Is medical care different? Old questions, new answers

This paper examines whether changes in medical markets may be making them more like other markets. The emergence of HMOs and other managed care systems appears to have increased the consumer's potential ability to make better comparative judgments about the price and quality of medical care, and also seems to have made medical care more like other goods. However, the evidence that medical care is a "reputation good" suggests that it is, in this respect, different from other goods. Finally, the social concerns about medical care use necessarily make medical care different.     

Bicommunalism in Northern Ireland

Northern Ireland is a bicommunal society in which Protestantsare numerically dominant; Roman Catholics constitute virtuallyall of the remaining population. On the island as a whole, Protestantsare heavily outnumbered; the Republic of Ireland (the "South")has a population that is about 96 percent Catholic. Social segregationof the two northern communities is relatively distinct, andthere is little crosscutting between groups that might lessenbicommunal conflict. A reciprocal relationship exists betweenthe social system and political structures. Northern Irish politicalinstitutions followed the Westminster model, which facilitatedthe political exclusion of Catholics and impeded social as wellas political integration. The bicommunal social structure hasimpeded the development of more accommodating political structures.Geographic issues and external linkages compound the politicalproblem. Northern Irish politics can be viewed as a "dual dyad"in which the United Kingdom and the Republic of Ireland arecritical components. Psychological dimensions of Northern Irishbicommunalism further exacerbate the conflict.     

Special report on liability and insurance. An update on assignment of patient benefits under ERISA

While the holdings in Davidowitz and Arkansas Blue Cross & Blue Shield arose in different contexts, they both reflect the courts' increasing willingness to consider the importance of cost containment in the health insurance arena, even though patient accessibility to health care may be restricted as a result. If the holding in Davidowitz is not successfully appealed, providers may need legislative relief in order to retain their ability to take valid assignments of patient claims for payment from ERISA plans. It is uncertain whether such legislation can be sought at the state level or must instead come from Congress due to ERISA preemption of state legislation. Clearly, the district court decision on remand in Arkansas Blue Cross & Blue Shield will be closely watched for any light it may shed on this question. On a pragmatic note, providers who have not entered into "participation" agreements with insurers or other private payors may now have a greater incentive to do so, and "nonparticipating" providers who continue to obtain assignments from patients in order to collect directly from insurers or other private payors should determine on a case-by-case basis whether the source of the patient's benefits is a group health plan--which is likely to fall under ERISA and may contain nonassignment provisions--or some other form of coverage. For an additional perspective on insurers' responses to copayment waivers, see Newsletter, Vol. 6, No. 10, October 1991, at 7.     

Facing the powers that be

Lobbyists, entrenched forces in congress and self-interested friends will try to stymie Clinton's efforts. A look at four key arenas of combat.     

Widows and neighbors,cornfields and magueys. The impact of population increase in the Toluca Valley: the case of Tenango del Valle during the eighteenth century

The author examines the effect of rapid population growth due to migration on the parish of Tenango del Valle, Mexico, during the eighteenth century. She gives special consideration to the impact on quality of life in indigenous villages, especially for widows and female heads of households who were impoverished as a result of discriminatory land transactions. Data are mainly from the parish register for 1770.