The Protection of Patients Under the Clayton Act.

The vast consolidation among health-care providers in the aftermath of the Affordable Care Act's enactment has led to much debate over the benefits of mergers in the health-care industry. In 2016, the Federal Trade Commission filed motions in federal court to enjoin three hospital mergers in various parts of the country. This amounted to more challenges to hospital mergers in a single year than any year in recent history. Though two of these motions succeeded at the district court level, both were overturned on appeal, which led many to wonder what the effect of these decisions would be on future health-care mergers. While many fear that hospital mergers lead to higher prices for consumers, there are also those who contend that mergers lead to efficiencies, which allow merging parties to utilize resources more effectively, increase the quality of patient care and coordination, and potentially save lives. This Note argues that the possibility of quality-enhancing or life-saving efficiencies is worth the risk that consumers see increased prices. To allow mergers that may realize these types of efficiencies, antitrust enforcement agencies and courts must begin placing greater weight on merging parties' efficiency arguments by easing the current standard. Additionally, in light of new research suggesting that cross-market health-care mergers, or mergers between providers in different geographic markets, affect bargaining dynamics between providers and insurers, this Note argues that parties' relative bargaining power must be considered in agencies' and courts' analyses of the competitive landscape relevant to a merger.

Filling Voice Promotion Gaps in Healthcare through a Comparative Analysis of Error Reporting and Learning Systems and Open Communication and Disclosure Policies in the United States and Germany.

Voice in healthcare is crucial because of its ability to improve organizational performance and prevent medical errors. This paper contends that a comparative analysis of voice promotion in the American and German healthcare industries can strengthen a culture of safety in both countries. It provides a brief introduction to the concept of voice in healthcare, including its impact on safety culture, barriers to voice, and the dual influences of confidentiality and transparency on voice promotion policies. It then examines the theoretical basis, practical workings, and legal aspects of voluntary error reporting and error disclosure as avenues for exercising voice in the U.S. and Germany. Finally, it identifies transferable practices that can remedy shortcomings in each country's voice promotion policy.

International legal regulation of impact of occupational injuries and diseases on agricultural workers' health.

INTRODUCTION: Agricultural workers' health depends on many factors: working conditions, security arrangements, medicine, quality of drugs, the environment, etc. Occupational injuries and diseases are also among the factors that can negatively affect their health. THE AIM: To analyze provisions of the international legislation and scientific literature concerning existence of restrictions on impact of occupational injuries and diseases on agricultural workers' health. MATERIALS AND METHODS: International acts, data of international organizations and conclusions of scientists have been examined and used in the study. The article also integrates information from scientific journals and monographs from a medical and legal point of view with scientific methods. This article is based on dialectical, comparative, analytic, synthetic and comprehensive research methods. Impact of occupational injuries and diseases on agricultural workers' health has been studied within the system approach, as well as analysis and synthesis. CONCLUSIONS: The level of occupational morbidity, traumatism and above all standard of agricultural workers' health depends on the way of occupational safety organization. Working conditions and safety in agricultural industry and therefore the appropriate standard of health remain unsatisfactory in many countries.

Evaluating the efficiency of nuclear energy policies: an empirical examination for 26 countries.

The decarbonization of the global economy is an urgent concern. As a potential solution, it can be important to understand the efficiency of nuclear energy policies. For this purpose, the paper analyzes whether there is a unit root in nuclear energy consumption in 26 countries and it uses the unit root tests with two endogenous (unknown) structural breaks. The paper finds that nuclear energy consumption is stationary around a level and the time trend in 25 of 26 countries and nuclear energy consumption contains a unit root only in France. The paper also discusses the potential implications of the findings.

[Work quota setting and man-hour productivity estimation in pathologists]. / Normirovanie truda i otsenka trudozatrat vrachei patologoanatomicheskikh otdelenii.

The paper considers the development and current state of the regulation of work quota setting and remuneration in pathologists. Reasoning from the current staff standards for morbid anatomy departments (units), the authors present a method to calculate the load of pathologists. The essence of the proposed method is demonstrated using a specific example.

