Setting limits through global budgeting: hospital cost containment in Rhode Island

In 1974, hospitals in Rhode Island have participated in annual negotiations with state officials and representatives from Blue Cross to determine the allowed increase in statewide hospital costs (the "Maxicap") for the next fiscal year, based on projected increases in hospitals' revenues, changes in patient volume and operating expenses. Individual hospital budgets may be above or below the Maxicap as long as the total increase in hospital costs for all hospitals in the state does not exceed the negotiated amount. At a time when regulatory solutions are increasingly under fire, continued support for Rhode Island's approach to hospital cost containment from third party payers, providers and public officials stands in stark contrast to other states where rate setting was either dismantled or discredited as a cost control strategy. A negotiated global cap on hospital expenditures offers an alternative to formula-based state rate-setting methodologies which could be incorporated as part of an all-payer reimbursement methodology or as an incremental step towards more comprehensive reform.     

Inequality and fertility

This article focuses on the relationship between inequality and fertility, with empirical analysis only of direct influences. Whereas much of the literature seems to be based on 0-order correlations, the present study uses multiple regression analysis to test the strength of the evidence for a relationship between inequality and fertility when competing hypotheses are also considered. In addition, this study attempts to clarify some of the issues surrounding the measurement of inequality and to show how these may affect empirical results. It appears from the results presented here that research into the relative status of women as an influence on fertility holds considerable promise. In particular, it is interesting that a measure of the relative status of women (ratio of female school enrollment to male school enrollment) that is highly correlated with absolute educational status of people in the nation in general, and even more highly correlated with absolute educational status of women, emerges as one of 3 important predictors of fertility. The other measure of the relative educational status of women (female school enrollment ratio minus male school enrollment ratio), which has lower correlations with absolute educational status both of women and people in general, does not appear important, although it should be an equally valid indicator of women's status. It also has lower correlations with total fertility rates. 1 focus of further research should be an attempt to disentangle the effects of the relative status of women from absolute status of women and absolute status of people in the nation as a whole. Less promising is the prospect of future work on the relationship between income inequaltiy and fertility. The results are unencouraging with respect to both sampling problems and the actual magnitude of the effect of inequality on fertility. Overall, it appears that the importance of income inequality as an influence on fertility may have been overstated in the past.     

Pathological myophosphorylase reaction in malignant hyperthermia

In malignant hyperthermia, myophosphorylase reaction shows characteristic changes that take place within minutes: (1) a generally strongly weakened reaction; (2) numerous negatively reacting fibres; (3) frequently, fibre sections that show spotty and/or striatal weak or negative reactions and fibre sections with strong striatal reactions with relatively narrow sarcomere spacings (a "sign of hypercontraction"). Obviously, the morphological findings that show characteristic "striated fibres" are typical of the malignant hyperthermia syndrome! It is important to note that the muscular fibres showing such changes are, as a rule, inconspicuous when using other stains and reactions. These pathological myophosphorylase reactions were observed in five deceased patients (one independently of anaesthesia after an extended walk) and in 19 pigs (18 times after halothane testing and once in an experimental animal with clinical evidence of the presence of malignant hyperthermia). These reactions were not noted in pigs with negative halothane reactivity or prior to halothane testing. They were also not seen in a large number of very different healthy and diseased control and reference cases from our biopsy and autopsy material. Myophosphorylase reaction enables convincing demonstration of malignant hyperthermia, past or present. Hence, it is possible to elucidate puzzling deaths or verify apparently clear death occurring during or subsequent to anaesthesia or simply following stress ("human stress syndrome"). Many of these deaths doubtlessly escape the attention of clinicians using the usual morphological examination methods. However, the reaction cannot be used to identify potential victims.