulation of the politics of planning. Blue Cross became a partner with the state in regulating hospitals. The state and Blue Cross behaved as co-regulators until the 1980s. The interpretation in this paper revises the earlier accounts of health politics in New York by Law (1976) and Alford (1975).     

Sensitivity of the Luminol Test with Blue Denim

Abstract: An article appearing in this journal in 2000 suggested that the sensitivity of the luminol test performed on denim fabric is usually no greater than at a 1:100 dilution of blood. This study shows that the luminol test may be unambiguously interpreted at substantially greater dilutions of blood. In this study, four different types of denim were tested by spraying a swatch of fabric with a typical formulation of the luminol reagent. Testing was conducted of dilutions of blood up to 1:1000, all of which showed distinct chemiluminescence. Diluted blood was applied to denim material in the form of a random number. A successful test was obtained only when a “blind” observer, i.e., an observer who was uninformed of the number, correctly reported the number.