Determinants of the New Entry of HMOs into A Medicare Risk Contract: A Resource Dependence-Diversification Model

The purpose of this study is to examine the determinants of the new entry of an HMO into a Medicare risk contract using a resource dependence—diversification model. This study is conducted through a non-experimental, panel design With one year time lag. An HMO’s market is defined as the service area. The primary sample for this study is composed of 440 HMOS that do not have a Medicare risk contract as of January 1994. Data for the variables are extracted from the 1994 and 1995 InterStudy and Group Health Association of America (GHAA) directories, the 1996 Area Resource File, the 1994 County and City Data Book, the 1993 County Business Patterns. Additional supplementary data on adjusted average per capita cost (AAPCC) and county-level Medicare beneficiaries are obtained from the Health Care Financing Administration. The dependent variable is discrete indicating an HMO’s market entry. Independent variables are grouped into four categories: market structure, resource munificence, market price, and organizational attributes. Twelve hypotheses are tested using multivariate logistic regression. This analysis reveals that HMO enrollment size is a predominant, positive factor in predicting a new market entry. HMOs are also sensitive to the level of AAPCC rates in making a market entry decision. Results from hypothesis testing suggest that competition encourages a new market entry. The importance of resource munificence is not statistically supported. This study demonstrates the appropriateness of a panel design to verify a cause-effect relationship and the applicability of the service area as an HMO’s market. This study also contributes to the theoretical understanding of an HMO’s market entry

GCSE grades and GNVQ outcomes: results of a pilot study

This paper reports an investigation into the importance of basic skills in literacy and numeracy in the promotion of success on intermediate vocational courses at age 16+. Two measures of attainment in literacy and numeracy are examined; GCSE passes in English and Mathematics analysed by grade awarded and the Adult Literacy and Basic Skills Unit (ALBSU) tests in communication and numeracy. The study examines the relationship between prior attainment as attested by GCSE grades and ALBSU scores and course outcome. The extent to which a consistent relationship is found between GCSE grades and ALBSU scores is also examined. The study uses a random sample of 142 students drawn from a population of all first year 16/7 year old students who enrolled at a London Further Education college in 1994. A sub-sample of students on GNVQ Intermediate and NVQ level 2 courses is examined in greater depth. Data on course outcomes was collected at three points in time, 1995, one year after enrolment and on two occasions in 1996. It was therefore possible to chart the progress of students in the sample who took more than one year to complete an Intermediate (G)NVQ. Initial analysis found that at the GCSE middle grade range (Grades C,D,E,F) there was a wide range of literacy and numeracy outcomes as measured by the ALBSU literacy and numeracy tests. GCSE Maths and English passes at these grades do not appear to guarantee threshold attainment levels in basic numeracy and literacy. No significant relationship is found between prior attainment as measured by GCSE Maths and English grades and course outcomes. The ALBSU test scores proved to be more helpful in predicting student outcomes on the Intermediate GNVQ but were still fairly weak predictors. The high proportion of leaves from the sample, probably influenced by ''pull'' factors from the labour market, gives cause for concern. There is no evidence to indicate that weaker students leave Intermediate GNVQ courses early, if anything, the reverse is true. A significant proportion of Intermediate GNVQ courses early, if anything, the reverse is true. A significant proportion of Intermediate GNVQ students gained their awards after the prescribed one year study period. Commitment and motivation to succeed appear to be as - if not more - important than academic qualifications for success on Intermediate GNVQ. The study offers evidence that, for those motivated to persist with the studies, GNVQ can offer a valuable ''bridge'' to further and higher education opportunities to students who have performed poorly on ''academic'' GCSEs