Managed care operations and plan design

Plan design has come a long way from the days when all one had to do was figure out the right deductible, coinsurance and out-of-pocket amounts and consider some questions about competitive practice and employee perception. Today one must also consider systems capabilities, strategic fit, provider requirements and consistency of the logic supporting each payment decision.     

Medicare risk HMOs: careful consideration can yield rewards

Enlightened employers have discovered that Medicare HMOs, especially risk HMOs, offer employees and retirees a win-win alternative. They lower today's costs, controlling-term increases and offer the broadest, quality coverage. Implementing a "winning" Medicare risk HMO requires careful scrutiny of how the HMO operates and delivers care to the Medicare audience and depends on effective communication that is sensitive to the special needs of retirees.     

Book Reviews

Ross H, McLeod (ed.), Indonesia Assessment 1994: Finance as a Key Sector in Indonesia's Development, Research School of Pacific and Asian Studies, The Australian National University, Canberra, and Institute of Southeast Asian Studies, Singapore, 1994, pp. 353. $25.00; S$35.00; A$30.00.

Miranda S. Goeltom, Indonesia's Financial Liberalization: An Analysis of 1981–88 Panel Data, Institute of Southeast Asian Studies, Singapore, 1995, pp. xii + 93.

Joan Hardjono and Charles Warner (eds), In Love with a Nation: Molly Bondan and Indonesia, published by Charles Warner, Picton, NSW, 1995, pp. 256. A$16.95.

ln Love with a Nation is privately published and obtainable from the following Australian suppliers: Gleebooks, 49 Glebe Point Rd, Glebe 2037; Nusantara Bookshop, 72 Maroondah Hwy, Croydon 3136; or from Charles Warner, PO Box 194, Picton 2571. (If ordered from Charles Warner, price including postage is AS20 within Australia; A$25 to Europe, America or Africa; A$23 to Asia, Pacific.)     

Exploring the boundaries of the framing effect: The moderating roles of disparate expected values and perceived costs of judgmental errors

Framing effects on retail store choice decisions were investigated in four experiments. Subjects preferred the store that guaranteed (a sure option) good prices (experiment 1), product availability (experiment 2), or a rebate (experiment 3) when consequences were framed in terms of gains; subjects preferred the risky option when consequences were framed in terms of losses. Consistent with fuzzy-trace theory, framing effects were reduced when the expected values of options were disparate in a direction that disfavored sure gain or probabilistic loss options (experiment 2) and when the perceived costs of committing a judgmental error were high (experiment 3). Experiment 4 shows that the moderating effects of disparate expected values and costs of judgment errors generalize to within-subject designs.     

Finding a lasting cure for U.S. health care

In "Making Competition in Health Care Work" (July-August 1994), Elizabeth Olmsted Teisberg, Michael E. Porter, and Gregory B. Brown ask a question that has been absent from the national debate on health care reform: How can the United States achieve sustained cost reductions while at the same time maintaining quality of care? The authors argue that innovation driven by rigorous competition is the key to successful reform. A lasting cure for health care in the United States should include four basic elements: corrected incentives to spur productive competition, universal insurance to secure economic efficiency, relevant information to ensure meaningful choice, and innovation to guarantee dynamic improvement. In this issue's Perspectives section, eleven experts examine the current state of the health care system and offer their views on the shape that reform should take. Some excerpts: "On the road to innovation, let us not forget to develop the tools that allow physicians, payers, and patients to make better decisions." I. Steven Udvarhelyi; "Health care is not a product or service that can be standardized, packaged, marketed, or adequately judged by consumers according to quality and price." Arnold S. Relman; "Just as antitrust laws are the wise restraints that make competition free in other sectors of the economy, so the right kind of managed competition can work well in health care." Edward M. Kennedy "Biomedical research should be considered primarily an investment in the national economic well-being with additional humanitarian benefits." Elizabeth Marincola.     

Problem-solving in teaching/learning packages for Technology

In the project Technology in Secondary Education: Problem-solving in Teaching/learning Packages, two experiments regarding a construction problem and an explanation problem were conducted, in which two variants of a teching/learning package (strongly structuredvs. weakly structured) were compared. Only with the strongly structured instructional variant of the package for the explanation problem did the pupils come to a quick solution of the problem. In both experiments, the factors that influenced the problem-solving processes of the pupils were investigated. The results are of importance for curriculum developers and the authors of teaching/learning packages for Technology but further research into the factors influencing the problem solving process of pupils is necessary.     

Training,migration, and regional income disparities

"It is assumed that there are two regions, that production requires both skilled and unskilled labour, and that one region is innately more productive than the other. Workers, who differ in their migration or training costs, make individually rational decisions. In equilibrium the ratio of skilled workers to unskilled workers is always higher in the more productive region. Average incomes differ between regions because regional differences in wage rates are reinforced by regional differences in the structure of employment. The model is also used to analyse the effects of policies intended to equalize the distribution of income."