Cost-shifting: the discount dilemma

Cost-shifting, the practice by hospitals of raising their prices to make up for reimbursement shortfalls from payers that do not pay full charges, is an important and controversial issue. Concerns about cost-shifting, particularly its effects on payment equity and cost escalation, have led many insurers, business groups, and legislators to advocate rate-setting regulation for hospitals. This article seeks to clarify the definition of cost-shifting, and quantifies its magnitude in Minneapolis/St. Paul. We believe that cost-shifting is the consequential result of the failure of both public and private payers to structure payment policies that reward cost-effective hospitals, and we outline a market-oriented alternative to rate-setting to address the discount dilemma caused by cost-shifting.     

Biological monitoring: the employer's dilemma

The industrial workplace contains many potential health hazards that not only can cause great harm to workers, but also can destroy the employers' economic stability. Often these hazards are documented and dealth with, but frequently they are unknown. When health-conscious employers monitor the physical well-being of their employees in an effort to avoid the terrible personal and economic costs these hazards can produce, they may be supplying their employees with the documentation necessary to recover financially for their industrial illnesses. This Article analyzes this dilemma confronting employers. It describes the many factors employers must consider when deciding whether to institute a monitoring process that takes full advantage of technological developments in medical care. The Article suggests an approach employers may take until some of the disincentives surrounding the implementation of monitoring are removed.     

Liability of manufacturers and providers of health related goods and services: confronting the dilemma.

In this Article, Theodore Cooper, M.D., Assistant Secretary for Health at HEW, contends that the crush of lawsuits brought by aggrieved health care consumers against medical professionals and institutions, and drug and medical equipment manufacturers, may be the result, in large part, of a widely held impression--often encouraged by members of the health professions and industries themselves--that medicine has unlimited powers to heal. Dr. Cooper suggests that those involved in providing health care services and products--and members of the legal profession-have a responsibility to inform the public that this expectation is unrealistic and that everyone suffers when the number of such lawsuits and the size of damage awards are excessive.     

An administrative dilemma: Sexual harassment and liability

Conservative estimates suggest that 40% of working women and 15% of their male counterparts have experienced some form of sexual harassment; and law enforcement personnel are no exception. Police officers are expected to adhere to the highest ethical standards and are subjected to greater public scrutiny than civilians. With criminal and civil remedies readily available to deter police misconduct, police agencies should be establishing policies that take a strong, pro-active stance against sexual harassment in the workplace. Surprisingly, though, 34% of police agencies in this country are still without formal policies regulating such behavior. This article is a guide to the legislation and case law that regulates those behaviours. Recommendations for policy formulation and implementation also are included. sexual harassment in the workplace presents a clear and present danger to law enforcement agencies. A recent survey found that thirty-four percent of law enforcement agencies in the United States have yet to formulate a written sexual harassment policy.     

HealthConnect and the duty of care: a dilemma for medical practitioners

This article asks whether medical practitioners' duty of care to their patients will encompass participation in the HealthConnect shared electronic records initiative. Medico-legal aspects of the HeathConnect scheme relating to the nature of shared electronic health record summaries (SEHRS) are examined, focusing on their function as an element of patient care and their ultimate purpose. The analysis is based on the premise that an incomplete and hence inaccurate shared electronic health record summary is clinically and legally more perilous than no record at all.