The cost of consent: why healthcare providers must be compliant with the Montgomery principles

2020 ◽  
Vol 102-B (5) ◽  
pp. 550-555
Author(s):  
Nick Birch ◽  
Nick V. Todd
Keyword(s):  
Positive Impact ◽  
Healthcare Providers ◽  
International Comparisons ◽  
Point Of View ◽  
Public Healthcare ◽  
Health Board ◽  
Malpractice Claim ◽  
The Usa ◽  
The Uk ◽  
The Cost

The cost of clinical negligence in the UK has continued to rise despite no increase in claims numbers from 2016 to 2019. In the US, medical malpractice claim rates have fallen each year since 2001 and the payout rate has stabilized. In Germany, malpractice claim rates for spinal surgery fell yearly from 2012 to 2017, despite the number of spinal operations increasing. In Australia, public healthcare claim rates were largely static from 2008 to 2013, but private claims rose marginally. The cost of claims rose during the period. UK and Australian trends are therefore out of alignment with other international comparisons. Many of the claims in orthopaedics occur as a result of “failure to warn”, i.e. lack of adequately documented and appropriate consent. The UK and USA have similar rates (26% and 24% respectively), but in Germany the rate is 14% and in Australia only 2%. This paper considers the drivers for the increased cost of clinical negligence claims in the UK compared to the USA, Germany and Australia, from a spinal and orthopaedic point of view, with a focus on “failure to warn” and lack of compliance with the principles established in February 2015 in the Supreme Court in the case of Montgomery v Lanarkshire Health Board. The article provides a description of the prevailing medicolegal situation in the UK and also calculates, from publicly available data, the cost to the public purse of the failure to comply with the principles established. It shows that compliance with the Montgomery principles would have an immediate and lasting positive impact on the sums paid by NHS Resolution to settle negligence cases in a way that has already been established in the USA. Cite this article: Bone Joint J 2020;102-B(5):550–555.

scholarly journals Experiences and impact of international medical volunteering: a multi-country mixed methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041599 ◽  
Author(s):  
Mary McCauley ◽  
Joanna Raven ◽  
Nynke van den Broek
Keyword(s):  
Low Income ◽  
Online Survey ◽  
Positive Impact ◽  
Healthcare Providers ◽  
International Medical ◽  
Middle Income ◽  
Use Of Resources ◽  
The Uk ◽  
Medical Volunteers ◽  
The Impact

ObjectiveTo assess the experience and impact of medical volunteers who facilitated training workshops for healthcare providers in maternal and newborn emergency care in 13 countries.SettingsBangladesh, Ghana, India, Kenya, Malawi, Namibia, Nigeria, Pakistan, Sierra Leone, South Africa, Tanzania, UK and Zimbabwe.ParticipantsMedical volunteers from the UK (n=162) and from low-income and middle-income countries (LMIC) (n=138).Outcome measuresExpectations, experience, views, personal and professional impact of the experience of volunteering on medical volunteers based in the UK and in LMIC.ResultsUK-based medical volunteers (n=38) were interviewed using focus group discussions (n=12) and key informant interviews (n=26). 262 volunteers (UK-based n=124 (47.3%), and LMIC-based n=138 (52.7%)) responded to the online survey (62% response rate), covering 506 volunteering episodes. UK-based medical volunteers were motivated by altruism, and perceived volunteering as a valuable opportunity to develop their skills in leadership, teaching and communication, skills reported to be transferable to their home workplace. Medical volunteers based in the UK and in LMIC (n=244) reported increased confidence (98%, n=239); improved teamwork (95%, n=232); strengthened leadership skills (90%, n=220); and reported that volunteering had a positive impact for the host country (96%, n=234) and healthcare providers trained (99%, n=241); formed sustainable partnerships (97%, n=237); promoted multidisciplinary team working (98%, n=239); and was a good use of resources (98%, n=239). Medical volunteers based in LMIC reported higher satisfaction scores than those from the UK with regards to impact on personal and professional development.ConclusionHealthcare providers from the UK and LMIC are highly motivated to volunteer to increase local healthcare providers’ knowledge and skills in low-resource settings. Further research is necessary to understand the experiences of local partners and communities regarding how the impact of international medical volunteering can be mutually beneficial and sustainable with measurable outcomes.

scholarly journals Earnings quality and the cost of equity capital: evidence on the impact of legal background

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ahmed Hassan Ahmed ◽  
Yasean Tahat ◽  
Yasser Eliwa ◽  
Bruce Burton
Keyword(s):  
Earnings Quality ◽  
Institutional Ownership ◽  
Equity Capital ◽  
Cost Of Equity Capital ◽  
Cost Of Equity ◽  
Content Type ◽  
The Usa ◽  
The Uk ◽  
The Cost ◽  
The Impact

