The workers’ compensation systems of several states have been expanded in recent years to include injuries and diseases caused by cumulative injury and occupational stress. This expansion has placed a financial burden on the respective systems, on employers, and on consumers, who ultimately must pay the cost of claims through higher priced products or services. This expansion may not be justified from a social perspective, however; extant medical and sociological evidence is not conclusive as to whether occupational-stress injuries or diseases—such as coronary heart disease, hypertension, stroke, and neuropsychiatric illness—are the direct result of stressful work environments. Using the California workers” compensation system as a model, the authors submit that the underlying premises of liability governing the expanded systems should be reassessed based (1) on economic factors, specifically, the increasing costs of workers’ compensation; (2) on the capacity of the system to process an ever-increasing number of claims; and (3) on the principle on which workers’ compensation systems were established, that of equity between the employer and the employee.

On the basis of these three factors, the authors evaluate three legislative approaches to restructuring the expanded system: presumption of compensability, apportionment of liability, and threshold of compensability. The first recognizes that although certain health problems are related to the workplace, the degree of causation is difficult to prove; under this approach, therefore, causation is presumed, and injury compensated, for all diseases and injuries that the system defines as work-related. The second holds that where a causal relationship between the work and the injury can be proved, the employer nevertheless should be responsible only for that portion of the disability actually caused by the workplace. The third directs that the injured employee be compensated only when a direct causal link between the job and the injury or disease can be proved. The authors recommend that legislators implement this third alternative. For one reason, it is feasible economically; for a second, it would not burden the system or increase litigation; for a third, it is equitable to both employees and employers.

Many hospitals presently find themselves at a vulnerable stage in their development. The increased efficacy of antibiotics, together with the population's increased life span and decreasing birth rate, have reduced the need for the kind of acute inpatient care that hospitals traditionally have provided. Moreover, hospitals now are feeling pressure from federal and state regulatory agencies to eliminate approximately 20 percent of the nation's acute-care beds. Concurrent with the population's changing health needs and with the increasing regulatory pressure from government, the acute-care hospital also must contend with the advent of a rival medical care delivery organization—the health maintenance organization (HMO)—whose primary goal is to provide quality medical services in a costefficient manner. One of the most important ways in which HMOs contain costs is by attempting to reduce significantly the rate of hospitalization of their members, an approach that threatens the very livelihood of some hospitals.

The authors describe five alternative strategies that hospitals can adopt to meet the potential threat of HMOs—filibustering, passive acceptance, direct sponsorship, accommodation, or strong support. They maintain that the latter of these strategies, strong support, places hospitals in the most favorable position to convert the threat of HMO development into an opportunity to build a mutually beneficial relationship.

Catastrophic health insurance may be necessary to curb rising health care costs in the United States. A major factor in this rise has been the current structure of the nation's health insurance system, which inadequately protects individuals with expensive illnesses, but encourages overinsurance for less expensive illnesses. This Note examines the current health insurance system, and analyzes its impact oh health care costs for individuals and society. It evaluates several proposals to modify the structure of the current health insurance system, and recommends the adoption of a catastrophic health insurance plan based on an economic definition of catastrophe. Such a plan would decrease shallow coverage, and would use coinsurance and deductible rates keyed to the individual's income as means of increasing consumer cost consciousness without making necessary care unreasonably expensive. This Note also recommends that a catastrophic plan only cover treatment that has been determined medically necessary by utilization review, and that this review encourage outpatient rather than costly inpatient treatment.

In 1974, Congress passed the Health Care Amendments to the National Labor Relations Act, thus bringing nonprofit health care institutions within the purview of the Act and within the jurisdiction of the National Labor Relations Board. Since the passage of these Amendments, the Board consistently has held that hospital no-solicitation rules prohibiting employees from engaging in union organizational activities on hospital premises in other than immediate, patient-care areas are presumptively invalid. In N.L.R.B. v. Baptist Hospital Inc., 442 U.S. 773 (1979), however, the U.S. Supreme Court questioned the rationality of the Board's presumption, although the Court did not specifically overrule the presumption itself. By examing the special interests arising in the hospital setting, as well as the legislative intent behind the Health Care Amendments, this Note evaluates the Board's presumption in light of the four Supreme Court opinions in Baptist Hospital. The Note concludes that the Board's presumption— that hospital no-soliciation rules are invalid in all areas of a hospital except for those areas directly involved in immediate patient care—is rational and reasonable (1) because it properly balances the interests of the hospital, of the employees, and of the patients, and (2) because it is consistent with the legislative intent behind passage of the Health Care Amendments. In addition, this Note contends that the Board has expanded its “immediate patient-care area” standard in an effort to address the Supreme Court's concern in Baptist Hospital that, the Board's balancing of interests had weighted the patients' well-being too lightly.

In Parham v. J.R., 442 U.S. 584 (1979), the U.S. Supreme Court held that a parent or a guardian can commit a minor to a mental institution if a staff physician certifies that the minor should be committed, even if the minor strenuously opposes their decision. The Court specifically rejected claims that commitment of a minor by a parent or guardian without an adversary hearing is a deprivation of the minor's liberty without due process of law. This Note reviews the Parham opinion, with special attention to its impact on “mature minors” and wards of the state and to its definition of a neutral factfinder. The Note argues first that the Court's failure to establish special safeguards for “mature minors” and wards of the state is inconsistent with constitutional standards of due process, and second, that the Court's acceptance of staff physicians as neutral factfinders may be unwarranted. The Note recommends the creation of moire stringent procedural safeguards for the commitment of minors by parents and guardians, including the use of independent mental health professionals as “neutral factfinders.”