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Fewer Restrictions (fewer + restriction)
Selected AbstractsThe End of an Era: What Became of the "Managed Care Revolution" in 2001?HEALTH SERVICES RESEARCH, Issue 1p2 2003Cara S. Lesser Objective. To describe how the organization and dynamics of health systems changed between 1999 and 2001, in the context of expectations from the mid-1990s when managed care was in ascendance, and assess the implications for consumers and policymakers. Data Sources/Study Setting. Data are from the Community Tracking Study site visits to 12 communities that were randomly selected to be nationally representative of metropolitan areas with 200,000 people or more. The Community Tracking Study is an ongoing effort that began in 1996 and is fielded every two years. Study Design. Semistructured interviews were conducted with 50,90 stakeholders and observers of the local health care market in each of the 12 communities every two years. Respondents include leaders of local hospitals, health plans, and physician organizations and representatives of major employers, state and local governments, and consumer groups. First round interviews were conducted in 1996,1997 and subsequent rounds of interviews were conducted in 1998,1999 and 2000,2001. A total of 1,690 interviews were conducted between 1996 and 2001. Data Analysis Methods. Interview information was stored and coded in qualitative data analysis software. Data were analyzed to identify patterns and themes within and across study sites and conclusions were verified by triangulating responses from different respondent types, examining outliers, searching for disconfirming evidence, and testing rival explanations. Principal Findings. Since the mid-1990s, managed care has developed differently than expected in local health care markets nationally. Three key developments shaped health care markets between 1999 and 2001: (1) unprecedented, sustained economic growth that resulted in extremely tight labor markets and made employers highly responsive to employee demands for even fewer restrictions on access to care; (2) health plans increasingly moved away from core strategies in the "managed care toolbox"; and (3) providers gained leverage relative to managed care plans and reverted to more traditional strategies of competing for patients based on services and amenities. Conclusions. Changes in local health care markets have contributed to rising costs and created new access problems for consumers. Moreover, the trajectory of change promises to make the goals of cost-control and quality improvement more difficult to achieve in the future. [source] London Business School Roundtable on Shareholder Activism in the U.K.JOURNAL OF APPLIED CORPORATE FINANCE, Issue 2 2006Article first published online: 16 JUN 200 Finance scholars have produced little evidence of the effectiveness of direct attempts by institutional shareholders to improve corporate performance. What studies we have,focused mainly on the activities of U.S. pension funds,show no clear effect on shareholder returns. But a new study of shareholder activism in the U.K. looks promising. The subject of the study is a "Focus Fund," launched in 1998 by the U.K. investment firm Hermes, whose aim is to identify underperforming companies, propose changes to their managements and boards, and,in contrast to the practices of the best-known U.S. shareholder activists,work mainly "behind the scenes" with the companies to bring about those changes. In keeping with the more private nature of U.K. activism, which reflects in part the fewer restrictions on communication between companies and their investors than in the U S., the study's method of investigation is also notably different from the methods used in studies of U.S. investors. Four academics were allowed to examine Hermes' records of its "engagements" with companies, including letters, recordings and transcripts of telephone conversations, and the staff's personal notes and recollections. Using this information, the researchers show that the Fund has been remarkably successful in bringing about three kinds of proposed changes: replacements of CEOs and Chairmen; changes in investment and financial policies (mainly increased payouts and more disciplined capital spending); and restructurings (typically leading to greater corporate focus). Of equal importance, the study also shows that the market reaction to the announcement of such changes has been significantly positive, and that the cumulative effect of these positive reactions accounts for as much as 90% of the Fund's impressive "alpha," or market out-performance, over its eight-year life. The first public presentation of these findings took place on February 9 at the inaugural event of the London Business School's Center for the Study of Corporate Governance. In our account of the event, an overview of the study's findings by two of its authors is followed by an "insider's" view of the Hermes' success story (presented by the Chief Executive of the Fund from 2002,2004) and a panel discussion of the general import of the findings featuring four distinguished practitioners. [source] Options for Sustaining School-Based Health CentersJOURNAL OF SCHOOL HEALTH, Issue 4 2004Susan M. Swider ABSTRACT: Several methods exist for financing and sustaining operations of school-based health centers (SBHCs). Promising sources of funds include private grants, federal grants, and slate funding. Recently, federal regulation changes mandated that federal funding specifically for SBHCs go only to SBHCs affiliated with a Federally Qualified Health Center (FQHC). Becoming a FQHC allows a SBHC to bill Medicaid at a higher rate, be notified about federal grants, and access the federal drug-pricing program. However, FQHCs must bill for services, including a sliding-fee scale based on ability to pay; develop a governance board with a majority of consumer members; provide a set of designated primary care services; and serve all people regardless of ability to pay. Private grants impose fewer restrictions and usually provide start-up and demonstration funds for specific program needs. Such funds are generally time limited, so new programs need to be incorporated into the operational budget of the center. State funding proves relatively stable, but fiscal challenges in some states made these funds less available. Using a variety of funding sources will enable ongoing provision of health care to students. Overall, SBHCs should consider infrastructure development that allows a variety of funding options, including formalizing existing partnership commitments, engaging in a needs assessment and strategic planning process, developing the infrastructure for FQHC status, and implementing a billing system for client services. [source] An Evaluation of Alternative Tax and Expenditure Limitation Policies on Kansas Local GovernmentsPUBLIC BUDGETING AND FINANCE, Issue 2 2009JOB D. SPRINGER Cross-sectional time series data in a partial adjustment model are used to examine county government fiscal behavior under a "hard" tax and expenditure limitation policy, an aggregate property tax levy limit, versus a "soft" limit under Truth in Taxation in Kansas. Results indicate that under the aggregate levy limit, per capita property taxes, own-source revenues and own-source expenditures were significantly higher than under the Truth in Taxation policy where local officials face many fewer restrictions on their ability to raise the levy. [source] Rural-Urban Differences in the Social Climate Surrounding Environmental Tobacco Smoke: A Report From the 2002 Social Climate Survey of Tobacco ControlTHE JOURNAL OF RURAL HEALTH, Issue 1 2004Robert McMillen PhD ABSTRACT: Context: Although previous research has found smoking rates to be higher among residents of rural areas, few studies have investigated rural-urban differences in exposure to environmental tobacco smoke (ETS). Objective: This study contrasted the social climate surrounding ETS among Americans who resided in 5 levels of county urbanization. Design: Data were collected via telephone interviews administered to a representative sample of 3,009 civilian, noninstitutionalized adults over age 18 in the United States. Households were selected using random digit dialing procedures. Findings: Compared to residents of urban counties, rural residents reported fewer restrictions on smoking in the presence of children and lower incidences of smoking bans in households, family automobiles, work areas, convenience stores, fast-food restaurants, and restaurants. Interestingly, when rural-urban variations in knowledge and attitudes about ETS were examined, the magnitude of rural-urban differences was smaller or nonexistent for these indicators. Moreover, logistic regression models indicated that none of these rural-urban differences in knowledge and attitudes persisted after statistically controlling for region, smoking status, gender, race, age, and education factors. This suggests that the observed rural-urban differences in ETS bans could not be explained adequately by rural-urban differences in knowledge and attitudes about the dangers of ETS. Conclusions: The policy implications of this research point to a greater need in rural America for programs focusing on the restriction and elimination of ETS. They also suggest that programs focusing only on influencing the levels of ETS knowledge and attitudes among the general population may not be adequate in producing the desired change. [source] | |||||||||||||