Valoración de la repercusión del dolor sobre la productividad laboral: validación del cuestionario WPAI: pain / Assessment of the impact of pain on work productivity: validation of the Spanish WPAI: pain questionnaire

Fundamento: Los instrumentos de medida de salud son esenciales en la actividad clínica diaria. Sin embargo, es necesario un proceso de validación para poder certificar la validez y fiabilidad de los mismos. En la actualidad no existe ninguno que permita evaluar la repercusión del dolor en la productividad laboral de los pacientes. El objetivo de nuestro estudio es validar un cuestionario para evaluar las consecuencias del dolor en dicha productividad. Método: En base al Work Productivity and Activity Impairment Questionnaire - General Health hemos creado una versión modificada denominada WPAI:Pain con el fin obtener un cuestionario que pudiera medir las consecuencias del dolor en la productividad laboral. El estudio se realizó siguiendo las pautas habituales de validación de pruebas, omitiéndose las fases de redacción y validez de contenido ya que se modificaba un cuestionario existente. Resultados: Se obtuvieron 577 cuestionarios en dos hospitales universitarios españoles. Se comprobó la capacidad discriminante del cuestionario mediante prueba de U de Mann-Whitney. Se realizaron los test de fiabilidad obteniéndose un alfa de Cronbach de 0,896 con un test de dos mitades de Guttman de 0,921. Se comprobó la estabilidad con un test-retest estadísticamente significativo. La validez de constructo se estableció mediante correlación de Pearson comparando los resultados del cuestionario con el dolor en escala visual analógica, que resultó estadísticamente significativa para todos los valores. Conclusiones: El cuestionario WPAI:Pain es un instrumento de medida válido para determinar las consecuencias del dolor en la productividad laboral de los pacientes, siendo el único validado en español. Sin embargo, se requieren estudios de mayor envergadura para poder confirmar una validez universal (AU)

Background: Health measuring instruments are essential in daily clinical practice. However, a validation process is needed in order to certify the validity and reliability of it. The aim of our study is to validate a questionnaire to assess the consequences of pain in work productivity. Methods: Based on the Work Productivity and Activity Impairment Questionnaire - General Health we have created a modified version called WPAI:Pain in order to be able to measure the consequences of pain in work productivity. The study was conducted following the usual guidelines of test validation, omitting face validity as WPAI:Pain is a modification of an existing questionnaire. Validity and reliability were calculated. Results: A total of 577 questionnaires were obtained in 2 spanish university hospitals. The questionnaire's discriminating power was verified by Mann-Whitney test. Reliability tests were realized, Cronbach's alpha was 0.896 and Guttman split-half was 0.921. Stability was evaluated with a test-retest which was significant. Construct validity was established by Pearson correlation comparing the results of the questionnaire with the pain visual analog scale, which was statistically significant for all values. Conclusions: The WPAI:Pain questionnaire is a valid instrument for measuring the consequences of pain in work productivity. It is currently the only one validated in Spanish. Major studies are needed in order to establish its universal validity (AU)

Analysis of Productivity Improvement Act for Clinical Staff Working in the Health System: A Qualitative Study.

INTRODUCTION: The productivity of healthcare staff is one of the main issues for health managers. This study explores the concept of executive regulation of Productivity Improvement Act of clinical staff in health. METHODS: In this study phenomenological methodology has been employed. The data were collected through semi-structured interviews and focus group composed of 10 hospital experts and experts in human resources department working in headquarter of Mashhad University of Medical Sciences and 16 nursing managers working in public and private hospitals of Mashhad using purposive sampling. Findings were analyzed using Colaizzi's seven step method. RESULTS: The strengths of this Act included increasing spirit of hope in nurses, paying attention to quality of nursing care and decreasing problems related to the work plan development. Some of the weaknesses of Productivity Improvement Act included lack of required executive mechanisms, lack of considering nursing productivity indicator, increasing non-public hospitals problems, discrimination between employees, and removal of resting on night shifts. Suggestions were introduced to strengthen the Act such as increased organizational posts, use of a coefficient for wage in unusual work shifts and consideration of a performance indicator. CONCLUSION: The results may be used as a proper tool for long term management planning at organization level. Finally, if high quality care by health system staff is expected, in the first step, we should take care of them through proper policy making and focusing on occupational characteristics of the target group so that it does not result in discrimination among the staff.

Internal Controlling of a Radiology Department.

Caused by legal reform initiatives there is a continuous need to increase effectiveness and efficiency in hospitals and surgeries, and thus to improve processes.Consequently the successful management of radiological departments and surgeries requires suitable structures and optimization processes to make optimization in the fields of medical quality, service quality and efficiency possible.In future in the DRG System it is necessary that the organisation of processes must focus on the whole clinical treatment of the patients (Clinical Pathways). Therefore the functions of controlling must be more established and adjusted. On the basis of select Controlling instruments like budgeting, performance indicators, process optimization, staff controlling and benchmarking the target-based and efficient control of radiological surgeries and departments is shown.

The cost of alcohol in the workplace in Belgium.

