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3M Dental Products Division's Baldrige application is grounded in a ten-year process of continuous improvement in the basic business principles of customer commitment, innovation and reliability, and sensitivity to employees and the community. The application is summarized in the seven standards of the Baldrige program.
OBJECTIVE: To examine the theoretical possibility of monopsony behavior under managed care insurance. STUDY DESIGN: Use of microeconomic theory to examine how managed care plans with market power would be expected to behave, and effects of that behavior on consumer and supplier welfare. PRINCIPAL FINDINGS: The article shows that, under managed care monopsony, the welfare of consumers may be increased but overall economic welfare will necessarily be reduced. It offers a test for whether the lower prices paid by managed care buyers with larger market share represent welfare-reducing monopsony or a welfare-increasing movement away from provider monopoly. The test says that, if the quantity of inputs (supplied under conditions of increasing long-run marginal cost) declines, monopsony is present. The article also argues that the translation of lower provider prices into lower premiums is consistent with welfare-reducing monopsony by nonprofit health plans. In contrast, for-profit health plans that obtain monopsony may reduce the welfare of consumers as well as that of input suppliers. These theoretical conclusions are shown to be consistent with recent empirical research indicating a negative relationship between buyer market power and cost per enrollee. CONCLUSIONS: Traditional antitrust policy has not been able to deal well with monopsony. The article concludes that health plans that use their market power to reduce medical spending may harm the well-being both of specialized medical workers and of consumers of medical care. Antitrust policy may need to be modified to deal with this situation.
Purchasers of fast-moving consumer goods generally exhibit multi-brand choice, selecting apparently randomly among a small subset or "repertoire" of tried and trusted brands. Their behavior shows both matching and maximization, though it is not clear just what the majority of buyers are maximizing. Each brand attracts, however, a small percentage of consumers who are 100%-loyal to it during the period of observation. Some of these are exclusively buyers of premium-priced brands who are presumably maximizing informational reinforcement because their demand for the brand is relatively price-insensitive or inelastic. Others buy exclusively the cheapest brands available and can be assumed to maximize utilitarian reinforcement since their behavior is particularly price-sensitive or elastic. Between them are the majority of consumers whose multi-brand buying takes the form of selecting a mixture of economy -- and premium-priced brands. Based on the analysis of buying patterns of 80 consumers for 9 product categories, the paper examines the continuum of consumers so defined and seeks to relate their buying behavior to the question of how and what consumers maximize.
This article examines forces that influence physicians to change the percentage of their admissions to a hospital (loyalty) and to cease admitting patients to a hospital altogether (exit). Because physicians are both members of a hospital and consumers of its services, their admitting patterns can be described using models of employee commitment and consumer buying behavior. We test several hypotheses drawn from these literatures using data on physician admissions at hospitals over a two-year period. Results indicate that admitting patterns are explained primarily by convenience and inertia processes characteristic of consumer behavior. On the other hand, factors believed to influence organizational commitment (e.g., decision-making involvement, conflict, economic investments) have little effect on loyalty and exit. The findings question the utility of hospital strategies to improve the climate of physician-hospital relations, and suggest several qualifications for research on the commitment of professionals.
