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Context: Dramatic increases in pharmaceutical merger and acquisition (M&A) activity since 2010 suggest we are in the midst of a third wave of industry consolidation. Methods: The authors reviewed 168 economic, legal, medical, industry, and government sources to examine the effects of consolidation on competition and innovation and to explore how industry attributes complicate M&A regulation in a pharmaceutical context. Findings: The authors find that, in spite of certain metrics that might argue otherwise, consolidation consistently reduces innovation and harms the public good. They also find that several factors within the pharmaceutical industry impede proper evaluation of proposed mergers. Because consumer choice across substitutes is limited, pharmaceutical markets frustrate conventional methods of defining markets. Volume bargaining in the pharmaceutical supply chain and asset managers’ common ownership of pharmaceutical firms further complicate the definitional process. Hence, the Herfindahl-Hirschman Index (HHI), one measure used by the Federal Trade Commission and the Department of Justice to screen for concerning M&A activity, sometimes depends on faulty market definitions and fails to capture the implications of consolidation for future market share. Conclusions: The authors describe ways to improve how pharmaceutical markets are defined, highlight quantitative alterations to HHI to account for common ownership, and propose areas requiring further research.

International reference prices (IRP), also called external reference prices, are widely used across developed nations. IRP uses the prices paid in other countries to either inform negotiations with the pharmaceutical industry or as a cap on market prices. The authors review the application of IRP to cap the prices of negotiated outcomes in the context of US proposals for changing the way prescription drug prices are established for the Medicare program. They examine the economic, political, and administrative issues associated with the use of IRP, and they summarize the evidence on the impacts of IRP.

El bienestar, sus componentes y determinantes han retomado importancia en la teoría económica, y se han convertido en un tema actual y significativo. Por ello, este estudio tuvo como objetivo conocer el impacto de tres variables económicas del bienestar objetivo en la felicidad (bienestar subjetivo) de los individuos, en el ámbito urbano. A través de un modelo de regresión logística aplicado a datos de la ciudad de Montevideo, se pudo observar que existe una relación significativa entre el ingreso, la riqueza y el desempleo de un individuo con la probabilidad de que se autoproclame feliz (positiva en los dos primeros casos y negativa en el tercero). Los resultados obtenidos permiten asistir a la construcción de política pública en lo que respecta a la relevancia de las variables consideradas. The well-being, its components, and determinants have regained importance in the economic theory. Therefore, the aim of this study was to identify the impact of three economic variables of the objective well-being on happiness (subjective well-being) of the individuals at an urban environment. Through a logistic regression model applied to data from Montevideo city, it was observed a significant relationship between income, wealth, and unemployment of a person and the probability to self-report as happy (positive in the first and second cases and negative in the third). Results allow to assist in the construction of public policy with respect to the relevance of the variables considered.

POLICY POINTS: Looking for a way to curtail market power abuses in health care and rein in prices, 20 states have restricted most‐favored‐nation (MFN) clauses in some health care contracts. Little is known as to whether restrictions on MFN clauses slow health care price growth. Banning MFN clauses between insurers and hospitals in highly concentrated insurer markets seems to improve competition and lead to lower hospital prices. CONTEXT: Most‐favored‐nation (MFN) contract clauses have recently garnered attention from both Congress and state legislatures looking for ways to curtail market power abuses in health care and rein in prices. In health care, a typical MFN contract clause is stipulated by the insurer and requires a health care provider to grant the insurer the lowest (i.e., the most‐favored) price among the insurers it contracts with. As of August 2020, 20 states restrict the use of MFN clauses in health care contracts (19 states ban their use in at least some health care contracts), with 8 states prohibiting their use between 2010 and 2016. METHODS: Using event study and difference‐in‐differences research designs, we compared prices for a standardized hospital admission in states that banned MFN clauses between 2010 and 2016 with standardized hospital admission prices in states without MFN bans. FINDINGS: Our results show that bans on MFN clauses reduced hospital price growth in metropolitan statistical areas (MSAs) with highly concentrated insurer markets. Specifically, we found that mean hospital prices in MSAs with highly concentrated insurer markets would have been $472 (2.8%) lower in 2016 had the MSAs been in states that banned MFN clauses in 2010. In 2016, the population in our sample that resided in MSAs with highly concentrated insurer markets was just under 75 million (23% of the US population). Hence, banning MFN clauses in all MSAs in our sample with highly concentrated insurer markets in 2010 would have generated savings on hospital expenditures in the range of $2.4 billion per year. CONCLUSIONS: Our empirical findings suggest banning MFN clauses between insurers and providers in highly concentrated insurer markets would improve competition and lead to lower prices and expenditures.

