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This article focuses on the arguments concerning the implementation of critical loss methodology in defining market condition in the U.S. It provides information on the criticisms expressed by several economists on the concept of control loss analysis which is an implementation of the hypothetical monopolist test based on the Horizontal Merger Guidelines established by the Department of Justice and Federal Trade Commission. It reveals that the author have developed economic models in calculating control loss in markets that offer homogenous goods and businesses that sell different products.

To identify and explore cultural dynamics influencing the psychiatric care of immigrant Somalis in the USA, we reviewed demographic data from Minnesota Departments of Human Services, and interviewed health professionals, exploring community perceptions of medical/psychiatric needs, cultural characteristics, barriers to care, and potential solutions. An informal survey of 37 members of the Mayo Clinic Department of Psychiatry and Psychology, to determine caregiver perceptions of care of Somali patients, cited language barriers (74%), and cultural misperceptions (68%) as the most frequent obstacles. Difficulties working within the patriarchal family structure, limited community resources, poor compliance, and financial issues ranged between 18 and 8%. Additional barriers mentioned were problems working with interpreters from 'warring clan factions,' patients' fears of being labeled 'crazy,' difficulties viewing illness within an emotional framework, and the need to address mental health from a physical framework through a focus on somatic symptoms. Somalis rarely acknowledge psychiatric problems and common traditional treatments have become ineffective in the new context. Recommendations include alternative health care approaches utilizing family values, 'bargaining: and educational approaches to acculturation. [ABSTRACT FROM AUTHOR]

A joint Russian and US model intercomparison study was undertaken to develop more realistic contaminant transport models of the Mayak Site, southern Urals. The test problems were developed by the Russian team based on their experience in modeling contaminant migration near Lake Karachai. The intercomparison problems were designed to address lake and contaminant plume interactions, as well as river interactions and plume-density effects. Different numerical codes were used. Overall, there was good agreement between the results of both models. Features shown by both models include (1) the sinking of the plume below the lake, (2) the raising of the water table in the fresh water adjacent to the lake in response to the increased pressure from the dense plume, and (3) the formation of a second sinking plume in an area where evapotranspiration exceeded infiltration, thus increasing the solute concentrations above the source (i.e., lake) values. [ABSTRACT FROM AUTHOR]

The evidence is overwhelming that a collaborative care approach to common mental illnesses is superior to usual care. Why isn't this model widely available? The authors of this column argue that the problem is not a lack of evidence or documentation of a better model, but the need for adoption of implementation science and dissemination knowledge to bring collaborative care in to practice. They discuss the challenge of providing mental health care in the United States, the evidence that collaborative care is effective and can play a major role in expanding mental health services, the science of dissemination, six successful large-scale dissemination programs for collaborative care, and the implications of this shift in care delivery for psychiatry and all mental health providers. [ABSTRACT FROM AUTHOR]

Introduction: Lower socioeconomic status (SES) has been associated with poor healthcare outcomes in depression. However, reliable individual-level SES data rarely exists for clinical research. The HOUSES index relies on publicly available data allowing for evaluation of individual-level SES on patient outcomes.Hypothesis: Primary care patients with depression within the lower SES quartile (Quartile 1 vs. Quartile 4, of the HOUSES index) would experience worse clinical outcomes of their symptoms six months after diagnosis.Study Design: A retrospective cohort study which followed 4313 adult primary care patients that were diagnosed with depression during the study period of 2008-2015. The outcome measures were the six month PHQ-9 scores.Results: At six months, a higher HOUSES quartile was associated with greater odds of remission of depressive symptoms (RDS) and lower odds of persistent depressive symptoms (PDS), after controlling for covariates. Patients in Quartile 4 had 27% more likelihood of RDS and a 24% lower likelihood of PDS at six months compared to a Quartile 1 patient.Limitations: As a retrospective study only can observe associations but not causation. Only one institution participated and not all treatments were readily available, limiting the generalizability of these findings.Conclusions: Lower SES as demonstrated by a lower HOUSES quartile (Quartile 1 versus 4) was associated with lower odds of RDS and increased odds of PDS at six months. HOUSES index is a useful tool for identifying patients at risk for worse clinical outcomes and may help health care systems plan resource allocation for depression care. [ABSTRACT FROM AUTHOR]