Effect of preservation method on intake and chewing behavior was examined using a first, late vegetative harvest (mid-June) of Kanlow switchgrass (Panicum virgatum L.). For silage (S), forage was harvested with a commercial field chopper (1.5 to 4 cm average chop length) and ensiled directly in silos 1.2 m in diameter and 3.6 m in height. For hay (H), forage was harvested with a flail-chopper (7 to 15 cm average chop length) and cured as hay in a drier at 77 degrees C. Diets of H and S were fed to six Hereford steers (338+/-5 kg) in a single crossover experiment. Chewing behavior was monitored for 4 d with a computerized system. At feeding, H was higher in DM and contained greater concentrations (DM basis) of NDF, CP, and hemicellulose, but lower concentrations of ADF and cellulose, and had lower in vitro DM disappearance values. Steers fed S had higher intakes of DM (P < .02) and NDF (P < .04) and consumed less water from the water supply (P < .01) than animals fed H. However, total amount of water (from water supply and feed) consumed per kilogram of DMI did not differ between diets. Crude protein intake was similar between diets. Preservation method had no effect on eating time, number of boli ruminated, bolus duration, and number of rumination chews per bolus. Steers fed S made fewer eating chews (P < .10) and ruminated for a longer time (P < .05) while making a greater number of rumination chews (P < .04) than steers fed H. Rumination intercycle time was slightly shorter in steers fed H (P < .05) than in steers fed S. When expressed per kilogram of NDF intake, steers fed S spent less time eating (P < .03) and made fewer eating chews (P < .02) than steers fed H; however, rumination time, number of rumination chews, and number of boli ruminated were not affected by preservation method. Steers fed S ingested feed at a greater rate (P < .03), excreted smaller fecal particles (P < .03), had meals of shorter duration (P < .06), spent less time eating during main meals (meals following feed distribution: P < .05), had more rumination periods (P < .01), and a shorter morning (P < .06) latency time (interval between end of main meal and onset of rumination) than steers fed H. These results indicate that preservation method with its concomitant differences in chop length affected forage chemical composition and voluntary intake, and that differences in chewing behavior occurred mostly during eating.
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The public release of health care-quality data into more formalized consumer health report cards is intended to educate consumers, improve quality of care, and increase competition in the marketplace The purpose of this review is to evaluate the evidence on the impact of consumer report cards on the behavior of consumers, providers, and purchasers. Studies were selected by conducting database searches in Medline and Healthstar to identify papers published since 1995 in peer-review journals pertaining to consumer report cards on health care. The evidence indicates that consumer report cards do not make a difference in decision making, improvement of quality, or competition. The research to date suggests that perhaps we need to rethink the entire endeavor of consumer report cards. Consumers desire information that is provider specific and may be more likely to use information on rates of errors and adverse outcomes. Purchasers may be in a better position to understand and use information about health plan quality to select high-quality plans to offer consumers and to design premium contributions to steer consumers, through price, to the highest-quality plans.
OBJECTIVES: The authors studied enrollees in employer-sponsored managed health plans to determine the extent of multiple behavioral health consumers within families, use of behavioral health services by employees who have another family member using such services, congruence of diagnoses between two family members using behavioral health services, and the effect on covered charge per behavioral health consumer when other family members use behavioral health services. METHODS: Claims data from 911 plans sold or managed by a single managed behavioral health care company were examined. The plans provided coverage for 724,789 employees and covered about 1.7 million lives. Family members of employees were identified by the relationship codes on the claims. Service utilization rates were calculated for employees overall and for employees who had spouses or children who used behavioral health services. Mean and median covered charges were determined and were examined by number and type of consumers in the family. RESULTS: The use of behavioral health services was greater among employees whose children or spouses used behavioral health services. Utilization rates varied by the child's or spouse's diagnoses. More than 50 percent of male employees whose children received treatment for a depressive disorder also received such treatment. Congruence of diagnoses within families was noted. Covered charges per person generally increased with the number of family members who used behavioral health services. CONCLUSION: Greater knowledge about patterns of use of behavioral health services within families may help in improving access to care and developing more effective family interventions.
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Past studies on uses and gratifications theory suggested that consumer motives affect how they will use media and media contents. Recent advertising research has extended the theory to study the use of Internet advertising. The current study explores the effects of consumer motives on their search behavior using Internet advertising. The study employed a 2 by 2 between-subjects factorial experiment design. A total of 120 subjects were assigned to an experiment condition that contains an Internet advertisement varying by advertising appeals (i.e., rational vs. emotional) and product involvement levels (high vs. low). Consumer search behavior (measured by the depth, breadth, total amount of search), demographics, and motives were collected by post-experiment questionnaires. Because all three dependent variables measuring search behavior were conceptually related to each other, MANCOVA procedures were employed to examine the moderating effects of consumer motives on the dependent variables in four product involvement-advertising appeal conditions. Results indicated that main effects for product involvements and advertising appeals were statistically significant. Univariate ANOVA also showed that advertising appeals and product involvement levels influenced the total amount of search. Three-way interactions among advertising appeals, product involvement levels, and information motive were also statistically significant. Implications and future research directions are discussed.
