Vertical integration of primary care practices with acute hospitals in England and Wales: why, how and so what? Findings from a qualitative, rapid evaluation

ObjectivesTo understand the rationale, implementation and early impact of vertical integration between primary care medical practices and the organisations running acute hospitals in the National Health Service in England and Wales.Design and settingA qualitative, cross-comparative case study evaluation at two sites in England and one in Wales, consisting of interviews with stakeholders at the sites, alongside observations of strategic meetings and analysis of key documents.ResultsWe interviewed 52 stakeholders across the three sites in the second half of 2019 and observed four meetings from late 2019 to early 2020 (further observation was prevented by the onset of the COVID-19 pandemic). The single most important driver of vertical integration was found to be to maintain primary care local to where patients live and thereby manage demand pressure on acute hospital services, especially emergency care. The opportunities created by maintaining local primary care providers—to develop patient services in primary care settings and better integrate them with secondary care—were exploited to differing degrees across the sites. There were notable differences between sites in operational and management arrangements, and in organisational and clinical integration. Closer organisational integration was attributed to previous good relationships between primary and secondary care locally, and to historical planning and preparation towards integrated working across the local health economy. The net impact of vertical integration on health system costs is argued by local stakeholders to be beneficial.ConclusionsVertical integration is a valuable option when primary care practices are at risk of closing, and may be a route to better integration of patient care. But it is not the only route and vertical integration is not attractive to all primary care physicians. A future evaluation of vertical integration is intended; of patients’ experience and of the impact on secondary care service utilisation.

A scoping review of the changing landscape of geriatric medicine in undergraduate medical education: curricula, topics and teaching methods

Purpose The world’s population is ageing. Therefore, every doctor should receive geriatric medicine training during their undergraduate education. This review aims to summarise recent developments in geriatric medicine that will potentially inform developments and updating of undergraduate medical curricula for geriatric content. Methods We systematically searched the electronic databases Ovid Medline, Ovid Embase and Pubmed, from 1st January 2009 to 18th May 2021. We included studies related to (1) undergraduate medical students and (2) geriatric medicine or ageing or older adults and (3) curriculum or curriculum topics or learning objectives or competencies or teaching methods or students’ attitudes and (4) published in a scientific journal. No language restrictions were applied. Results We identified 2503 records and assessed the full texts of 393 records for eligibility with 367 records included in the thematic analysis. Six major themes emerged: curriculum, topics, teaching methods, teaching settings, medical students’ skills and medical students’ attitudes. New curricula focussed on minimum Geriatrics Competencies, Geriatric Psychiatry and Comprehensive Geriatric Assessment; vertical integration of Geriatric Medicine into the curriculum has been advocated. Emerging or evolving topics included delirium, pharmacotherapeutics, healthy ageing and health promotion, and Telemedicine. Teaching methods emphasised interprofessional education, senior mentor programmes and intergenerational contact, student journaling and reflective writing, simulation, clinical placements and e-learning. Nursing homes featured among new teaching settings. Communication skills, empathy and professionalism were highlighted as essential skills for interacting with older adults. Conclusion We recommend that future undergraduate medical curricula in Geriatric Medicine should take into account recent developments described in this paper. In addition to including newly emerged topics and advances in existing topics, different teaching settings and methods should also be considered. Employing vertical integration throughout the undergraduate course can usefully supplement learning achieved in a dedicated Geriatric Medicine undergraduate course. Interprofessional education can improve understanding of the roles of other professionals and improve team-working skills. A focus on improving communication skills and empathy should particularly enable better interaction with older patients. Embedding expected levels of Geriatric competencies should ensure that medical students have acquired the skills necessary to effectively treat older patients.

VERTICAL INTEGRATION in AGRO-INDUSTRY: ECO-FRIENDLY GAMBIER PRODUCTS

Textile dyeing on fabrics and clothing causes environmental pollution and health problems. There is an innovation of natural coloring using gambier in the Gambo Muba fabric industry and the garment industry in Indonesia. Gambier farmers supply natural dye raw materials. Then through the supply chain of the Gambo Muba fabric industry and the garment industry, it causes vertical integration in the gambier agro-industry. This study uses primary data from 39 vertically integrated companies in the gambier agro-industry, including the gambier rubber industry, the Gambo Muba fabric industry, and the garment industry. The data was then analyzed using descriptive qualitative. This study analyzes the relationship between vertically integrated industries, including the transaction costs between them, their impact of vertical integration on added value, and their profitability. Vertically integrated industries have low transaction costs. The impact of vertical integration on the gambier agro-industry adds to the chain of economic activities that can increase added value and profits. The impact of vertical integration can reduce transaction costs, especially the supplier coordination cost component, distributor cost component, inter-company lobbying costs components. The benefits of vertical integration in the gambier agro-industry are increasing high added value, profit levels, decreasing environmental pollution, and agro-industry sustainability.

MONOPOLI DI BIDANG TEKNOLOGI INFORMASI

Competition in the business world causes business actors to sometimes resort to various ways to conduct unfair business competition, resulting in losses for other business actors. In the virtual world (information technology for example) this action is often found. So it is necessary to study how the prohibition of monopolistic practices and unfair business competition against businesses in the field of information technology. This research is a normative legal research, the main data of which is obtained through library research. Based on the results of the research, it is known that the form of market monopoly and unfair business competition in information technology law can be in the form of vertical integration, discrimination of business actors, taking of domain names, and other actions that can harm business competitors. The Tying Arrangement in the Microsoft case is a form of unfair business competition, in which the giant software company Microsoft is accused of violating the antitrust law by taking Tying Arrangements by linking the windows product (the tying product) with the internet explorer browser product (the tied product). The Tying Arrangement was allegedly carried out in order to win a monopoly in the internet browser product market.

Analysis of Factors Affecting Indonesian Coffee Exports in 2001-2018 Using The Vector Autoregression (VAR) Approach

Coffee exports are influenced by the exchange rate, the price of coffee and the amount of production. The purpose of the study was to determine the short-term and long-term relationship between coffee exports in 2001-2018. The research method is quantitative descriptive using classical assumption test and Error Correlation Model (ECM). The results of the VAR study are that coffee exports are not affected by coffee prices, coffee production and the rupiah exchange rate. Coffee exports were not significantly affected by coffee production, coffee prices and the exchange rate (exchange rate) using VAR. result Grangger's is that coffee production affects coffee exports and the exchange rate affects coffee exports. Test IRF and VD is the coffee production is influenced by coffee prices and the exchange rate, the price of coffee affects the production of coffee, coffee exports and the exchange rate and the exchange rate is influenced by the price of coffee and coffee exports. As for advice because coffee production affects coffee exports from Indonesia then, the government should do a vertical integration from upstream (people's plantations) to downstream (industries) to increase export expansion.

The Portuguese Hub of Companies in 1973 – Discussing the Corporate Concentration in the Portuguese Economy on the Eve of the April Revolution

The network of Portuguese companies in 1973 has been identified as a relevant element for understanding the economic structure of the country in the decade of 1970–1980. This network had been formed before 1974, during the dictatorship, but it remained after the Carnation Revolution. In spite of such research, this network has not yet been properly analysed, especially through adequate tools from network analysis. This work will detail this network, the different scores of centrality of each company, and their modular structures; it will also discuss estimates from exponential random graph models to identify significant attributes that explain the discovered flows of investment. This work will also detail the processes of vertical integration as well as the specificities of the identified oligopolies.