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PubMed2005

It's a bet! A problem-solving approach promotes the construction of contingent agreements.

Negotiators often have different expectations about the future. A contingent agreement, or a bet that makes the ultimate outcome dependent on some future event, builds on negotiators' differences. The authors argue that a problem-solving approach, in which negotiators thoroughly explore options to build on their differences, is most likely to construct contingent agreements. The authors explore two factors expected to influence this problem-solving approach, namely, negotiators' relational and accountability concerns. The authors argue when these considerations are imbalanced, negotiators are less likely to adopt a problem-solving style and construct a contingent agreement. To test this hypothesis, negotiators' relationships and accountability pressures were manipulated in two experiments. In Experiment 1, participants engaged in an integrative negotiation, allowing the authors to examine whether a contingent agreement was constructed and joint gain. Experiment 2 sought to replicate and extend the findings of Experiment 1 using a scenario study. Results across the two experiments support the authors' hypotheses.

Cooperative Behavior↗
PubMedDate not supplied

Problem solving, contention, and struggle: how siblings resolve a conflict of interests.

In a laboratory setting, 48 sibling dyads age 4 and 6 or 6 and 8 years negotiated the division of six toys. Findings revealed that, in general, children reached divisions while using a preponderance of constructive problem-solving strategies, rather than contentious tactics. The degree of conflict of interests and the quality of sibling relationships predicted the children's use of problem-solving and contentious negotiation strategies, and was related to the types of resolutions achieved. Dyads experiencing low conflict of interests resolved their differences quickly. High conflict of interests coupled with positive relationships and constructive negotiation resulted in longer negotiations and creative, agreeable resolutions. High conflict of interests coupled with more negative relationships and destructive negotiations resulted in children's failures to reach agreement. Developmental differences indicated that older siblings within the pairs took the lead in negotiation, and benefited slightly more from the divisions. Furthermore, children in older dyads were more sophisticated and other oriented in their negotiations.

Child↗
PubMed2005

Equilibria, prudent compromises, and the "waiting" game.

While evaluation of many e-negotiation agents are carried out through empirical studies, this work supplements and complements existing literature by analyzing the problem of designing market-driven agents (MDAs) in terms of equilibrium points and stable strategies. MDAs are negotiation agents designed to make prudent compromises taking into account factors such as time preference, outside option, and rivalry. This work shows that 1) in a given market situation, an MDA negotiates optimally because it makes minimally sufficient concession, and 2) by modeling negotiation of MDAs as a game gamma of incomplete information, it is shown that the strategies adopted by MDAs are stable. In a bilateral negotiation, it is proven that the strategy pair of two MDAs forms a sequential equilibrium for gamma. In a multilateral negotiation, it is shown that the strategy profile of MDAs forms a market equilibrium for gamma.

Algorithms↗
PubMed2005

Conflict's consequences: effects of social motives on postnegotiation creative and convergent group functioning and performance.

Two studies tested the effects of social motives during negotiation on postnegotiation group performance. In both experiments, a prosocial or a proself motivation was induced, and participants negotiated in 3-person groups about a joint market. In Experiment 1, groups subsequently performed an advertisement task. Consistent with the authors' predictions, results showed that proself groups performed worse on the convergent aspects of this task but better on the divergent aspects than prosocial groups. In Experiment 2, the authors manipulated social motive and negotiation (negotiation vs. no negotiation), and groups performed a creativity task (requiring divergent performance) or a planning task (requiring convergent performance). Proself groups showed greater dedication, functioned more effectively, and performed better than prosocial groups on the creativity task, whereas prosocial groups showed greater dedication, functioned more effectively, and performed better than proself groups on the planning task, and these effects only occurred when the task was preceded by group negotiation.

Adult↗
PubMed2001

Making the best of corporate integrity agreements.

Corporate integrity agreements (CIAs) imposed by the Office of Inspector General (OIG) of HHS have increased dramatically in the past five years. Healthcare organizations that enter into a CIA face burdensome monitoring and reporting requirements. However, it may be possible to lessen these burdens by negotiating modifications to the CIA's requirements. Organizations that have compliance programs in place can negotiate with the OIG to integrate elements of their existing compliance programs into the CIA. The organization also should attempt to negotiate limiting the scope of the monitoring to include only the area that was originally investigated. In addition, it may be valuable to negotiate insertion of a clause in the CIA allowing the organization to request renegotiation of the terms and duration of certain elements of the agreement after the first year, if conditions are met. An organized CIA negotiation process may be valuable in obtaining a reduced scope of the procedures required by the CIA and preparing the organization to meet its obligations.

