Health care purchasing alliances--a Michigan multiemployer trust funds' approach

A group of multiemployer trust funds in Michigan has formed a coalition that eventually will offer its members an integrated managed health care program. As the first step toward this goal, the coalition recently implemented a managed pharmaceutical program.     

Lebesgue measure and social choice trade-offs

Summary An Arrovian social choice rule is a social welfare function satisfying independence of irrelevant alternatives and transitivity of social preference. Assume a measurable outcome spaceX with its (Lebesgue) measure normalized to unity. For any Arrovian rule and any fractiont, either some individual dictates over a subset ofX of measuret or more, or at least a fraction 1–t of the pairs of distinct alternatives have their social ordering fixed independently of individual preferences. Also, for any positive integer (less than the total number of individuals), there is some subsetH of society consisting of all but persons such that the fraction of outcome pairs (x, y) that are social ranked without consulting the preferences of anyone inH, whenever no individual is indifferent betweenx andy, is at least 1–1/4.We are grateful to Roy Mathias and Daniel Waterman for help with some technical matters, and to chairman Jim Follain and the Syracuse University Economics Department for financing the exchange that launched this project. Campbell's research was funded by National Science Foundation grants, SES 9007953 and SES 9209039.     

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.     

An investigation of cointegration and causality between fertility and female labour force participation

Both economists and demographers have long been interested in the nature of the relationship between fertility rate (BR) and female labor force participation (FR). Earlier work suggests an inverse relationship between BR and FR, except in preindustrial countries. The author applies Hsiao's version of the Granger causality method to examine the causality between BR and FR using transformed US data for the period 1948-93. An unidirectional causality is found to run from BR to FR with no feedback. These results confirm the hypothesis that the presence of small children discourages women from seeking employment outside of the home. Employment does not, however, affect a woman's decision to have children.     

Survival strategies in the era of managed care

The era of managed care has forced an unprecedented restructuring of the health care environment. As hospitals downsize in response, materiel managers should consider adopting strategies that may help ensure their survival, including innovative approaches to supply management and the development of individual responses that will best position them to succeed in this new reality.     

Nothing is so good it can't be made better

The concept of continuous improvement can be viewed from the perspectives of the elimination of waste or the improvement of quality. The waste elimination approach attacks all forms of waste, whereas quality improvement uses the concept of total customer satisfaction. This article describes an eight-step model for continuous improvement that addresses waste elimination and customer satisfaction.     

Strategy and the new economics of information

We are in the midst of a fundamental shift in the economics of information--a shift that will precipitate changes in the structure of entire industries and in the ways companies compete. This shift is made possible by the widespread adoption of Internet technologies, but it is less about technology than about the fact that a new behavior is reaching critical mass. Millions of people are communicating at home and at work in an explosion of connectivity that threatens to undermine the established value chains for businesses in many sectors of the economy. What will happen, for instance, to dominant retailers such as Toys "R" Us and Home Depot when a search through the Internet gives consumers more choice than any store? What will be the point of cultivating a long-standing supplier relationship with General Electric when it posts its purchasing requirements on an Internet bulletin board and entertains bids from anybody inclined to respond? The authors present a conceptual framework for approaching such questions--for understanding the relationship of information to the physical components of the value chain and how the Internet's ability to separate the two will lead to the reconfiguration of the value proposition in many industries. In any business where the physical value chain has been compromised for the sake of delivering information, there will be an opportunity to create a separate information business and a need to streamline the physical one. Executives must mentally deconstruct their businesses to see the real value of what they have. If they don't, the authors warn, someone else will.     

When an executive defects

The news that one of the company's senior managers is leaving comes as a complete surprise to Paul Simmonds, CEO of Kinsington Textiles, Inc. Ned Carpenter, KTI's vice president of operations for three years, writes in his resignation letter than he is leaving for a better opportunity. Simmonds soon learns that Carpenter's new job is at Daltex, one of KTI's main rivals in the intensely competitive carpet industry. Hiring Carpenter had helped Simmonds establish his reputation as a topnotch manager. Carpenter came to KTI with lots of ideas and put his enthusiasm to good use. Three years into a five-year change program, Carpenter had turned KTI's operations from one of the worst in the industry to one of the best. He also had helped develop and plan the upcoming launch of a new fiber coating--KTI's first breakthrough in years. In this fictitious case study, Simmonds, along with the company's counsel and vice president of human resources, must figure out how much and what sort of damage control they need. What are they going to tell the company's employees and the media? Should they immediately replace Carpenter with John Brady, the second-in-command of operations? What if Carpenter is taking KTI employees--and strategic information--with him to Daltex? Should Simmonds ask all his managers to sign noncompete agreements-something Carpenter was never asked to do? Should KTI sue Carpenter? Five experts offer advice about communicating with KTI's employees, the media, and Carpenter himself, and about protecting the company's confidential information.     

Poverty,population and environmental degradation in China

This article examines the relationship between poverty, population, and environmental degradation in China. Environmental conditions include water pollution, deforestation, destruction of grasslands, soil erosion, and salinization. The authors review China's success in controlling environmental degradation through leadership, environmental policies, and institutional capacity. Findings suggest that environmental progress is best achieved indirectly by poverty alleviation, market integration, and population control. Government policies were not very effective. Degradation occurs due to limited financial resources, poorly trained personnel, and political factors. Control of water pollution was instituted since the 1980s. The levels of pollutants have been reduced, but the type of pollutant determines the seriousness of impact. Water pollution is due to industrial wastes, agricultural run-off, and soil erosion. Since the 1970s, reforestation targets have not been met. Technical extension and monitoring of planting is not available in most areas, and private, profit seeking interests control acreage. Grassland destruction is due to deforestation, agricultural expansion, and overgrazing. Independent regional authorities have successfully managed pasture programs. Erosion is the most serious in Loess Plateau, the Red Soils area, the Northeast China Plain, and the Northwest Grasslands, which comprise 70% of total land area. In 1990, erosion control was practiced in 39% of eroded land area. Salinization has remained fairly constant. Environmental controls (direct regulation, planned recovery, and state-mandated technological improvements) are uneven. The main tool for environmental management is the State Environmental Protection Commission and its executive unit, SEPA. Problems stem from vague laws, lack of means of enforcement, lack of coordination of laws, and lack of standards, schedules, and other provisions in ordinances.