PPS waivers: implications for Medicare, Medicaid, and commercial insurers

This paper compares the Medicare prospective payment system (PPS) to four all-payer rate-setting systems that operated under HCFA waiver authority. The study examines the experience of Medicare, Medicaid, and commercial insurers under the two approaches. Data from several American Hospital Association surveys and from Medicaid 2082 report forms are analyzed. The paper concludes that the all-payer waiver programs have been as successful as PPS in controlling the rate of growth in Medicare costs. In addition, Medicaid programs are more successful in controlling their outlays in all-payer rate-setting environments than when they "go alone." Finally, there is no evidence to suggest that hospitals can increase charges in response to greater financial need under either PPS or the state waivers. Nevertheless, it appears that commercial insurers are better able to compete with Blue Cross plans in all-payer rate-setting states than elsewhere.     

The state action doctrine and the Local Government Antitrust Act: the restructured public hospital model

This Article analyzes the development and complexities of the antitrust state action doctrine and the Local Government Antitrust Act as these doctrines apply to both "municipalities" and private entities. The restructuring of a public hospital is used as a model to facilitate the antitrust analysis. The restructuring model, which typically involves the leasing of a hospital facility by a public entity to a private nonprofit corporation, offers the unique opportunity to compare the different standards employed under the state action doctrine and the Local Government Antitrust Act. As a practical matter, the Article provides a framework for a public hospital to evaluate the impact of corporate restructuring on its antitrust liability exposure and to develop strategies to minimize antitrust risks.     

Fiji: country profile

Fiji is a country consisting of 300 South Pacific islands, of which the largest is Vitu Levu, which includes the capital, Suva. The islands are home to 700,000 people, of whom 50% are Indian, 46% Melanesian, and the rest Chinese or European. The official language is English, and the major religions are Hinduism and Christianity. Literacy is 79% for men and 64% for women, whose status is generally low in this patriarchal society. Infant mortality is 27/1000 live births, but life expectancy is 70 years. The British began sending missionaries and manufactured goods in the early 1800s and annexed the islands in 1874 as a source of sugar, for which they expropriated the land and imported the Indians as agricultural workers. Sugar remains the largest export along with coconut oil, gold, and timber. Manufactured goods, food, fuel, and chemicals are imported, and the national debt is over $200 million. Foreign investment, mostly by Australia, is $13.2 million. Inflation is 20%; 200,000 people are unemployed, and poverty is general except for the urban elite. The Fijian dollar is worth US. 80. Independence, granted in 1970, replaced colonial control with military governments, currently that of Colonel Rambuka, who refused to allow a democratically elected government to take office. Faced with a declining economy and the political power of the fascist Taukei movement, the Indians, who had been the shopkeepers, craftsmen and bureaucrats during the later period of colonial rule, have been emigrating en masse.     

Swaziland: country profile

Although Swaziland had been independent from colonialism for 20 years, a powerful monarch, King Mswati II, continues to control the country's political, religious, and social system. Swaziland has a population of 676,000, half of whom are under 15 years of age. The infant mortality rate is 105/1000 live births and 25% of children die before they reach their 5th birthday. Life expectancy is 54 years. Tribal chiefs, representing the king, hold and distribute about half of the national land. Most of the fertile land remains in the hands of white settler farmers. The concentration of income in foreign companies and urban centers has exacerbated poverty in rural areas. Depreciation of rand-linked local currency has boosted export earnings, but it has also raised the price of food and medical imports. Swaziland's main exports are sugar, wood pulp, chemicals, and fruit, most of which go to the UK and South Africa. The major food crops are maize, beans, groundnuts, and sorghum. About half of the working population is engaged in small-scale subsistence farming, but food yields are declining. The major producers are foreign companies attracted by Swaziland's low taxes and cheap labor supply.     

The transition of migratory patterns in medium-sized cities

"The authors attempt to present some empirical findings regarding a phenomenon which they chose to call the 'transition in migratory patterns'.... The general hypothesis states that: changes in migratory patterns are due to an interaction between those economic, political and social processes which affect the distribution of the population; and that this interaction is also highly influenced by macroeconomic politics--an arena where technology plays a dominant role." Data are for Guadalajara and the state of Jalisco in Mexico. (SUMMARY IN ENG)     

The development of drug trade and drug control in the Netherlands: a historical perspective

Drug trade is widely seen as a phenomenon rather new to the Netherlands. However, at the beginning of the 20th century the Dutch pharmaceutical industries were already extensively involved in the production of both opiates and cocaine, and they went on exporting large quantities of these drugs after the Opium Act (1919) took force. Until the 1960s, arrests were not at all common, and these largely affected minority groups like Chinese opium smokers and black marijuana users. Since then, drug control efforts have increased by leaps and bounds. At first, cannabis was the main target; then the focus turned to heroin, and that was later joined by cocaine. This paper traces the history of the drug trade and drug control in the Netherlands, with emphasis on their development in Amsterdam. The conclusion is reached that, in spite of drastic changes in both drug trade and drug control, certain ideologies, constructs and strategies have remained remarkably stable.