Annual Reports as Topic↗
PubMed1993

How expenditure caps and expenditure targets really work.

Every organized payment system must contain its costs in order to keep within revenue without denying benefits. Fixed expenditure caps requiring the provider to operate within its annual financial grant can be imposed on organizations like hospitals, but are fiercely resisted by the medical profession. All financial arrangements with doctors are negotiated, including systems of fixed expenditure caps and more flexible expenditure targets. If the doctors accept the principle of caps and cooperate in achieving them, they do so only as part of a negotiated settlement to avoid a worse outcome. Government's power is minimized, even when government is the payer. Caps on the physicians' sector are unusual. Instead, we see the spread of flexible targeting systems, wherein cost overruns are compensated for by lower expenditure targets the following year. Medical associations in all countries resisted even these restraints for years, but eventually accepted them, provided that target setting, judgments of overruns, utilization control, and all other features are part of a joint negotiating system. Targeting systems are often complicated because they preserve the semiprivate character of statutory health insurance and they are the result of negotiated compromises. To succeed in controlling costs, they require the cooperation of the medical association and of the rank-and-file doctors--but they can succeed. The United States has enacted a small-scale targeting system for Medicare physician payments alone. It cannot become the method for universal health insurance, which must heed lessons from abroad. Only an all-payer system can cover an entire population and contain the costs of the system. A few government officials cannot dictate and implement expenditure goals, but a system of consultation is required for setting and carrying out targets. Impartial officials can regulate hospitals according to the guidelines produced by the consultations, but the record of the medical profession in the countries reviewed here is that they insist on negotiating the final rules and rates. Americans have become bewitched by the mirage of econometric formulas automatically governing a sector, but the real problem is to devise and operate a harmonious decision-making system.

Canada↗
PubMed2002

The variable stiffness colonoscope: assessment of efficacy by magnetic endoscope imaging.

BACKGROUND: Variable-stiffness colonoscopes combine the flexibility of pediatric instruments for negotiation of the sigmoid colon with the ability to stiffen the insertion tube to prevent or control looping after straightening. Previous studies have found wide variation in the efficacy of the stiffening mechanism. Thus, two studies were conducted to assess the potential benefit of the stiffening device and its optimal use. METHODS: In study 1, the effect of routinely stiffening the straightened variable-stiffness colonoscopes in the mid-descending colon was determined in 82 patients. Two insertions were performed (mid-descending colon to cecum) in each patient with and without application of the stiffening device (randomized). The time to negotiate the proximal colon (mid-descending to cecum), time to pass the variable-stiffness colonoscopes across the splenic flexure into the transverse colon, time to pass the right colon, and ancillary maneuvers used were recorded for each insertion. In study 2, consecutive patients, excluding any with previous colonic resection, were examined by using standard adult variable-stiffness colonoscopes. Real-time views of the procedure with magnetic endoscope imaging were recorded for all examinations, but procedures were randomized to be done either with (n = 88), or without (n = 87) the endoscopist viewing the magnetic endoscope imaging display. Whenever stiffening was applied, the anatomic location of the colonoscope tip and stiffness efficacy were recorded. RESULTS: In study 1, time taken to negotiate the proximal colon (p = 0.0041) and time to negotiate the splenic flexure (p = 0.006) were significantly shorter and ancillary maneuvers performed were fewer (p = 0.0014) with the stiffening device activated. In study 2, stiffening was used with similar frequency in patients examined with and without the magnetic endoscope imaging view, most commonly for passing the splenic flexure (71%), but also in the transverse colon (12%), right colon (9%), and sigmoid/descending colon (8%). Stiffening was significantly more effective when used in combination with magnetic endoscope imaging (69% with imager vs. 45% without imager; p = 0.0102). CONCLUSIONS: Overall, the variable-stiffness device used was effective in controlling looping 57% of the time. Activating maximum stiffness appears to be effective once the sigmoid colon has been negotiated and the colonoscope straightened with the tip in the proximal colon, reducing the number of ancillary maneuvers and shortening the insertion time through the proximal colon. Routine magnetic endoscope imaging further enhances the efficacy of the variable-stiffness colonoscopes by helping to identify the optimal time for stiffening.

Colon↗
PubMed1990

Purchasing principles to reduce acquisition and inventory costs.

Knowing how, what, when, and where to negotiate are all part of the system that finally determines how much you pay for products and services. Knowing the primary and secondary objectives of materiel management is important in establishing purchasing and inventory policies and procedures. Negotiating all of the terms and conditions up front, before you finalize any deal, is important to minimize your acquisition, operating, disposal, and inventory costs and to maximize profit. Most purchasers and negotiators only bargain for part of the costs; then they have to bargain to try to control the rest of the costs or they are at the mercy of others. Prepare to negotiate for all the factors that will influence the final operating cost from the beginning to the end of the negotiation process.

