Violations of Service Fairness and Legal Ramifications: The Case of the Managed Care Industry

Adapted from Chan's (2000) model depicting success of litigation, this paper argues that with the application of various legislation, health maintenance organizations' (HMOs') violations of service fairness to each group: enrollees, physicians, and hospitals give rise to each group's lawsuits against the HMOs. Various authors (Bowen et al., 1999; Seiders and Berry, 1998) indicate that justice concepts such as distributive, procedural, and interactional justice can be applied to the area of service fairness. The violation of these underlying justice principles with HMOs' service unfairness to enrollees, physicians, and hospitals is examined. A general synopsis of the ethical issues in the managed care industry is provided. The various lawsuits launched by each group: enrollees, physicians, and hospitals together with the key statutes used are discussed. This paper also highlights the provisions and ramifications of the 11 April 2000 landmark agreement that Aetna made with Texas Attorney General John Cornyn to settle the 1998 lawsuit brought against the company. Lastly, the current ethical issues in the managed care industry are further discussed. The value of this paper can be adapted to the study of organizations' service fairness violations in other industries or in the educational, governmental, and not-for-profit sectors both nationally and internationally.     

The Effects of Occupational Injuries After Returns to Work: Work Absences and Losses of On-the-Job Productivity

We extend the research on postinjury employment by estimating productivity losses for workers with permanent partial disabilities (PPDs) in the first three years after injury. Our method distinguishes between productivity losses attributed to spells of work absence versus reduced earnings during spells of employment. The method is applied to data for 800 Ontario workers with PPDs. The results document large productivity losses persisting at least three years after injury, with different loss patterns for workers returning to stable versus unstable employment. Human capital investments or job accommodations can reduce productivity losses, but the significant determinants of losses differ for the stable versus unstable employment groups.     

Predicting corporate financial distress: Reflections on choice-based sample bias

Financial distress precedes bankruptcy. Most financial distress models actually rely on bankruptcy data, which is easier to obtain. We obtained a dataset of financially distressed but not yet bankrupt companies supplying a major auto manufacturer. An early warning model successfully discriminated between these distressed companies and a second group of similar but healthy companies. Previous researchers argue the matched-sample design, on which some earlier models were built, causes bias. To test for bias, the dataset was partitioned into smaller samples that approach equal groupings. We statistically confirm the presence of a bias and describe its impact on estimated classification rates.     

Poor relief in Elizabethan English communities: an analysis of Collectors' accounts

This article analyses 30 accounts of income and expenditure left by Collectors for the Poor in Elizabethan England, before the period known as the old poor law. Collectors were appointed by parishes and incorporated boroughs in accordance with the poor laws of 1552 and 1563, but few of their fragile records survive. The accounts examined here document early use of compulsory rates to provide income, but several features of the distribution of relief differ from patterns common in the seventeenth and eighteenth centuries. Adult male recipients outnumbered women in many of the parishes; children were frequently helped directly; and cities and towns assisted a smaller fraction of their total populations than did villages but awarded larger per capita payments. Accounts from the 10 villages and small towns analysed most fully show that Elizabethan Collectors were moving away from the late medieval practice of providing only occasional aid; increasingly they awarded regular payments to a selected subset of the local poor. Comparison with the early seventeenth century suggests that the poor laws of 1598 and 1601 contributed to a transition that was already underway but did not create a new system of relief.     

Making compassion count: equal recognition and authentic involvement in mental health care

Compassionate care within mental health services is often taken for granted as something that can be made visible and authentic. However, recent government reports and policy suggest that we are far from providing compassionate care and may be more focused upon risk and surveillance. This paper will discuss the visibility of compassionate care and explore outcomes that consumers and practitioners could measure in practice. Separating the fact from fiction within compassionate care will make authentic involvement practices more visible and open to discussion around consumer collaboration. In a qualitative analysis of a small study with mental health consumers, compassion was found to be a major factor in whether consumers became more involved in their own health care. Demonstrating compassionate care may therefore also demonstrate consumer participation and engagement. This paper will argue that compassionate care can be observed in the relationships between practitioners and consumers that are collaborative and use presence and persistence as methods of practice. Emancipatory practices can be made more visible in mental health care in order to make compassion measurable and to encourage consumer participation and engagement.     

The Impact of the Inpatient Prospective Payment System and Diagnosis-Related Groups

Abstract

The outpatient prospective payment system for the Medicare program became effective Aug. 1, 2000, as mandated by the Balanced Budget Act of 1997. This outpatient program complements Medicare’s inpatient prospective payment system, which was introduced in 1983. A survey of the literature over the past 20 years is undertaken to review the effects of the inpatient prospective payment system and diagnosis-related groups (DRGs) on inpatient hospital utilization, expenditures, and outcomes. The level of the DRG payment has been questioned, as well as the process of adjusting the payment levels from one year to the next. In addition, past research has speculated that the DRG classification may not be sensitive to severity and is subject to coding ambiguities. These conclusions can be used as input to future research on the new outpatient program, as well as updating research on the inpatient program.     

A Note on Laurence Seidman’s Article

Mihail Manoilescu was among the foremost intellectual figures of the interwar period in Romania. He was known as a politician and central banker, as well as an economist. From the very beginning of his theoretical and practical career, or at least from the late 1920s onward, Manoilescu’s ideas and theories (especially his corporatist theory) were marked by clear continuity and consistency based on the theory of protectionism grounded on productivity differences. By developing his model — an alternative to the theory of comparative advantage — Manoilescu endeavored to show the need for protectionist measures to promote the development of peripheral countries. His defense of protectionism is usually presented as clumsy and founded on an incorrect method, even if he is often recognized as the forerunner of the theory of unequal exchange and the dependency theory. Few scholars note the similarity of Manoilescu’s theory with Karl Marx’s labor theory. This paper contributes to validating Manoilescu’s conclusions, the soundness of which we test here by reconstructing the theory from a Marxian perspective. A reconstruction of this type offers new possibilities of evaluating his theory and a better understanding of its contributions and limitations.     

Are We Sending Mixed Messages? How Philosophical Naturalism Erodes Ethical Instruction

To develop critical thinking skills, higher order ethical reasoning, a better grasp of the implications of ethical decisions, and a basis for ethical knowledge, it is necessary to explore the philosophical premises foundational to one’s ethical persuasion. No philosophical premises are more important than those pertaining to the nature of human personhood and business’ responsibility to respect the inherent value of human beings. Philosophical naturalism assigns the essence of human personhood strictly to causal interactions of physical matter. Substance dualism, on the other hand, posits both a physical aspect and an immaterial substance to personhood, interacting within the totality of each being. This paper argues for the logical superiority of substance dualism in achieving the overriding objective of discerning ethical knowledge. Substance dualism offers a better explanation – and one that more closely follows the way most people commonly experience themselves and others–than naturalism for free agency and accountability, meaningful moral standards, confidence in knowing what ethical decisions to make, and the moral drive residing in conscience. Marjorie J. Cooper (aka Caballero), Ph. D. is a Professor of Marketing in the Hankamer School of Business at Baylor University in Texas. She received her B.A. from Wheaton College in 1970, her M.B.A. from Oklahoma City University in 1977, and her Ph. D. in Business Administration from Texas A&M University in 1981. Her articles have appeared in the Journal of Marketing, Journal of Advertising, Journal of the Academy of Marketing Science, Journal of Advertising Research, Journal of Business Research, Psychology & Marketing, Journal of Professional Selling & Sales Management, Journal of Business & Industrial Marketing, Business Horizons, Journal of Promotion Management, Journal of Small Business Management, Human Systems Management, and elsewhere.