Promoting substitution of lower priced generics for brand drugs once the market exclusivity period for the latter expires is a key component of the US strategy for achieving value in prescription drugs.This study examines the effect of generic competition on drug prices by estimating the effect of entry of generic drugs, following a brand's loss-of-exclusivity (LOE), on the average price of competing drugs.Using the Medicare Part D drug event (PDE) data from 2007 to 2018, we utilize both fixed effects and random effects at the drug level to estimate the relationship of competitors and prices within each drug while controlling for factors across drugs. We follow a drug 24 months and 36 months after first generic entry to examine whether the relationship between number of suppliers and price would change over time. We also test the hypothesis that drugs with more recent LOE might face less competition than those with earlier LOE.We find that drug prices fall with increasing number of competitors. Prices decline by 20% in markets with about three competitors (the expected price ratio of current generic to pre-generic entry brand average prices is 80%). Prices continue to decline by 80% relative to the pre-generic entry price in markets of ten or more competitors (the expected price ratio is about 30% following 2 years after entry, dropping to 20% following 3 years after entry). We also find that the impact of competition on relative prices is similar for generic drugs first entering the market in either 2007-11 or 2012-15.Promoting generic entry and maintaining effective provider competition are effective methods for containing drug prices.

The authors believe that understanding Islamic banking financial governance at a globally competitive level is an exciting issue in global economic studies. We have carried out the completeness of the data and the discussion from various sources of information and economic data. Furthermore, our understanding efforts were made to find solutions in answering questions and problems in the context of this study by involving a comprehensive study of economics review, involving a system of data analysis, evaluation, and in-depth conclusion drawing. We carry out this study is in a qualitative type of study relying on secondary data in the form of evidence from previous studies, which we consider valid and updated in response to the problems and questions of this study. Based on the existing data supported by the evidence of previous findings, we found that Islamic banking financial governance in the context of a globally competitive economy is an exciting issue for the parties because the world today is questioned by the failure of the conventional capitalist economy in contributing solutions to the world community. Other findings are very relevant to be discussed and become an essential theme in competitive economics, especially Islamic economics.

Refugees’ effect on domestic terrorism is conditioned by host-country social perception (attitude about living next-door to foreigners) and economic competition. These hypotheses are tested cross-nationally from 1995-2014 leveraging data from the World Values Survey. The results show social perception matters. When refugee flow to a country increases from the mean to 75th percentile, it does not statistically alter domestic terrorism risk. But when a host-country’s preference to not live next-door to foreigners is accounted for and changes from the mean (20.9%) to 75th percentile (30.3%), the change in refugee flow increases the risk of domestic terrorism by 40%.

Although hospital consolidation within markets has been well documented, consolidation across markets has not, even though economic theory predicts-and evidence is emerging-that cross-market hospital systems raise prices by exerting market power across markets when negotiating with common customers (primarily insurers). This study analyzes hospital systems using the American Hospital Association Annual Survey Database and defines hospital geographic markets as commuting zones that link workers to places of employment. The share of community hospitals in the US that were part of hospital systems increased from 10 percent in 1970 to 67 percent in 2019, resulting in 3,436 hospitals within 368 systems in 2019. Of these systems, 216 (59 percent) owned hospitals in multiple commuting zones, in part because 55 percent of the 1,500 hospitals targeted for a merger or acquisition between 2010 and 2019 were located in a different commuting zone than the acquirer. Based on market-power differences among hospitals in systems, the number of systems in urban commuting zones that could potentially exert enhanced cross-market power increased from thirty-seven systems in 2009 to fifty-seven systems in 2019, an increase of 54 percent. The increase in cross-market hospital systems warrants concern and scrutiny because of the potential anticompetitive impact of hospital systems exerting market power across markets in negotiations with common customers.

