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.     

The influence of the farm size on the parity of a farming family in Poland

This paper aims at statistical identification of the relationship between the parity of farming families and the area of the farm and the role this variable plays among variables describing the model of families' parity. To reach this objective results of a questionnaire survey were used, one performed among the group of individual farmers' families keeping agricultural accounting in 1985. The analysis covered 1291 rural farming couples who married in the years 1920-1984. According to the results obtained, the thesis posed by W. Stys with regard to positive relationships between parity in a family and the farm's area only relates to marriages entered into between 1920-1964. In single five-year marriage cohorts, a change of shape of this relationship was observed. It took the shape of a parabolic function or polynomial of the third order. The research results showed that in marriage cohorts with finished fertility, variable area of the farm turned out to be almost insignificant in explaining changes in the number of live born children compared to other demographic factors, especially cultural and demographic ones.     

The power of boards in service providing agencies: three models

Tensions in the relationship between boards and staff are a common feature of voluntary and nonprofit agencies which deliver services. Many of the difficulties reflect lack of clarity about the power of boards. The author describes three models of governance: traditional, membership, and entrepreneurial. Each model has different implications for the power of a board in relation to staff. Practitioners in nonprofit service delivering agencies in the UK have found the models to be a useful tool for explaining the practical difficulties they experience.     

Non-profit institutions in a flow of funds framework

The benefits of providing a separate accounting for non-profit organisations in the financial accounts of the United States are discussed. At present, national economic accounts in the US include non-profit organisations with individuals in the household sector; separate information on the financial activity of non-profit institutions until now has not been available. In this paper, aggregate statistics from federal government tax-exempt filings for non-profit institutions are put into a US flow-of-funds framework. The data for the 1982–1988 period indicate that non-profit institutions accounted for a significant and growing proportion of assets of the household sector in the United States. Their liabilities were also a surprisingly large share of the household sector total. Moreover, funds supplied by the non-profit sector for investment were in some years comparable to funds made available by several important groups of non-depository financial intermediaries. Separate accounting for non-profit organisations within national economic accounts would be likely to reveal an important channel for investment financing in the United States and would significantly improve our ability to measure and analyse the financial activity of individuals by allowing for a purer household sector.The analysis and conclusions set forth are those of the authors and do not necessarily indicate concurrence by Salomon Brothers, the Board of Governors, Federal Reserve Banks or other members of their staffs.     

The new health care civilization: integration of physician land and manageria

Changes occurring in health care demand that physicians expand their professional knowledge and skills beyond the medical and behavioral sciences. Subjects absent from traditional medical education curricula, such as the economics and politics of health care, practice management, and leadership of professional organizations, will become important competencies, particularly for physicians who serve in management roles. Because physicians occupy a central role in planning and allocating medical care services and other health care resources, they must be better prepared to work with other health care professionals to create a new civilization, even if this means leaving the cloistered domain of "physician land" to serve as interface professionals between the delivery of medical services and the management of health care. Our research findings and conclusions strongly suggest that economic, management, and leadership competencies need to be incorporated into the professional development of physicians, especially in postgraduate and continuing education curricula.     

DO RESPONDENTS REALLY "MARK ALL THAT APPLY" ON SELF-ADMINISTERED QUESTIONS?

An experiment was conducted to assess the effect of using "markall that apply" question instructions on survey reporting aspart of the field test for the Second Follow-up of the NationalEducation Longitudinal Study of 1988 Eighth Graders (NELS:88).Mark-all-that-apply instructions were compared with instructionsasking respondents to indicate "yes" or "no" to each responseoption on responses to three items dispersed throughout thequestionnaire and consisting of different topics and numbersof response options. For the three items, significantly fewerresponse options were selected with the mark-all-that-applyinstructions than with the yes/no instructions, but becauseexternal validity criteria were not available, overreportingto the yes/no instructions cannot be ruled out. Instructiondependentprimacy effects, predicted under the hypothesis that respondentswould engage in more superficial processing when given the mark-all-that-applyinstructions, were not found.     

Women's legal knowledge: a case study of Mexican urban dwellers

In Mexico, the nongovernmental organization Sevisio, Desarrollo y Paz, A.C. (SEDEPAC) is helping poor women acquire legal knowledge in an economic climate characterized by the increased feminization of poverty brought about by the Structural Adjustment Program. The Mexican legal system is grounded in a patriarchal tradition, and the codified laws continue to favor men. Women were not granted full citizenship until 1953, and discrimination against women was not addressed in Mexican law until 1974 as the country prepared to host the First UN International Women's Conference. However, legal advances are not being applied in the family or in larger society where men remain in power. Mexico also distinguishes between private law and public law. Because domestic violence falls in the realm of private law, authorities are loathe to follow-up on women's complaints in this area. Since its founding in 1983, SEDEPAC has applied a gender perspective to its activities and programs. SEDEPAC held its first women's legal workshop in 1987 and realized that most poor women have no knowledge of existing laws or their rights, that alternative legal services for women are scarce, that existing laws must be changed, and that the authoritarian and conservative legal system helps maintain cultural stereotypes. Since then, SEDEPAC has held annual workshops, follow-up meetings, and training sessions and has provided counseling. The main topics addressed are women's social conditions; violence and the penal code; civil rights, power, and dependency; women's bodies and reproductive rights; and women's organization and leadership. The workshops use techniques of popular education such as group participation and use of gossip as a communication tool. The workshops have changed participants' lives and led to the formation of an independent Popular Defenders' Coordination.     

Capitation and informatics

When physicians, hospitals, and allied health professionals bill for services they render, their information processing requirements are relatively simple, at least compared to those of capitated organizations. When payers (insurers or employers) accept financial risk for the health care services of beneficiaries, they have usually invested in claims processing, membership tracking, and, under managed care, utilization review and provider profiling systems. But payers, for the most part, have not invested in electronic collection of clinical information about beneficiaries, nor have they tended to keep all claims they have processed in electronic form for study after accounts are settled and payments disbursed. In this article, we will explore why informatics is so important to capitated organizations and why payers that have traditionally taken financial risk for insuring the health care costs of populations are also learning about the importance of informatics.