Communication↗
PubMed1989

Cost containment and physician payment methods in The Netherlands.

Cost containment in the Netherlands has been partly achieved by negotiated agreements between insurers and physician associations. The negotiating system in the Netherlands involves the determination of capitation and fee-for-service rates, based on negotiated norms for personal remuneration, practice costs, and practice size. Physician practice patterns are monitored in an effort to control volume. Selected aspects of the negotiating structure could be adopted by Medicare and HMOs to clarify issues in negotiations with physicians and to reimburse physicians more equitably. However, establishment of standardized fees and volume monitoring may not be as effective as global expenditure controls.

Cost Control↗
PubMed2001

Condom use, power and HIV/AIDS risk: sex-workers bargain for survival in Hillbrow/Joubert Park/Berea, Johannesburg.

Through interviews with 50 female sex-workers in the Hillbrow/Berea/Joubert Park area of Johannesburg, this paper explores sexual negotiations between men and women in the sex industry. This paper focuses on factors that affect sexual decision-making including safer sex practices. In moving beyond approaches that emphasize women's 'powerlessness' in sexual negotiation, this article focuses on ways in which sex-workers capitalize on clients' reluctance to use condoms in sexual exchanges. We emphasize sex-worker's agency and use a broader, Foucauldian understanding of power, which couples power with resistance. Further, this paper examines other elements of the sex industry that contribute to unsafe sex such as competition between women for clients and violence in the industry. Finally, this paper suggests that HIV-prevention programs take cognizance that power negotiations between men and women cannot be simplistically understood as men having power and women being powerless. Rather, this article contributes to a growing body of literature in medical anthropology, which elucidates the complexities of sexual negotiations between men and women. This focus on agency is important in trying to lessen the stigma and discrimination that sex-workers face at the hands of clients, pimps/managers, police and health care workers.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Relationship between coping strategies and depression among employed Korean immigrant wives.

Coping strategies, such as working harder and negotiation, may have an effect on depression for employed Korean immigrant wives. Additionally, income and education have been associated with depression in previous research. A cross-sectional survey research design was used to explore which coping strategies and demographic variables were significantly related to depression for employed Korean immigrant wives. The results of multiple regression analysis revealed that coping strategies and demographic variables accounted for 24% of the variance in depression. Specifically, as wives worked harder cleaning the house, their depression increased, whereas when they negotiated with their husbands, they were less likely to be depressed. To enhance negotiation among Korean wives, mental health nurses need to work within the community to foster the development of cultural and traditional norms that sanction negotiation between husbands and wives.

Adaptation, Psychological↗
PubMed2001

The female condom, a tool for empowering sexually active urban adolescent women.

Adolescent women are at high risk of sexually transmitted diseases/human immunodeficiency virus (STDs/HIV) because of physiologic susceptibility and risky sexual behavior. The latter may be related to the "personal factors" of self-efficacy, sexual knowledge, self-esteem, and ability to communicate/negotiate. In the current study, near-peers attempted to have an impact on these factors by using the female condom as a negotiating tool for safer sex in a group of 100 urban adolescent women recruited from an adolescent health center waiting room. This pilot study consisted of a questionnaire, a workshop on how to use the female condom and negotiate its use, and follow-up interviews at 1 and 4 months. Demographics of the study sample define a multiethnic (40% black, 33% Hispanic) group in late adolescence (average age 18 years) completing high school. At baseline, 18% evidenced depression, 62% had moderate-to-low self-esteem, 91% had an internal locus of control. At baseline, male condom use in the prior 6 months was 28% always, 51% inconsistently, 21% never. When baseline and follow-up scores were compared, there was a statistically significant increase in sexual knowledge and self-efficacy, together with the suggestion of improved negotiating skills. At 1 month, 50% (20/40) had tried the female condom, and 17 of these women planned to use it in the future. Total percentage of protected sex acts increased significantly during the follow-up period through increased use of both the male and female condoms. The data suggest that adolescent women will accept the female condom and can be empowered to protect themselves from STDs/HIV through its application or through the using of it as a negotiating tool.

Adolescent↗
PubMed1997

Physician relations in Canada: shooting inward as the circle closes.