This study aims to investigate the continuance of village unit cooperative, the management, and preparation in facing business competition and globalization. This study employed a qualitative method with a phenomenological approach to gain an understanding of the phenomenon. Three village unit cooperatives were involved as a research subject in the area of oil palm plantations in Muaro of Jambi municipalities. The findings indicate that the village unit cooperative has been able to provide better prosperity for its members. Second, the village unit cooperative does not have a more advanced and modern business plan to compete in the current era. However, the business undertaken is a monopoly that makes it village unit cooperatives difficult to compete with other parties.

The purpose of this article is to summarize and critique from a public health perspective the recent report from the U.S. Department of the Treasury (DOT) regarding competition in the beer, wine, and spirits markets in the United States.A critical review of the recent DOT report was conducted.The report is remarkable primarily for its ability to spend 64 pages on alcohol regulation and reference none of the public health literature either on the health, social, and economic burden of alcohol use or on the importance and effectiveness of regulatory policies to reduce that burden.The report is clear evidence that structural public health input into DOT deliberations about policy is missing. The department should create something parallel to its Office of Industry and State Outreach to ensure that future assessments of alcohol markets balance economic insights with public health data and evidence.

BackgroundPrice competition has the potential to reduce health expenditures without hindering pharmaceutical innovation. However, empirical evidence on price competition after generic drugs are introduced is scarce. This study investigates product- and substance-level determinants of price competition following the entry of generics into the South Korean market.MethodsWe selected substances that were approved by the Ministry of Food and Drug Safety from 2000 to 2019, linked their corresponding pharmaceutical products, measured the degree of price competition under various scenarios, and utilized multilevel analysis to investigate the determinants of price competition.ResultsA total of 986 substances and 12,109 corresponding pharmaceutical products were identified. Only 11% of products were affected by price competition in the 10% scenario. However, the number increased to 43% when we measured price competition at the substance level. Major domestic manufacturers mainly initiated price competition at the product level, while foreign manufacturers were reluctant to initiate price competition. At the substance level, the maximum reimbursement price was a significant determinant of price competition.ConclusionPrice competition at the product level is rare in South Korea. In contrast, the market is quite price competitive at the substance level. Policy options could be introduced to encourage “discounted generic” substitution in an effort to maximize the effects of price competition at the substance level. Major domestic manufacturers are essential in the introduction of discounted generics into the South Korean health system.

This article looks globally at the motivations behind attitudes to immigration. Such motivations have been typically conceptualised by academics either in terms of the ‘economic competition’ or ‘cultural threat’ that immigrants are perceived to pose to the individual or their ‘in-group’. We propose and test a third possibility: that support for or opposition to immigration is determined by one's perceptions of immigration's effects on social conflict. Using the 2017–2020 World Values Survey (WVS) for forty-nine countries, we show that: in most countries, globally, citizens are more likely to agree than disagree that immigration leads to social conflict; levels of concern about the effects of immigration on social conflict are higher than those regarding unemployment or culture in sixteen—disproportionately economically developed—countries; concern about social conflict is conceptually and distributionally distinct; belief that immigration leads to social conflict predicts immigration policy preferences; but, uniquely, is positively predicted by higher education. Our findings highlight the importance of institutional conflict resolution capacity, including those related to integration, for the politics of migration.

The main factors of economic competition are considered, namely: people, time, money and quality. The ability to manage these factors through specific project management tools is reflected. The practical significance of each of the factors of economic competition is emphasized and the appropriate project management tool for the management of each of the factors on the example of companies in various sectors of the economy, based on research results or statistics. In particular, when considering the factor of economic competition "people", it is recommended to pay special attention to their role in improving the effectiveness of strategies implementation and changing the goal as a key quintessence of the organization, and for the development of this factor improved stakeholder assessment process is proposed, which is often used in project management to increase its competitiveness. Another tool in people management is analyzed - SCRUM teams, which have become especially popular globally. Research data on the level of their use in various areas of management are presented. To control the time parameter of economic competition, it is recommended to pay attention to the SMART technique, according to which the goals should be specific, measurable, achievable, relevant and limited in time. The importance of the "time" factor in the competitive environment is demonstrated by the example of postal companies and compared their level of competitive advantage according to this criterion, as well as those companies that responded quickly to restrictive measures during the Covid-19 pandemic and changed their priority projects to those that are more urgent today. Regarding the "quality" factor, analyzing the world's achievements, attention was paid to the effectiveness of using 14 principles of E. Deming, which still remain relevant. The "costs" factor is governed by classical and further tools such as budgeting and the popular E. Deming cycle. It is concluded that the use of various project management tools in the field of economic competition to increase the positive impact of its factors allows ensuring the desired level of competitiveness of the organization of any field of activity and at any stage of its life cycle. These tools are easy to use, versatile and practical.

