PHYSICIANS' COST SHIFTING BEHAVIOR: MEDICAID VERSUS OTHER PATIENTS

Much of the debate about rising health care costs in the United States centers on the notion of "cost shifting." Cost shifting is loosely defined as charging one set of patients a higher price to offset losses on another set of patients. One aspect of the cost shifting debate that the empirical work has ignored is whether or not doctors—as opposed to hospitals—practice cost shifting. The analysis here investigates this question using the Physicians' Practice Costs and Income Survey, 1983–1985 (PPCIS, expanded version)
Using variation across states in Medicaid reimbursements, the analysis finds that lower Medicaid reimbursements tend to lower the fees physicians charge, contradicting the standard cost shifting story. Evidence also suggests that lower Medicaid reimbursements tend to cause physicians to treat fewer Medicaid patients. These results are consistent with profit maximizing behavior for physicians and also with the hypothesis that physicians exert some monopoly power.     

Data Fixation and the Use of Traditional Versus Activity-Based Costing Systems

An important debate in the contemporary accounting literature relates to the relative merits of activity-based versus volume-based product costing methodologies. Traditional volume-based costing systems are said to be flawed and may seriously mislead strategic decision making. Such arguments assume that decision makers use such information in an unproblematic way. This article reports on an experiment designed to investigate whether decision makers are able to overcome data fixation in a setting involving the use of product cost information. In response to criticisms of previous accounting studies of data fixation, subjects received some feedback after each decision, and were rewarded based on performance. The experiment involved subjects making a series of production output decisions based on detailed case information of a hypothetical firm facing different market conditions for each decision. A between-subjects design was utilized with two cost system treatments: activity-based costing (ABC) and traditional costing (TC). It was hypothesized that the group provided with ABC cost data would make 'optimal' decisions and the group provided with TC cost data would overcome fixation. The results of the experiment indicated that there was, in general, evidence of data fixation among TC subjects, but a small number of subjects did adjust to ABC costs. These results are discussed in the light of previous research and some future directions are outlined.     

Allocations and Common Costs in Long-Run Investing and Pricing Decisions: An Historical Analysis

The extent to which allocated common costs should influence business decisions remains controversial in management accounting. In the finance and investment literature this issue is generally ignored or dismissed by appeals to the'incremental' principle. This article presents an historical analysis of allocations in long-run investing and pricing decisions. It is demonstrated that seminal figures in the development of both investment and price theory were conscious of the need for firms to cover common costs and generally favoured some form of allocation. The anti-allocationist position is shown to be of relatively recent origin and to have caused an inconsistency in the management accounting literature in the treatment of common costs. European costing theory is shown to have been consistently allocationist. Evidence of a return in the recent U.S. literature to the older Anglo-American, and continuing European, allocations tradition is presented.     

Extensification of agriculture and deforestation: empirical evidence from Sudan

Extensification of agriculture is one of the major factors contributing to the destruction of forests in Africa. In Sudan, such horizontal expansion comes at the expense of land devoted to trees and other vegetation, thereby inducing conditions that are inimical to sustainable agricultural production. Different factors have contributed to extensification. Although high economic returns from crop (mainly sorghum) production was an important factor encouraging extensification of rainfed mechanized farming, other factors outside agriculture have also contributed to that expansion. This paper uses data from eastern Sudan and an acreage response model, to identify the most important factors influencing acreage expansion. Different measures and forms of risk were used in the acreage response model. The paper shows how policies in the energy sector can indirectly influence acreage expansion in the agricultural sector.     

Are the elderly really machiavellian? A reinterpretation of an unexpected finding

In an article published recently in theJournal of Business Ethics, Vitellet al. (1991) found that elderly respondents scored surprisingly high on a measure of Machiavellianism. This paper offers an alternative explanation for this unexpected result — it may be an artifact of the survey format employed — and recommends additional research to help clarify the issues raised by Vitell and his colleagues.Peter E. Mudrack is an Assistant Professor in the Department of Management and Organization Sciences at Wayne State University's School of Business Administration. His publications have appeared inHuman Relations, Journal of Business Ethics, andJournal of Organizational Behavior.     

Issues in the estimation and application of latent structure models of choice

Our paper provides a brief review and summary of issues and advances in the use of latent structure and other finite mixture models in the analysis of choice data. Focus is directed to three primary areas: (1) estimation and computational issues, (2) specification and interpretation issues, and (3) future research issues. We comment on what latent structure models have promised, what has been, to date, delivered, and what we should look forward to in the future.