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.     

Materiel management reengineering: value creation through innovation

By reengineering their department's core processes, materiel managers can expand their role in the health care setting while realizing significant cost savings. Using a team model, Inova Health System materiel management staff integrated their processes for vendor selection, purchasing, inventory reduction, and utilization across three hospitals and ancillary services. An integrated approach at all levels of the organization gained buy-in from administrators and staff systemwide.     

Computing equilibria of GEI by relocalization on a Grassmann manifold

An algorithm is described to compute equilibria of the general economic model with incomplete asset markets, that is, of GEI. The algorithm is based on the existence of a route of zeros of a homotopy whose domain includes the price simplex and a Grassmann Manifold. This route is followed, in effect, by localizing and following diffeomorphic pieces in Euclidean space, and by relocalizing as is necessary.     

Hidden risks of hedge accounting in financial institutions: A study of Franklin Savings Association

The hedge accounting standards for financial institutions stipulated in SFAS No. 80 impose ambiguous guidelines whose enforcement can produce detrimental effects on the financial condition of institutions. Combining these standards with the interpretive authority of regulatory agencies can subject institutions to regulatory risk-the risk of an adverse regulatory ruling resulting from disparate interpretations of the accounting standards. The accounting regulations specified in SFAS No. 80 permit financial institutions to defer derivative-contract losses over the life of the underlying asset or liability. If the hedge designation is misused, however, the capital position of the institution may potentially be misstated prior to maturity of the derivative contracts. Further, when a hedging program goes awry, the current hedge accounting standards may actually encourage the shift to what is actually a speculation program by permitting a larger asset base on which to “earn back” a portion of the hedging losses. Thus, institutional programs initially designed to mitigate interest-rate risk can instead become risk-increasing, separate profit centers. Events leading to the RTC conservatorship of Franklin Savings Association are used to illustrate the opportunities and regulatory threats inherent in hedge accounting. Subsequent analysis indicates that similar ordeals could be avoided by a clarification of hedge accounting standards, the consistent application of standards by regulators, or by increasing capital requirements for those institutions that use derivatives as separate profit centers as opposed to hedging risk exposures.     

Statistical inference on regression with spatial dependence

Central limit theorems are developed for instrumental variables estimates of linear and semiparametric partly linear regression models for spatial data. General forms of spatial dependence and heterogeneity in explanatory variables and unobservable disturbances are permitted. We discuss estimation of the variance matrix, including estimates that are robust to disturbance heteroscedasticity and/or dependence. A Monte Carlo study of finite-sample performance is included. In an empirical example, the estimates and robust and non-robust standard errors are computed from Indian regional data, following tests for spatial correlation in disturbances, and nonparametric regression fitting. Some final comments discuss modifications and extensions.