In the United States, brand-name prescription drugs remain expensive until market exclusivity ends and lower-cost generics become available. Delayed generic drug uptake may increase spending and worsen medication adherence and patient outcomes. We assessed recent trends and factors associated with generic uptake.Among 227 drugs facing new generic competition from 2012 to 2017, we used a national claims database to measure generic uptake in the first and second year after generic entry, defined as the proportion of claims for a generic version of the drug. Using linear regression, we evaluated associations between generic uptake and key drug characteristics.Mean generic uptake was 66.1% (standard deviation 22.1%) in the first year and 82.7% (standard deviation 21.6%) in the second year after generic entry. From 2012 to 2017 generic uptake decreased 4.3% per year in the first year (95% confidence interval, 2.8%-5.8%, P.001) and 3.2%/year in the second year (95% confidence interval, 1.2%-5.1%). Generic uptake was lower for injected than oral drugs in the first year (38.5% vs 70.0%, P.001) and second year (50.3% vs 86.9%, P.001). In the second year, generic uptake was higher among drugs with an authorized generic (86.1 vs 80.1%, P = .045) and those with ≥3 generic competitors (87.7% vs 78.6%, P = .055).Early generic uptake decreased over the past several years. This trend may adversely affect patients and increase prescription drug spending. Policies are needed to encourage generic competition, particularly among injected drugs administered in a hospital or clinic setting.

The study focuses on the ambiguity of management decisions in conditions of economic competition and quarantine restrictions. It is concluded that in the field of freight transportation there are antagonistic interests of the environment in the process of making management decisions by managers of JSC “Ukrzaliznytsia”. The classification of information situations related to the uncertainty of the environment is used, according to which the fifth information situation most closely corresponds to the current situation in the market of transport services. The choice of the fifth information situation is due to the factors caused by the government’s decisions to impose quarantine restrictions. Most of these factors have had a negative impact on the expectations of businesses in general and cargo owners in particular. The state of economic competition in the field of freight transportation was studied by analyzing the structure of goods by different modes of transport for January-November 2019-2020, indicating the absence of significant changes or restrictions on freight traffic. Thus, quarantine restrictions did not cause irreparable damage to the railway industry directly, but they indirectly affected a number of indicators. Analysis of economic competition, level of uncertainty, degree of ambivalence of government decisions and structural and dynamic analysis of the market of transport services in January-November 2019-2020, allowed creating a methodology that ensures the validity of management decisions in economic competition and ambivalence of government actions. It consists of 6 stages: formulation of the purpose; formation of the corresponding information base; formation of an expert group; direct survey; selection of the most promising solutions for stabilizing the situation in the field of rail freight; assessment of the homogeneity of the expert group. The application of this technique gives railway companies additional competitive advantages, even in conditions of growing uncertainty and risk.

Policy Points Much concern about generic drug markets has emerged in recent policy debates. Important changes in regulations, the structure of purchasing, and the length of the drug supply chain have affected generic drug markets. Effective price competition remains the rule in generic markets for large-selling drugs. Smaller markets and those for injectable products often have less price competition and are more susceptible to supply disruptions. Context The image of generic drugs as a commodity sold in competitive markets is an oversimplification, as evidenced by increasing accounts of price spikes, sustained high price-cost margins, and market disruptions. The mismatch between the canonical economic model of generic drug markets and reality motivated our empirical project. Methods To explore recent changes in those factors impacting the supply and demand for generic drugs, we studied, from a variety of sources, the data on price, competition, supply disruptions and recalls, changes to the supply chain, and buy-side concentration. We examined quarterly data through 2018 for a cohort of 77 molecules that lost patent protection during the so-called patent cliff between 2010 and 2013. Findings On the supply side, we found that for large-market oral solids, generic entry and price declines were consistent with past studies showing a significant number of market entrants and substantial reductions in the average price of a molecule. In smaller markets for oral solids and injectable products, we observed fewer entrants, higher rates of exit, smaller price reductions, and, in some cases, considerable price instability. The number of reported shortages increased across all generic market types over time, with the rate of shortage increases especially pronounced in markets for injectable products. The number of product recalls also rose over our study period. Although we did not estimate causal effects, we did find several changes in the market environment for generic drugs that may contribute to these phenomena. The demand side for generics has become more concentrated. Supply chains rely more on producers outside the United States (particularly from China and India). Contracting practices have undergone changes that may inhibit competition in product supply. FDA regulatory scruitiny has increased. Conclusions Competition in generic drug markets varies widely by market size and product form. Recent changes in demand-side market structure imply more downward pressure on prices stemming from buy-side concentration. The FDA's greater regulatory oversight puts upward pressure on costs, and the lengthening of the supply chain increases production uncertainty for producers. Demand and supply-side changes point to further market instabilities across all generic markets due to producers' changing economic position.