As economic disputes between physicians become more frequent, discussions between physicians are becoming increasingly important. Those seeking insight into how physician organizations might mediate these disputes may be able to learn from others who have had negotiating responsibilities for over a quarter of a century--the provincial medical associations in Canada. In this article we examine the structure, process, and outcomes of negotiations between physicians, with a focus on responses to new physician expenditure caps in Ontario, Alberta, and British Columbia. Early negotiations between physicians over changes in relative fees favored general practitioners because they were the dominant voting block within the associations. Despite fewer gains in the fee arena, specialists were willing to remain in the associations because all physicians generally enjoyed similar income growth. Under new physician expenditure caps, however, physicians have been unable to resolve conflicts over how to allocate income limits across specialties. Negotiations between physicians face expanding economic issues and diverging interests as expenditure caps force physicians to concentrate on total costs.

Alberta↗
PubMed1995

Health care purchasing and market changes in California.

This paper analyzes the process and outcomes of collective negotiations among large private employers and health maintenance organizations (HMOs) in California. In 1994, prior to collective negotiations, differences in benefit packages, risk mix, and volume of purchasing accounted for only one-third of the variance in premiums among firms and HMOs. The 1995 collective negotiations reduced the variance by 22 percent and the enrollment-weighted mean premium by approximately 9 percent, while enriching the standard benefit package. Savings for the eleven participating firms totaled $36.5 million. Large purchasers are reducing the number of health plans offered to their employees, standardizing the benefit package, using collective negotiations to contain costs, and shifting from vendor to partner relations with HMOs.

California↗
PubMed1998

Determining when integrated delivery systems should belong to GPOs.

Membership in national group purchasing organizations (GPOs) is a proven way for healthcare organizations to access supply price discounts through collectively negotiated contracts. Yet, for various reasons, both suppliers and healthcare materials managers have expressed dissatisfaction with GPOs. Integrated delivery systems (IDSs), in particular, may find that negotiating with suppliers independently is a more cost-effective alternative. Whether an IDS should participate in group purchasing or negotiate with suppliers on its own depends on the following factors: whether the IDS would find it relatively simple to get its clinicians to standardize on certain key supplies; whether the IDS has sufficient staff to devote to contracting; whether the benefits offered by the GPO do not outweight the costs of membership; and whether all of the supplier products and services the GPO makes available also are available through second-tier suppliers eager to negotiate directly with the IDS.

Consumer Behavior↗
PubMed2001

Managing patient demand: a qualitative study of appointment making in general practice.

BACKGROUND: Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments. AIM: To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations. DESIGN OF STUDY: A qualitative study using participant observation. SETTING: Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice. METHOD: Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists. RESULTS: Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments. CONCLUSION: Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria.

Adolescent↗
PubMed2002

Research-tool patents: issues for health in the developing world.

The patent system is now reaching into the tools of medical research, including gene sequences themselves. Many of the new patents can potentially preempt large areas of medical research and lay down legal barriers to the development of a broad category of products. Researchers must therefore consider redesigning their research to avoid use of patented techniques, or expending the effort to obtain licences from those who hold the patents. Even if total licence fees can be kept low, there are enormous negotiation costs, and one "hold-out" may be enough to lead to project cancellation. This is making it more difficult to conduct research within the developed world, and poses important questions for the future of medical research for the benefit of the developing world. Probably the most important implication for health in the developing world is the possible general slowing down and complication of medical research. To the extent that these patents do slow down research, they weaken the contribution of the global research community to the creation and application of medical technology for the benefit of developing nations. The patents may also complicate the granting of concessional prices to developing nations - for pharmaceutical firms that seek to offer a concessional price may have to negotiate arrangements with research-tool firms, which may lose royalties as a result. Three kinds of response are plausible. One is to develop a broad or global licence to permit the patented technologies to be used for important applications in the developing world. The second is to change technical patent law doctrines. Such changes could be implemented in developed and developing nations and could be quite helpful while remaining consistent with TRIPS. The third is to negotiate specific licence arrangements, under which specific research tools are used on an agreed basis for specific applications. These negotiations are difficult and expensive, requiring both scientific and legal skills. But they will be an unavoidable part of international medical research.

Developing Countries↗
PubMed1995

The pathologist and managed care. Integration into the new health care delivery system.

As the health care system evolves, managed care plans are expanding rapidly, and pathologists face radical changes in contractual relationships and payment methodology. As a result, entirely new relationships will often need to be negotiated to adapt successfully. The experience of pathologists in areas where there is already high market penetration by managed care plans can be used in strategic planning, learning to gain entry to negotiations, and planning what and how to negotiate. Proper preparation is critical to successful negotiations in our new health care system and requires an understanding of capitation, contracting risks, and opportunities.

Capitation Fee↗