The impact of health maintenance organizations and competition on hospitals in Minneapolis/St. Paul

The Healthcare Educational and Research Foundation (HERF) in Minneapolis undertook a two-year research project to study the effects of health maintenance organizations (HMOs) and competition on the hospital industry in Minneapolis/St. Paul. This article summarizes HERF's major findings surrounding three key questions: (1) do the HMOs in Minneapolis/St. Paul use fewer hospital resources relative to conventional payers?; (2) do recent overall community trends in inpatient use suggest evidence of hospital utilization-reducing effects attributable to HMOs?; and (3) given the highly visible competitive process among Minneapolis/St. Paul providers, do hospital cost and revenue data suggest any evidence of cost-containment? The findings (based on data through 1982) indicate that for comparable patients, Twin Cities HMOs appear to use fewer medical care resources per hospitalized patient. There was, however, no clear evidence of community-wide, utilization-reducing effects directly attributable to the "competitive effect" of HMO introduction and development in the market. In addition, there was no empirical evidence that HMOs (which had enrolled 25 percent of the consumer market by 1982), or other large buyers of inpatient services, have selected hospitals on the basis of price as hypothesized by competition advocates.     

Inner-city birth rates following enactment of the Minnesota parental notification law

An increase in birth rates to Minneapolis minors following the enactment of a parental notification law was examined. A well-publicized link between increasing birth rates and the law is shown to have been premature. Birth, abortion, and population data by age, race, and region suggest that the increasing birth rate in Minneapolis was not related to parental notification, but rather to a growing racial minority population.Preparation of this article was supported in part by an Aldeen Grant from Wheaton College. The authors wish to thank the Minnesota Center for Health Statistics, particularly James Wigginton and Carol Vargas, for their considerable work to provide birth, abortion, and population data in a form suitable for the current analysis. The authors also thank Americans United for Life for purchasing the data and providing them to the authors.     

Reviews

Orlando Figes, A People's Tragedy: The Russian Revolution 1891–1924. London: Jonathan Cape, 1996, xx + 923 pp., £25.00

Hafeez Malik (ed.), The Roles of the United States, Russia and China in the New World Order. Basingstoke: Macmillan, 1997, xvi + 333 pp., £47.50.

Leszek Buszynski, Russian Foreign Policy after the Cold War. Westport and London: Praeger, 1996, xiv + 243 pp., £46.95.

Mette Skak, From Empire to Anarchy: Postcommunist Foreign Policy and International Relations. London: C. Hurst & Company, 1996, x + 340 pp., £35.00 h/b, £14.95 p/b.

Hans von Zon, The Future of Industry in Central and Eastern Europe. Aldershot: Avebury, 1996, x + 164 pp., £35.00.

Bartlomiej Kaminski (ed.), Economic Transition in Russia and the New States of Eurasia. Armonk, New York: M.E. Sharpe, 1996, xviii + 430 pp.

Ben Fowkes, The Disintegration of the Soviet Union: A Study in the Rise and Triumph of Nationalism. Basingstoke: Macmillan, 1997, xii + 273 pp., £40.00

Juan J. Linz & Alfred Stepan, Problems of Democratic Transition and Consolidation. Southern Europe, South America, and Post‐Communist Europe. London: The Johns Hopkins University Press, 1996, xx + 479 pp., £15.50.

David Lane, The Rise and Fall of State Socialism. Cambridge: Polity Press, 1996, 233 pp., £12.95.

Reneo Lukic & Allen Lynch, Europe from the Balkans to the Urals: The Disintegration of Yugoslavia and the Soviet Union. Oxford: Oxford University Press, 1996, xvii + 436 pp.

Thomas Cushman & Stjepan G. Mestrovic (eds), This Time We Knew: Western Responses to Genocide in Bosnia. New York: New York University Press, 1996, ix + 412 pp., $50.00 h/b, $18.95 p/b.

Derek Hall & Darrick Danta (eds), Reconstructing the Balkans. A Geography of the New Southeast Europe. Chichester: John Wiley & Sons, 1996, xx + 260 pp., £45.00.

Ajay Patnaik. Central Asia. Between Modernity and Tradition. New Delhi: Konark Publishers, 1996, viii + 238 pp.

Rudolf L. Tokes, Hungary's Negotiated Revolution: Economic Reform, Social Change and Political Succession, 1957–1990. Cambridge: Cambridge University Press, 1996, xxiii + 544 pp., £19.95.

John D. H. Downing, Internationalizing Media Theory, Transition, Power, Culture, Reflections on Media in Russia, Poland and Hungary 1980–95. London: Sage, 1996, xviii + 269 pp., £45.00 h/b, £13.95 p/b.

Rogers Brubaker, Nationalism Reframed: Nationhood and the National Question in the New Europe. Cambridge: Cambridge University Press, 1996, xi + 202 pp., £35.00 h/b, £12.95 p/b.

Donald P. Steury (ed.), Intentions and Capabilities: Estimates on Soviet Strategic Forces, 1950–1983. Washington DC: Center for the Study of Intelligence, 1996, xxii + 504 pp.