Universities in Indonesia, including in Bandung, inspite of being a social organization, it must be able to compete with the foreign universities. Internal Marketing approach is one way to analyze the strengths of Internal Resources owned by a service company. This study examines the mediating role of satisfaction in trust and commitment relationships with loyalty in a University in Bandung. Sample size is 162 respondents whom taken by self-administered questionnaires from bureau academic staff of X University. This research shows that satisfaction is still a major consideration that cause loyalty, since there is a fully mediating role of satisfaction in trust and loyalty relationship. It means that trust should be elaborated into satisfaction firstly before turn into loyalty. The authors also make some recommendations, especially the recommendation that satisfaction is still an important factor in determining loyalty, It means that a universities in Bandung should developed employees’ satisfaction to survive in the borderless economic competition.

Does democratisation promote economic competition? This paper documents that the disruption of political connections associated with Suharto's fall had a modest pro-competitive effect on Indonesian manufacturing industries. Firms with connections to Suharto lost substantial market share following his resignation. Industries in which Suharto family firms had larger market share during his tenure exhibited weak improvements in broader measures of competition in the post-Suharto era relative to industries in which Suharto firms had not been important players.

Policy Points Looking for a way to curtail market power abuses in health care and rein in prices, 20 states have restricted most-favored-nation (MFN) clauses in some health care contracts. Little is known as to whether restrictions on MFN clauses slow health care price growth. Banning MFN clauses between insurers and hospitals in highly concentrated insurer markets seems to improve competition and lead to lower hospital prices.ContextMost-favored-nation (MFN) contract clauses have recently garnered attention from both Congress and state legislatures looking for ways to curtail market power abuses in health care and rein in prices. In health care, a typical MFN contract clause is stipulated by the insurer and requires a health care provider to grant the insurer the lowest (i.e., the most-favored) price among the insurers it contracts with. As of August 2020, 20 states restrict the use of MFN clauses in health care contracts (19 states ban their use in at least some health care contracts), with 8 states prohibiting their use between 2010 and 2016.MethodsUsing event study and difference-in-differences research designs, we compared prices for a standardized hospital admission in states that banned MFN clauses between 2010 and 2016 with standardized hospital admission prices in states without MFN bans.FindingsOur results show that bans on MFN clauses reduced hospital price growth in metropolitan statistical areas (MSAs) with highly concentrated insurer markets. Specifically, we found that mean hospital prices in MSAs with highly concentrated insurer markets would have been $472 (2.8%) lower in 2016 had the MSAs been in states that banned MFN clauses in 2010. In 2016, the population in our sample that resided in MSAs with highly concentrated insurer markets was just under 75 million (23% of the US population). Hence, banning MFN clauses in all MSAs in our sample with highly concentrated insurer markets in 2010 would have generated savings on hospital expenditures in the range of $2.4 billion per year.ConclusionsOur empirical findings suggest banning MFN clauses between insurers and providers in highly concentrated insurer markets would improve competition and lead to lower prices and expenditures.

