The U.S. Medicare Disproportionate Share Hospital program and capacity planning

U.S. Medicare's Disproportionate Share Hospital (DSH) program provides financial assistance to hospitals that serve low-income populations. Statutory formulas determine the DSH payments made to hospitals; however, the formulas applied to “large” urban hospitals (at least 100 beds) are more generous than those used for “small” urban hospitals (less than 100 beds). The purpose of this study is to determine if the DSH program's 100-bed threshold influences bed capacity planning. We find that the threshold drives a significant discontinuity in the distribution of urban hospital bed capacities, with hospitals tending to maintain just enough beds to qualify for higher DSH payments. The magnitude of the discontinuity is greatest in hospitals with strong incentives to manage bed capacity; and, compared to government and not-for-profit hospitals, for-profit hospitals are more likely to manage capacity to meet the 100-bed threshold. Our findings highlight the potential for regulatory institutions to have unintended influence on capacity planning decisions.     

Organisational susceptibility to fraud and theft,organizational size and the effectiveness of management controls: some UK evidence

This paper examines the principal determinants of an organization's susceptibility to theft and fraud in the context of a rational economic framework in which the level of protection is determined by the minimization of cost. The empirical study shows that, adjusting for differences in organizational type and industrial sector, both organizational susceptibility and the size of a typical theft or fraud increase with organizational size. Access to resources and the manner in which the theft or fraud is perpetrated are also important determinants of the money lost. However, they are unaffected by management controls or the nature of their violation. Copyright © 2007 John Wiley & Sons, Ltd.     

Regulation and quality in monopoly industries

Regulating the privatised utilities has turned out to be more difficult than was expected, and the regulation that will be imposed on the water and electricity industries is likely to be different to that which the Government imposed on the telecommunications industry. By looking at the quality of British Telecom's services, some insights can be gained into why regulation has turned out to be so complex, and where the UK regulatory model may be heading.     

Cattle numbers,biomass, productivity and land degradation in the commercial farming sector of Namibia, 1915‐95

As part of a natural resource accounting project undertaken in Namibia, livestock accounts have been drawn up and are being used to analyse the relationship between numbers of livestock, rainfall, land degradation, and economic and policy variables. Part of the analysis concerns an investigation into trends in cattle numbers, changes in cattle biomass and the productivity of livestock in commercial areas. Cattle numbers increased from 1914 until 1960, then declined steadily to half that number. This decline was at least partly due to deliberate actions by farmers to improve herd productivity and production efficiency. Although beef production did not decline over this period, productivity is still lower than potential industry standards. Range degradation (bush encroachment) may have contributed to this curtailment. This investigation has implications for an understanding of long‐term carrying capacity, land degradation and rangeland management, and for agricultural development policies in Namibia and similar regions in southern Africa.     

Developing Primary Care Groups in the New NHS: Towards Diversity or Uniformity?

This article examines how the Government's 'third way' is being implemented in relation to the involvement of primary care professionals in the commissioning of health services. Prior to 1997, the single preferred model of GP fundholding evolved into a diversity of approaches to commissioning and these approaches became increasingly collaborative rather than competitive. From this starting point, the authors examine the key assumptions underlying the present single model of the primary care group (PCG) as the commissioning body for the 'New NHS'. They suggest that PCGs will also evolve into a diversity of models, but there will be tensions arising over the greater emphasis on central direction and performance management.     

Restructuring the automotive industry in the English West Midlands

This paper investigates the changes taking places in the automotive industry in the English West Midlands. For over a century this region has been the heartland of car production in the UK, but over recent decades the volume side of the trade has been in serious decline, leading to increasing dependence on the luxury side of the industry. The implications are that the supply side of the industry will be forced to move into new technologies if the auto cluster is to prosper in future. Finally, the paper looks at the attempts made by bodies such as Advantage West Midlands and the industry itself to effect change.