The structure of the market for physicians' services.

In this paper, structural equations for the supply of and the demand for general practitioners' services are derived. Two variants of the model, based on alternative specifications of the role of health insurance, are tested, using data drawn from the American Medical Association's Eighth Periodic Survey of Physicians (PSP8). While results of the estimation require the rejection of the hypothesis that the market for general practitioners' service is perfectly competitive, the elasticities of demand implied are quite high. Estimates of the supply relationships support the presence of "backward bending" supplies of physicians' services, but this finding should be interpreted cautiously.

Rural hospitals under PPS: a five-year study.

This research examines the impact of prospective payment (PPS) on the financial performance of Kansas hospitals, which are predominantly rural. Financial ratios are presented and regressed on bed size and year. The data suggest that bed size has the strongest effect on financial viability. There are indications of a delayed effect of PPS on the rural, smallest hospitals (fewer than 25 beds), suggesting that non-operating sources of revenue (local property tax mill levies) are being used to subsidize them in the short term. Small hospitals appear to be delaying all capital and long-term costs to survive. The research suggests that the effect of PPS may be long term.

Options analysis of managed care contracting and regulation: theory and evidence.

Managed care contracts can be represented as bundles of options. In particular, the managed care provider is short a call option. To hedge the risk involved in such contracts, managed care contractors can construct several types of virtual put options, among them the ownership of facilities. Agency theory and options theory suggest that for-profit managed care plans, in the presence of debt, will engage in less hedging activity than will other managed care plans. Here, the authors test that hypothesis, using data for Florida HMOs in 1995, and they reject the null hypothesis. That managed care organizations act as if they are short a call option raises interesting regulatory issues, including the possibility of using a hedge-based regulatory scheme in place of a net-worth-based scheme.

Futures markets provide risk-shifting option for providers.

Healthcare providers are exposed to the risks of their financial and economic environments just as are other types of businesses. But risk can be managed. One option available to the provider for managing risk is hedging with futures contracts. In futures transactions, hedging is the shifting of unavoidable risks from a party unwilling to bear the risk to a party willing to in return for the prospect of some gain. With careful planning and an understanding of the role of risk shifting, healthcare providers can use futures market transactions to enhance their abilities to assume economic risk. And, providers who can assume greater risk can ultimately deliver more care.

Opportunities in the international health services arena.

Fundamental changes in domestic healthcare delivery in the '90s have prompted many U.S. healthcare organizations to consider entering international markets. Opportunities available to U.S. organizations include investing in foreign organizations, controlling foreign facilities, and obtaining referrals from extraterritorial or cooperating foreign providers. Before entering into these arrangements, however, organizations must consider the benefits, risks, and constraints they may face, specifically with regard to reimbursement and cash flow, currency risk, regulation, and political risk. To succeed in international service delivery ventures, organizations also may need to make adjustments in the training of healthcare financial managers who will face the international marketplace. Being sensitive to the culture of the countries with which they will be dealing is just as important as knowing the currency and financial regulations.

A strategic planning framework for endowment management.

New techniques in portfolio management can be used to integrate the management of long-term investments into implementation of the strategic plan. This integration requires cash-flow planning, portfolio restructuring, and continuous monitoring.

Agency costs and complex contracts in health care organizations.

Agency theory explains the results of conflicts of incentive between principals and their agents. Health care organizations offer many examples of agency problems, among which are conflicts between patients and physicians and between administrators and investors.

Outside directors: stakeholder representation in investor-owned health care organizations.

The nature of investor-owned health care firms suggests that corporate boards may include representatives of "stakeholder" groups as well as representatives of stockholders and management. A sample of investor-owned firms was developed and examined. Physicians, financiers, attorneys, health care executives, and academics were well represented on the boards of directors in the sample. Small firms included more financial professionals on their boards than did larger firms, and HMOs included more physicians than did other firms, but these effects were not statistically significant. The greater the degree of representation of physicians, the greater was the return on assets of the firms in the sample.

Cost-volume-profit and net present value analysis of health information systems.

The adoption of any information system should be justified by an economic analysis demonstrating that its projected benefits outweigh its projected costs. Analysis differ, however, on which methods to employ for such a justification. Accountants prefer cost-volume-profit analysis, and economists prefer net present value analysis. The article explains the strengths and weaknesses of each method and shows how they can be used together so that well-informed investments in information systems can be made.

Health, obesity, and earnings.