Organisational competitive procurement environment positively impacts prices while supply side factors also determine participation in bidding. With strong competition costs come down. Instances of low competition in equipment purchase in the apex tertiary care hospital led to this study aimed at determining procurement practices, competition in procurement and its determinants. Review of tender records for three financial years (2011-2014) was conducted to ascertain procurement practices and resulting competition. Sellers' perspective on factors determining participation was captured through a questionnaire. Although four bids per tender were received only two qualified technically emphasising need for broad based specifications. Both sellers and peer staff also feel that specifications are not broad based. Regression analysis showed that one unit increase in bid led to six per cent price reduction. Increase in number of equipment led to an increase in the number of bids received but no price decrease. Pre-bid meetings have no effect on the price offered. Quality of tender document and feasible demonstration are modifiable bidding factors. Procuring agencies need to be transparent to reflect an organisationally supported competitive environment. The future research directions are interventional studies on specifications, pre-bid meetings and increasing transparency.

Public health insurers often use an implicit or explicit cost-effectiveness threshold to determine which health products and services should be insured. We challenge the convention of a single threshold. For competitively provided products and services, prices are determined by cost; but for products with market power, patentees will increase the price according to the perceived threshold. As a result, a change in the threshold affects the prices of all patented products, including those which would have been developed even at a lower threshold. The insurer can increase efficiency by reducing the threshold for patented products, even accounting for the effect on innovation. We also model a multi-country setting, in which thresholds for patented products will fall below the globally cooperative solution because each country does not recognize the positive externality of its own spending on innovative medicines. We show that this tragedy of the commons problem can be partly corrected through referencing other countries' thresholds, but only when the countries have similar willingness to pay.

Growth in pharmaceutical prices is a major policy issue in the United States. Competition is encouraged to counteract such growth, yet less is known about the effect of brand competition on prices. We discover a unique feature of this market by studying the pricing strategies of incumbent drug manufacturers under tiered-insurance anticipating branded competition. Using the insulin market as a natural experiment, we exploit exogenous variation in several potential entrants' completion of clinical trials to identify the effect of drug pipeline pressure on the prices of incumbent drugs. We find that pipeline pressure exerts cumulative and significant upward pressure on prices of incumbent drugs. In the insulin market such pressure explained 10.5% of the growth of prices. We were able to replicate these findings among incumbents with other emerging biosimilars. Insurance designs that fail to promote price competition through negotiations and value-based principles may contribute to such price increases.

Blacks, Latinx, and American Indians are killed by police at a disproportionately higher rate than Whites and Asians, but whether racial discrimination accounts for these killings remains disputed. We contribute to this debate by examining structural conditions in U.S. metropolitan areas that are associated with the expected count of police-caused killings. Using an economic competition model, we find that the size of the metropolitan Black population (relative to the White population) positively predicts the expected count of police-caused killings for Blacks. Moreover, the size of the Latinx population (relative to Whites) predicts the expected count of police-caused killings of Latinx civilians. Furthermore, we find that metropolitan areas with more mixed-race neighborhoods experience higher expected counts of police-caused killings, specifically, for all, Black and White civilians. Finally, we find that overall population size also predicts the expected number of people killed by the police but violent crime does not, calling into question accounts that deaths are a function of crime. Our findings suggest, first, that the underlying conditions that lead to the deaths of Black and Latinx people at the hands of police are different than police-caused deaths of people of other races. Second, in developing solutions to the serious social problem of police-caused deaths, we need to look beyond the proximal causes of these deaths (i.e., the police) to the distal factors operating at the metropolitan level that promote White supremacy.

The article discusses the concept of “competitiveness” in various aspects of the life of society. It was revealed in the course of the analysis of the works of domestic and foreign scientists that the competitiveness was actively used and is used in the economy, in particular, as a tool to stimulate labor in the form of competitions. As economic forms of competition, one can single out: labor competition, economic competition, production competition, socialist competition. The characteristic features and disadvantages of each of the forms are noted. The author of the article, taking into account the peculiarities of each of the economic forms of competition, substantiates the necessity of introducing a new form – industrial and economic competition, gives his own definition of the term “industrial and economic competition”, adapted to the Belarusian economic system. It is noted that holding industrial and economic competitions is an effective mechanism in stimulating the labor of workers and increasing labor productivity in general. The principles of holding production and economic competitions are stated, the mechanism of holding is described. It is concluded that competitiveness, as a specific personality trait, is an effective tool for stimulating labor, and in terms of production activity, it is advisable to introduce and apply a system of industrial and economic competition, which will be maximally adaptive to the production conditions of the modern Belarusian economy and will become a powerful catalyst for increasing labor productivity.

