The new structure of individual practice associations

There are two types of HMOs: prepaid group practices (PGPs) and individual practice associations (IPAs). Because of rapid change in the HMO industry, the academic literature, which is based primarily on data from the 1970s, is dated in several ways. The literature has focused on PGPs, but IPAs are growing three times faster than PGPs and are likely to dominate the HMO industry in the near future. The literature indicates that a small proportion of an IPA physician's practice is capitated, but such practices often are as much as one-third capitated. And while the literature indicates that IPA physicians are rarely given financial incentives to control cost, such incentives are now common. In this decade IPAs have cut their hospital days per thousand enrollees. Furthermore, IPAs in which individual physicians or medical groups bear some of the financial risk of hospital costs appear to have the same rate of hospital days as PGPs. Additional research is especially needed on cost and quality of care in modern IPAs.     

All Het up! Rescuing Heterosexuality on the <Emphasis Type="Italic">Oprah Winfrey Show</Emphasis>

The Oprah Winfrey Show provides an interesting set of contradictions. On the one hand, it appears to challenge common-sense assumptions about relationships, specifically heterosexual relationships (for example, by consistently raising issues of sexual violence within a heterosexual context). Yet, at the same time, Oprah's presentation often works to reinforce precisely the norms she seeks to challenge. Through a close analysis of a selection of programme clips from one particular programme among many about relationships, sexuality and families, this article will consider the ways in which the Oprah Winfrey Show both problematizes and yet normalizes the boundaries of heterosexuality. Here we shall discuss both the resolute exposure and exploration of what could be termed the casualities of normative (and compulsory) heterosexuality and, paradoxically, its recuperation as a ‘rational’ ideal. In exploring the ways in which this recuperation takes place, we shall begin with a brief consideration of two of the key discourses which shape the show: the discourse of therapy and that of kinship. Our analysis of the sexual politics of the Oprah Winfrey Show in these terms will focus on the programme, ‘How to Make Love Last’ (18 January 1993). Like so many other programmes, ‘How to Make Love Last’ intends to highlight and deal with problems within heterosexual relationships as distressing but solvable (through the medium of therapeutic self-help). At another level, however, the programme also (unwittingly) reveals a different order of problems which, ironically, can only be reinforced by the mode of rescue proposed and staged.     

Taking action to contain health care costs---Part II

Last month, Mr. Larson explained some large corporations' methods of saving health care dollars within existing corporate roles. This month, he outlines what companies are capable of doing, once certain organizational barriers are removed.