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.     

Repeat autopsies on corpses from abroad. A futile effort?

A large number of corpses transferred to Athens and the Piraeus Morgue from abroad have been examined in second autopsies. Lack of information, mistakes in data, useless effort, and disappointment on the part of the forensic pathologists because of the lack of new information revealed are characteristic of these cases. With some exceptions, the second autopsy provided no news for the anxious relatives, who, for the most part, had been prompted by their attorneys or other "well-meaning friends" to demand a second autopsy on the corpses of their loved one (who generally died on board ship abroad). Nevertheless, in 10 of 59 cases, the cause of death was completely different from the determined in the autopsy performed abroad or assumed from the information available. This fact ensures that any corpse from abroad undergoes a careful and thorough examination on its arrival in Greece.     

Wrongful termination lawsuits: the employers finally win a few

Much attention has been given of late to the erosion of the "employment-at-will" doctrine. Exceptions to this doctrine began to emerge when courts held that at-will employees could sue if their termination violated public policy. The at-will doctrine was further eroded by court rulings that a contract requiring good cause in order to terminate could be inferred from employee handbooks, company personnel policies, and circumstances of employment. As the initial flood of wrongful termination lawsuits now reaches the appellate level, some guidance on the standards employers must observe can be drawn from court decisions. The authors examine these decisions as well as the legislative reform being proposed in response to them.     

Practitioner fraud and abuse in medical benefit programs: government regulation and professional white-collar crime

Physicians who defraud and abuse medical benefit programs provide a unique group of lawbreakers for scientific study. They could be considered to epitomize white collar criminals given their exceedingly high socioeconomic status and power as a professional group. Using official reports and documents, as well as interviews with enforcement and program personnel at both state and federal levels, this study examines the problem of physician fraud and abuse in Medicare and Medicaid. Major areas relevant to understanding this phenomenon and its control are presented and policy implications of present knowledge in the area are discussed.     

The voter as juror: Attributing responsibility for economic conditions

One assumption of Key's reward-punishment theory that has attracted comparatively little attention is that voters hold the incumbent party responsible for all manner of economic fluctuations. A brief review of the survey literature in economic voting indicates that this assumption is in need of revision. The handful of existing studies in political science on responsibility attribution suffers from a lack of conceptual clarity and a failure to develop a theory of the attribution process. This paper outlines a model of economic voting in which people act as intuitive jurors using various decision rules to evaluate the evidence surrounding the president's responsibility for national economic problems. The generalizability of the framework and directions for future research are discussed     

From IDA to IIROC: Has self-regulation in the Canadian investment industry evolved?

This article analyzes the enforcement practices of the Investment Industry Regulatory Organization of Canada (IIROC) and compares them with its predecessor, the Investment Dealers Association of Canada (IDA). The study collected data from IIROC's tribunal cases decided between June 2008 and December 2019 and compared them with data on the IDA's enforcement of complaints from 1984 to 2008. The findings reveal no statistically significant difference in the fines imposed by the two regulatory bodies. Furthermore, IIROC has refrained from issuing lenient penalties such as retaking examinations/courses or mandating terms and conditions for offenders. The results also indicate no significant impact on the number or distribution of offense types committed in the industry over time. Most notably, the Ontario Securities Commission, the Canadian Securities Regulators, and the new Self-Regulatory Organization of Canada should consider these findings when formulating policies concerning the role of self-regulation in the financial markets.