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.     

The writings of Sir Bernard Spilsbury: Part I

This is a two-part historical feature, highlighting the rare writings of Sir Bernard Spilsbury, the recognized leader of British forensic medicine in the first half of the 20th century. Parts I and II were compiled from the publications of the Medicolegal Society of Great Britain, where Sir Bernard Spilsbury served as President in 1933. Although his profile was presented previously in this Journal (vol. 2, no. 2, 179-182, 1981), it is felt that much of Sir Bernard Spilsbury's personality comes out in his writings and recordings of his speeches in the Medicolegal Society publications. Part I includes his lecture on "The Medico-Legal Significance of Bruises," presented before the Medicolegal Society in 1938; and a short case report read before the Medicolegal Society in 1924. The subject of the case report was sudden death from inhibition. Part II will contain two papers from the Medicolegal Society publications.     

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.     

Interest in political campaigns: The influence of question order and electoral context

A split-ballot experiment shows that, when people are asked how interested they are in following political campaigns, their response depends not only on the order in which the question is asked, but also on the broader electoral context in which it is posed. When asked how interested they were in following the political campaigns immediatelyafter a question about whether or not they voted in the (1982) election, people were more likely to think they were interested in the campaign, especially if they claimed to have voted, than if they were asked about it immediatelybefore the question on whether or not they voted. This order effect, however, appears to depend onwhen the questions are asked. If asked within a few weeks after the election, there is little or no order effect. But later, as the memory of the campaign fades, the order of the questions makes a sizable difference in the results. This order effect also seems to be more pronounced among better-educated respondents, suggesting that they are more likely to feel pressured by a social norm to vote and to express an interest in political affairs, not only in real life, but in the survey interview as well. The paper concludes with a brief discussion of the implications for the design of the interview schedule used in the American National Election Studies.The research reported in this paper was supported by a grant from the National Science Foundation (SES81-11404).