Federal antitrust jurisdiction in peer review cases: the Pinhas decision

In Summit Health Ltd. v. Pinhas, the United States Supreme Court by a narrow majority found that the exclusion of an ophthalmologist from a hospital in Los Angeles had a sufficient effect on interstate commerce to establish federal jurisdiction under the Sherman Act. In resolving a split among the federal circuit courts of appeal, the Court applied the broad jurisdictional test from McLain v. Real Estate Board of New Orleans, Inc. to peer review proceedings. Despite many ambiguities in the majority opinion by Justice Stevens and a scathing dissent by Justice Scalia, the effect of Pinhas will be to increase the suits in federal court on antitrust grounds brought by aggrieved medical staff members and applicants denied appointments or privileges, and to decrease, if not eliminate, the likelihood of preliminary dismissal on jurisdictional grounds. This, in turn, should serve to emphasize the importance of complying with the Health Care Quality Improvement Act in order to obtain immunity from damages under federal antitrust and state laws.     

Circumventing formal structure through commitment: Presidential influence and agenda control

Although the formal institutional structure that defines the temporal order of play in a policy game between the Congress and President ought to provide Congress with agenda power, the President is traditionally treated as the dominant player in this relationship. We show that if the President can make clear-cut commitments, presidential commitment can counter the dominance hierarchy and the complexion of equilibrium outcomes. Thus, the details of political interactions (in particular, the possibilities for commitment) may be as important as the formal specification of institutional structure.We thank Peter Aranson, David Austen-Smith, Ed Campos, Gerry Faulhaber, Art Frank, Ken Koford, William Riker, Janet Pack, the anonymous referees, and seminar participants at the University of Delaware, the University of Pennsylvania, and the University of Rochester for helpful comments, subject to the usual caveat. We also thank Joel Friedlander and Harold Dichter for research assistance.     

The influence of individual and community-level child mortality on fertility in Egypt

Child mortality was analyzed in relation to 3 dimensions of reproductive behavior: birth intervals, additional children desired, and contraceptive use. Study data were drawn from a 1978 survey conducted in 2 predominantly rural governorates, Beheira and Kafr El-Sheikh, in lower Egypt. Within each governorate, 2 districts were selected on the basis of their distance from the capital of the governorate, agricultural output by major crops, percent of the population urban, infant mortality rate, and crude birthrate. Within each of the 4 districts, villages were randomly drawn from 3 strata: villages lacking any governmental services; villages with limited services (health center or primary school); and villages served by a combined unit center providing integrated services. A random sample of household heads was selected from household registration records of the provision office of each district. 1200 interviews were obtained from 685 households. Restriction of the sample to women with 1 or more live births, and the elimination of 13 cases with incomplete or inaccurate information, yielded 1010 cases for analysis. The basic measure of actual fertility was birth intervals. For the total sample and within each age category, cumulative fertility is higher the greater the number of child deaths. The data demonstrate a strong relationship between child mortality experience and cumulative fertility. The problem lies in interpreting such results. With some exceptions, birth intervals increased as expected with increasing parity. Women without child death experience displayed longer birth intervals than women who had not lost a child. With the single exception of the 7th parity women, all differences were statistically significant. The data fail to eliminate potential biological influences on subsequent fertility. With biological influences adequately controlled, no behavioral differences remained. Women who experienced child mortality desired greater numbers of additional children than women without child death experience. 19% of respondents were ever users of contraception, with women of low parity the least likely ever to have used contraception.