Transaction Prices and Managed Care Discounting for Selected Medical Technologies: A Bargaining Approach

It is generally assumed that managed care has been successful at capturing discounts from medical providers, but the implications have been a matter of debate. Critics argue that managed care organizations attain savings by reducing intensity of services, while others have argued that savings are 'real' and are a consequence of discounts per unit of care. To address this, we obtain separate transaction prices for hospital episodes (treatment) and for the narrowly defined surgical procedure, using the example of heart bypass surgery. Both sets of prices were drawn from a database of insurance claims of self-insured firms that offer a menu of insurance options. We use a Nash-Bargaining framework to obtain price discounts by type of insurance. Adjusting for product and patient heterogeneity, the per-procedure prices yield the anticipated pattern of discounts: Relative to traditional fee for service, point-of-service HMOs exhibited the largest discounts followed by Preferred-Provider-Organizations (18 and 12 percent, respectively). While reductions in intensity of services are not directly observable from the data, combining the results from the per-procedure and per-episode analysis yields a range of intensity reduction of 20-6 percent, with a corresponding per-unit price discount of 4-18 percent for the entire episode. We conclude that a large share cost savings by managed care organizations are due to per-unit price reductions.

IT Industry Success in Small Developed Countries

While much research has focused on the reasons for information systems success, little research has focused on reasons for the success of U industries. This study investigates IT industry success in three small developed countries: Israel, New Zeahid and Singapore. All three countries have seen the rapid development of their IT industries in recent years. This is despite the fact that they are considerably different in many geographic, cultural, and political aspects and are widely dispersed around the globe

Probing diplomacy on resource conflicts between Kenya and South Sudan

The diversity of African Conflicts has become a field of inquiry and drawn the attention of many scholars who wish to theorize the origin of these conflicts. Such conflicts were perceived, in many ways, as originating from a colonial legacy. However, conflicts over natural resources have always played a role in human society, and have retarded socio-development in many countries. Guy Martin acknowledges that, over the last 40 years, Africa has been and continues to be one of the most conflict-ridden regions of the world; this has resulted in untold human suffering (Guy, 2002:185-188). This study focuses on resource conflicts and their outcomes on Public Administration as a discipline. The discussion offers a theoretical review of academic literature in combination with an analysis of the feature of resource conflicts and the relevant policies which govern conflict resolution and management. According to Terry et al (2007:32), “these two regions suffered from developmental and educational ignorance”. Most of the people living in this area are pastoralists; as such, the violence emanating from cattle rustling within Sudan and across its borders with Kenya, Uganda and Ethiopia continues to erode their moral fabric. The remoteness of the area has caused it to be a landscape of conflicts and insecurity and might have been cause for the paralysis of public administration and, in turn, reflected in poor service delivery. During the course of the study, an orderly and systematic use of mixed methods was chosen, since quantitative and qualitative research methods were found to be complementary rather than oppositional approaches. Using both prominent and modest collection procedures, the methods employed in this study proved to be practical and useful. The study examines resource conflict between the Turkana of Kenya and the Toposa of South Sudan. It suggests practical strategies and mechanisms by which the problem will be ameliorated, here and elsewhere, in as far as providing effective and efficient service delivery to the community without fail

Analysis of Expression Patterns: The Scope of the Problem, the Problem of Scope

Studies of the expression patterns of many genes simultaneously lead to the observation that even in closely related pathologies, there are numerous genes that are differentially expressed in consistent patterns correlated to each sample type. The early uses of the enabling technology, microarrays, was focused on gathering mechanistic biological insights. The early findings now pose another clear challenge, finding ways to effectively use this kind of information to develop diagnostics

Comparing Cost-Effectiveness of HIV Testing Strategies: Targeted and Routine Testing in Washington, DC.

