scholarly journals Competition and market power in physician private practices

2012 ◽  
Vol 44 (2) ◽  
pp. 1005-1029 ◽  
Author(s):  
Timothy S. Gunning ◽  
Robin C. Sickles
2017 ◽  
Vol 2 (2) ◽  

Background: Gestational diabetes mellitus is a condition that affects many pregnancies and ethnicity appears to be a risk factor. Data indicate that approximately 18% of Tamil women are diagnosed with gestational diabetes mellitus. Today, approximately 50,000 of Tamils live in Switzerland. To date, there is no official tool available in Switzerland that considers the eating and physical activity habits of this migrant Tamil population living in Switzerland, while offering a quick overview of gestational diabetes mellitus and standard dietetics management procedures. The NutriGeD project led by Bern University of Applied Sciences in Switzerland aimed at closing this gap. The aim of this present study was to evaluate the implementation potential of the tools developed in the project NutriGeD for dietetic counseling before their wide scale launch in Swiss hospitals, clinics and private practices. Method: An online survey was developed and distributed to 50 recruited healthcare professionals working in the German speaking region of Switzerland from October – December 2016 (31% response rate). The transcultural tools were sent to participants together with the link to the online survey. The evaluation outcome was analysed using binary logistic regression and cross tabulation analysis with IBM SPSS version 24.0, 2016. Results: 94% (N=47) respondents believed that the transcultural tools had good potential for implementation in hospitals and private practices in Switzerland. A binary logistic regression analysis revealed that the age of participants had a good correlation (42.1%) on recommending the implementation potential of the transcultural tool. The participants with age group 34- 54 years old where the highest group to recommend the implementation potential of the transcultural tool and this was found to be statistically significant (p=0.05). 74% (34 out of 50) of the respondents clearly acknowledged the need for transcultural competence knowledge in healthcare practices. 80% (N =40) of the respondents agreed that the information presented in the counseling display folder was important and helpful while 60% (N= 30) agreed to the contents being clinically applicable. 90% (N=45) participants recommended the availability of the evaluated transcultural tools in healthcare settings in Switzerland. Conclusion: The availability in healthcare practice of the evaluated transcultural tools was greatly encouraged by the Swiss healthcare practitioners participating in the survey. While they confirmed the need for these transcultural tools, feed-backs for minor adjustments were given to finalize the tools before their official launch in practice. The developed materials will be made available for clinical visits, in both hospitals and private practices in Switzerland. The Migmapp© transcultural tool can serve as a good approach in assisting healthcare professionals in all fields, especially professionals who practice in areas associated with diet - related diseases or disorders associated with populations at risk.


2017 ◽  
Author(s):  
James Gibson

Despite what we learn in law school about the “meeting of the minds,” most contracts are merely boilerplate—take-it-or-leave-it propositions. Negotiation is nonexistent; we rely on our collective market power as consumers to regulate contracts’ content. But boilerplate imposes certain information costs because it often arrives late in the transaction and is hard to understand. If those costs get too high, then the market mechanism fails. So how high are boilerplate’s information costs? A few studies have attempted to measure them, but they all use a “horizontal” approach—i.e., they sample a single stratum of boilerplate and assume that it represents the whole transaction. Yet real-world transactions often involve multiple layers of contracts, each with its own information costs. What is needed, then, is a “vertical” analysis, a study that examines fewer contracts of any one kind but tracks all the contracts the consumer encounters, soup to nuts. This Article presents the first vertical study of boilerplate. It casts serious doubt on the market mechanism and shows that existing scholarship fails to appreciate the full scale of the information cost problem. It then offers two regulatory solutions. The first works within contract law’s unconscionability doctrine, tweaking what the parties need to prove and who bears the burden of proving it. The second, more radical solution involves forcing both sellers and consumers to confront and minimize boilerplate’s information costs—an approach I call “forced salience.” In the end, the boilerplate experience is as deep as it is wide. Our empirical work should reflect that fact, and our policy proposals should too.


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