BACKGROUND: It has been suggested that alcohol problems have a major impact in the workplace. It has long been recognized that misuse can have serious consequences for the productivity of workers. The extent of the problem is still an uncalculated cost. Few studies provide clear evidence of a cause, effect or relationship between substance abuse and workplace costs and valuable guidance to employers in evaluating the cost of substance abuse in their workplaces is missing. OBJECTIVE: To estimate the awareness, policies and cost to employers of drinking in the workplace in Belgium and to illustrate the potential gains from drinking cessation provision. Costs vary with type of industry and policy in place; therefore, to estimate these costs, results from a survey were combined with evidence drawn from a review of literature. STUDY DESIGN: An Internet survey of 216 workplaces in Belgium, based on a stratified random sample of workplaces with 50 or more employees, was conducted in 2005. Further information was collected from 150 occupational physicians. Additional evidence was compiled from a review of the literature of drinking-related costs. RESULTS: 216 General Directors or HR Directors completed a questionnaire related to awareness, policy and costs. 150 occupational physicians completed a questionnaire related to awareness and policy. Companies are unaware or underestimate alcohol misuse among their employees. At least 84% of companies have no education or information policy about substance abuse. Absenteeism, accidents and turnover account for 0.87% of the wage bill. Reduced productivity/ (presenteeism accounts for 2.8%. The construction industry, postal services, hospitality industry (hotel/restaurants and catering) and sanitation industry (collection, street cleaning) are the most problematic sectors. CONCLUSION: Awareness: many companies are totally unaware of the impact of substance abuse and those that are aware underestimate the problem. Sectors are heterogeneous; some are more problematic than others. Policy: although there is a link between policy and consumption, few companies have a clear substance abuse policy. Cost: reduced productivity is perceived as the most important cost.

Regulatory neutrality is essential to establishing a level playing field for accountable care organizations.

Accountable care organizations (ACOs) are among the most widely discussed models for encouraging movement away from fee-for-service payment arrangements. Although ACOs have the potential to slow health spending growth and improve quality of care, regulating them poses special challenges. Regulations, particularly those that affect both ACOs and Medicare Advantage plans, could inadvertently favor or disfavor certain kinds of providers or payers. Such favoritism could drive efficient organizations from the market and thus increase costs or reduce quality of and access to care. To avoid this type of outcome, we propose a general principle: Regulation of ACOs should strive to preserve a level playing field among different kinds of organizations seeking the same cost, quality, and access objectives. This is known as regulatory neutrality. We describe the implications of regulatory neutrality in four key areas: antitrust, financial solvency regulation, Medicare governance requirements, and Medicare payment models. We also discuss issues relating to short-term versus long-term perspectives--to promote the goal of regulatory neutrality and allow the most efficient organizations to prevail in the marketplace.

[Efficiency of inspections of the corpse before cremation performed in the area of the Halle University Medical Centre]. / Effizienz der Krematoriumsleichenschau im Bereich des Universitätsklinikums Halle.

From 1993 to 2007, the Institute of Forensic Medicine in Halle conducted 882 post-mortems before cremation. These records were now used for a systematic analysis of these cases to assess the efficiency of so-called second inspections of the corpse carried out in the area covered by the Halle University Hospital. In the period under review, considerable fluctuations were found from year to year, but these are mainly attributable to changes in the Saxony-Anhalt burial law introduced in 2002. Our 882 post-mortems were based on 84,677 corpse inspections before cremation; thus, an autopsy was performed in about 1% of all cases. Males were significantly overrepresented, younger age groups were dominant and there was a relatively high percentage where the first inspection of the corpse could not determine the manner of death or had to declare death by an unnatural cause. With regard to the manner and cause of death, the results of the first inspection and the post-mortem differed significantly. In 17.6% of our 882 cases, only the post-mortem revealed that death had been due to an unnatural cause. Despite the presence of sometimes strong clues to an unnatural cause, 156 of these cases were classified as natural deaths (56.4%) or the manner of death was stated as undetermined (43.6%). For more than two thirds of these 156 cases we were able to inspect the records kept by the Departments of Public Prosecution. 105 of these at first overlooked cases of unnatural deaths turned out to be deaths by accident. The other cases included 11 suicides, and 36 deaths related to medical treatment. In the remaining four cases, the autopsy results strongly suggested homicide, but only in one of these four cases subsequent police investigations were able to identify the perpetrator. This outcome demonstrates that the rule of inspecting the corpse a second time before cremation is clearly indispensable, even in its currently rather limited form.

Administrative simplification: adoption of operating rules for health care electronic funds transfers (EFT) and remittance advice transactions. Interim final rule with comment period.

This interim final rule with comment period implements parts of section 1104 of the Affordable Care Act which requires the adoption of operating rules for the health care electronic funds transfers (EFT) and remittance advice transaction.