Directors' duty of care to monitor information systems in HMOs: some lessons from the Oxford Health Plan

This paper examines the legal and strategic issues raised by the use of information systems in health maintenance organizations (HMOs) and other managed care organizations. Given the critical nature of information systems to an HMO's business success and regulatory compliance, the large financial investment HMOs make in their systems, and the widely publicized concerns over the year 2000 "millennium bug" problem, information systems are appropriately a matter of concern to an HMO's board of directors. The recent experience of Oxford Health Plans, Inc. offers a case study in the apparent failure of the directors to monitor adequately the in-house development of an information system. The systems disaster which this corporation suffered in 1997 led to a dramatic drop in stock price, from which the company has yet to recover, as well as intense scrutiny by state and federal regulators and countless shareholder derivative actions against the directors. Corporate directors are subject to the fiduciary duty of care. Despite statutes in some states requiring directors to act prudently, state courts almost always apply the standard of gross negligence. As a result, even when directors act without due deliberation in their decision, it is rare that a court will find them to have failed in their duty of care. The business and regulatory community may find otherwise, however, when directors fail to evaluate information systems options carefully and the business suffers as a result.     

Policy trade-offs in “home care”: the Ontario example

Abstract: As Canada enters the twenty-first century, its highly prized program, medicare, is undergoing radical transformation. With technological change and the restructuring of health systems, the locus of care is shifting from institutions to the home. As a result, care that was formerly publicly financed under the Canada Health Act is technically becoming de-insured. This paper analyses the reform of community-based long-term care services in Ontario from 1985 to the present. During this period, three different parties, the Liberals, the ndp and the Progressive Conservatives, in turn, formed the government. Four different models were put forward before the current model was adopted by the current pc government. Each of these models is analysed with respect to design decisions that must be made in the policy dimensions of financing, delivery and allocation and evaluated in terms of equity, liberty, security and efficiency. Underlying the debate in Ontario was a fundamental disagreement about the role of government, reflected in views about the responsibilities of individuals and their families, and the appropriate place of for-profit organizations within a publicly funded system. The reform of this sector has significance that goes beyond its boundaries, with wider implications and warnings for health care in general. Sommaire: Au moment même où le Canada se trouve au seuil du vingtième siècle, son très populaire régime d'assurance-maladie subit une transformation radicale. À cause de l'évolution technologique et de la restructuration du systéme de soins de santé, le fardeau de ces soins se déplace des institutions vers les foyers. Par conséuent, des soins auparavant financés par les deniers public en vertu de la Loi cana-dienne sur la santé deviennent techniquement non-assurés. Dans cet article, on analyse la réforme des services ontariens de soins à long terme axés sur la communauté, de 1985 áG ce jour. Pendant cette période, trois partis differents, les Libéraux, les Né-démocrates et les Progressistes conservateurs ont formé le gouvernment à tour de rôle. Quatre modèles différents ont été préconisés avant l'adoption du modèle actuel par le gouvernement progressiste conservateur qui est aujourd'hui au pou-voir. On y analyse chacun de ces modèles quant aux décisions conceptuelles á faire pour les politiques de financement, de prestation et d'allocation, et chaque modèle doit être évalué en termes d'équité, de liberté, de sécurité et d'efficacité. À l'arrièreplan du débat, en Ontario, il y avait un désaccord fondamental sur le rôle du gouvemement, que reflétaient les opinions concemant la responsabilité des citoyens et de leurs familles ainsi que sur la place appropriée des organismes à but lucratif à au sein d'un système financéà même les derniers publics. La réforme de ce secteur a des répercussions non seulement sur le secteur hi-même mais aussi sur les soins de santé en général.     

Industry, occupation, and disability insurance beneficiary work return.

This article uses the New Beneficiary Data System to describe the first job held after award of Disability Insurance benefits, in terms of occupation and industry. It examines work activity within sectors of employment, and looks at the issues of whether work return in certain industries and occupations varies according to the demographic characteristics of the beneficiaries. The article also presents data on sector-specific employer accommodations that can aid in sustained work return. Postentitlement work was fairly evenly distributed across occupational and industrial sectors. Persons with higher levels of educational attainment were found to be in white-collar employment sectors. There were noticeable differences in the availability of employer accommodations across postentitlement occupations and industries.     

Reversal of fortune: the politics and economics of the superconducting supercollider

Congress approved the superconducting supercollider (SSC), but later cut all funding after construction for the project had begun. We claim that this reversal was due, in part, to a problem of time inconsistency. Representatives from states in contention to receive the project had an incentive to support it early in the process. Once Texas was chosen as the SSC site, the other contender states had a greatly diminished incentive to continue to support it. Our empirical results show that the probability of switching from ‘for’ to ‘against’ the project is significantly higher for representatives from the former contender states.