Background Through participation in payment reforms such as bundled payment and accountable care organizations (ACOs), hospitals are increasingly financially responsible for health care use and adverse health events occurring after hospital discharge. To improve management and coordination of postdischarge care, ACO hospitals are establishing a closer relationship with skilled nursing facilities (SNFs) through the formation of preferred SNF networks. Research design We evaluated the effects of preferred SNF network formation on care patterns and outcomes. We included 10 ACOs that established preferred SNF networks between 2014 and 2015 in the sample. We first investigated whether hospitals "steer" patients to preferred SNFs by examining the percentage of patients sent to preferred SNFs within each hospital before and after network formation. We then used a difference-in-difference model with SNF fixed effects to evaluate the changes in patient composition and outcomes of preferred SNF patients from ACO hospitals after network formation relative to patients from other hospitals. Results We found that preferred network formation was not associated with higher market share or better outcomes for preferred SNF patients from ACO hospitals. However, we found a small increase in the average number of Elixhauser comorbidities for patients from ACO hospitals after network formation, relative to patients from non-ACO hospitals. Conclusions After preferred SNF network formation, there is some evidence that ACO hospitals sent more complex patients to preferred SNFs, but there was no change in the volume of patients received by these SNFs. Furthermore, preferred network formation was not associated with improvement in patient outcomes.

BACKGROUND: Local market competition has been previously associated with more aggressive surgical decision-making. For example, more local competition for organs is associated with acceptance of lower quality kidney offers in transplant surgery. We hypothesized that market competition would be associated with the size of an abdominal aortic aneurysm (AAA) at the time of elective endovascular aneurysm repair (EVAR). METHODS: We included all elective EVARs reported in the Vascular Quality Initiative database (2012–2018). Small AAAs were defined as a maximum diameter

The regulations of the economic competition agreement were introduced by the 20th Act of 1931 after the economic crisis attention to the cartel regulations in Europe in the interwar period. We can realize that the regulation of the unfair business completion has a long codification history which started in the period of the Dualism. Before the end of dualism the Hungary regulated some question related to the cartels special attention to the circulation of commodities. In my presentation, I aim to describe the Hungarian and European codification antecedents and steps (for example: the regulation of industry) of the first Hungarian Cartel Act. This codification process was very important in Hungarian economy and social life because the economic changes started processes in both the field of legal life and legal sciences, and as a result of this, a demand arose to legally codify any rules in connection to cartels. The foundations of these were found in private law, especially in the regulations of the commercial law, which could be further elaborated upon and lead to a development of the regulations on the annulment of contracts in connection to dishonourable business competition.

Brand-name prescription drug manufacturers use various strategies to extend their market exclusivity periods by delaying generic or biosimilar competition. Recent Congressional legislation has targeted four such tactics. We analyze these proposals and assess their likely effect on competition in the U.S. drug market.

This paper discusses the problem of a GR concept comprehensive perception within the framework of Russian political science. Some researchers believe that GR is a modern replacement for the classic term “lobbyism” and is not new. Others call it a new direction in corporate management. Still others believe that GR is a new approach to political management. However, it cannot be denied that this area is gaining weight, evolving, and forming a research conceptual model. In this paper, an analysis and assessment of existing approaches to the definition of the GR concept by Russian and foreign political scientists are carried out. An author's definition of GR was put forward based on an understanding of the main goal of interaction between business actors and public authorities. In particular, GR is understood as the activity of representatives of large business actors in building sustainable relations with government to achieve competitive advantages and create favorable conditions for their own economic activities.

هدفت الدراسة للتعرف على واقع مهارات القرن الحادي والعشرين في التعليم من وجهة نظر المعلمات وتوصلت الدراسة الى العديد من العوامل التي کانت سبب لتوجه التعليم لتطبيق مهارات القرن الحادي والعشرين منها: التطورات العالمية والانفجار المعلوماتي والتقني تحتم على السياسات التعليمية التطور والتغيير ,و للارتقاء بمهارات الطلاب وتفعيل دورهم في العملية التعليمية , و لتجويد مخرجات التعليم وللموائمة مع متطلبات سوق العمل ومواکبة التنافس الاقتصادي بين الدول, وکانت من التحديات منها: ضعف الکوادر المؤهلة, عدم وجود جهة داعمة لتدريب المعلمين, قلة المتدربات على اتقان المهارات اللازمة, عدم اقتناع بعض المعلمين بها وسيرهم بالطريقة التقليدية. Abstract: The appropriate study aimed at the reality of the skills of the twenty-first century in education from the point of view of the teachers. The study reached many factors that were the reason for directing education to the skills of the twenty-first century, including: global developments and the information and technical explosion necessitating educational policies to develop and change, and to improve the skills of students and activate their role In the educational process, and to improve educational outcomes and to align with the requirements of the labor market and keep pace with economic competition between countries, among which are challenges: weak qualified cadres, the lack of a supportive body for teacher training, lack of female trainees The necessary skills, some teachers are not convinced of them and they will walk in the traditional way