Purpose Earnings quality is of great concern to corporate stakeholders, including capital providers in international markets with widely varying regulatory pedigrees and ownership patterns. This paper aims to examine the association between the cost of equity capital and earnings quality, contextualised via tests that incorporate the potential for moderating effects around institutional settings. The analysis focuses on and compares evidence relating to (common law) UK/US firms and (civil law) German firms over the period 2005–2018 and seeks to identify whether, given institutional dissimilarities, significant differences exist between the two settings. Design/methodology/approach First, the authors undertake a review of the extant literature on the link between earnings quality and the cost of capital. Second, using a sample of 948 listed companies from the USA, the UK and Germany over the period 2005 to 2018, the authors estimate four implied cost of equity capital proxies. The relationship between companies’ cost of equity capital and their earnings quality is then investigated. Findings Consistent with theoretical reasoning and prior empirical analyses, the authors find a statistically negative association between earnings quality, evidenced by information relating to accruals and the cost of equity capital. However, when they extend the analysis by investigating the combined effect of institutional ownership and earnings quality on financing cost, the impact – while negative overall – is found to vary across legal backdrops. Research limitations/implications This paper uses institutional ownership as a mediating variable in the association between earnings quality and the cost of equity capital, but this is not intended to suggest that other measures may be of relevance here and additional research might usefully expand the analysis to incorporate other forms of ownership including state and foreign bases. Second, and suggestive of another avenue for developing the work presented in the study, the authors have used accrual measures of earnings quality. Practical implications The results are shown to provide potentially important insights for policymakers, creditors and investors about the consequences of earnings quality variability. The results should be of interest to firms seeking to reduce their financing costs and retain financial viability in the wake of the impact of the Covid-19 pandemic. Originality/value The reported findings extends the single-country results of Eliwa et al. (2016) for the UK firms and Francis et al. (2005) for the USA, whereby both reported that the cost of equity capital is negatively associated with earnings quality attributes. Second, in a further increment to the extant literature (particularly Francis et al., 2005 and Eliwa et al., 2016), the authors find the effect of institutional ownership to be influential, with a significantly positive impact on the association between earnings quality and the cost of equity capital, suggesting in turn that institutional ownership can improve firms’ ability to secure cheaper funding by virtue of robust monitoring. While this result holds for the whole sample (the USA, the UK and Germany), country-level analysis shows that the result holds only for the common law countries (the UK and the USA) and not for Germany, consistent with the notion that extant legal systems are a determining factor in this context. This novel finding points to a role for institutional investors in watching and improving the quality of financial reports that are valued by the market in its price formation activity.

scholarly journals Epidemiological changes and financial consequences of hypertension in Latin America: implications for the health system and patients in Mexico

2012 ◽  
Vol 28 (3) ◽  
pp. 497-502 ◽  
Author(s):  
Armando Arredondo ◽  
Alexis Zuñiga
Keyword(s):  
Probabilistic Models ◽  
Evaluation Method ◽  
Healthcare Providers ◽  
Indirect Costs ◽  
Cost Evaluation ◽  
Public Healthcare ◽  
Epidemiological Changes ◽  
Financial Consequences ◽  
Prevention Of Hypertension ◽  
The Cost

The aim of this study was to assess the costs and financial consequences of epidemiological changes in hypertension in México. The cost evaluation method to estimate costs was based on instrumentation techniques. To estimate the epidemiological changes and expected cases of hypertension in 2010-2012, three probabilistic models were constructed according to the Box-Jenkins technique. Comparing the economic impact, from 2010 to 2012 there will be a 24% increase in financial requirements (p < 0.05). The total cost of hypertension in 2011 will be US$ 5,733,350,291, including US$ 2,718,280,941 in direct costs and US$ 3,015,069,350 in indirect costs. If the risk factors and various healthcare models remain unaltered in the institutions analyzed here, the financial consequences will have a major impact on users' pockets, followed by social security providers and public healthcare providers. The authors suggest a revision in the planning, organization, and allocation of resources, particularly programs for health promotion and prevention of hypertension.

scholarly journals Why the book “More than Medicine: the Broken Promise of American Health” is important to the future of behavioral medicine, health psychology, and public health

2019 ◽  
Author(s):  
Dawn K Wilson
Keyword(s):  
Public Health ◽  
Behavioral Interventions ◽  
Healthcare Providers ◽  
Cost Utility ◽  
National Institutes Of Health ◽  
Independent Evaluation ◽  
Environmental Determinants Of Health ◽  
The Usa ◽  
The Cost

