Violations of Service Fairness and Legal Ramifications: The Case of the Managed Care Industry

Adapted from Chan's (2000) model depicting success of litigation, this paper argues that with the application of various legislation, health maintenance organizations' (HMOs') violations of service fairness to each group: enrollees, physicians, and hospitals give rise to each group's lawsuits against the HMOs. Various authors (Bowen et al., 1999; Seiders and Berry, 1998) indicate that justice concepts such as distributive, procedural, and interactional justice can be applied to the area of service fairness. The violation of these underlying justice principles with HMOs' service unfairness to enrollees, physicians, and hospitals is examined. A general synopsis of the ethical issues in the managed care industry is provided. The various lawsuits launched by each group: enrollees, physicians, and hospitals together with the key statutes used are discussed. This paper also highlights the provisions and ramifications of the 11 April 2000 landmark agreement that Aetna made with Texas Attorney General John Cornyn to settle the 1998 lawsuit brought against the company. Lastly, the current ethical issues in the managed care industry are further discussed. The value of this paper can be adapted to the study of organizations' service fairness violations in other industries or in the educational, governmental, and not-for-profit sectors both nationally and internationally.     

The Effects of Occupational Injuries After Returns to Work: Work Absences and Losses of On-the-Job Productivity

We extend the research on postinjury employment by estimating productivity losses for workers with permanent partial disabilities (PPDs) in the first three years after injury. Our method distinguishes between productivity losses attributed to spells of work absence versus reduced earnings during spells of employment. The method is applied to data for 800 Ontario workers with PPDs. The results document large productivity losses persisting at least three years after injury, with different loss patterns for workers returning to stable versus unstable employment. Human capital investments or job accommodations can reduce productivity losses, but the significant determinants of losses differ for the stable versus unstable employment groups.     

Predicting corporate financial distress: Reflections on choice-based sample bias

Financial distress precedes bankruptcy. Most financial distress models actually rely on bankruptcy data, which is easier to obtain. We obtained a dataset of financially distressed but not yet bankrupt companies supplying a major auto manufacturer. An early warning model successfully discriminated between these distressed companies and a second group of similar but healthy companies. Previous researchers argue the matched-sample design, on which some earlier models were built, causes bias. To test for bias, the dataset was partitioned into smaller samples that approach equal groupings. We statistically confirm the presence of a bias and describe its impact on estimated classification rates.     

Informed and uninformed trading on the Australian dollar

Using a high-frequency data set of the spot Australian/US dollar, this study examines the distribution of quotes, spreads, and returns across the trading day. By identifying the direction of trade and the subsequent quote returns from contributing banks, the segmented nature of the market into market-makers and informed and uninformed traders is investigated. The results suggest that the economic gain possible from private information is maximised over 2 to 5 quotes and is rapidly eroded by 20 quotes (about 2 min later during busy trading times) as other new information enters the market. Also, the analysis is revealing of discontinuities in trading and the volatility of pricing across the trading day.     

Summary of Results of Survey of Seminar Attendees

Abstract

The Society of Actuaries undertook a three-phase research project on mortality improvement in the three NAFTA countries: Canada, Mexico, and the U.S. Phase 1 consisted of a literature review of papers on projecting mortality levels in the future and a study of the trend in mortality improvement during this century. Phase 2 consisted of a discussion of different facets of modeling mortality rates at a seminar attended by 79 experts (actuaries, demographers, economists, and medical researchers) representing different countries. The last session of the seminar consisted of the completion of a survey by the attendees to obtain input for Phase 3, which would analyze the impact of mortality improvement on the social security system of each country. This paper summarizes the results of the survey.

The survey results illustrate the difficulty in forecasting mortality levels, because the effects of many factors that could have significant impact on mortality rates are unknown. This suggests the need for dynamic forecasting, which allows for the possibility of random shocks. A majority of the survey respondents believe that stochastic forecasting models, despite their complexity, have significant potential to add value. Respondents also believe that both historical data and cause-specific mortality forecasts are useful as input and also in validating forecasts of the aggregate levels of mortality. The challenge is to develop more sophisticated forecasting models to produce results that are relatively easy to interpret and to communicate these results to the desired audiences, including the public and policymakers.

The survey results suggest that the aggregate effect of lifestyle changes, medical advances, diseases, catastrophe, and physical environmental changes is an increase in life span. However, there is much uncertainty about the future. Respondents expect that beyond the year 2020 the mean annual rate of reduction in mortality for males age 65 and over will average about 0.58% for Canada, 0.76% for Mexico, and 0.67% for the U.S. The results for the female age 65 and over population are 0.64%, 0.83%, and 0.70%, respectively. The age 65 and over population is expected to see larger percentage reductions in mortality than the 0–14 and 15–64 populations. The reductions in male and female mortality will be ultimately the same, and the mortality levels in the three countries will ultimately converge, although differences may persist for decades.     

Economic and financial themes in Australian aged care

This contribution reflects the results of work for a review of aged care in Australia. Initial material covers the policy arrangements in place prior to the beginning of the Review in September 2002. The main feature of the contribution is a survey of economic and financial performance of aged care entities not hitherto attempted. Most attention is directed to labour costs in relation to total costs and earnings before interest and taxes. Cross-section analyses are based on institutional differences between providers of services with some operating as “for profit” entities but most are not reflecting their religious, community-based and charitable origins. Locational differences are also examined. The results show a very great disparity in experiences so that notions of the average experience across providers of services cannot be upheld. Differences between the top 10 percent of entities offering services and the bottom quartile are striking. The implications for development of new strategic approaches to policies are clear.     

The residual market factor,the APT,and mean-variance efficiency

The rapidly increasing volume of both published and unpublished work on the arbitrage pricing theory (APT) of Ross (1976) has given rise to a number of misunderstandings at the interface of theoretical and econometric work. In this article we extend the theoretical structure of our previous work (McElroy and Burmeister, 1985, 1988; Burmeister and McElroy, 1987, 1988) to provide a broad yet rigorous framework both for econometric estimation and for better economic interpretation of new empirical results. We begin with the case where allK factors are observed, and then present the second case ofK−1≡J observed APT factors and one unobserved factor, theresidual market factor introduced in McElroy and Burmeister (1985). The economic interpretations for equivalent specifications of this model are discussed, and we enumerate several immediate payoffs to these specifications. The main new results are concerned with the sometimes intricate relationships among APT models withK factors and APT models withK factors that are constrained to satisfy mean-variance efficiency restrictions. These results are not only of theoretical interest, but more importantly they provide the basis for econometric estimation and testing of nested hypotheses. These econometric issues are discussed in detail.     

Making compassion count: equal recognition and authentic involvement in mental health care

Compassionate care within mental health services is often taken for granted as something that can be made visible and authentic. However, recent government reports and policy suggest that we are far from providing compassionate care and may be more focused upon risk and surveillance. This paper will discuss the visibility of compassionate care and explore outcomes that consumers and practitioners could measure in practice. Separating the fact from fiction within compassionate care will make authentic involvement practices more visible and open to discussion around consumer collaboration. In a qualitative analysis of a small study with mental health consumers, compassion was found to be a major factor in whether consumers became more involved in their own health care. Demonstrating compassionate care may therefore also demonstrate consumer participation and engagement. This paper will argue that compassionate care can be observed in the relationships between practitioners and consumers that are collaborative and use presence and persistence as methods of practice. Emancipatory practices can be made more visible in mental health care in order to make compassion measurable and to encourage consumer participation and engagement.