"Quicker and sicker" under Medicare's prospective payment system for hospitals: new evidence on an old issue from a national longitudinal survey

Medicare's prospective payment system for hospitals (PPS), introduced in the USA in 1983, replaced cost reimbursement with a system of fixed rates which created incentives for hospitals to control costs. Previous studies found that elderly patients were discharged from hospital "quicker and sicker" under PPS and concluded that families were coping at home. We analyse a national longitudinal survey, the first National Health and Nutrition Examination Survey and its Epidemiologic Followup Study, which includes data on more outcomes over a longer period than earlier studies. We find that the rate of admission to nursing homes from the community in the first weeks after a hospital discharge more than tripled under PPS, suggesting that families were not always able to cope. As another response to sicker patients, discharges directly to nursing homes from hospitals, which jumped initially under PPS, may have risen further when payment rates were tightened in the early 1990s. Hospital readmissions fell after the first few years. Our findings are strengthened by the fact that we control for patients' health using health information collected independently of hospital admission.     

Concerning trust and information

Communication and the associated information exchanges are key drivers of the development of relationships and of the trust embedded within them. This paper considers the development of business relationships in terms of the continuing co-evolution of trust and information exchange and the issues associated with researching these processes. The interconnections of trust and information exchange are examined in a survey of business relationships involving information exchange (n = 355). Analysis of variance shows few, if any, of the aspects of the standard conceptualizations of information exchange are associated with increased levels of trust. It is information exchange norms that have the greatest (positive) association with the level of trust. These norms emerge as part of the long term co-production of the relationship itself. This has important managerial implications. We conclude there are few managerial actions involving managing communication that can “manufacture” trust and improve or develop relationships in the short term. The paper concludes with a discussion of alternative ways of envisaging communication and relationship management and the nature and future of research into the evolution of business relationships.     

“At Risk” Young People and Preparedness for Work: The Youth Choice Project

This paper is based on the critical evaluation of an initiative devised to support young people, on the margins of criminality, to gain inclusion into mainstream society through the provision of targeted support and work experience. Through a critical analysis of the processes and outcomes of the initiative we will demonstrate that what became known as the Youth Choice project contributed much to enhance the personal and professional development of the young people engaged in the project. We will also demonstrate that Youth Choice impacted positively on young people’s knowledge and attitudes towards decision making and self-development; an improved opinion of self; the development of life skills, confidence, and self-esteem, as well as increased aspirations for the future. We conclude that there is a strong and persuasive economic argument for making similar opportunities available to all ‘at risk’ young people.