BACKGROUND: Routine HIV testing is an essential approach to identifying undiagnosed infections, linking people to care and treatment, and preventing new infections. In Washington, DC, where HIV prevalence is 2.4%, a combination of routine and targeted testing approaches has been implemented since 2006. METHODS: We sought to evaluate the cost effectiveness of the District of Columbia (DC) Department of Health\u27s routine and targeted HIV testing implementation strategies. We collected HIV testing data from 3 types of DC Department of Health-funded testing sites (clinics, hospitals, and community-based organizations); collected testing and labor costs; and calculated effectiveness measures including cost per new diagnosis and cost per averted transmission. RESULTS: Compared to routine testing, targeted testing resulted in higher positivity rates (1.33% vs. 0.44%). Routine testing averted 34.30 transmissions per year compared to targeted testing at 17.78. The cost per new diagnosis was lower for targeted testing ($2,467 vs.$7,753 per new diagnosis) as was the cost per transmission averted ($33,160 vs.$104,205). When stratified by testing site, both testing approaches were most cost effective in averting new transmissions when conducted by community based organizations ($25,037 routine;$33,123 targeted) compared to hospitals or clinics. CONCLUSIONS: While routine testing identified more newly diagnosed infections and averted more infections than targeted testing, targeted testing is more cost effective per diagnosis and per transmission averted overall. Given the high HIV prevalence in DC, the DC Department of Health\u27s implementation strategy should continue to encourage routine testing implementation with emphasis on a combined testing strategy among community-based organizations

Social Activism in IS Research: Making the World a Better Place

Information Systems (IS) can play a salient role in the transformation of our societies, especially in less-developed (or under-served) communities. IS can be used to benefit citizens in these societies through improvements in education, government, healthcare, social, and entrepreneurial systems. It would be a mistake to think that under-served communities can develop without optimal deployment of IS, after all advanced societies depended on IS to boost their development. The realization that IS offers potential benefit to improve the livelihood of the less-privileged is not new or recent. However, what is not clear is what should be the role of IS researchers in addressing the needs of the under-served communities

Social Activism in Information Systems Research: Making the World a Better Place

This paper reports on a panel held during the 2006 International Conference on Information Systems (ICIS). The panel titled, Social Activism in IS Research: Making the World a Better Place, was organized to question whether and how Information System (IS) research is making tangible impacts to our society. More specifically, each panelist was asked to address: (1) How can IS research, and researchers, make contributions to underdeveloped societies and underserved communities?; and (2) How can IS researchers learn from the particularities of these communities to inform better research, teaching, and service? While each panel member had different perspectives to offer in relation to these two questions, all agreed that IS academe needs to raise its awareness and efforts considerably with a view to address the needs of underserved communities

Sudden Cardiac Death: Epidemiology, Pathogenesis and Management

Sudden cardiac death (SCD) is an unexpected sudden death due to a heart condition, that occurs within one hour of symptoms onset. SCD is a leading cause of death in western countries, and is responsible for the majority of deaths from cardiovascular disease. Moreover, SCD accounts for mortality in approximately half of all coronary heart disease patients. Nevertheless, the recent advancements made in screening, prevention, treatment, and management of the underlying causes has decreased this number. In this article, we sought to review established and new modes of screening patients at risk for SCD, treatment and prevention of SCD, and the role of new technologies in the field. Further, we delineate the current epidemiologic trends and pathogenesis. In particular, we describe the advancement in molecular autopsy and genetic testing, the role of target temperature management, extracorporeal membrane oxygenation (ECMO), cardiopulmonary resuscitation (CPR), and transvenous and subcutaneous implantable cardioverter devices (ICDs)

Analysis of Expression Patterns: The Scope of the Problem, the Problem of Scope

Studies of the expression patterns of many genes simultaneously lead to the observation that even in closely related pathologies, there are numerous genes that are differentially expressed in consistent patterns correlated to each sample type. The early uses of the enabling technology, microarrays, was focused on gathering mechanistic biological insights. The early findings now pose another clear challenge, finding ways to effectively use this kind of information to develop diagnostics