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.     

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.     

The transition of migratory patterns in medium-sized cities

"The authors attempt to present some empirical findings regarding a phenomenon which they chose to call the 'transition in migratory patterns'.... The general hypothesis states that: changes in migratory patterns are due to an interaction between those economic, political and social processes which affect the distribution of the population; and that this interaction is also highly influenced by macroeconomic politics--an arena where technology plays a dominant role." Data are for Guadalajara and the state of Jalisco in Mexico. (SUMMARY IN ENG)     

The development of drug trade and drug control in the Netherlands: a historical perspective

Drug trade is widely seen as a phenomenon rather new to the Netherlands. However, at the beginning of the 20th century the Dutch pharmaceutical industries were already extensively involved in the production of both opiates and cocaine, and they went on exporting large quantities of these drugs after the Opium Act (1919) took force. Until the 1960s, arrests were not at all common, and these largely affected minority groups like Chinese opium smokers and black marijuana users. Since then, drug control efforts have increased by leaps and bounds. At first, cannabis was the main target; then the focus turned to heroin, and that was later joined by cocaine. This paper traces the history of the drug trade and drug control in the Netherlands, with emphasis on their development in Amsterdam. The conclusion is reached that, in spite of drastic changes in both drug trade and drug control, certain ideologies, constructs and strategies have remained remarkably stable.     

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.     

The Medicare secondary payor provisions: possible rewards and pitfalls

A 1990 report prepared by the Office of Inspector General estimated that as much as $1 billion is lost to the Medicare program annually because (i) secondary payor situations are not detected and (ii) insurance companies often do not pay when they are required to be the primary payors. Office of Inspector General, No. A-09-98-00151, April 1990, Medicare and Medicaid Guide (CCH) [symbol: see text] 39,112, at 25,649. In order to better enforce the MSP provisions, suggestions have been made at the Congressional level to impose sanctions against providers who demonstrate a pattern of inappropriate billing practices such as double billing, repeated failures to screen beneficiaries for other insurance coverage, and the repeated submission to Medicare of bills that should be submitted to another payor. (See the Subcommittee Report on erroneous payments under the MSP program, supra.) Although authority for such sanctions has yet to be adopted, given the fiscal problems currently plaguing the federal government, providers can expect increased enforcement of the MSP provisions as a means of reducing Medicare costs, and should review their screening and billing practices accordingly.