Objective We explore if there are ways to characterize health systems-not already revealed by secondary data-that could provide new insights into differences in health system performance. We sought to collect rich qualitative data to reveal whether and to what extent health systems vary in important ways across dimensions of structural, functional, and clinical integration. Data sources Interviews with 162 c-suite executives of 24 health systems in four states conducted through "virtual" site visits between 2017 and 2019. Study design Exploratory study using thematic comparative analysis to describe factors that may lead to high performance. Data collection We used maximum variation sampling to achieve diversity in size and performance. We conducted, transcribed, coded, and analyzed in-depth, semi-structured interviews with system executives, covering such topics as market context, health system origin, organizational structure, governance features, and relationship of health system to affiliated hospitals and POs. Principal findings Health systems vary widely in size and ownership type, complexity of organization and governance arrangements, and ability to take on risk. Structural, functional, and clinical integration vary across systems, with considerable activity around centralizing business functions, aligning financial incentives with physicians, establishing enterprise-wide EHR, and moving toward single signatory contracting. Executives describe clinical integration as more difficult to achieve, but essential. Studies that treat "health system" as a binary variable may be inappropriately aggregating for analysis health systems of very different types, at different degrees of maturity, and at different stages of structural, functional, and clinical integration. As a result, a "signal" indicating performance may be distorted by the "noise." Conclusions Developing ways to account for the complex structures of today's health systems can enhance future efforts to study systems as complex organizations, to assess their performance, and to better understand the effects of payment innovation, care redesign, and other reforms.

Objective To examine system integration with physician specialties across markets and the association between local system characteristics and their patterns of physician integration. Data sources Data come from the AHRQ Compendium of US Health Systems and IQVIA OneKey database. Study design We examined the change from 2016 to 2018 in the percentage of physicians in systems, focusing on primary care and the 10 most numerous nonhospital-based specialties across the 382 metropolitan statistical areas (MSAs) in the US. We also categorized systems by ownership, mission, and payment program participation and examined how those characteristics were related to their patterns of physician integration in 2018. Data collection/extraction methods We examined local healthcare markets (MSAs) and the hospitals and physicians that are part of integrated systems that operate in these markets. We characterized markets by hospital and insurer concentration and systems by type of ownership and by whether they have an academic medical center (AMC), a 340B hospital, or accountable care organization. Principal findings Between 2016 and 2018, system participation increased for primary care and the 10 other physician specialties we examined. In 2018, physicians in specialties associated with lucrative hospital services were the most commonly integrated with systems including hematology-oncology (57%), cardiology (55%), and general surgery (44%); however, rates varied substantially across markets. For most specialties, high market concentration by insurers and hospital-systems was associated with lower rates of physician integration. In addition, systems with AMCs and publicly owned systems more commonly affiliated with specialties unrelated to the physicians' potential contribution to hospital revenue, and investor-owned systems demonstrated more limited physician integration. Conclusions Variation in physician integration across markets and system characteristics reflects physician and systems' motivations. These integration strategies are associated with the financial interests of systems and other strategic goals (eg, medical education, and serving low-income populations).

In this paper, the notion of picture fuzzy competition graph along with its few generalizations such as m-step picture fuzzy competition graphs, picture fuzzy economic competition graphs and picture fuzzy competition hypergraphs are introduced. Some related picture fuzzy graphs including picture fuzzy m-step neighborhood graph, picture fuzzy m-step economic competition graph and picture fuzzy k-competition hypergraphs are introduced. Some properties of these graphs have been investigated. Finally, applications of m-step picture fuzzy competition graphs and picture fuzzy competition hypergraphs are presented in several fields such as in education system, ecosystem, business market and job competition.