Abstract In his book, “More than Medicine: The Broken Promise of American Health,” Robert Kaplan brings together extensive data to make the case that healthcare priorities in the USA need to place greater emphasis on behavioral, social and environmental determinants of health. Kaplan argues that the effect sizes for health outcomes resulting from environmental exposures, stress, and socioeconomic status are all much larger than are many traditional biological risk factors. There are discrepancies between estimates of how much the National Institutes of Health spends on behavioral and social sciences research, but an independent evaluation suggests it is <5% of the entire budget. Addressing this neglect requires advocacy and bringing together of like-minded organizations to promote more funding for behavioral interventions, health promotion and public health policies to address important contextual factors such as poverty, lack of education, and poor environmental conditions. Importantly, Kaplan argues that several metrics to integrate life expectancy and quality of life have been proposed and allow healthcare providers to prioritize the value of health over the volume of healthcare delivered. Although standards exist, there are still a limited number of studies on the cost-effectiveness and cost-utility of behavioral and public health interventions.

The Place of the General Practitioner in Modern Medical Care-Some International Comparisons

1970 ◽  
Vol 63 (2) ◽  
pp. 205-209
Author(s):  
John Fry
Keyword(s):  
General Practitioner ◽  
Medical Care ◽  
International Comparisons ◽  
Comprehensive Service ◽  
The Usa ◽  
The Cost ◽  
Changing World

Dr J Fry considers the role of medical care in a changing world in relation to social demands and the cost of providing a comprehensive service. A consideration of services in other countries, such as the USA, USSR, Europe and Australia, provides lessons towards improving the NHS and also warnings of the faults inherent in these differing systems of medical care.

scholarly journals Community work – a cure for stigma and social exclusion?

2009 ◽  
Vol 33 (8) ◽  
pp. 281-284 ◽  
Author(s):  
Justine Schneider
Keyword(s):  
Mental Health ◽  
Social Capital ◽  
Mental Health Services ◽  
Health Services ◽  
Social Exclusion ◽  
Mental Health Providers ◽  
Health Providers ◽  
The Usa ◽  
The Uk ◽  
The Cost

SummaryIt is possible to tackle exclusion by altering the nature of transactions between individuals and groups, including mental health services. One way to do this is to cultivate ‘social capital’ or interdependence between individuals and groups – as well as giving, each is entitled, but not compelled, to claim something in return. It is difficult, if not impossible, to sustain stigma and social exclusion when people are meeting mutual needs, building trust and helping each other. Mental health providers can foster social capital by creating community cohesion, namely interdependent relationships between individuals and organisations. This approach has been put into practice in the USA, where providers assert that small investments in building social capital return many times the cost. In the UK there is evidence that community development can make a contribution to mental health but it does not fit well with conventional approaches to mental health services – it calls for different skills and a vision that is collective rather than individualised.

The Psychoanalytical Approach

1982 ◽  
Vol 140 (1) ◽  
pp. 85-93 ◽  
Author(s):  
Ismond Rosen
Keyword(s):  
Personality Development ◽  
Point Of View ◽  
The Body ◽  
Clinical Approach ◽  
Sexual Dysfunctions ◽  
Psychotherapeutic Treatment ◽  
The Unconscious ◽  
Clinical Theory ◽  
The Usa ◽  
The Uk

Modern psychodynamic formulations concerning the sexual dysfunctions stem directly from Freud's Three Essays on Sexuality (1905). Amplification and modification of psychoanalytical views since then have provided a further store of observation and clinical theory of personality development and the working of the unconscious mind, from which both behaviourally-, as well as psychoanalytically-orientated workers continue to draw. However, no single unified psychoanalytic theory of sexual dysfunction exists, nor should it at this stage of our understanding. Psychoanalysis continues to be the major source of psycho-dynamic principles in this field; there are three avenues down which progress is being made. The first, which forms the body of this contribution, is the application of psychoanalysis to the psychotherapeutic treatment of sexual dysfunctions. The second is the amalgamation of certain of the techniques and principles of psychoanalysis together with active behavioural practices based on the discoveries of Masters and Johnson and the behavioural therapists. [Singer (1974) in the USA; Robinson and Creed (1980) in the UK]. The third, no less interesting from a psychodynamic point of view is the way in which some modern behavioural learning theory psychologists are finding themselves facing psychodynamic complexities, such as transference, counter-transference, and a growing reliance on talking rather than manipulative procedures. Some behavioural sex-therapists see themselves as psychotherapists (Mackay, 1976). A knowledge of psychodynamics is therefore invaluable whatever one's final clinical approach.

