Legal implications of managed care arrangements

Prior to the 1980s, managed care was virtually nonexistent as a force in health care. Presently, 64 percent of employees in America are covered by managed care plans, including health maintenance organizations (20 percent) and preferred provider organizations (44 percent). In contrast, only 29 percent of employees were enrolled in managed care plans in 1988 and only 47 percent in 1991. To date, the primary reason for this incredible growth in managed care has been economic-market pressure to reduce health care costs. For the foreseeable future, political pressures are likely to fuel this growth, as managed care is at the center of President Clinton's national health care plan. Although there are numerous legal issues surrounding managed care, this article focuses primarily on antitrust implications when forming managed care entities. In addition, the corporate practice of medicine doctrine, certain tax issues, and the fraud and abuse laws are discussed.     

Fertility incentives and participation in localities with limited means: a dynamic model of per capita resources

Several countries have attempted to change human fertility through economic incentives. This paper presents simple mathematical models of the participation of couples in a locally funded program of economic incentives. The models take as a springboard China's one-child program. Localities with low per capita incentives attract few couples to the program, while localities with high incentives attract many couples at first, but the value of the benefits is then watered down. The models show that participation in the program may persistently oscillate or may decay to a stationary level. Which behavior occurs is determined by whether there are decreasing, constant, or increasing returns in the rates of participation in response to successive equal increments in the incentive offered, and by the extent to which prospective parents learn from experience with past oscillations in the incentives. The models raise many empirical questions about the dynamics of incentive programs.     

Meeting the change challenge: managing growth in the nonprofit and public human services sectors

The current economic climate has been particularly hard on non-profit and public human services organizations, frequently resulting in managing organizational decline. The authors believe that the dominant concern should be with fostering organizational growth. To this end, they suggest that nonprofit board members and executives, as well as public sector leaders, need to concern themselves with the concurrent management of two agendas: Running the Shop and Meeting the Change Challenge. This can be done effectively through the use of strategic issue management, which is a set of techniques that represents a blend of traditional strategic management and change management approaches.     

Employment-based health benefits: analysis of the April 1993 Current Population Survey

The April 1993 CPS differs from the March 1993 CPS in a number of respects. The April 1993 CPS supplement surveys only workers, whereas the March CPS examines the noncash benefits received by all Americans. The April CPS asks workers about health coverage in the week in which the questions were fielded, whereas the March CPS asks about coverage in the preceding year. In April 1993, there were 112.5 million civilian American workers between the ages of 18 and 64 with jobs. Eighty-two million (73 percent) of them worked for an employer that sponsored a health insurance plan, and 65 million (58 percent of all workers) participated in their employer's health plan. About one-third of workers at firms with fewer than 10 employees had employers who offer health benefits; about one-quarter of all of the workers in these firms participated in their employer's plan. Conversely, 94 percent of workers at firms with more than 1,000 employees had an employer who sponsored health benefits, and over 77 percent of these workers participated in their employer's plan. There are 16.5 million American workers whose employers sponsored health benefits but who did not participate in these benefits. Over one-half of these workers (8.5 million) chose not to be covered. Another 36 percent of these workers (5.9 million) did not participate because they were ineligible or denied coverage. Over 66 percent of the ineligible workers did not participate because they were part-time, contract, or temporary workers. Another 26 percent had not yet completed a probationary period. Among the reasons that those who chose not to participate in their employer's coverage, the vast majority (75 percent) stated they were covered by another health care plan. Twenty-nine percent stated that they chose not to purchase coverage because it was too costly or that they did not need or want the coverage. In 1993, there were 16.7 million workers with no health insurance coverage. The vast majority of these workers (95 percent) were employed by private employers. Sixty-six percent of the workers with no health insurance coverage were self-employed or worked for firms with fewer than 100 employees.     

Making room for alternatives

Alternative healing is an idea whose time has come, and 1993 was the critical year for that recognition. So believes internist David Edelberg, founder of the Chicago Holistic Center. There patients can see one of four allopathic physicians as well as practitioners in 37 additional therapies, including acupuncture, infant massage, homeopathy, nutrition counseling, and Ayurvedic medicine.     

Taikongs and Calos: the role of middlemen and brokers in Javanese international migration

"This article discusses international migration from Java in the past and present and the role brokers have played in stimulating this movement. It describes legal and clandestine labor migration to Singapore, Malaysia, and Saudi Arabia, the influence of employment brokers on the process, and the organization of the recruitment networks. The involvement of brokers is crucial but not always beneficial for the migrants. Migrants are dependent on the brokers and risk exploitation. In the case of movement to Saudi Arabia, there is a linkage with religious institutions and the Islamic pilgrimage."     

Ropes course training for youth in a rural setting: “At first I thought it was going to be boring ...”

Outdoor structured activities, such as Ropes Challenge Courses, are typically utilized as interventions for youth coming from urban settings. Evaluation of such programs is scanty at best. In this instance, the course experience is used as a prevention tool for high risk youth in a remote, rural setting of high unemployment, alcohol problems, and low income. The authors discuss the effectiveness of this approach, and the intended and unintended consequences for the rural community at large. The evaluation design relies on extensive qualitative methodology as well as quantitative methods to capture the unique nature of this rural project.