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.     

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)     

Mandates, Powers, and Policies

Elections provide a mandate to pursue a set of policies. Party label provides a concise ideological cue for voters to choose among candidates, and research on industrial democracies verifies a link between the parties voters elect and subsequent policy outcomes. The combination of inchoate party systems and economic vulnerability elsewhere may weaken the link between voter choice and policy. When examining economic policies in Latin America, there is some controversy as to whether governments carried out "reform by surprise"—promising one thing during a campaign while implementing another in office. We test whether the ideological reputations of executives' and legislators' parties explain whether they adopt market-oriented policies. We find that the future behavior of presidential candidates is difficult for voters to predict. However, the ideological reputation of legislators is a reliable predictor of policy outcomes, and the relationship is clarified by the prospects of collective action by legislative delegations.     

Citizenship in a time of empire: the World Social Forum as a new public space

Under conditions of neoliberal globalization, structural adjustment and the war on terror, the progressive expansion of modern citizenship, both in its substance and geographic reach, is increasingly in question. Yet, popular demands for democratization, rights and participation are exploding worldwide. This article argues for shifts in focus in the study of citizenship from states, institutions and the national scale to cultural practices in civil society at multiple scales in order to discern and theorize emergent citizenship practices under conditions of ‘empire’. The article examines the World Social Forum as a new kind of public space, ‘placed’ but transnational, and giving rise to a transnational subaltern counterpublic. Through its practices, this counterpublic is forging a new paradigm of citizenship.     

Taking the Keys from Grandpa

Recent highly publicized traffic accidents involving older drivers have led to renewed interest in state policies and administrative practices that award and renew drivers’ licenses in the American states. Because the probability of traffic accidents is linked to the medical conditions that are more prevalent among the elderly, and because the number of older drivers is expected to rise over the next several decades, one might expect that this will be an increasingly important policy issue. This article discusses variations that are observed across states in law and administrative practice. A longitudinal analysis of data on crashes involving elderly drivers in fifteen states indicates that crash rates are directly related to the length of the renewal cycle for older drivers and inversely related to the stringency of testing at renewal. It is also likely that states requiring physicians to report conditions that would impair driving will experience lower crash rates. A secondary analysis of policy impacts on the licensing rates is not conclusive, a finding that is attributable to inaccuracies in the reported numbers of licensed drivers.