Leapfrog standards: implications for nursing practice

Annually, thousands die unnecessarily as a result of preventable medical errors. Medical literature supports use of evidence-based standards to increase safety and improve the quality of health care. Nursing implications from three imposed standards are examined.     

Predicting nurses' organizational and professional identification: the effect of nursing roles, professional autonomy, and supportive communication

Recruiting and retaining qualified nursing staff is of growing importance to today's hospital and nurse leaders. Findings from a survey completed by 190 RNs at a major teaching hospital revealed that nursing roles, professional autonomy, and supportive communication were differentially related to the nurses' organizational and professional identification. Professional autonomy was by far the strongest predictor of nurse identification, followed by manager and co-worker support. Co-worker support and traditional nursing roles predicted nurse professional identification, but neither traditional nor collaborative roles predicted nurses' identification with their organization. Communication strategies intended to help executives retain qualified nursing staff are presented.     

The option of joint purchase in vertically differentiated markets

Summary. Within the framework proposed by Mussa and Rosen (1978) for modelling quality differentiation, consumers are assumed to make mutually exclusive purchases. A unique pure strategy equilibrium exists in this case. In this note, we allow consumers to buy simultaneously different variants of the differentiated good. We call this the “joint purchase option”. The paper proposes a detailed analysis of price competition when this option is opened: first, we show that either uniqueness, or multiplicity, or absence of price equilibrium arise, depending on the utility derived from joint purchase relative to exclusive purchase. Second, we characterize these equilibria, whenever they exist. Received: July 25, 2001; revised version: October 21, 2002 RID="*" ID="*" The second author gratefully acknowledges the financial support from Interuniversity Attraction Pole Program- Belgian State- Federal Office for Scientific, Technical and Cultural Affairs under contract PAI 5/26. Correspondence to: X.Y. Wauthy     

Treatment effects of selection behavior in managed care plans: evidence from Medicaid

This paper tests whether capitated payments to Medicaid managed care plans induce to plans strategic undercutting of treatment for specific diagnostic groups. I focus on treatment (measured by length of stay and cost) in acute care hospitals in Massachusetts. I use a differences-in-differences-in-differences approach, where the third differences compare treatment patterns between managed care plans that receive capitated payments with those that do not. I find that the first reduce treatment significantly more to mental health patients than to patients in other disease groups, whereas the latter reduce hospital resource use more uniformly across disease groups. These results highlight the importance of using payment mechanisms in public programs that reflect the variability in costs of beneficiaries.Received: September 2002, Accepted: May 2003, JEL Classification: I11I thank Randall Ellis, Kevin Lang and Thomas McGuire and anonymous referees for valuable comments and suggestions. I also thank seminar participants at The Brookings Institution and Harvard/MIT/BU Health Economics Seminar. The Portuguese National Science Foundation (B.D. 5910/95) and NIMH (NIMH R01 MH59254) provided financial support. I am indebted to the Massachusetts Division of Health Care Finance and Policy for kindly providing the data to me for this project. I am responsible for any errors that may remain.     

Earnings Preannouncement Strategies

We examine the disclosure strategies managers follow when theyd preannounce quarterly earnings shortly before formal earnings announcements. We document that managers with bad news release essentially all of their news at the preannouncement date, while managers with good news only release about half of their news. Controlling for the combined news released at the preannouncement and earnings announcement dates, firms with negative earnings announcement surprises have significantly lower excess returns for the period from just before the preannouncement to just after the earnings announcement. This finding is consistent with the observed disclosure strategies whereby managers attempt to avoid negative earnings announcement surprises, and suggests that how information is presented can affect the market's reaction to that information.     

Non-Segmented Equilibria Under Differential Taxation: Evidence from the Canadian Government Bond Market

This paper investigates tax effects in the Canadian governmentbond market during the period 1964—1986. Unlike previousstudies, we apply both statistical and nonstatistical teststoanalyze clientele effects and market equilibria. The resultsdivide the sample into two distinct periods of time, with theend of 1976 marking the division. We find that tax effects arealmost nonexistent in the Canadian government bond market beforethe end of 1976, but are predominant in the post-1976 period.Non-segmented market equilibria cannot be rejected before 1977,but are strongly rejected after 1976. In fact, segmented equilibriawith clientele effects in both quantities and prices characterizethe entire five year period from 1982 to 1986. These findingsare consistent with tax reforms, government deficit financingand interest rate fluctuations in Canada during our sample period.     

Empowering the managed care consumer: not as easy as it sounds

Managed care remains one of the most highly publicized issues in employee benefits, with its accompanying controversy causing concern to the consumer and the employer. The authors of this article discuss the very basic things consumers of health benefits should know about their plans in order to be prepared, as well as what they should reasonably expect from employers that sponsor the plans.     

Organizational learning and the learning organization in health care

Learning is seen as a systems-level phenomenon that stays within the organization regardless of the "players" involved. However, this article reviews some of the history of organizational learning and the learning organization and makes a proposal for how health care organizations are becoming learning organizations.