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Background: In recent years, policymakers have paid particular attention to the emergence of a robust for-profit hospice sector and increased hospice use by nursing home residents. Previous research has explored financial incentives for nursing home-hospice use, but there has been limited research on nursing home-hospice partnerships and none on the extent of nursing home-hospice common ownership., Objective: To describe trends in nursing home-hospice contracting and common ownership and to identify potential tradeoffs in care provided by nursing homes and hospice agencies that share common ownership., Research Design: Retrospective cohort study of nursing home-hospice patients between 2005 and 2015., Results: Between 2005 and 2015, the number of hospice agencies and nursing homes with common ownership grew substantially, now representing almost 1-in-5 providers in each sector. Relative to individuals using hospice in nursing homes without common ownership, adjusted analyses found that individuals receiving hospice from a commonly owned agency had a greater likelihood of having stays of 90 days or more [odds ratio (OR)=1.06; 95% confidence interval (CI), 1.02-1.10], having a stay resulting in a live discharge (OR=1.06; 95% CI, 1.02-1.11), and having at least 1 registered nurse/licensed practical nurse visit during the last 3 days of life (OR=1.17; 95% CI, 1.05-1.29); these individuals also had a lower mean visit hours per day (-0.07; P=0.003)., Conclusions: Common ownership between hospice agencies and nursing homes is an emerging trend that reflects a broader push toward consolidation in the health care sector. Our analyses highlight potential concerns relevant to Medicare payment policy and are a first step toward improving our understanding of these trends and their implications.

Health-care providers are allowed to opt-out of Medicare, privately contract with beneficiaries, and require that beneficiaries pay the full cost of services. Responses from a nationally representative sample of Medicare beneficiaries reveal that they lack the knowledge necessary to make informed decisions regarding such contracts. For example, only 4.6% of participants knew the correct answer to a real-life $74,973 question, leaving a full 95.4% vulnerable to paying a large bill, even a $74,973 bill, they should not pay. In addition to advocating that Medicare effectively monitor private medical care contracts, social workers should educate beneficiaries and/or their caregivers on the implications of entering into such contracts or refer them to their State Health Insurance Assistance Program or Senior Medicare Patrol program for expert guidance.

Limited research exists which aids in structuring health IT contracts in an era of performance-based payments. We provide an assessment of common approaches to contracting and measuring of performance in practice. We conducted a review of existing literature and compliment this approach with a survey of healthcare professionals directly involved with health IT systems to further understand and classify current approaches. We identified architypes for structuring healthcare IT performance contracts to include: (1) internal operations, (2) external evaluation and (3) joint agreement for the delivery of value-based care.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Since the late 1990s, contracting has been employed in Cambodia in an attempt to accelerate rural health system recovery and improve health service delivery. Special Operating Agencies (SOA), a form of 'internal contracting', was introduced into selected districts by the Cambodia Ministry of Health in 2009. This study investigates how the SOA model was implemented and identifies effects on service delivery, challenges in operation and lessons learned., Methods: The study was carried out in four districts, using mixed methods. Key informant interviews were conducted with representatives of donors and the Ministry of Health. In-depth interviews were carried out with managers of SOA and health facilities and health workers from referral hospitals and health centres. Data from the Annual Health Statistic Report 2009-2012 on utilisation of antenatal care, delivery and immunisation were analysed., Results: There are several challenges with implementation: limited capacity and funding for monitoring the SOA, questionable reliability of the monitoring data, and some facilities face challenges in achieving the targets set in their contracts. There are some positive effects on staff behaviour which include improved punctuality, being on call for 24 h service, and perceived better quality of care, promoted through adherence to work regulations stipulated in the contracts and provision of incentives. However, flexibility in enforcing these regulations in SOA has led to more dual practice, compared to previous contracting schemes. There are reported increases in utilization of services by the general population and the poor although the quantitative findings question the extent to which these increases are attributable to the contracting model., Conclusion: Capacity in planning and monitoring contracts at different levels in the health system is required. Service delivery will be undermined if effective performance management is not established nor continuously applied. Improvements in the implementation of SOA include: better monitoring by the central and provincial levels; developing incentive schemes that tackle the issues of dual practice; and securing trustworthy baseline data for performance indicators.

Margaret McGregor and colleagues consider Bradford Hill's framework for examining causation in observational research for the association between nursing home care quality and for-profit ownership.

Big employers like Boeing and Intel are directly contracting with hospitals in an effort to control health care prices. Some hospital CEOs see direct contracting as the future, while others wonder how they can participate.

