The impact of health maintenance organizations and competition on hospitals in Minneapolis/St. Paul

The Healthcare Educational and Research Foundation (HERF) in Minneapolis undertook a two-year research project to study the effects of health maintenance organizations (HMOs) and competition on the hospital industry in Minneapolis/St. Paul. This article summarizes HERF's major findings surrounding three key questions: (1) do the HMOs in Minneapolis/St. Paul use fewer hospital resources relative to conventional payers?; (2) do recent overall community trends in inpatient use suggest evidence of hospital utilization-reducing effects attributable to HMOs?; and (3) given the highly visible competitive process among Minneapolis/St. Paul providers, do hospital cost and revenue data suggest any evidence of cost-containment? The findings (based on data through 1982) indicate that for comparable patients, Twin Cities HMOs appear to use fewer medical care resources per hospitalized patient. There was, however, no clear evidence of community-wide, utilization-reducing effects directly attributable to the "competitive effect" of HMO introduction and development in the market. In addition, there was no empirical evidence that HMOs (which had enrolled 25 percent of the consumer market by 1982), or other large buyers of inpatient services, have selected hospitals on the basis of price as hypothesized by competition advocates.     

Non-commercial, accidental water transport (boating) fatalities

A study of non-commercial accidental water transport (boating) fatalities was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Fla., during the years 1980-1984. A total of 23 cases were collected and analyzed as to the age, race, sex, and the cause of death of the victim along with the blood alcohol content and the Urine EMIT drug screen at autopsy. Furthermore, the type of boat involved, the geographic locale, the time of the incident, the reason or risk factor for the incident, and the scene circumstances were also noted. Commonly, one is dealing with a male population below the age of 30 years who die of drowning. In approximately half of the cases alcohol is detected. The scenario involves "small" boats or canoes in the Atlantic Ocean or in canals in the afternoon or evening. Inexperience in boating/or stupidity plays a key role. A discussion ensues concerning recommendations designed to avoid such tragedies.     

The future of public health law

Developments in medicine and constitutional law dictate modification of public health legislation in the United States. Traditionally overlooked by legislators, present public health laws provide inadequate decision-making criteria and inappropriate procedures for dealing with issues. Revised legislation should provide health care officials and agencies with the tools to balance individual rights against public health necessities. This Article makes four recommendations for legislative reform: (1) remove artificial legislative distinction between venereal and other communicable diseases; (2) provide criteria defining "public health necessity" to limit discretionary exercise of police power by health officials; (3) provide strong confidentiality protections in the collection and storage of public health information; (4) empower public health officials to select from a graded series of less restrictive alternatives in dealing with public health problems.     

Therapists' obligations to report their patients' criminal acts

The law governing the obligation of therapists to report their patients' previous criminal acts was reviewed. Most often, discussions of this subject fall under the general category of "misprison of a felony," that is, the presumed general obligation of all citizens to report felonies that come to their attention. Review of federal law revealed that the courts have consistently interpreted the federal misprision statute as requiring active concealment of a crime, not a mere failure to report, in order to convict for the offense. State law is more diverse. Only one state has a general misprison statute labeled as such, and several states have recently repealed such statutes. The strong trend in states without statutes is to reject misprison as a common law crime, because of its incompatibility with modern notions of justice. Most states, however, have limited reporting statutes, such as for child abuse or gunshot wounds, that impose similar obligations. Therapists' reporting of past crimes may be affected by clinical and ethical concerns, as well as by obligations to protect future victims. In almost all jurisdictions, however, the fear of prosecution for failure to report a past crime should not be a factor in deciding on a course of action.     

Legalization of consensual unions in Mexico

Data examined in this study are from the 1976 Mexican Fertility Survey. The authors review previous findings and compare information from this survey with data from the 1969 PECFAL Survey. They then examine the types of consensual union and factors such as women's age, educational status, occupation, premarital fertility, and rural or urban residence. The focus of the study is on the extent to which consensual unions eventually become legal marriages. The authors also investigate the increasing probability of termination of marriage through divorce or separation, especially in urban areas.     

Book reviews

Handbook of Legal Information Retrieval Edited by J Bing, Norwegian Research Centre for Computers and Law, Oslo, in co‐operation with T Fjeldvig, T Harvold and R Svoboda North‐Holland 1984, US $96.25

Information Technology: The Challenge to Copyright. James Lahore, Gerald Dworkin and Yvonne Smyth Sweet & Maxwell and The Centre for Commercial Law Studies 1984, £12.00

Data Processing and the Law Edited by Colin Campbell Sweet and Maxwell 1984, £20.00

Le droit des Contrats Informatiques — Principes — Applications Centre de Recherches informatique et droit des Facultes Universitaires de Namur Maison Ferdinand Larder (Brussels), 1983, 45 FB

Computer Insecurity Adrian R.D. Norman Chapman and Hall 1983, £14.95

The Data Protection Act Richard Sizer and Philip Newman Gower Publishing, 1984, £16.95

The Data Protection Act 1984 Professor Bryan Niblett Oyez Longman Publishing, 1984, £18.00

The Data Protection Act 1984 — A Guide to the New Legislation J. A. L. Sterling CCH Editions, 1984, £15.00

Privacy and Data Protection — An International Bibliography Professor David H. Flaherty Mansell Publishing, 1984, £23.50

Computer Contracts R Morgan & G Stedman Oyez Longman Publishing 1984, 2nd Edition, £27.50

Computer Contracts Handbook Michele Rennie Sweet & Maxwell 1984, £15.00

Computer Contracts — An International Guide to Agreements and Software Protection Hilary Pearson Financial training 1984, £14.95     

An examination of the psychological aspects of bite marks

The intent of this paper is to present some psychological threads which appear to be operative for the perpetrator of bite marks. In the catalogue of multiple motivations, there appears to be a current theme of power, control, potency, and the attempt to have a psychological symbolization of the perpetrator's omniscient capacity for absorbing life essences. In an examination of these highly complex needs, the modern perpetrator appears to act out consistently with cultural biases coupled with immediate psychological needs which have pressed for expression. Due to a pattern of psychologically expressed ritualism, the perpetrator will often inadvertently leave important psychological clues at the crime scene. The attack style, mode of death, characteristics of the victim, etc.--these components reveal the information on the type of psychological needs that the perpetrator is trying to satisfy. In the cases of bite marks associated with violent crime, it becomes crucial to an "investigator" what type of personality characteristics are welded together to form this kind of need complex. After reviewing cases reported in the literature and after conducting psychological interviews with perpetrators, three major groups of perpetrators seem to be apparent. The first group is motivated out of an anger track, the second group is motivated out of sadistic biting, and the third is out of the more traditional "cannibal complex" motif.