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.     

The state action doctrine and the Local Government Antitrust Act: the restructured public hospital model

This Article analyzes the development and complexities of the antitrust state action doctrine and the Local Government Antitrust Act as these doctrines apply to both "municipalities" and private entities. The restructuring of a public hospital is used as a model to facilitate the antitrust analysis. The restructuring model, which typically involves the leasing of a hospital facility by a public entity to a private nonprofit corporation, offers the unique opportunity to compare the different standards employed under the state action doctrine and the Local Government Antitrust Act. As a practical matter, the Article provides a framework for a public hospital to evaluate the impact of corporate restructuring on its antitrust liability exposure and to develop strategies to minimize antitrust risks.     

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).