The fall and rise of the global economy

Economic conditions - United States ; Economies of scale

Second opinion utilization by healthcare insurance type in a mixed private-public healthcare system: a population-based study

Objectives: To evaluate the utilization (overall and by specialty) and the characteristics of second-opinion seekers by insurance type (either health-fund or supplementary insurance) in a mixed private-public healthcare. Design: An observational study. Setting: Secondary care visits provided by a large public health-fund and a large supplementary health insurance in Israel. Participants: The entire sample included 1,392,907 patients age 21 and above who visited at least one specialist over an 18-months period, either in the secondary care or privately via the supplementary insurance. Outcomes measures: An algorithm was developed to identify potential second-opinion instances in the dataset using visits and claims data. Multivariate logistic regression was used to identify characteristics of second-opinion seekers by the type of insurance they utilized. Results: 143,371 (13%) out of 1,080,892 patients who had supplementary insurance sought a single second-opinion, mostly from orthopedic surgeons. Relatively to patients who sought second-opinion via the supplementary insurance, second-opinion seekers via the health-fund tended to be females (OR=1.2, 95% CI 1.17–1.23), of age 40-59 (OR= 1.36, 95% CI 1.31– 1.42) and with chronic conditions (OR=1.13, 95% CI 1.08–1.18). In contrast, second-opinion seekers via the supplementary insurance tended to be native-born and established immigrants (OR=0.79, 95% CI 0.76–0.84), in a high socio-economic level (OR= 0.39, 95% CI 0.37–0. 4) and living in central areas (OR= 0.88, 95% CI 0.85–0.9). Conclusions: Certain patient profiles tended to seek second-opinions via the supplementary insurance more than others. People from the center of the country and with a high socioeconomic status tended to do so, as medical specialists tend to reside in central urban areas

Beyond Kolpak: EU Law’s unforeseen contribution to the movement of African Cricketers

The movement of professional cricketers from South Africa to England to play in County Cricket has expanded since the late 1960s. It became more attractive during the period of South African isolation and some players saw English cricket as a route to play at Test match level through changing national allegiance. This paper explores the role of law in facilitating movement in two ways. First, in the case of Greig, the attempt to ban players who chose to participate in the new commercial venture, World Series Cricket, was overturned. Second, in the Kolpak case a decision of the European Court of Justice paved the way for South Africans and Zimbabweans to abandon their national side and play in England as domestic players without the usual constraints applied to overseas players. The opportunity was taken by numerous players because of the political upheaval in cricket that was contemporaneously taking place in both South Africa and Zimbabwe. The movement of players caused concern in both South Africa and England and led to a re-consideration of the financial relationships between governing bodies and players

Unconscionability and Contract: The creeping shoots of Bundy

Unconscionability and Contract: The creeping shoots of Bund

Reconceptualising the standard of care in sport: The case of youth rugby in England and South Africa

Sport is an important area of civil society in both South Africa and England, and this article is broadly concerned with the relationship between sport and personal injury. More specifically, the article compares how rugby is regulated by the tort of negligence in England and delict in South Africa respectively. Regarding liability, for sport there are very specific factors that need to be taken into account. The article is concerned with, firstly, the broader context of sport as an important social and cultural activity, and secondly the specific sporting context that includes the rules of the game as well as the playing culture, with a focus on rugby at junior level. Through a critical and comparative analysis of how the standards of care in sport have been developed in both jurisdictions, the aim of this article is to consider how sport specific elements can be incorporated into the traditional legal principles. This comparative analysis contextualises the various discussions in the light of the differences between the English tort of negligence and the South African law of delict. Our argument is that the context and specificity of rugby should be more explicitly taken into account when evaluating potential liability. To establish a standard of care for sport is complex, with many factors to be taken into account and balanced against one another. The law of negligence/delict therefore needs to be adaptable and flexible to resolve new situations where injuries have occurred. Even in established situations where liability has been previously determined, novel events do occur and knowledge develops that requires a reconsideration of the principles that govern liability. In junior rugby, the risk of very serious injuries is relatively small and the law needs to tread a cautious path through liability, ensuring it is a vehicle that promotes sport rather than creating barriers to its enjoyment and practice. A greater understanding of sport, informed by detailed research, can unearth new areas of potential liability that will need to be considered in the future

