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.     

Legalization of consensual unions in Mexico

Data examined in this study are from the 1976 Mexican Fertility Survey. The authors review previous findings and compare information from this survey with data from the 1969 PECFAL Survey. They then examine the types of consensual union and factors such as women's age, educational status, occupation, premarital fertility, and rural or urban residence. The focus of the study is on the extent to which consensual unions eventually become legal marriages. The authors also investigate the increasing probability of termination of marriage through divorce or separation, especially in urban areas.     

Practitioner fraud and abuse in medical benefit programs: government regulation and professional white-collar crime

Physicians who defraud and abuse medical benefit programs provide a unique group of lawbreakers for scientific study. They could be considered to epitomize white collar criminals given their exceedingly high socioeconomic status and power as a professional group. Using official reports and documents, as well as interviews with enforcement and program personnel at both state and federal levels, this study examines the problem of physician fraud and abuse in Medicare and Medicaid. Major areas relevant to understanding this phenomenon and its control are presented and policy implications of present knowledge in the area are discussed.     

"False confessions" and identification with the aggressor: another forensic misuse of a psychiatric concept

Some psychiatrists misuse theoretical concepts beyond their generally accepted dimensions in an attempt to support a conclusion favorable to a litigant or defendant. In the case presented, the concept of identification with the aggressor was used in an attempt to eliminate or minimize the effect of a confession and to buttress the claim that the confession itself was false. Quotations from the actual reports and testimony are used to reflect both this tactic and the context in which these issues were pursued, including a rather startling admission by the psychiatrist dealing with the thoroughness of his professional effort. A brief history of "identification with the aggressor" is presented, a history which contrasts with its application to rather routine police questioning. Similarly, skepticism is clearly merited when a psychitrist testifies as to truthfulness or falsity of a statement.     

The gas chromatographic determination of carbophos in cadaveric material

The authors developed a method of malathion insecticide determination in the cadaveric material (blood and wall of the stomach) including extraction of 5 ml of blood (5 g of fragmented tissue of stomach wall) by hexan; preparative chromatographic purification of extract on silicagel layer L 5/40 mkm in hexan-diethyl ether system 10:2; Gas-liquid chromatographic investigation on column with 5% SE-30 and 5% XE-60 (Chromatograph "Colour-106" with thermionic detector). This method makes it possible to detect 72-76% of malathion added.