Incomplete vertical integration in the health care industry: pseudomarkets and pseudopolicies

Most economic relationships are either arm's-length exchange transactions, each party seeking his or her own interest, or command structures, such as a firm or public agency, integrating joint efforts toward a common goal. The health care industry, however, displays a pattern of incomplete vertical integration--relationships which are neither truly arm's-length nor completely hierarchical. The doctor-patient relationship is archetypical. Physicians appear to sell services in private markets; yet they reach through the exchange process to direct the consumer-patient's utilization decisions, implicity undertaking to act in the patient's interest, and thus integrate forward. But they also integrate backward to control the public regulatory process--self-government--and some forms of insurance. The health care systems of different countries--Canada, the United Kingdom, and the United States--can be interpreted as different patterns of incomplete integration among five basic classes of transactors: consumer-patients, first-line providers, second-line providers, insurers, and governments. Each system of linkage has characteristic strengths and weaknesses. Nowhere, however, do we find a predominance of arm's-length market relationships. Where they exist, markets in health care are usually pseudomarkets dominated by one side of the transaction. The rhetoric of market relationships serves principally to obscure political struggles over shifting patterns of integration.     

Book reviews

Bryan S. Turner, Orientalism, Postmodernism and Globalising (Routledge, London 1994). 208pp. ISBN 0–415–10861–6, 0–415–10862–4 (pb).

Mir Zohair Husain, Global Islamic Politics, (Harper Collins, London 1995). 282pp. ISBN 0–06501484–7 (pb).

Sondra Farganis, Situating Feminism: From Thought to Action, (Sage, London 1994). 195pp. ISBN 0–8039–4650–3

Tom Mayer, Analytical Marxism, (Sage, California 1994). 371pp. ISBN 0–8039–4681–3 (pb).

Ian Adams, Political Ideology Today, (Manchester University Press, Manchester 1995). 369pp. ISBN 0–7190–3347–0.

Geoffrey Pridham and Tatu Vanhanen, Democratization in Eastern Europe: Domestic and international perspectives, (Routledge, London 1994). 274pp. ISBN 0–415–11063–7(hb), 0–415–11064–5(pb).

Ash Amin (ed), Post‐Fordism: A Reader, (Basil Blackwell, Oxford 1994). 435pp. ISBN 0–631–18857–6 (pb).     

Microchemical identification of gamma-hydroxybutyrate (GHB)

A new microcrystal test for the detection of gamma-hydroxybutyrate (GHB) is described. The silver/copper reagent consists of an aqueous solution of 0.1 g of cupric nitrate and 0.1 g of silver nitrate in 10.0 mL water. While some crystals form upon evaporation of the reagent, the test forms distinctive crystals for GHB and does not form crystals with some commonly encountered controlled substances. The reagent was also tested against some controlled substances that have similar biological activity to GHB, including flunitrazepam, and some barbiturates. No crystals were observed with these compounds. A blind test was performed to determine if GHB could be discriminated from the other compounds. Two of ten unknowns were correctly identified as GHB--one solid, one liquid. One GHB sample was not identified as GHB and the remaining seven non-GHB samples were not identified as GHB. The reagent is therefore selective for GHB, but not extremely sensitive.     

Reducing Variability in Civil Jury Awards

The purpose of the present study was to test several procedures that could be adopted for reducing unwanted variability in civil damage awards. Four methods for providing guidance to jurors (and judges) about the distribution of awards in comparable cases were compared to each other, to a no-guidance control, and to the capping of awards at a specified maximum, which has been the most commonly legislated solution. The findings of this study suggest several alternative solutions that are better able than caps to solve the problem of unwanted variability in awards.     

Wetlands on trial: Ontario Municipal Board decisions affecting wetlands, 1980–1993

