Competition in Primary Healthcare in Ireland:More and Better Services for Less Money

Understanding precisely the nature of competition in primary healthcare has an important role to play in understanding how to improve the delivery of healthcare services. This is particularly the case in Ireland, where the private sector plays such a large role in primary care. If we do not understand competition, well-intentioned regulations and policies are less likely to be effective and more likely to result in excessive costs and under-utilisation of primary healthcare. This in turn can increase Ireland’s overall health expenditure and contribute to a higher cost of living in Ireland and thus lower competitiveness. This paper shows how well-designed regulations and systems for State funding of primary healthcare can ensure that competition works well and contributes to the better availability and quality of services at the lowest possible cost. The most common barriers to entry and expansion in primary healthcare markets are outlined and pricesetting mechanisms examined. Examples are used to illustrate the benefits to consumers and the State where these obstacles to competition have been removed, and the difficulties where they remain. Conclusions are drawn on the implications of this analysis for the governance of regulatory bodies, for regulatory Codes of Conduct, and for achieving value for money. It is time for the culture of the healthcare professions to move towards one where it is no longer considered “unprofessional” to provide a competitive service.

Sunny Samaritans and Egomaniacs: Price-Fixing in the Gamete Market

Krawiec compares the egg market to sperm market to illustrate the extent to which public-interest rhetoric enables private wealth transfers in the egg market. She also illuminates why such rhetoric is so effective, playing on deeply held societal norms. In addition, she provides an overview of the oocyte business, highlighting issues relating to recruitment, compensation, controversy, retrieval, and risk. She does the same for the sperm business. Furthermore, she discusses the anticompetitive behavior in the egg market and argues that the horizontal price-fixing embodied in the American Society for Reproductive Medicine\u27s pricing guidelines violates the Sherman Act. Lastly, she concludes that market forces, rather than collusive industry agreement, must be allowed to determine the proper mix of altruism and monetary payment that ultimately constitutes total egg donor compensation

Planning Guide Outdoor Recreation Facilities

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Confidentiality in Patent Dispute Resolution: Antitrust implications

nformation is crucial to the functioning of the patent system, as it is for other markets. Nevertheless, patent licensing terms are often subject to confidentiality agreements. On the one hand, this is not surprising: sellers and buyers do not normally publicize the details of their transactions. On the other hand, explicit confidentiality agreements are not common in other markets, and they may be particularly problematic for patents. Several United States Supreme Court cases have condemned agreements that suppress market information, and those cases could be applied to confidentiality agreements in the patent context. Of course, confidentiality may sometimes be pro-competitive, particularly when it involves only private negotiations. In other contexts, however, and notably in arbitration, which is a substitute for open court proceedings, the competitive balance is more problematic. Indeed, U.S. patent law mandates that patent arbitration awards be made public through the Patent and Trademark Office, though this requirement is generally ignored. Information about licensing terms is particularly important in one of today’s most important patent licensing contexts. The standard-setting organizations that define the technologies used in products like smartphones typically require their members to commit to license patented technologies that are adopted in standards on fair, reasonable, and non- discriminatory (FRAND) terms. The non-discriminatory element of this commitment is difficult for potential licensees to enforce without information about the licensing terms to which other licensees have agreed. This Article describes the value of patent licensing information and discusses the antitrust implications of agreements to keep that information confidential, particularly in the FRAND context and in arbitration. The Article also offers several ways in which parties, standard- setting organizations, and arbitration bodies could seek to avoid the anticompetitive effects of confidentiality

Contracting with General Dental Services: a mixed-methods study on factors influencing responses to contracts in English general dental practice

Background: Independent contractor status of NHS general dental practitioners (GDPs) and general medical practitioners (GMPs) has meant that both groups have commercial as well as professional identities. Their relationship with the state is governed by a NHS contract, the terms of which have been the focus of much negotiation and struggle in recent years. Previous study of dental contracting has taken a classical economics perspective, viewing practitioners’ behaviour as a fully rational search for contract loopholes. We apply institutional theory to this context for the first time, where individuals’ behaviour is understood as being influenced by wider institutional forces such as growing consumer demands, commercial pressures and challenges to medical professionalism. Practitioners hold values and beliefs, and carry out routines and practices which are consistent with the field’s institutional logics. By identifying institutional logics in the dental practice organisational field, we expose where tensions exist, helping to explain why contracting appears as a continual cycle of reform and resistance. Aims: To identify the factors which facilitate and hinder the use of contractual processes to manage and strategically develop General Dental Services, using a comparison with medical practice to highlight factors which are particular to NHS dental practice. Methods: Following a systematic review of health-care contracting theory and interviews with stakeholders, we undertook case studies of 16 dental and six medical practices. Case study data collection involved interviews, observation and documentary evidence; 120 interviews were undertaken in all. We tested and refined our findings using a questionnaire to GDPs and further interviews with commissioners. Results: We found that, for all three sets of actors (GDPs, GMPs, commissioners), multiple logics exist. These were interacting and sometimes in competition. We found an emergent logic of population health managerialism in dental practice, which is less compatible than the other dental practice logics of ownership responsibility, professional clinical values and entrepreneurialism. This was in contrast to medical practice, where we found a more ready acceptance of external accountability and notions of the delivery of ‘cost-effective’ care. Our quantitative work enabled us to refine and test our conceptualisations of dental practice logics. We identified that population health managerialism comprised both a logic of managerialism and a public goods logic, and that practitioners might be resistant to one and not the other. We also linked individual practitioners’ behaviour to wider institutional forces by showing that logics were predictive of responses to NHS dental contracts at the dental chair-side (the micro level), as well as predictive of approaches to wider contractual relationships with commissioners (the macro level) . Conclusions: Responses to contracts can be shaped by environmental forces and not just determined at the level of the individual. In NHS medical practice, goals are more closely aligned with commissioning goals than in general dental practice. The optimal contractual agreement between GDPs and commissioners, therefore, will be one which aims at the ‘satisfactory’ rather than the ‘ideal’; and a ‘successful’ NHS dental contract is likely to be one where neither party promotes its self-interest above the other. Future work on opportunism in health care should widen its focus beyond the self-interest of providers and look at the contribution of contextual factors such as the relationship between the government and professional bodies, the role of the media, and providers’ social and professional networks. Funding: The National Institute for Health Research Health Services and Delivery Research programme

THE IMPACT OF ENDORSERS’ CHARACTERISTICS ON CONSUMERS’ REACTION TO THE ADS

Everyday, consumers are bombarded by messages inducing them to change their attitudes. These persuasion attempts can range from logical arguments to expressive images, from regular consumers’ advice to celebrities’ recommendation. The literature and the research on advertising indicates the benefits of using the right type of endorser as consumers respond in a different manner to the same advertisement conveyed by various endorsers. Thus the objective of this empirical research paper regards the evaluation of the impact of endorsers’ characteristics (credibility, attractiveness) on consumers’ reaction toward advertisements. Furthermore we examine the consumer’s perception of the credibility and expertise of, the resemblance to, admiration for, and attractiveness of the source used in advertisements. Our research shows that there are no universal recipes in the selection of the endorser of the advertisement. Rather, each endorser may become the optimal solution depending on the circumstances under wich it will be used.advertising, endorser, consumers’ attitude, endorser’ credibility, endorsers’ attractiveness