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.     

Integration managers: special leaders for special times

Although the integration of an acquired company with the parent organization is a delicate and complicated process, traditionally no one has ever been responsible for that process--for charting how the two companies will combine their operations, for seeing to it that the integration project meets its deadlines and performance targets, and for educating the new people about the parent company and vice versa. Some enlightened companies have recognized this gap and have appointed a guide--the integration manager--to shepherd everyone through the rocky territory that two organizations must cross before they can function effectively together. The authors have interviewed a number of these leaders in depth, as well as some of the people with whom they've worked. They've determined that integration managers help the merger process in four principal ways: they speed it up, create a structure for it, forge social connections between the two organizations, and help engineer short-term successes. In this article, the authors detail five acquisitions--at TI, General Cable, Meritor Automotive, Lucent, and Johnson & Johnson--and discuss the role that integration managers played in each. They describe exactly what sort of person should do this job. The integration manager must be able to jump into complex situations quickly, relate to many levels of authority smoothly, and bridge gaps in culture and perception. The ever-changing organizations of the Internet age will need leaders with similar skills. In fact, the authors contend, the integration manager should be considered a prototype for the leader of the future.     

Having trouble with your strategy? Then map it

If you were a military general on the march, you'd want your troops to have plenty of maps--detailed information about the mission they were on, the roads they would travel, the campaigns they would undertake, and the weapons at their disposal. The same holds true in business: a workforce needs clear and detailed information to execute a business strategy successfully. Until now, there haven't been many tools that can communicate both an organization's strategy and the processes and systems needed to implement that strategy. But authors Robert Kaplan and David Norton, cocreators of the balanced scorecard, have adapted that seminal tool to create strategy maps. Strategy maps let an organization describe and illustrate--in clear and general language--its objectives, initiatives, targets markets, performance measures, and the links between all the pieces of its strategy. Employees get a visual representation of how their jobs are tied to the company's overall goals, while managers get a clearer understanding of their strategies and a means to detect and correct any flaws in those plans. Using Mobil North American Marketing and Refining Company as an example, Kaplan and Norton walk through the creation of a strategy map and its four distinct regions--financial, customer, internal process, and learning and growth--which correspond to the four perspectives of the balanced scorecard. The authors show step by step how the Mobil division used the map to transform itself from a centrally controlled manufacturer of commodity products to a decentralized, customer-driven organization.