The World Trade Organisation's Trade Related Intellectual Property Rights [TRIPS] agreement aimed to harmonise intellectual property rights and patent protection globally. In India, the signing of this agreement resulted in a sharp increase in clinical trials since 2005. The Indian government, along with larger Indian pharmaceutical companies, believed that they could change existing commercial research cultures through the promotion of basic research as well as attracting international clinical trials, and thus create an international level, innovation-based drug industry. The effects of the growth of these outsourced and off-shored clinical trials on local commercial knowledge production in India are still unclear. What has been the impact of the increasing scale and commercialisation of clinical research on corporate science in India? In this paper we describe Big-pharmaceuticalisation in India, whereby the local pharmaceutical industry is moving from generic manufacturing to innovative research. Using conceptual frameworks of pharmaceuticalisation and innovation, this paper analyses data from research conducted in 2010-2012 and describes how Contract Research Organisations (CROs) enable outsourcing of randomised control trials to India. Focussing on twenty-five semi-structured interviews CRO staff, we chart the changes in Indian pharmaceutical industry, and implications for local research cultures. We use Big-pharmaceuticalisation to extend the notion of pharmaceuticalisation to describe the spread of pharmaceutical research globally and illustrate how TRIPS has encouraged a concentration of capital in India, with large companies gaining increasing market share and using their market power to rewrite regulations and introduce new regulatory practices in their own interest. Contract Research Organisations, with relevant, new, epistemic skills and capacities, are both manifestations of the changes in commercial research cultures, as well as the vehicles to achieve them. These changes have reinvigorated public concerns that stress not only access to new medicines but also the 'price' of innovation on research participants., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This article addresses the recent trend of physicians being pressured to sell to hospitals in order to stay in practice. The author utilizes his experience in the healthcare industry to identify causes of this trend and ways in which physician groups can avoid finding themselves in these situations. The author uses real data from an existing medical practice to support his ideas and demonstrate how implementing change now will be beneficial for the success of this medical practice in the future. Objective practice evaluation and the execution of an efficient strategic plan are cited as the most important factors contributing to the financial solvency of medical practices in the current and future healthcare environment.

On January 1, 2004, the medical service unit was founded in Germany. However, one of the results of the reform in 2007 was that most of the advantages of medical service units were no longer idiosyncratic to this legal form, but granted to individual general practitioners as well. Since then, a decline in the foundation of medical service units by medical doctors can be observed. Today, the medical service unit rather seems to be a means for hospitals expanding in the intermediary medical sector and, maybe, a re-foundation of the former hospital-owned polyclinics., (Copyright © 2012. Published by Elsevier GmbH.)

The profession of dentistry developed essentially based on the rapid progress of research in general. With the law of dentistry in 1952, the dentist became an independent profession in Germany. The EU directive 2005/36 for recognition of professional qualifications now regulates the requirements for practicing as a dentist in the European Union. Today, dentistry is a scientifically based medical discipline which has increased its preventive, diagnostic, and therapeutic possibilities especially over the last 3 decades. The implementation is carried out in dental practice under the framework and basic conditions of present health care policy and conditions. A new order regulating licenses to practice dentistry is under development in which the first 2 years will be nearly identical with the studies of medicine and the medical licensure act. The closer orientation toward medicine is reasonable as more multimorbid patients will have a need for dental treatment in daily practice and co-operation with physicians will be more frequent in the future. New occupational profiles in dentistry are proposed above the level of a graduated dentist as well as below but also in completely new noncurative areas.

The latest NHS reforms in England will require all general practices to become members of general practitioner (GP) consortia. These organisations will have responsibility for commissioning the majority of health care for their local populations. This article reviews the history and evidence on impact of the previous models of GP commissioning that have been introduced in the NHS with the aim of distilling key lessons for the design, implementation and evaluation of the latest reforms. GP commissioning has the potential to generate a variety of benefits for the NHS and patients, including lowering elective and non-elective referrals, reducing waiting times, improved coordination of primary and community support services and better financial risk management. GP commissioning has also the potential to reduce patient satisfaction, increase inequalities between geographical areas and may generate substantial management and transaction costs. The GP community will need to display strong directive leadership as well as nurture a culture of collaboration and group camaraderie among practices if the GP consortia model of commissioning is to deliver the desired improvements in quality and performance. The implementation of the new GP consortia model of commissioning needs to be monitored and evaluated to ensure that the benefits are maximized and any unintended and dysfunctional effects mitigated.

Introduction: A new dental contract was introduced in the National Health Service (NHS) General Dental Services (GDS) in April 2006. Responsibility for clinical audit activities was devolved to Primary Care Trusts (PCTs) as part of their clinical governance remit. In July 2003, an NHS Modernisation Agency pilot scheme for clinical audit was launched by Southend PCT., Aim: The aim of this study was to evaluate this scheme., Methods: A qualitative research method was used. It used audiotape recorded semi-structured research interviews with eight general dental practitioners (GDPs) who had taken part in the scheme. The evaluation focused on dentists' experiences of the scheme., Results: Dentists appreciated the central PCT-based coordinator for the scheme and found that the streamlining of design, analysis and report writing within the audit projects enabled efficient use of time. The design by an outside agency appeared to add credibility to the scheme. Participants felt that comparability of data derived from clinical audit was enhanced by the scheme and could lead to comparison across PCT patch, regional or even national levels. The use of feedback mechanisms within the scheme was appreciated and thought to help produce maximum value from a clinical audit project. There was evidence of beneficial change occurring within practices and for patients., Conclusions: This study provided an evaluation of a particular clinical audit scheme, several aspects of which differed from the traditional GDS scheme. Organisations proposing to undertake clinical audit activities in conjunction with dentistry in the future may benefit from incorporating elements of this scheme into their project design.