Hospital Mergers and Antitrust: Some Economic and Legal Issues

A bstract The article traces the development of the market for hospital services through evolutionary stages to the present emphasis on merger and consolidation. Examination of the traditional principles of antitrust analysis suggests they are sufficiently flexible to warrant their application in evaluating the competitive impact of hospital mergers.     

Fair markets

The paper challenges a minimalist strategy in business ethics that maintains if it's legal, it's moral. In hard cases, judges decide legal issues by appealing to moral ideals. Investigation shows that the bedrock concept is fairness. Often judges define fairness in terms of non-coerciveness or equality of bargaining power. The prudent manager must look beyond the legal department to the ethical notion of fairness. Moreover, if the courts were to consistently appeal to non-coerciveness and equality of bargaining power, some practices now considered morally acceptable would be neither moral nor legal. Norman E. Bowie is Professor of Philosophy and Director of the Center for the Study of Values at the University of Delaware. He is the author of numerous articles on business ethics and social and political philosophy and of Business Ethics, Making Ethical Decisions (ed.), The Tradition of Philosophy (co-ed.), and Ethical Theory and Business (co-ed.).     

The structural and economic implications of urbanization

"This study surveys the policy issues associated with urbanization following the abolition of the pass laws [in South Africa]. The demographic background is briefly sketched. Using neo-classical analysis as a starting point, particular attention is paid to the present inefficiencies of city form associated with segregation. It is argued that current planning procedures are in danger of perpetuating or even worsening the situation. Obstacles to employment generation are considered and transport, local government and housing issues are discussed. On every front, urbanization policy is unstable and, even in the short term, there will be pressures to change it."     

Projecting the future size and health status of the U.S. elderly population

"A projection model based on a multivariate continuous state, stochastic process is presented. The model allows multiple time-varying covariates to be used so parameters can be estimated from time series information on health changes and mortality, and their interaction. Health changes are simulated by altering parameters controlling the age trajectory and diffusion of risk factor means, variances, and covariances....By increasing the information used in projections it may be possible to better (a) anticipate the state of health at extreme ages, (b) forecast changes in health at specific ages over time, (c) stimulate the effects of specific interventions, and (d) determine the sensitivity of outcomes to a range of interventions."     

Purchasing practices in a hospital environment: an ethical analysis

The critical state of the hospital industry, as previously described, generates a difficult decision environment for the materiel manager and those in the purchasing function. The unique life- and death circumstances of hospitals impose a further onus on those who manage them. In the name of saving lives, they can find a convenient excuse to disregard all moral principles, forgetting the Socratic dictum "it is not enough that one lives, but that one lives well." Without the moral "right stuff," they can easily give in to the seductions of momentary gains and glory through ethical short-cuts. There is wisdom and consolation in the words that "nice guys may appear to finish last, but usually they're running in a different race." Studies have established a direct relationship between corporate excellence and ethical values. The reality of competition in the hospital industry dictates that the integration of ethics into the life of the organization should happen by design and not by accident. This is what is meant by strategy. If hospitals would strive for excellence to survive and grow, they should have a strategy with a mission statement that also embodies its moral values and moral agenda. Such an approach does not guarantee that an organization will become immune to moral contamination, but it does provide an antidote.     

Body support testing and rating

The REF, C, and score are a means to give quantitative values for product performance. Other product variables defined as humidity control factor, shear control factor, differential temperature control factor, product life factor, and cost factor were not addressed as part of this study. Additional variables include delivery, maintenance, and warranties. These components can be added to the score in some weighted manner as they become clinically founded. Interface pressures and shears were not measured for beds that are gatched. Each product tested will have characteristics pertinent to its own design that must be addressed to minimize sacral and coccyx skin breakdown when subjects are in this posture because some pneumatic pads bottom out to give excessive sacral and coccyx pressure while others wrinkle when used in this position. This is of major concern when one considers that the coccyx is more susceptible to pressure than any other bony prominence. There may be some aversion to labeling support product performance because it will allow the purchaser to know what is being bought. This initial study indicates the feasibility of quantitating what all patients require: a valid interface support surface for each specific need. The user can be adequately informed before the purchase as to a product's merits without being influenced by the results of inadequate testing, referrals, or sales media influences. Although cushions, shoes, or other prosthetic/orthotic devices were not part of this study, it is appropriate to rate all these devices in a similar manner by simply comparing pressure relief attained to that desired, expressing the result as a percentage of the worst case, and then labeling the product accordingly. Those subjects with sensation can rate comfort as part of the overall score. For cushions, ischial tuberosity pressure relief can be expressed as a percentage of the maximum attainable relief. Metatarsal head relief during gait as well as during static testing can be measured, and claims can be made for shoes and sneakers. Where impact loads and shear forces are paramount, the score must comprise appropriate parameters. Similarly, amputee distal stump relief as a percentage of worst case could be specified by the fitter. Iliac crest relief as a percentage of worst case can also be specified by the fitter. In all instances the score is not a subjective rating but one that can be measured correctly. All body support products can be given an REF, C value, and score as well as other qualifying values where appropriate instrumentation and sufficient subject sampling is used.     

Yes, the market can curb health costs

Memo to Clinton's transition team: forget those tough expenditure ceilings you're considering. Look instead at what managed competition is already accomplishing.     

Preliminary test estimators of the parameters of simple linear model with measurement error

In this paper, we discuss the properties of preliminary test estimators (PTE) of the parameters of simple linear model with measurement error (ME model) when the slope of the linear model is suspected to be zero. Expressions of the bias, MSE and efficiencies are obtained under conditional as well as unconditional situations with known reliability coefficient. Conditional model results are compared to the standard model without measurement error. We also provide the unconditional model analysis in finite samples. Asymptotic theory under local alternatives is developed when the variance of measurement error or the ratio of the variance of the model error relative to the variance of the measurement error is known. Asymptotic expressions of bias and MSE of the estimators along with their efficiencies are obtained. In every case, it is shown that the measurement error tend to increase the variability of the estimators compared to the estimators without measurement error. Graphs and tables are provided to see these results and to determine optimum level of significance for minimum guaranteed efficiency. Received October 2001 RID="*" ID="*"  A. K. Md. E. Saleh is a Distinguished Research Professor and H. M. Kim is a Ph.D. candidate in the School of Mathematics and Statistics, Carleton University, Ottawa. Acknowledgment. The authors gratefully acknowledge the constructive suggestion of the referees to improve the paper. The research is supported by NSERC grant A3088.     

Local and National Impacts from Landing North Sea Gas in Western Norway

A bstract . A simple framework is presented for the analysis of the local employment, income, sales , and local government impacts of landing North Sea gas at either of two Norwegian kommunes (municipalities). These impacts indicate the different forms of economic change arising from a major economic development event. The average annual net change in these economic measures is estimated for the operational phase of a gas terminal. The analysis indicated substantial differences in local and regional net gains. Both sites yielded positive neteconomic gains, which means noneconomic and national considerations become key decision determinates. These national issues provide the setting to judge the local/regional net gains. The unresolved questions include the national benefits and costs of the landing decision given the small scale of the Norwegian economy, potential future gas finds, and a fully employed economy.