Published reports and economic theory suggest that a worker's earnings may be affected by his degree of obesity. The purpose of this research was to estimate the size of such an effect. The earnings-obesity hypothesis was tested with data from the National Longitudinal Survey of Mature Men. Results of the test suggest that, for members of that sample, there is no earnings-depressant effect due to obesity.

Strategic options in capital budgeting and program selection under fee-for-service and managed care.

Many assets and projects provide value to organizations in excess of the direct and indirect cash flows that they generate. Under pure capitation, the link between individual investment decisions and future cash flows is completely severed. Including the value of strategic options enhances the usefulness of the capital budgeting process for health care organizations and provides a means of adapting that process to managed care settings.

Modeling of time-dependent temperature profiles in multilayer optical storage media.

A computer model has been developed to calculate the heat input through multilayered optical storage media. This is combined with a finite element calculation to determine the time-dependent temperature profiles through the layers. A series of calculations are presented on a number of different layer structures and materials in an attempt to optimize the storage medium. It is shown that the efficiency of heat absorption and the resulting temperature profiles are critically dependent on layer thicknesses.

Effects of meat-curing salts and temperature on production of staphylococcal enterotoxin B.

We investigated the effect of time, temperature, and the presence of sodium chloride, nitrates, and nitrites in the medium on the growth and production of enterotoxin B by Staphylococcus aureus. Assays by the double gel-diffusion method showed that maximal enterotoxin B production occurs at the beginning of the stationary phase of growth. Lowering the temperature of incubation decreased the amount of toxin produced without affecting the total amount of growth. Increases in concentration of curing salts reduced toxin production more rapidly than cell growth. The relationship of these observations to food-poisoning outbreaks is briefly discussed.

III. Abortion and mortality study. Twenty-year study in New York State exclusive of New York City.

PIP: An epidemiological study of abortion and abortion-related mortality in New York State (exclusive of New York City) shows a pattern of continued decline in mortality over the last 20 years. There is a discussion of maternal mortality associated with the following abortion-connected circumstances: infected spontaneous abortion, spontaneous abortion incidental to primary cause of death, therapeutic abortion, elective abortion, and illegal abortion. Infection was found to be the most important factor associated with abortion-related mortality. Women over 25 died 5 times more often than the teenage group who underwent abortion. Increased length of gestation increased the risk of death. Death from illegal abortion fell substantially after 1970, the year in which a liberalized abortion law was passed in New York.^ieng

Butorphanol tartrate for partial reversal of oxymorphone-induced postoperative respiratory depression in the dog.

A randomized, blinded, crossover study was designed to evaluate the respiratory, cardiovascular, and behavioral effects of butorphanol given postoperatively to oxymorphone-premedicated and surgically stimulated dogs. Nine healthy adult dogs were premedicated intramuscularly with atropine (0.04 mg/kg), acepromazine (0.10 mg/kg), and oxymorphone (0.2 mg/kg). Anesthesia was induced with thiamylal (12 mg/kg) and maintained with halothane in oxygen. According to the protocol of a concurrent study, all dogs had percutaneous endoscopic gastrostomy (PEG) feeding tubes placed during the first anesthetic episode and removed during the second anesthetic episode. All dogs received postoperatively either butorphanol tartrate (0.2 mg/kg) or an isovolumetric dose of saline placebo, both given intravenously. Respiratory rate (RR), tidal volume (TV), minute ventilation (MV), end-tidal CO2 concentration (ETCO2), heart rate (HR), and indirect diastolic (DP), systolic (SP) and mean arterial (MAP) blood pressures were measured at times 0, 2, 5, 10, 20, 40, 80, and 120 minutes after injection. The time from injection of the test drug until extubation was recorded. RR, MV, HR, and DP were significantly (P < .05) increased, while ETCO2 was significantly decreased, for a minimum of 30 minutes in butorphanol-treated dogs compared with saline controls. TV, SP, and MAP were transiently (< or = 15 minutes) increased in butorphanol-treated dogs compared with saline controls. There was no significant difference between the times to extubation in the butorphanol-treated dogs versus the saline control dogs.

Induction of ovulation with human pituitary gonadotrophin. Twelve years' experience.

Twelve years' experience in the therapeutic use of human pituitary gonadotrophins in 74 patients with anovulation is reviewed. Of these 74 patients, 54 conceived on at least one occasion. A new development, the use of radioimmunoassays for oestrone-3-glucuronide and pregnanediol-3-glucuronide to monitor responses, has been shown to be as effective as the more laborious chemical methods which were previously used. The adoption of radioimmunoassay monitoring allows the simultaneous treatment of up to five patients, and will markedly reduce existing waiting lists for this treatment.