Cost-effectiveness of clozapine

1997 ◽  
Vol 171 (2) ◽  
pp. 125-130 ◽  
Author(s):  
Katherine J. Aitchison ◽  
Robert W Kerwin
Keyword(s):  
Cost Effectiveness ◽  
Community Setting ◽  
Chronic Schizophrenia ◽  
Naturalistic Study ◽  
Clozapine Treatment ◽  
Effectiveness Analysis ◽  
The Usa ◽  
Prescription Costs ◽  
The Uk ◽  
The Cost

BackgroundSchizophrenia is highly expensive in calculable and incalculable costs. Measures which impact the cost in the most severely affected are likely to produce the greatest cost reductions. Studies regarding clozapine in the USA have demonstrated clear cost-effectiveness, despite the high prescription costs. There are no prior UK studies.MethodWe performed a cost-effectiveness analysis comparing the three years prior to commencing clozapine to the period following establishment of clozapine treatment (mean 36.4 months) for 26 patients with chronic schizophrenia or schizoaffective disorder.ResultsThere was a significant improvement in all clinical ratings applied (and a mean net saving of £3768 per annum). The cost-effectiveness of clozapine was double that of conventional neuroleptics (15.2 pre-, 33.0 post-clozapine, P < 0.005).ConclusionsAs a naturalistic study our data provide valuable information on the cost-effectiveness of clozapine in the UK. Our methodology could be applied in a community setting or in the study of another atypical neuroleptic.

scholarly journals Editorial: An international outlook of corporate governance research

2020 ◽  
Vol 17 (4) ◽  
pp. 4-6
Author(s):  
Raef Gouiaa ◽  
Alexander Kostyuk
Keyword(s):  
Corporate Governance ◽  
Saudi Arabia ◽  
Point Of View ◽  
Corporate Ownership ◽  
Research Results ◽  
The World ◽  
The Usa ◽  
The Uk ◽  
New Research ◽  
And Control

This issue of the journal “Corporate Ownership and Control” is absolutely unique from the point of view of the geodiversity of the research. Thus, having published 16 papers in this issue of the journal we can count the research on corporate governance in the USA, the UK, Norway, Australia, Italy, Germany, Netherlands, Portugal, Spain, Belgium, Sweden, Finland, Austria, Greece, Ireland, Poland, France, Brazil, Tunisia, Morocco, Egypt, the UAE, Saudi Arabia, Kuwait, and others. This provides a very solid vision of the corporate governance national practices worldwide. This issue of the journal proves once again that corporate governance became a global subject for research during the last decade. Scholars from all the countries of the world try to deliver the new research results related to the national markets providing room for further comparison and research and we hope that the readers will enjoy the results of the recently published papers.

scholarly journals ‘Walking in the shoes of our patients’: a scoping review of healthcare professionals learning from the simulation of patient illness experiences

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Milda Karvelytė ◽  
Janet Rogers ◽  
Gerard J. Gormley
Keyword(s):  
Scoping Review ◽  
Positive Impact ◽  
Research Question ◽  
Healthcare Providers ◽  
Embodied Experience ◽  
Negative Effects ◽  
Diverse Range ◽  
Illness Experiences ◽  
The Usa ◽  
The Impact

Abstract Background Health professionals who have experienced ill-health appear to demonstrate greater empathy towards their patients. Simulation can afford learners opportunities to experience aspects of illness, but to date, there has been no overarching review of the extent of this practice or the impact on empathic skills. Objective To determine from the evidence—what is known about simulation-based learning methods of creating illness experiences for health professions and the impact on their empathic skills. Study selection Arksey and O’Malley’s methodological framework informed our scoping review of articles relevant to our research question. Three databases (MEDLINE, Embase and Web of Science) were searched, and a sample of 516 citations was screened. Following review and application of our exclusion criteria, 77 articles were selected to be included in this review. Findings Of the 77 articles, 52 (68%) originated from the USA, 37 (48%) of studies were qualitative based and 17 (22%) used a mixed-methods model. Of all the articles in our scope, the majority (87%) reported a positive impact and range of emotions evoked on learners. However, some studies observed more negative effects and additional debriefing was required post-simulation. Learners were noted to internalise perceived experiences of illness and to critically reflect on their empathic role as healthcare providers. Conclusions A diverse range of simulation methods and techniques, evoking an emotional and embodied experience, appear to have a positive impact on empathy and could be argued as offering a complementary approach in healthcare education; however, the long-term impact remains largely unknown.

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