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Tests the theory that owners (hospital, physician, insurance) of vertically integrated health maintenance organizations (HMOs) might substitute towards production of their own specialty goods. Uses data from various sources in the USA. Determines the impact of ownership on factors such as average physician ambulatory services per enrollee and average hospital days per enrollee. Concludes that policymakers need to encourage the development of standard publicly available quality measures to intensify competition and eliminate excess profits accruing to provider‐owners who substitute towards production of their own goods.

Estimates a total effects cost function using a national 1994 health maintenance organization (HMO) data set to examine and update findings related to HMO efficiency. The cost function controls for ownership characteristics (profit status and ownership), size, enrollment diversity, regional location, product diversity, model type, payment characteristics, and years of operation. While not explicitly controlling for quality or acuity, measures of plan and enrollee diversity help control for acuity and quality. Results show that most of the difference in cost efficiency between HMOs is explained by factors specific to the HMO, including efficiencies of scale and scope, lower levels of Medicare patients, and efficient levels of capital. The study also shows that for‐profits are more efficient than non‐profits because they rely less on withhold pools to control costs. Limitations of the study include weak controls for quality of care, and limited data related to payment characteristics.

This study aimed to address three key gaps in existing knowledge about postgraduate researchers’ (PGRs) well-being. It investigated 1) the frequency and nature of depression, anxiety and well-being amongst PGRs, and relatedly, characteristics that convey vulnerability, 2) factors that impact PGR well-being, and 3) factors that influence help-seeking.

The mixed-methods design comprised quantitative and qualitative approaches. Using opportunity sampling, 585 PGRs registered at a large UK University completed an online survey. The perspectives of a purposive sample of academic and Professional Services staff (n = 61) involved in supporting PGRs were sought through in-depth focus groups and semi-structured interviews, which were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis.

PGRs scored lower on measures of well-being and higher on measures of anxiety and depression than aged-matched groups in the general population. PGR well-being was positively affected by personal and professional relationships, and negatively affected by academic challenges and mental health problems. Academic supervisors were the primary source of support for students experiencing well-being difficulties. Thematic analysis revealed four domains that impact upon PGR well-being: postgraduate researcher identity; pressures and expectations of postgraduate research; complexity of the supervisor role; and pinch points in postgraduate research. Each domain had associations with help-seeking behaviours.

This study provides evidence that the PGR experience is perceived to be distinct from that of other students, and this helps understand sources of stress and barriers to help-seeking. It provides a steer as to how higher education institutions could better support the PGR learning experience.