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This paper analyzes health care as a context for building value through human capital and culture. We examine how health care managers can nurture a favorable culture for providers enabling them to focus on customer service. A case study of a large medical center examines how organization culture affects clinicians versus support and managerial staff while adversely impacting patient satisfaction and organizational costs associated with turnover and the cost of replacing personnel. An agenda for managing internal customers and organization culture is presented.

Recent premium increases imposed by managed care plans raise a serious question about the long-run viability of managed care as a solution for controlling health care costs. The last decade's growth of total expenditures on health care has only been modestly influenced by managed care reimbursement policies. It is clear that other variables, besides reimbursement policies, must be considered in the effort to achieve a fiscally sound health care system. This chapter explores the role of investments in management staffing as a predictor of sound financial performance in medical groups. Investments in management staffing by multispecialty groups surfaced as a consistent predictor of higher gross charges, net revenue and operating margins, and lower operating costs. Investments in management staffing surfaced as a predictor of lower operating costs and higher operating margin for specialty groups. The implications of these findings for practice, theory and research are discussed.

Medical practice guidelines are increasingly being used by managed care plans to ensure quality of care while achieving cost reductions. However, it is unclear that physicians are complying with these clinical protocols. This paper reviews pertinent literature to assist in: understanding why physicians encounter different incentives for complying with guidelines; identifying initiatives that managed care plans can utilize in managing clinical guidelines; and, identifying a research agenda for investigating issues surrounding physician compliance with guidelines.

A study of the price discounts granted by Morton Salt Company and other producers of table salt in the U.S. on their sales of table salt to grocery wholesalers and retailers. The discounts were found to be illegal under the Robinson-Patman Act by the Federal Trade Commission and the Supreme Court. The Commission and the Court believed that the discounts were unjustified price concessions granted to “large” buyers, consistent with the concerns of the Robinson-Patman Act. However, the evidence indicates that the most common discount – the “carload discount” – was received by virtually all buyers, regardless of the buyer’s size; the other discounts – “annual volume” discounts – though received primarily by “large” buyers, were likely cost based. The history of the discounts and likely reasons why they were granted are explored in detail.