"Managed Care, Physician Incentives, and Norms of Medical Practice: Racing to the Bottom or Pulling to the Top?"

The incentive contracts that managed care organizations write with physicians have generated considerable controversy. Critics fear that if informational asymmetries inhibit patients from directly assessing the quality of care provided by their physician, competition will lead to a "race to the bottom" in which managed care plans induce physicians to offer only minimal levels of care. To analyze this issue we propose a model of competition between managed care organizations. The model serves for both physician incentive contracts and HMO product market strategies in an environment of extreme information asymmetry--physicians perceive quality of care perfectly, and patients don't perceive it at all. We find that even in this stark setting, managed care organizations need not race to the bottom. Rather, the combination of product differentiation and physician practice norms causes managed care organizations to race to differing market niches, with some providing high levels of care as a means of assembling large physician networks. We also find that relative physician practice norms, defined endogenously by the standards of medical care prevailing in a market, exert a "pull to the top" that raises the quality of care provided by all managed care organizations in the market. We conclude by considering the implications of our model for public policies designed to limit the influence of HMO incentive systems.

Operation of a forced circulation, croloy 9 m, mercury loop to study corrosion product separation techniques

Forced circulation, Croloy 9M mercury loop designed to investigate corrosion product separation technique

Clementine Observations of the Zodiacal Light and the Dust Content of the Inner Solar System

Using the Moon to occult the Sun, the Clementine spacecraft used its navigation cameras to map the inner zodiacal light at optical wavelengths over elongations of 3-30 degrees from the Sun. This surface brightness map is then used to infer the spatial distribution of interplanetary dust over heliocentric distances of about 10 solar radii to the orbit of Venus. We also apply a simple model that attributes the zodiacal light as being due to three dust populations having distinct inclination distributions, namely, dust from asteroids and Jupiter-family comets (JFCs), dust from Halley-type comets, and an isotropic cloud of dust from Oort Cloud comets. The best-fitting scenario indicates that asteroids + JFCs are the source of about 45% of the optical dust cross-section seen in the ecliptic at 1 AU, but that at least 89% of the dust cross-section enclosed by a 1 AU radius sphere is of a cometary origin. When these results are extrapolated out to the asteroid belt, we find an upper limit on the mass of the light-reflecting asteroidal dust that is equivalent to a 12 km asteroid, and a similar extrapolation of the isotropic dust cloud out to Oort Cloud distances yields a mass equivalent to a 30 km comet, although the latter mass is uncertain by orders of magnitude.Comment: To be published in Icaru

"Physician Incentives In Managed Care Organizations: Medical Practice Norms and the Quality of Care"

This brief considers the interaction between physician incentive systems and product market competition in the delivery of medical services via managed care organizations. At the center of the analysis is the process by which health maintenance organizations (HMOs) assemble physician networks and the role these networks play in the competition for customers. The authors find that although physician practice styles respond to financial incentives, there is little evidence that HMO cost-containment incentives cause a discernable reduction in care quality. They propose a model of the managed care marketplace that solves for both physician incentive contracts and HMO product market strategies in an environment of extreme information asymmetry: physicians perceive the quality of care they offer perfectly and their patients do not perceive it at all.

Observation of narrow-band noise accompanying the breakdown of insulating states in high Landau levels

Recent magnetotransport experiments on high mobility two-dimensional electron systems have revealed many-body electron states unique to high Landau levels. Among these are re-entrant integer quantum Hall states which undergo sharp transitions to conduction above some threshold field. Here we report that these transitions are often accompanied by narrow- and broad-band noise with frequencies which are strongly dependent on the magnitude of the applied dc current.Comment: 4 pages, 3 figure

Underwater space suit pressure control regulator

A device is reported for regulating the pneumatic pressure in a ventilated space suit relative to the pressure imposed on the suit when being worn by a person underwater to simulate space environment for testing and experimentation. A box unit located on the chest area of the suit comprises connections for suit air supply and return lines and carries a regulator valve that stabilizes the air pressure differential between the inside and outside of the suit. The valve and suit pressure is controlled by the suit occupant and the valve includes a mechanism for quickly dumping the suit pressure in case of emergency. Pressure monitoring and relief devices are also included in the box unit

Elevated-temperature application of the IITRI compression test fixture for graphite/polyimide filamentary composites

Seventy-nine graphite/polyimide compression specimens were tested to investigate experimentally the IITRI test method for determining compressive properties of composite materials at room and elevated temperatures (589 K (600 F)). Minor modifications were made to the standard IITRI fixture and a high degree of precision was maintained in specimen fabrication and load alignment. Specimens included four symmetric laminate orientations. Various widths were tested to evaluate the effect of width on measured modulus and strength. In most cases three specimens of each width were tested at room and elevated temperature and a polynomial regression analysis was used to reduce the data. Scatter of replicate tests and back-to-back strain variations were low, and no specimens failed by instability. Variation of specimen width had a negligible effect on the measured ultimate strengths and initial moduli of the specimens. Measured compressive strength and stiffness values were sufficiently high for the material to be considered a usable structural material at temperatures as high as 589 K (600 F)