Abstract: There has been a continued loss of wetlands in Ontario as pressurcs from conflicting land uses escalate. This paper examines the manner in which the Ontario Municipal Board has treated the issue of wetlands protcction in hearings on land-use disputes in the provinw. Bastul on a review of nine wetlands caws dating from 1980 to 1993, the decision-making process of the Ontario Municipal Board was examined with regard to wetlands prokxtion. Analysis of the cases revealed a number of issues: the lack of relevant information at hearings; the role of policy and legislation in thc decision-making process; the use of negotiation and mediation in the hearing process; and the significance of private property rights versus the public interest in wetlands protection. This paper dismsses these issues in the context of the role of the Ontario Municipal Board in the planning and management of wetlands in Ontario. Sommaire: AG mesure qu'augmentent les pressions résultant des utilisations contra-dictoires des terres, la pcrte de terres humides continue en Ontario. Cct article examine la manière dont la Commission des affaires municipales de l'Ontario a traité cette question au cours des audiences sur les disputes concernant l'utilisation des terres dans la province. En analysant neuf cas relatifs aux teres humides datant de 1980 à 1993, on a examiné le processus décisionnel de la Commission en ce qui concerne leur protection. L'analyse des cas a révélé plusieurs questions telles que le marque d'informations disponibles pendant les audiences, le rôle des plitiques et des lois dans le processus décisionnel, l'emploi de la négcriation et de la médiation dans le processus d'audience et enfin, la prise en compte des droits fonciers privés par rapport à l'intérêt public dans la protection des terres humides. L'articlc examine ces questions dans le contexte du rôle que joue la Commission des affaires municipales de l'Ontario dans la planification et la gestion des terres humides dam cette province.     

Adolescents' self-perceptions of competence in life skill areas

The perceptions of a sample of 1061 adolescents of their own competence in a number of life-skill areas were assessed. Three sets of scales were used—those concerned with competence viewed as efficacy in various life areas and situations, those concerned with competence as the satisfaction of goals based on Maslow's hierarchy of needs, and assessments of the structural complexity of performance on a short essay task. In addition to comparisons among self-perceptions for different areas, a number of major comtextual and personal variables was studied for differences in self-perceptions—course type, school type, state, career aspirations and expectations, major life concerns, age, and gender. There were strong gender differences that suggested that females generally underrated their own competence. The major educational or work contexts reflected important differences in patterns of self perceptions of skill. Differences between those with different major life concerns and career hopes and expectations aligned with course type differences. Finally, there were strong indications that the self-perceptions of competence that were reported formed a strong general factor, favoring the notion of generic over domain specific self-perceptions.Reveived Ph.D. in Socio- and psycholinguistics from La Trobe Unitersity. Research interests include youth and adolescence and social policy.Received Ph.D. in educational psychology from University of Queensland. Research interests include adolescent life skills and learning and cognition.     

Development of a methodology for the standardisation and improvement of ‘Smartphone’ photography of patterned bruises and other cutaneous injuries

Human bite-mark analyses can play a prominent role in forensic case investigations, including those involving sexual assault. High-quality photographs routinely secure a link between a bite-mark and an individual's dentition. Access to around the clock forensic photography, however, is often limited, resulting in delay and/or missed opportunities to record valuable evidence. The emergence of Smartphone high-quality photographic technology now provides a previously unimagined opportunity to gather timely forensic photographic evidence. Problems can arise, however, due to the relatively poor quality of the photographs, as a result of many of those taking photographs having received little or no forensic photography training. This study compares unassisted photography with assisted photography, by a specifically developed camera application (App), to provide a standardised method for taking forensic photographs. An App, written in Java, was hosted on the Google Android Operating System, on a Samsung Galaxy SII Smartphone. Twenty-four volunteers participated in a study to photograph a pseudo bite-mark using three methods, (1) unassisted (as a control), (2) assisted by an ABFO No.2 right-angled photographic reference scale and (3) assisted by the App. The App, method (3), was shown to consistently outperform methods (1) and (2), demonstrating greater standardisation and precision (p < 0.001). Analysis of the data showed the extent to which acquiring an accurate photograph depends on the image being orthogonal to the camera. It appears likely that the relatively inaccurate photographs acquired by methods (1) and (2), were as a result of deviation from the plane, orthogonal to the bite-mark. Therefore, the App was successful in ensuring that the camera was both orthogonal and at an appropriate distance, relative to the bite-mark. Thus, the App enhanced the abilities of non-experts to acquire more accurate photographs and created the potential to significantly improve the quality of forensic photographs.     

The Wasted Costs Jurisdiction

The wasted costs jurisdiction is flawed for six reasons, based on an analysis of all reported cases in the last nine years and five years of statistics provided by the Bar Mutual Insurance Fund Limited, and despite the guidance laid down by the Court of Appeal in Ridehalgh v Horsefield [1994] Ch 205. First, it is very costly proportionate to the amount recovered. Secondly, judges can initiate a wasted costs enquiry, which is unfair and even more disproportionately costly. Thirdly, it is procedurally complex. Fourthly, it is unpredictable whether the client will waive privilege, and what the consequences will be whether or not privilege is waived. Fifthly, it is not possible for solicitors and barristers to make contribution claims against each other. Sixthly, it is mostly used against lawyers representing legally aided litigants from whom costs cannot be recovered.