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PubMed1989

Most-favored-nation clauses and monopsonistic power: an unhealthy mix?

Most-favored-nations clauses appear in health insurance contracts allegedly to prevent price discrimination by health care providers among competing insurers. In fact, use of these provisions often works to exclude competitors from the health insurance market. This Note examines the antitrust implications of most-favored-nations clauses as used in the health insurance industry.

Economic Competition↗
PubMedDate not supplied

Pitfalls and promises of diversification.

Diversification came upon the health-care scene with the promise of an expanded market base and financial solvency for all. Now with several diversification models advanced and successes and failures widely available for examination, what do we know about the potential pitfalls and promises of diversification? This article will present an overview of tried diversification models and analyze opportunities for success and warning signals of financial risk.

Economic Competition↗
PubMed1985

Nonmammalian sources of eicosanoids.

Despite the considerable effort expended in the exploration of alternative, large-scale sources of eicosanoids, the first-discovered nonmammalian source--the gorgonian Plexaura homomalla--remains by far the most impressive. The evolutionary reasons for the huge concentrations of prostaglandins in this coral and the origin of the dependence of C-15 configuration on geographical location still constitute fascinating areas for speculation and research. Although the coral provided an extremely valuable interim source of prostaglandins between the eras of biosynthesis and total chemical synthesis, the best of the many synthetic routes now available offer the advantages of versatility and unlimited scale-up potential, and are economically competitive as well. Partial synthesis from various readily available iridoid glycoside intermediates still appears to be an attractive alternative for the preparation of selected eicosanoids. The discovery of unusual eicosanoids such as hybridalactone and the clavulones demonstrates that the oxidative metabolism of C20 unsaturated fatty acids may be considerably more complex than yet realized. The discovery of additional structurally novel, biologically significant eicosanoids from both animal and plant sources can be predicted with virtual certainty. Given the low levels of C20 unsaturated fatty acids in most plants, it is not surprising that the levels of oxidized eicosanoids (e.g., prostaglandins) observed to date in plants have also been very low. The levels were sufficient, however, to dispel the long-popular notion that prostaglandins existed only in the animal kingdom. Plants such as the mosses and ferns mentioned earlier (3,55), which contain unusually large amounts of arachidonic acid, seem to be particularly promising species in which to search for additional novel eicosanoids. In addition to new structures, further information regarding the physiological role of eicosanoids in plants will undoubtedly be forthcoming.

Animals↗
PubMed1986

Returns on equity for not-for-profit hospitals.

This study examines the circumstances in which a large third-party payer or regulator might want to set hospital prices to yield a positive rate of return on equity capital. The level of return is shown to depend on the willingness of donors to make funds available in the community relative to the (derived) demand for capital to produce output. It is shown that the appropriate price might well be set to yield a zero or below-market return, and that the return to not-for-profit firms should generally be less than that to for-profit firms, if for-profit firms are to be active in the market.

Capital Financing↗
PubMed1987

Resource allocation in health care: the allocation of lifestyles to providers.

The objective of this article has been to draw the spotlight onto a much neglected facet of the discussion on resource allocation in health care: the process by which society decides what lifestyle the providers of health care may extract, directly or indirectly, from the patient's pocket book. Given the slice of the GNP society surrenders to the providers of health care collectively, the quantity of real health care resources made available to patients obviously varies inversely with the elevation of the lifestyle attained by the providers. These reflections have been triggered by a vexing paradox plaguing contemporary American health care: incessant talk about rationing in the midst of plenty. Conference after conference in this country has been dedicated in recent years to the "agonizing choices visited upon American health care by the age of restricting resources." Remarkably, few of the avid conference organizers, and few of their fiery orators, ever stop to think just what resource flow has actually been constricting. Has it been the supply of physicians? Has it been the supply of hospital beds? Has it been the flow of real purchasing power into the health care system? In general, the preference has been to bypass these questions altogether and to lament in a data-free context. What has been contracting in American health care has not been the flow of money into the sector, nor the flow of professionals, facilities, and entrepreneurs seeking to to do well there by doing good, but, if anything at all, the flow of real health services from providers to patients, certainly to patients who are uninsured and of modest means. And what seems required to solve the sector's problem is not so much an infusion of yet larger sums of money, but a decision-making algorithm capable of using the money already in the system to redirect real health care resources from persons who now receive perilously too many health services to persons who now receive perilously too few. Part of such an algorithm, of course, would be a sensible determination of the lifestyles the health care process needs to support among the providers of care. Under the ideal circumstances envisaged by libertarian thinkers, the determination of these matters could safely be entrusted to the free market. For reasons not difficult to fathom, however, no modern society is willing to adopt that form of arbitration over resource allocation in health care.(ABSTRACT TRUNCATED AT 400 WORDS)

Canada↗
PubMed1987

Implications of changes in healthcare for biomedical communications.

Payment for medical services on the basis of DRGs and other innovations in medical care are restricting the income of major medical institutions. This has resulted in decreased demand for biomedical communication services (and more cost awareness) in support of traditional educational and patient care programs and an increased demand for services to support institutional public relations and marketing programs. Biomedical communications will need to respond to this fluid environment by broadening its institutional role and adopting new information technologies.

Computer Communication Networks↗
PubMed1988

Undocumented Mexican immigrants and the earnings of other workers in the United States.

This article examines the effects of undocumented Mexican immigrants on the earnings of other workers in geographical labor markets in the Southwest. The number of undocumented Mexicans included in the 1980 census in southwestern SMSAs is estimated. We then estimate the parameters of three specifications of a generalized Leontief production function with various demographic groups as substitutable factors. The statistically significant effects of undocumented Mexicans on the earnings of other groups are positive, but of slight magnitude. Legal immigrants' effects on native white earnings, however, are small and negative. The results are consistent with the possibility that undocumented Mexican immigrants' jobs complement those of other workers. The implications for public policy concerns about the effects of illegal Mexican immigration are discussed.

Economic Competition↗
PubMed1988

Vertical restraints among hospitals, physicians and health insurers that raise rivals' costs. A case study of Reazin v. Blue Cross and Blue Shield of Kansas, Inc. and Ocean State Physicians Health Plan, Inc. v. Blue Cross and Blue Shield of Rhode Island.

Two recent district court opinions consider whether affiliations among hospitals, doctors and health insurers--through contract or ownership--violate the antitrust laws. This Article applies a raising rivals' costs framework to the facts of those cases in order to assess whether the practices at issue were unreasonable.

Blue Cross Blue Shield Insurance Plans↗