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.     

Characteristics of adolescent incest sexual perpetrators: Preliminary findings

Adolescent incest sexual perpetrators seen at an out-patient clinic were interviewed regarding demographic characteristics and occurrence of deviant and nondeviant sexual behaviors. Results indicate that subjects (1) committed more sexual crimes than they had been arrested for, (2) reported a very early onset of sexual behavior, (3) had additional DSM-III psychiatric disorders, and (4) reported previous sexual victimization. Recommendations for future research are made.     

Repairing the Crack in New Orleans' Black Vote: VRA's Results Test Nullifies "Gerryduck"

In 1982, Section 2 of the U.S. Voting Rights Act was amendedto allow plaintiffs to prevail in voting rights litigation ifthey demonstrate that a challenged law or practice has a discriminatoryresult. One of the first applications of this new statutoryprovision invalidated a congressional districting plan for theNew Orleans metropolitan area, a plan that had divided the city'sblack population virtually in half. This article reviews boththe making and the unmaking of that plan, derisively known asthe "gerryduck." Although the judicial action invalidating thisexercise in racial cartography demonstrates the potential importanceof this new section of the VRA as a legal weapon against minorityvote dilution, the results test provides federal judges withenormous discretion, and the application of the test may thereforebe quite capricious.     

Book reviews

William C. Green and Theodore Karasik (Eds.), Gorbachev and his Generals: The Reform of Soviet Military Doctrine (Westview Press, 1990, 239pp. ISBN 0–8133–7898–2)

Daniel Patrick Moynihan, On the Law of Nations (Harvard University Press, 1990)

Peter J. Stavrakis, Moscow and Greek Communism, 1944–1949. Cornell University Press, Ithaca and London. 1989. ISBN 0–8014–2125–X.

Scalpino, R.A., The Politics of Development: Perspectives on Twentieth‐Century Asia (Harvard University Press, Cambridge, Mass., 1989, pp.131)

Sean M. Lynn‐Jones, Steven E. Miller and Stephen van Evera (Eds.), Soviet Military Policy (MIT Press, 1989. £26.95 [cloth]; £13.50 [paperback]).