PPS waivers: implications for Medicare, Medicaid, and commercial insurers

This paper compares the Medicare prospective payment system (PPS) to four all-payer rate-setting systems that operated under HCFA waiver authority. The study examines the experience of Medicare, Medicaid, and commercial insurers under the two approaches. Data from several American Hospital Association surveys and from Medicaid 2082 report forms are analyzed. The paper concludes that the all-payer waiver programs have been as successful as PPS in controlling the rate of growth in Medicare costs. In addition, Medicaid programs are more successful in controlling their outlays in all-payer rate-setting environments than when they "go alone." Finally, there is no evidence to suggest that hospitals can increase charges in response to greater financial need under either PPS or the state waivers. Nevertheless, it appears that commercial insurers are better able to compete with Blue Cross plans in all-payer rate-setting states than elsewhere.     

Assessment of competency for execution? A guide for mental health professionals

Assessment of competency for execution presents two compelling ethical questions for mental health professionals: whether clinicians can ethically provide such assessment, and if so, how it should be done in order to maximize quality and minimize ethical conflict. In this article we address the issue of whether to participate and, if so, how. The question of whether to participate is discussed by summarizing the arguments for and against participation and offering guidelines for making a decision. The question of how to proceed is discussed in two contexts: preadjudication (before a formal decision about competency) and postadjudication (following a determination of "incompetent" and transfer of the offender to another facility for treatment and further assessment). Finally, recommendations are made regarding research that would improve the quality of execution competency assessments.     

Resolving university landlord-tenant disputes

Conclusion The housing arbitration system used by Brigham Young University's Housing Arbitration Board (HAB) has been widely used at the school for many years. It has not worked perfectly. Some landlords are critical of the school's laxness in enforcing arbitral awards.In general, students prefer the process over small claims court (chiefly, it appears, because of cost factors). The school administrators prefer mediation over arbitration but recognize that mediation does not always resolve impasses. Legal questions exist about BYU's potential restraint of trade in using the obligatory contracts the school mandates for landlords. The process relies upon persons of goodwill to serve on the tribunals, but has a long enough track record to demonstrate the HAB concept works quite well. Because of annual turnover, the need for training of mediators/arbitrators is always critical. Other universities may well wish to emulate (or modify) the HAB model in resolving their landlord and student-tenant disputes. William M. Timmins is Professor of Personnel Administration and Labor-Management Relations at the Graduate School of Management, Brigham Young University, Provo, Utah 84602. Among his recent publications isThe International Economic Policy Coordination Instrument: The OECD Experience (London: The University Press, 1985).     

Medicaid in the 1990s: Trends, Innovations, and the Future of the "PAC-Man" of State Budgets

Rapidly escalating health-care inflation and congressionallymandated expansions have led to large increases in spendingfor Medicaid, the federal-state program of health care for thepoor. These increases came at a time when state budgets werealready under recession-induced stresses. In addition, 1991brought new pressures for Medicaid spending from the courtsand closer federal scrutiny and control over revenues used forthe program's state "match." Yet the Medicaid picture is farfrom bleak. Diversity, innovation, and an emerging stale policyrole also characterize the program in ways that epitomize thestrengths and weaknesses of the American intergovernmental system.     

Reviews

R. W. Davies, ed., From Tsarism to the New Economic Policy. Continuity and Change in the Economy of the USSR. London and Basingstoke: Macmillan, 1990, xx + 417 pp., £45.00.

Alastair McAuley, ed., Soviet Federalism, Nationalism and Economic Decentralisation. Leicester and London: Leicester University Press, 1991, ix + 214pp., £38.00.

Loren Graham, ed., Science and the Soviet Social Order. Cambridge, MA and London: Harvard University Press, 1990, ix + 443 pp., £27.95.

Ronald I. McKinnon, The Order of Economic Liberalization: Financial Control in the Transition to a Market Economy. Baltimore, MD, and London: The Johns Hopkins University Press, 1991. xii + 200 pp., £20.00. $32.00.

Mary McAuley, Bread and Justice: State and Society in Petrograd 1917–1922. Oxford: Oxford University Press, 1991, xviii + 461 pp., £45.00.

David Armstrong & Erik Goldstein, eds, The End of the Cold War. London: Frank Cass & Co Ltd, 1990. 216pp., £19.50.

Paul B. Stephan III & Boris M. Klimenko, eds, International Law and International Security: Military and Political Dimensions. A US‐Soviet Dialogue. Armonk, NY, and London: M. E. Sharpe, Inc., 1991, xxii + 362 pp., $90.00.

Richard F. Staar, Foreign Policies of the Soviet Union. Stanford, CA: Hoover Institution Press, 1991, xl + 352 pp., £14.95 p/b.

Robert O. Freedman, Moscow and the Middle East: Soviet Policy Since the Invasion of Afghanistan. Cambridge: Cambridge University Press, 1991, xi + 426 pp., £35.00 h/b, £14.95 p/b.

Galia Golan, Soviet Policies in The Middle East: From World War II to Gorbachev. Cambridge: Cambridge University Press, 1990, ix + 319 pp., £27.50 h/b, £10.95 p/b.

Brian McNair, Glasnost, Perestroika and the Soviet Media. London and New York: Routledge, 1991, x + 231 pp., £35.00.

Shams Ud Din, ed, Perestroika and the Nationality Question in the USSR. New Delhi: Vikas, 1991, xv + 145 pp., £15.95.

Ronald J. Hill & Jan Zielonka, eds, Restructuring Eastern Europe: Towards a New European Order. Aldershot: Edward Elgar, 1990, ix + 226 pp., £28.50.

Aleksa Djilas, The Contested Country: Yugoslav Unity and Communist Revolution 1919–1953. London: Harvard University Press, 1991, v + 259 pp., £27.95 h/b.

Bartlomiej Kamiriski, The Collapse of State Socialism: the Case of Poland. Princeton, NJ: Princeton University Press, 1991, xiv + 264 pp., $39.50 h/b, $14.95 p/b.

David Ost, Solidarity and the Politics of Anti‐Politics. Opposition and Reform in Poland since 1968. Philadelphia, PA: Temple UP, 1990, xi + 279 pp. $34.95.

Roman Laba, The Roots of Solidarity—A Political Sociology of Working Class Democratisation. Princeton, NJ: Princeton UP, 1991, xii + 247 pp., $24.95.

Keith Sword, ed, The Soviet Takeover of the Polish Eastern Provinces, 1939–41. London: Macmillan (in association with the School of Slavonic and East European Studies), 1991, xxiii + 318 pp., £45.00.

William B. Husband, Revolution in the Factory: The Birth of Soviet Textile Industry, 1917–20. New York and Oxford: Oxford University Press, 1990, viii + 227 pp. £25.00.