The juridification of sport: A comparative analysis of children’s rugby and cricket in England and South Africa

This article takes as its point of departure the notion of juridification in sport and, in particular, the perspective that the term has previously often been used in sport and law literature in a too narrow and limiting sense. Using the work of Ken Foster as a platform, the article examines a more nuanced notion of juridification. It does this by first unpacking two levels of juridification – the more well-known notion of increased legal intervention is considered before moving on to a more sophisticated application of the idea in terms of its impact upon rules and practices in sport. Foster termed this juridification as domestication. The article then applies these ideas in a practical context by examining two applications of the two children’s sports (rugby and cricket) in England and South Africa. The article concludes as to the future developments that are likely to occur. Despite the economic and cultural differences it seems likely that South Africa will continue to follow England, as is the case with the first level of juridification, and that the rules and their enforcement will themselves become more domesticated. It is likely that coaches and educators will find themselves under increased pressure to conform from both a general fear of litigation and a changing internal regulatory regime of sport codes

The impact of private online video consulting in primary care

Workforce and resource pressures in the UK National Health Service mean that it is currently unable to meet patients’ expectations of access to primary care.1 In an era of near-instant electronic communication, with mobile online access available for most shopping and banking services, people expect similar convenience in healthcare. Consequently, increasing numbers of web-based and smartphone apps now offer same-day ‘virtual consulting’ in the form of Internet video conferencing with private general practitioners.2 While affordable and accessible private primary care may be attractive to many patients, the existence of these services raises several questions. A particular concern, given continued development of antimicrobial resistance,3 is that some companies appear to use ease of access to treatment with antibiotics as an advertising strategy. We examine online video consulting with private general practitioners in the UK, considering its potential impact on patients and the National Health Service, and its particular relevance to antimicrobial stewardship

Clinical effectiveness and cost effectiveness of individual mental health workers colocated within primary care practices: a systematic literature review

Objectives Mental health disorders contribute significantly to the global burden of disease and lead to extensive strain on health systems. The integration of mental health workers into primary care has been proposed as one possible solution, but evidence of clinical and cost effectiveness of this approach is unclear. We reviewed the clinical and cost effectiveness of mental health workers colocated within primary care practices. Design Systematic literature review. Data sources We searched the Medline, Embase, PsycINFO, Healthcare Management Information Consortium (HMIC) and Global Health databases. Eligibility criteria All quantitative studies published before July 2019 were eligible for the review; participants of any age and gender were included. Studies did not need to report a certain outcome measure or comparator in order to be eligible. Data extraction and synthesis Data were extracted using a standardised table; however, pooled analysis proved unfeasible. Studies were assessed for risk of bias using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool and the Cochrane collaboration’s tool for assessing risk of bias in randomised trials. Results Fifteen studies from four countries were included. Mental health worker integration was associated with mental health benefits to varied populations, including minority groups and those with comorbid chronic diseases. Furthermore, the interventions were correlated with high patient satisfaction and increases in specialist mental health referrals among minority populations. However, there was insufficient evidence to suggest clinical outcomes were significantly different from usual general practitioner care. Conclusions While there appear to be some benefits associated with mental health worker integration in primary care practices, we found insufficient evidence to conclude that an onsite primary care mental health worker is significantly more clinically or cost effective when compared with usual general practitioner care. There should therefore be an increased emphasis on generating new evidence from clinical trials to better understand the benefits and effectiveness of mental health workers colocated within primary care practices

Drug therapies for attentional disorders alter the signal-to-noise ratio in the superior colliculus

Despite high levels of use, the mechanism of action of effective pharmacotherapies in attention deficit hyperactivity disorder (ADHD) is unknown. It has recently been hypothesized that one site of therapeutic action is the midbrain superior colliculus, a structure traditionally associated with visual processing, but also strongly implicated in distractibility, a core symptom of ADHD. We used male juvenile Wistar rats to examine the effects of therapeutically relevant doses of methylphenidate and d-amphetamine on collicular activity in vitro. Here we report a novel shared mechanism of the two drugs whereby they enhance the signal-to-noise ratio in the superior colliculus. The effects on the signal-to-noise ratio were mediated by serotonin (5-HT) via a pre-synaptic mechanism. This modulatory action would bias the system towards salient events and lead to an overall decrease in distractibility