Background: Care coordination has been a common tool for practices seeking to manage complex patients, yet there remains confusion about the most effective and sustainable model. Research exists on opinions of providers of care coordination but there is limited information on perspectives of those in the insurance industry about key elements. We sought to gather opinions from primary care providers and administrators in Minnesota who were involved in a CMS (Center for Medicare and Medicaid Services) transformational grant implementing COMPASS (Care Of Mental, Physical And Substance-use Syndromes), an evidence-based model of care coordination for depressed patients comorbid with diabetes and/or cardiovascular disease. We then sought to compare these views with those of private insurance representatives in Minnesota., Methods: We used qualitative methods to conducted forty-two key informant interviews with primary care providers (n = 15); administrators (n = 15); and insurers (n = 12). We analyzed the recorded and transcribed data, once de-identified, using a frameworks analysis approach., Results: We identified six primary themes: 1) a defined scope, rationale, and key partnerships for building comprehensive care coordination programs, 2) effective information exchange, 3) a trained and available workforce, 4) the need for a business model and a financially justifiable program, 5) a need for evaluation and ongoing improvement of care coordination, and 6) the importance of patient and family engagement. Overall consensus across stakeholder groups was high including a call for payment reform to support a valued service. Despite their role in paying for care, insurance representatives did not stress reduced utilization as more important than other outcomes., Conclusions: Primary care providers and administrators from different organizations and backgrounds, all with experience in COMPASS, in large part agreed with insurance representatives on the main elements of a sustainable model and the need for health reform to sustain this service.

Background: Existing literature on mood disorders suggests that the demographic distribution of bipolar disorder may differ from that of unipolar depression, and also that bipolar disorder may be especially disruptive to personal functioning. Yet, few studies have directly compared the populations with unipolar depressive and bipolar disorders, whether in terms of demographic characteristics or personal limitations. Furthermore, studies have generally examined work-related costs, without fully investigating the extensive personal limitations associated with diagnoses of specific mood disorders. The purpose of the present study is to compare, at a national level, the demographic characteristics, work productivity, and personal limitations among individuals diagnosed with bipolar disorder versus those diagnosed with unipolar depressive disorders and no mood disorder., Methods: The Medical Expenditure Panel Survey 2004-2006, a nationally representative survey of the civilian, non-institutionalized U.S. population, was used to identify individuals diagnosed with bipolar disorder and unipolar depressive disorders based on ICD-9 classifications. Outcomes of interest were indirect costs, including work productivity and personal limitations., Results: Compared to those with depression and no mood disorder, higher proportions of the population with bipolar disorder were poor, living alone, and not married. Also, the bipolar disorder population had higher rates of unemployment and social, cognitive, work, and household limitations than the depressed population. In multivariate models, patients with bipolar disorder or depression were more likely to be unemployed, miss work, and have social, cognitive, physical, and household limitations than those with no mood disorder. Notably, findings indicated particularly high costs for bipolar disorder, even beyond depression, with especially large differences in odds ratios for non-employment (4.6 for bipolar disorder versus 1.9 for depression, with differences varying by gender), social limitations (5.17 versus 2.85), cognitive limitations (10.78 versus 3.97), and work limitations (6.71 versus 3.19)., Conclusion: The bipolar disorder population is distinctly more vulnerable than the population with depressive disorder, with evidence of fewer personal resources, lower work productivity, and greater personal limitations. More systematic analysis of the availability and quality of care for patients with bipolar disorder is encouraged to identify effectively tailored treatment interventions and maximize cost containment.

Background: Trauma care is a well-known financial burden for hospitals, yet reimbursement for the surgeon has not been reported., Methods: For 1999, the percent of the surgeons' bills reimbursed for general surgery services (gPR) was compared with that for trauma services (tPR). Mean tPR for various groups were compared. Factors predictive of tPR lower than gPR were identified., Results: The gPR was 49%, and, for 371 trauma patients, tPR was 45% (P = 0.03). The mean tPR for injury severity score (ISS) < or =10 was 48%, and for ISS > or =11, 57% (P = 0.03). Patients transferred from outside facilities did not have a significantly lower mean tPR. Penetrating trauma (odds ratio 3.7, P = 0.008) was predictive of tPR lower than gPR., Conclusions: Surgeon reimbursements for trauma care was significantly, yet only slightly less than for all general surgery care. Surgeons should not be reluctant to take trauma call based on perceptions of low reimbursement.