R. W. Davies, Crisis and Progress in the Soviet Economy, 1931–1933. Basingstoke: Macmillan, 1996, xviii + 612 pp., £65.00.

William Chase, Jeffrey Burds, S. V. Praslova, A. K. Sokolov & E. A. Tiurina (eds), Russian Stale Archive of the Economy: A Research Guide: I. Guide to Collections. Moscow: Blagovest, 1994, xx + 679 pp.

V. P. Butt, A. B. Murphy, N. A. Myshov & G. R. Swain (eds), The Russian Civil War. Documents from the Soviet Archives. London: Macmillan, 1996, xvii + 217 pp., £15.99.

Ilya Somin, Stillborn Crusade: The Tragic Failure of Western Intervention in the Russian Civil War, 1918–1920. New Brunswick, NJ: Transaction Publishers, 1996, ix + 236 pp., £21.95, $32.99.

David R. Shearer, Industry, State, and Society in Stalin's Russia, 1926–1934. Ithaca: Cornell University Press, 1996, xiv + 263 pp., £33.50 h/b, £14.95 p/b.

Peter H. Solomon Jr., Soviet Criminal Justice under Stalin. Cambridge: Cambridge University Press, 1997, xvii + 494 pp., £55.00 h/b, £19.95 p/b.

Richard G. Hovannisian, The Republic of Armenia, Volume III, From London to Sèvres, February‐August 1920, xx + 534 pp., and Volume IV, Between Crescent and Sickle: Partition and Sovietization, xii + 496 pp. Berkeley, University of California Press, 1996. £35.00 each volume.

Ian D. Thatcher & James D. White (eds), Journal of Trotsky Studies. Glasgow: Institute of Russian & East European Studies, 1993–1996, Nos. 1–4, £10.00 (Institutions), £5.00 (Individuals).

Mikhail Baitalsky, Notebooks for the Grandchildren. Recollections of a Trotskyist Who Survived the Stalin Terror, Edited and translated by Marilyn Vogt‐Downey. Atlantic Highlands, New Jersey, 1996, xviii + 447 pp.

Leopoldina Plut‐Pregelj & Carole Rogel, Historical Dictionary of Slovenia. London: The Scarecrow Press, Inc, 1996, xxvii + 345 pp., £63.65.     

Book reviews

Roland Axtmann, Liberal democracy into the twenty‐first century: Globalization, integration and the nation‐state (Manchester University Press, Manchester, 1996), 198 pp., ISBN 0–7190–4304–2 (hb), 0–7190–4305–0 (pb)

Paul Kapteyn, The Stateless Market: The European Dilemma of Civilization (Routledge, London and New York, 1996), 194 pp., ISBN 0–415–12232–5 (hb), 0–415–12233–3 (pb)

Richard Werbner and Terence Ranger (eds), Postcolonial Identities in Africa (Zed Books, London & New Jersey, 1996), 292 pp., ISBN 1–85649–415–2 (hb), 1–85649–416–0 (pb)

Mark Wheeler, Politics and the Mass Media (Blackwell, Oxford, 1997), 274 pp., ISBN 0–631–19783–4 (hb), 0–631–19784–2 (pb)

Nigel Harris, The New Untouchables: Immigration and the New World Worker (Penguin Books, London, 1995), 254 pp., ISBN 0–14–014689‐X (pb)

Gilles Kepel, Allah in the West (Polity Press, Cambridge, 1997), 273 pp., ISBN 0–7456–1557–0 (hb), 0–7456–1558–9 (pb)

Leonard Weinberg, The Transformation of Italian Communism (Transaction Publishers, New Brunswick, New Jersey, 1995), 147 pp., ISBN 1–56000–180–1 (hb)

Brian Jenkins and Spyros A. Sofos (eds), Nation and Identity in Contemporary Europe (Routledge, London, 1996), x + 294pp., ISBN 0–415–12312–7 (hb), 0–415–12313–5 (pb)

Stuart Parkes, Understanding Contemporary Germany (Routledge, London, 1997), 247 pp., ISBN 0–415–14123–0 (hb), 0–415–14124–9 (pb)     

Candidate Character vs. The Economy in the 1992 Election

The outcome of the 1992 U.S. presidential election has been explained largely as a function of perceptions of George Bush's economic performance. The economy submerged questions about Bill Clinton's character, awarding the advantage to the Democrat. In this article, we evaluate the effect of economic evaluations along with character attacks on candidate support in the 1992 presidential contest. Claims that the economy submerged character have been somewhat exaggerated. But while character remains an important issue in presidential evaluation, its role in judging candidates cannot be taken at face value. We show that both economic evaluations and character judgments are highly politicized. The findings indicate that those protesting Clinton's character turned almost exclusively to Bush. Those protesting Bush's economic record turned to both Perot and Clinton. Still, the economy did not trump character. The troubles of both major party candidates fueled a strong protest vote that contributed to Perot's strong showing.