Designing a guideline-based utilization management program

Many public and private organizations are developing and publishing clinical guidelines to assist health care providers and patients in making appropriate medical decisions. Unless clinical guidelines are part of a well-designed managed care program, they have little effect on physician practice styles. This article explores integral components of an effective guideline-based utilization management program. Initial evaluation of this program suggests that, as part of a well-designed utilization management program, clinical guidelines can inform patients and physicians, and create appropriate incentives for effective health care delivery.     

The growth of UK companies and their contribution to job generation, 1985–1987

Theories of firm growth are reviewed and various models examined. The firm growth and job generation process in the UK over the period 1985–87, is examined empirically, by using the very large data files of the Dun and Bradstreet credit rating organisation. In the analysis, four computer processes were carried out; the sorting and matching of files, the cleaning of the data, the validation of the cleaned data, and the scaling up the results. The final adjusted data were grossed-up to provide an overview of the growth and job generation potential of UK firms. This is compared with past results for the periods 1971–81, and 1982–84. Small firms performed well, providing 48% of all new jobs, although consisting of only 21% of all employment in 1985. The 1000+ employee range provided only 13% of all new jobs over the period, although consisting of 37% of all employment in 1985. An overall trend of positive performance in smaller firms, and negative in larger firms was apparent. The 20–49 employee cohort performed unusually poorly in firm and job creation, against the expected pattern. The effect of takeovers, mergers and rationalisations on employment was examined. As expected, there was negligible restructuring of small firms, but over 5% of employees in the largest 1000+ cohort were involved in some form of reorganisation.In this and the two previous studies for 1971–81 and 1982–84, we found a consistent pattern of small firms as net generators of jobs, and large firms as net losers. This overall net behaviour is essential for the overall stability of the population, and can not be seen in good or bad terms. Bolton in 1971 found that the UK had an unduly small and weak small-firm sector. That trend to concentration is being reversed.This research was supported by the Department of Employment, Small Firms Division.     

Banks and the stability of the international financial system

Summary Does today's banking scene pose a potential threat to the stability of the international financial system? The article discusses three possible sources of vulnerability of the international banking system: a major bank failure causing a general banking crisis via the extensive interbank linkages; the systemic risks allegedly inherent in certain new (as well as traditional) financial products; and the impact of external events such as debt crises, violent swings in exchange or interest rates, deregulation and recession. The author's conclusion is twofold: systemic risks clearly exist, but the probability of a major banking crisis tends to be greatly exaggerated. Banks not only survived the various crises of the seventies and eighties; they also learned in the process. Capital and reserves have been strengthened, provisions for country risk and for general contingencies have increased, supervision has been tightened and it is exercised on a comprehensive as well as a world-wide consolidated basis (i.e. including all contingent and off-balance liabilities, and all offshore activities). Assuming reasonably intelligent policies on the part of the monetary authorities and adequate international coordination, a general banking crisis can be avoided. Official rescue operations do, however, raise difficult questions of an ethical, political and economic nature.