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

Outpatient Management of Mood Disorders by the Family Physician

It is well-known that the demand for psychiatric care in the US is higher than the supply of psychiatric clinical providers. Vermont, in particular, has a paucity of psychiatric providers and there are minimal providers in Chittenden County and the greater Burlington area. Many patients with psychiatric conditions are inconsistently managed given the lack of available outpatient providers, particularly for patients on Medicaid. Often times, patients suffer from psychiatric episodes that require an emergency department visit or inpatient stay, and they may leave the hospital with an outpatient medication regimen that can then be carried out by a primary care provider. Patients should not have to endure a psychotic episode bringing them into the hospital in order to receive appropriate psychiatric care. A possible solution to this gap in care would be for primary care providers to be armed with the knowledge and skills to appropriately and sustainably manage psychiatric conditions on an outpatient level. Tools to summarize the evidence and current guidelines around prescribing, testing, surveillance, and other drug-related parameters may enable providers to quickly assess the recommendations during a busy clinical day, especially if such tools were consistently updated and embedded into the electronic medical record. This project focuses on management of mood disorders in the outpatient family medicine clinic; a one-pager table summarizing guidelines around commonly prescribed mood stabilizers in the setting of bipolar disorder was created and displayed in the Hinesburg Family Medicine clinic.https://scholarworks.uvm.edu/fmclerk/1485/thumbnail.jp

Introduction to Library Trends 33 (3) Winter 1985: Collection Evaluation

published or submitted for publicatio

Children’s Health in a Legal Framework

The interdisciplinary periodical Future of Children has dedicated an issue to children’s health policy. This contribution to the issue maps the legal landscape influencing policy choices. The authors demonstrate that in the U.S. legal system, parents have robust rights, grounded in the Constitution, to make decisions concerning their children’s health and medical treatment. Following from its commitment to parental rights, the system typically assumes the interests of parents and children are aligned, even when that assumption seems questionable. Thus, for example, parents who would limit their children’s access to health care on the basis of the parents’ religious belief have considerable latitude to do so, unless the child’s life is imminently threatened. There are some exceptions to this legal regime. Adolescents have the right to obtain some health services independently; in these contexts, social welfare needs such as pregnancy prevention trump parental rights. Minors also have access to abortion (although this right is more restricted than for adults). Moreover, the state has the power to intervene when parents place their children’s health at risk through abuse or neglect. A hallmark feature of the legal regime based on parental rights is that the state has no affirmative obligation to help parents care for their children’s health needs. This libertarian framing of the family-state relationship has profound implications for the development of public policy. To the extent the state provides support for families and children, it is doing so as a matter of policy choice (as with Medicaid and the Children’s Health Insurance Program) and not enforceable legal obligation. The importance of family autonomy thus results in a weak conception of shared responsibility for children. The framework also means that the state often takes a reactive approach to child wellbeing, intervening primarily when families have broken down or parents have seriously defaulted on their duties. Appreciation of the legal framework underscores the need to develop political support for any initiative to improve health services for children. Often, as this article shows, the state intervenes to promote children’s health only in response to compelling social welfare needs such as crime or disease prevention, or to crises in which parents abuse their children or fail to provide adequate care

Wealth effects of bank holding company securities issuance and loan growth under the risk-based capital requirements

This paper tests a two-part hypothesis: first, that during the period between publication of the risk-based capital requirements in early 1989 and the end of 1992, bank holding companies (BHCs) faced a statistically significant decrease in stock returns if they issued new common stock; second, that this discouraged new common stock issuance and therefore, in effect, forced BHCs with Tier 1 and/or leverage capital-to-assets ratios below the regulatory minima to decrease loans outstanding more than did BHCs deficient only in their total capital ratios. Empirical evidence supporting both parts of the hypothesis is presented.Bank holding companies ; Bank loans ; Risk ; Bank capital ; Bank stocks ; Stock - Prices

Liquid Oxygen Cooling of Hydrocarbon Fueled Rocket Thrust Chambers

Rocket engines using liquid oxygen (LOX) and hydrocarbon fuel as the propellants are being given serious consideration for future launch vehicle propulsion. Normally, the fuel is used to regeneratively cool the combustion chamber. However, hydrocarbons such as RP-1 are limited in their cooling capability. Another possibility for the coolant is the liquid oxygen. Combustion chambers previously tested with LOX and RP-1 as propellants and LOX as the collant demonstrated the feasibility of using liquid oxygen as a coolant up to a chamber pressure of 13.8 MPa (2000 psia). However, there was concern as to the effect on the integrity of the chamber liner if oxygen leaks into the combustion zone through fatigue cracks that may develop between the cooling passages and the hot gas side wall. In order to study this effect, chambers were fabricated with slots machined upstream of the throat between the cooling passage wall and the hot gas side wall to simulate cracks. The chambers were tested at a nominal chamber pressure of 8.6 MPa (1247 psia) over a range of mixture ratios from 1.9 to 3.1 using liquid oxygen as the coolant. The results of the testing showed that the leaking LOX did not have a deleterious effect on the chambers in the region of the slots. However, there was unexplained melting in the throat region of both chambers, but not in line with the slots

Determinants of bank versus nonbank competitiveness in short-term business lending

Since about 1974, banks' share of the market for short-term business lending has been steadily eroded through competition with nonbank creditors. This paper tries to identify some factors that may affect bank competitiveness in this category in the short fun and discusses how these factors may have contributed to banks' loss of market share. Estimation of a simple linear model in first differences indicates that banks' market share responds negatively in the short run to above-average default risk and/or monetary tightness and to a decrease in banks' value of deposit insurance. Banks' market share responds positively to an increase in the level of interbank competition. Extrapolation from the short-run model to long-run effects demonstrates the plausibility that above average risk and/or monetary tightness and increases in the aggregate weighted capital-to-assets ratio, which contributes to decreases in the value of deposit insurance, may have played a small role in banks' loss of market share since the mid-1970s.Bank loans ; Bank competition ; Commercial loans