Selection and Improvement: Physician Responses to Financial Incentives

In this study we examine the effects of transferring physicians from a compensation system based on salary to a profit-sharing system. Consistent with theory, we find that the change has a large and significant effect on the quantity of services provided. In addition, we find a selection effect, where the least productive doctors leave the company and more productive doctors join.

Health Plan Conversions: Are They in the Public Interest?

Recently, not-for-profit health plans have been converting to for-profit status and these conversions have frequently occurred as steps to facilitate merger or acquisition with a for-profit company. Some industry observers attribute these managed care market place trends to an industry shake out resulting from increased competition in the sector. At the same time, the perceived competitive pressures have led to questions about the long run viability of non-profit health plans. Furthermore, some industry and government leaders believe that some non-profits are already conducting themselves like for-profit health plans and question the state premium tax exemption ordinarily accorded to such plans. This paper develops a framework for evaluating health plan conversions and examines related health policy issues through the lens of a case study of the proposed conversion of the CareFirst Blue Cross Blue Shield Company. Analyses demonstrate that CareFirst wields substantial market power in some segments of its local market, that it is unlikely to realize cost savings through expanded economies of scale, and that quality of care appears to be lower in the plans typically acquiring converting health plans.

Interventions for Autism Spectrum Disorders: State of the Evidence

The number of children in Maine with Autism Spectrum Disorders (ASD) has increased significantly over the past decade. Since 2000, the number of children receiving Special Education services for ASD in Maine schools jumped from 594 to 2,231in 2008 – an increase of 276%. A recent study estimated that the total cost of caring for a person with autism over his or her lifetime can reach $3.2 million, with more than$35 billion spent collectively per year (Ganz, 2007). To conserve already scarce resources and of-fer the best possible services to children with ASD, it is necessary to identify and understand the treat-ments and methods that produce positive outcomes as proven by research. Science helps to clarify some of the confusion about what “works” and enables evidence-informed treatment decisions, thus saving pre-cious time and resources

Human Capital and Organizational Performance: Evidence from the Healthcare Sector

This paper contributes to the literature on the relationship between human capital and organizational performance. We use detailed longitudinal monthly data on nursing units in the Veterans Administration hospital system to identify how the human capital (general, hospital-specific and unit or team-specific) of the nursing team on the unit affects patients' outcomes. Since we use monthly, not annual, data, we are able to avoid the omitted variable bias and endogeneity bias that could result when annual data are used. Nurse staffing levels, general human capital, and unit-specific human capital have positive and significant effects on patient outcomes while the use of contract nurses, who have less specific capital than regular staff nurses, negatively impacts patient outcomes. Policies that would increase the specific human capital of the nursing staff are found to be cost-effective.

Using gene expression data to identify certain gastro-intestinal diseases

BACKGROUND: Inflammatory bowel diseases, ulcerative colitis and Crohn’s disease are considered to be of autoimmune origin, but the etiology of irritable bowel syndrome remains elusive. Furthermore, classifying patients into irritable bowel syndrome and inflammatory bowel diseases can be difficult without invasive testing and holds important treatment implications. Our aim was to assess the ability of gene expression profiling in blood to differentiate among these subject groups. METHODS: Transcript levels of a total of 45 genes in blood were determined by quantitative real-time polymerase chain reaction (RT-PCR). We applied three separate analytic approaches; one utilized a scoring system derived from combinations of ratios of expression levels of two genes and two different support vector machines. RESULTS: All methods discriminated different subject cohorts, irritable bowel syndrome from control, inflammatory bowel disease from control, irritable bowel syndrome from inflammatory bowel disease, and ulcerative colitis from Crohn’s disease, with high degrees of sensitivity and specificity. CONCLUSIONS: These results suggest these approaches may provide clinically useful prediction of the presence of these gastro-intestinal diseases and syndromes

TRIAD zoning in Quebec: Experiences and results after 5 years

The TRIAD approach to forest management involves dividing the forest into 3 zones, each with its own management\ud objectives, but with the overall goal of increasing the ecological and economic sustainability of the forest. For the past 5 years, we have been experimenting with TRIAD zoning in central Quebec, incorporating social interests into the original concept of TRIAD management. Results generally indicate that this approach is economically viable, socially acceptable, and preferable ecologically in this area. Although much remains to be done, thus far the consensus among the\ud various project participants is that this approach may be a good fit for the public forest of Canada