Universal Service and Competition

The author is advising the Cook Islands on how to introduce mobile competition, drawing on the experience of Australia. In both countries the impact of infrastructure competition on mandated geographically uniform pricing is being (or proposed to be) addressed with a levy. The different approaches to measuring costs and setting the levy are contrasted. The paper proposes that a universal service levy has to be coupled with consistent access pricing to have efficient competition consistent with universal service policy. Interconnection between networks is free but the pricing of resold wholesale services should be consistent with the aims of the levy; to ensure universal service and efficient competition.

Bargain Hunting for Buffered Lidocaine: A Collaborative Discovery of Cost-saving Strategies That Can Improve Patient Care

Buffered lidocaine is a local anesthetic option during percutaneous needle-directed procedures in the breast. At our institution, sodium bicarbonate (the buffer) is dispensed in volumes that frequently lead to medical waste and shortages. In this study, we describe how moving the buffering of lidocaine from the procedure room to our clinical hospital pharmacy results in a reduction in costs and improves satisfaction across the breast radiology department. While cost savings are difficult to tease out in practices that opt for bundled payments, we were able to access pricing and supply data and coordinate with our pharmacy to change our practice. Making these changes saves our practice $26 000 a year and allows us to continue to offer buffered lidocaine even during sodium bicarbonate shortages. This manuscript describes how these changes came about and their economic impact.