Competition and product quality in the supermarket industry.

This article analyzes the effect of competition on a supermarket firm's incentive to provide product quality. In the supermarket industry, product availability is an important measure of quality. Using U.S. Consumer Price Index microdata to track inventory shortfalls, I find that stores facing more intense competition have fewer shortfalls. Competition from Walmart­the most significant shock to industry market structure in half a century­decreased shortfalls among large chains by about a third. The risk that customers will switch stores appears to provide competitors with a strong incentive to invest in product quality.

Food, feed, fuel: transforming the competition for grains.

Critical changes are underway in the domain of grain utilization. With the large-scale diversion of corn for the manufacture of ethanol, the bulk of it in the USA, there has been a transformation of the food­feed competition that emerged in the twentieth century and characterized the world's grain consumption after World War II. Concerns have already been expressed in several quarters regarding the role of corn-based ethanol in the recent food price spike and the global food crisis. In this context, this article attempts to outline the theoretical tenets of a food­feed­fuel competition in the domain of grain consumption. The study focuses on developments in the US economy from 1980 onwards, when the earliest initiatives on bio-fuel promotion were undertaken. The transformation of the erstwhile food­feed competition with the introduction of fuel as a further use for grains has caused a new dynamics of adjustments between the different uses of grains. This tilts the distribution of cereal consumption drastically against the low-income classes and poses tougher challenges in the fight against global hunger.

Designing HIGH-COST medicine: hospital surveys, health planning, and the paradox of progressive reform.

Inspired by social medicine, some progressive US health reforms have paradoxically reinforced a business model of high-cost medical delivery that does not match social needs. In analyzing the financial status of their areas' hospitals, for example, city-wide hospital surveys of the 1910s through 1930s sought to direct capital investments and, in so doing, control competition and markets. The 2 national health planning programs that ran from the mid-1960s to the mid-1980s continued similar strategies of economic organization and management, as did the so-called market reforms that followed. Consequently, these reforms promoted large, extremely specialized, capital-intensive institutions and systems at the expense of less complex (and less costly) primary and chronic care. The current capital crisis may expose the lack of sustainability of such a model and open up new ideas and new ways to build health care designed to meet people's health needs.

[The transformation of the dental services market and the battle over a monopoly in 19th century dental practice]. / A transformação no mercado de serviços odontológicos e as disputas pelo monopólio da prática odontológica no século XIX.

The article analyzes the process by which dentistry acquired the status of a profession. The setting is the mid-nineteenth-century United States, where the West's first professional dental organizations were founded, and the focus is on some aspects of the development of a dental market and on the professional disputes among practitioners of the dental trade, who wanted a monopoly within this field of knowledge. Certain outside factors played a major role in the emergence of the profession, including changes in patterns of sugar consumption (which spread dental caries disease throughout society) as well as the expansion of the dental service market. The subsequent proliferation of distinct groups of dental practitioners--both qualified and unqualified to practice dentistry--and their competition for a place in the dental market reflect the battle waged to establish jurisdiction in this field and the emergence of dentistry as a 'modern profession'.

Competition, race, and professionalization: African healers and white medical practitioners in Natal, South Africa in the early twentieth century.

The licensing of African healers in the province of Natal, South Africa combined with urbanization, medical commodification, and an overcrowded biomedical market led to ideological and commercial competition between White biomedical practitioners and African healers in the early twentieth century in southeastern Africa. This article examines the historical antecedents of this competition and focuses on the role that competition, race, and gender played in the construction of local biomedical and African ideas of medical authority. Adopting the idea that medicine is an important site of power, contestation, and cultural exchange, I aim not only to document these historical changes in African therapeutics, but to problematize current ideas of biomedicine's colonial hegemony.

Canadian biotechnology start-ups, 1991-1997: the role of incumbents' patents and strategic alliances in controlling competition.

Fligstein (1996) contends that organizations act to exploit the institutional context in which they are embedded so as to stabilize the competition they face. Drawing on Fligstein's theoretical analysis, we conceptualize incumbent biotechnology firms' patent-ing and alliance-building activities as attempts to stabilize and control potential competition and analyze how these activities shape rates of founding in the Canadian biotechnology industry. We find that increases in the level and concentration of incumbents' patenting discourage founding, particularly in human application sectors of the industry where development and approval processes are more costly and time consuming. Incumbents' horizontal alliances depress start-ups; vertical alliances stimulate start-ups. Our findings highlight how technology appropriation and strategic alliances structure the competitive dynamics and evolution of high-technology, knowledge-intensive industries.

Ambulatory surgery: the growth of an industry.

Over a short 30 years, ambulatory surgery has grown from a few freestanding facilities to a continuously growing industry. This article gives a historical overview of that growth, while specifically documenting the impact that competition, regulation, capitation, technology, and the consumer have on nursing and a single industry.

Keeping competition fair for health insurance: how the Irish beat back risk-rated policies.

OBJECTIVES: This paper describes how Ireland created a level playing field for competition in health insurance, the strategies of a major insurer to introduce risk-rated policies that would segment the market, the successful campaign to block these policies, and the policy implications of the European Union requirement of competition in health insurance. METHODS: Policy documents, interviews, and press reports were analyzed. RESULTS: The minister of health forced the commercial insurer to withdraw its policies and replace them with community-rated policies. CONCLUSIONS: Because it is easier and more profitable for insurers to engage in risk selection than to become more efficient, beneficial competition in health insurance markets is extremely difficult to create. Carefully drawn rules and monitoring are required to overcome inherent causes of market failure. The current enthusiasm for saving money through competitive schemes in health insurance seems likely to produce higher costs and greater inequality.

[Snoop, scandal, slander. Changing manners in the medical profession]. / Roddels, ruzie, achterklap. Veranderende omgangsvormen in de medische beroepsgroep.

During the seventeenth and eighteenth century medical men were rather secret about their therapies, instruments and techniques. In their discourses they pictured their rivals as worthless, incompetent characters, unfit for the medical profession. This article states that this manner of conduct was connected with the relation between physician and patient, as physicians were highly dependent on their patients' patronage. The rivalry between all kinds of medical professionals originated from this situation in which the physician's conduct was directed by his patient's patronage rather than by his medical capability. This doctor-patient relation changed during the nineteenth century. The development of the hospital from a place to die to a place to get the best medical care accompanied this change. In the hospital, physicians started to work as partners instead of rivals, they developed their therapies and techniques together, whereas the patient lost his influence on the physician's behaviour.

Survival of the fittest. The 'competition' model for health care.

The following are excerpts from an article first published in the Health/PAC Bulletin in 1981. This lengthy analysis was written in response to various proposals made during the late 1970s and early 1980s to unfetter the invisible hand of free-market competition in order to solve the nation's health care "crisis." Twelve years later...the health care "crisis" is considerably more grave, and it has become even more popular to wave the "invisible" hand in the hope it will go away. Twelve years later, the objections Sigelman raises have not gone away either, and his conclusions--that in the face of the competition model, the need is greater than ever for consumers to organize to compel providers to deliver services that respond to the needs of the community--is, unfortunately, prophetic.