Substantial evidence has been developed regarding the identity of health care information sources preferred by the elderly. However, this research has not empirically investigated why a given source might be more or less important to this segment. To address this gap, this research investigates OTC-health care information sources in terms of their credibility, expertise and associated risk. Differences in perceptions of these characteristics across the derived information source types are then examined across heavy and light users of OTC medications.
An unobtrusive observation system was developed to determine the extent to which dental professionals in two communities provided lead shielding to patients during X-ray exams. A lengthy baseline revealed low and irregular provision of shielding among half of these professionals. Subsequently, a program was undertaken by a consumer's group in which these professionals were requested to provide shielding and were given confidential feedback regarding its use during the baseline period. The provision of shielding dramatically increased at all offices and was maintained throughout a follow-up period extending to more than 9 months after the program's implementation. Little or no generalized effect was observed in the occurrence of three collateral behaviors that were also assessed throughout the study.
A positive coping style can be critical to successful rehabilitation of psychiatric consumers. Using structural equation modeling, this study examined the relationships among consumers' psychological characteristics, self-esteem, and behaviors, and the role of self-esteem in mediating the relationships between psychological characteristics and behavioral coping. The sample consisted of 393 psychiatric consumers recruited from 25 psychosocial rehabilitation services (PSR) agencies. Key findings were that affective (that is, negative and positive affect) and cognitive (that is, beliefs in devaluation-discrimination) traits influence self-esteem and behavioral coping, and significant effects of affective and cognitive traits on behavioral coping are mediated by self-esteem. The findings suggest that interventions targeting self-esteem could be effective in modifying the behavioral coping of consumers served in PSR agencies. Implications for social work practice are discussed in relation to attitude change theories.
This study examines the effect of disseminating physician fee information to consumers among two study populations; a Medicare enrolled population and a younger employed population. Using an experimental design, the effect of providing physician fee information on consumer knowledge, attitudes and behaviors is examined. The total sample size is 1,715 and includes 907 State employees and 801 Medicare enrollees. The findings suggest that the distribution of physician fee information may be a minor stimulant to consumerism in health care. The findings also suggest that the strength of the effect of fee information on consumer knowledge, attitudes and behaviors varies by population characteristics and the need for services.
The authors investigate the influence of various psychographic characteristics in distinguishing between those elderly patients who complain about dissatisfying experiences with health care providers and those who do not. Discriminant analysis results suggest that patients who are low in trust in their physicians and who are younger in terms of cognitive age are more likely to complain than are patients who are high in trust and older in terms of cognitive age. In light of these findings, the authors propose a number of managerially-relevant courses of action for health care providers.
This study assessed the creditability of self-help health support groups as an adjunct to traditional medical care among a sampling of physicians (N = 120) and group members (N = 73) located in the Dallas/Ft. Worth Metropolitan area. Findings suggest a general lack of awareness of local groups among physicians, referral to only a few select groups, as well as little communication between health care professionals and their patients. Physicians in group practice, surgical specialties, and having never referred patients to support groups responded less favorably. Several benefits were reported by the group members, although for a majority their patient-physician relationship remained relatively unchanged.
A popular program among consumer action groups involves publicizing comparative food price information (CFPI) gathered from retail stores. Its significance is based on the assumption that publishing CFPI maximizes retail competition (i.e., moderates price levels or price increases) and occasions more frugal store selections among consumers. We tested these assumptions during a 2-year analysis. Specifically, we monitored the prices of two distinct market baskets in the supermarkets of two midwestern cities (target and contrast cities). Following a lengthy baseline, we published the prices of only one of the market baskets at stores in the target city in the local newspaper on five different occasions. The results suggested that reductions in price inflation occurred for both market baskets at the independently operated target stores. The corporate chain stores were not similarly affected. In addition, surveys indicated that many consumers used the CFPI as a basis for store selection. Finally, the analysis included a discussion of the politics, economics, and future of CFPI programs.
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