Objectives: To use publicly available price transparency data files to establish empirical regularities about hospital-insurer contracting.
Study Design: Retrospective analysis of 10 price transparency data files from HCA Healthcare.
Methods: Cross-sectional qualitative analysis of 524 hospital-insurer contracts across 10 hospitals.
Results: We ascertain 4 empirical regularities in these files. First, hospitals contract with many payers, ranging from 35 to 82 across the hospitals in the sample. Second, contract structure varies significantly within and across hospitals: Of the 524 contracts in our sample, the median contract contained 9 contract elements, whereas the mean contract contained 1285 contract elements. Third, most of the contracts in our sample contained multiple contracting methodologies (eg, both fixed fee and percentage of charges). Fourth, these contracts indicated substantial variation for the same service within and across hospitals, validating findings from analyses based on claims data and hospital price transparency files.
Conclusions: Hospital-insurer contracts dictate the flow and structure of a significant portion of total health care expenditure in the US. Increased attention by both researchers and policy makers would lead to a greater understanding of this vital-yet understudied-element of the market for hospital services.

Competing Interests: Competing interests: none declared.

This article explores the toxic culture at Tesla's auto manufacturing facility in Fremont, California. It sheds light on racial harassment, sexual abuse, and workplace injuries. Black employees have reported experiencing racism, including racial slurs and discriminatory treatment, while women describe a work environment filled with sexual innuendo and inappropriate behavior. The article suggests that CEO Elon Musk may contribute to this culture. Tesla has not responded to requests for comment. Workers have filed complaints alleging racial discrimination, sexual harassment, and unsafe working conditions. The article emphasizes the need for unions to protect workers' rights and includes personal accounts from former employees who have chosen not to work at Tesla due to their negative experiences. [Extracted from the article]

The results of a survey of 1,071 adults in the United States reveal that most consumers do not pay attention to, let alone understand, arbitration clauses in their everyday lives. The vast majority of survey respondents (over 97%) report having opened an account with a company that requires disputes to be submitted to binding arbitration (e.g., Netflix, Hulu, Cash App, a phone or cable company), yet most are unaware that they have, in fact, agreed to mandatory arbitration (also known as "forced arbitration"). Indeed, over 99% of respondents who think they have never entered into an arbitration agreement likely have done so. Over 92% of respondents report that they have never based a decision to use a product or service on whether the terms and conditions contain an arbitration agreement. When prompted, they largely endorse the following reasons: they were unaware of the arbitration clause, they did not read the terms and conditions, and they thought they had no choice but to agree to mandatory arbitration. Moreover, many respondents presume that if a dispute arises, they will still be able to access the public courts, notwithstanding that they agreed to the terms and conditions. Consumers are largely unaware of opportunities to opt out of mandatory arbitration. They generally do not pay attention to or retain information about the steps required to opt out successfully (e.g., contacting the company within a specified time period). Generally, consumers are unaware that companies like Cash App and Venmo (mobile payment systems utilized by nearly 60% of respondents) allow customers to opt out of mandatory arbitration if they act within a limited time period. Among the minority of respondents (21%) who stated that they had been given an opportunity to opt out, vanishingly few could name any of the steps required to opt out successfully. When presented with a run-of-the-mill contract, of the type consumers routinely encounter, most respondents did not take notice of the arbitration clause. Less than 5% of respondents could recall that the contract they were shown had said anything at all about arbitration. Furthermore, most consumers misperceive the consequences of signing a predispute arbitration agreement. Most mistakenly believe that, after agreeing to terms and conditions mandating binding arbitration, they can still choose to settle their dispute in court, have a jury decide their case, join a class action, and appeal a decision made based on a legal error. For instance, less than 5% of respondents correctly reported that they could neither appeal an erroneous decision to another arbitrator (or set of arbitrators) nor start all over again in court. Less than 1% of respondents correctly understood the full significance of the arbitration agreement, as indicated by their responses to questions about whether they retained the rights to sue, have a jury decide their case, access the public courts, and appeal a decision based on a legal error. In summary, consumers are generally unaware of arbitration clauses, and they tend to hold mistaken beliefs about how arbitration agreements affect consumers' procedural rights.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Roseanna Sommers. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Family doctor contract services (FDCS) have been introduced in China in 2009 [1] and rapidly expanded recently. This study sought to investigate factors that influenced the willingness of Chinese residents to use FDCS.
Methods: We employed multistage stratified and convenience sampling to administer questionnaires to 1455 Beijing, Qinghai, and Fujian residents. The willingness of residents in each province to contract family doctors was analyzed using the chi-square test and binary logistic regression.
Results: The analysis in this study found that the signing rate of family doctors in China was about 27.77%, with differences in the signing up levels in Beijing (13.68%), Fujian (64.49%) and Qinghai (11.22%). In addition, the binary logistic regression results emphasized the relative importance of age, education, medical preference and policy knowledge on the willingness to sign up. Distrust of family doctors' medical skills (65.7%), not knowing how to contract (47.8%), and not knowing what medical problems can be solved (41.1%) were the top three reasons accounting for the reluctance of residents to contract with family doctors.
Conclusion: Residents from different backgrounds have different willingness to sign up, so the specific circumstances and needs of different groups should be taken into account. In order to increase the signing-up rate, consideration can be given to promoting the family doctor model in Fujian throughout the country. Individual hesitation can be eliminated by increasing the reimbursement rate of health insurance, reducing the out-of-pocket expenses of contracted patients, and providing incentives of certain discounts for consecutive contracted patients.
(© 2024. The Author(s).)

The role of the family doctor contracted service system in China's medical and health system is increasing day by day. However, with the steady increase in contracting coverage, the phenomenon of "signing up but not contracting" has become common; to improve the current situation, the personalized signing service model has been strongly advocated. To promote the smooth implementation of the personalized contracted service model with family doctor competency as its core, this study used the signal game model to analyze the market equilibrium state of the signing service model. The results of this analysis reveal the following: (1) The camouflage of the number of contracts leads to distortion of the signal effect and to market failure, that is, the cost of competency camouflage is the primary factor affecting the equilibrium of contracted services. (2) The incompleteness of contracted services leads to quantity but not quality in the contracting market, that is, the payment of personalized service packages, the value-added utility of personalized services, and service gaps are the key factors that affect the decision-making behavior of the public. With this knowledge in mind, a compensation incentive mechanism that matches the competence level of the family doctor should be established, the formulation of contracted service agreements should be improved, and the participation of family doctors and residents should be encouraged, while the promotion of personalized contracted services should be enhanced and relevant supporting measures should be improved.

Competing Interests: Competing interest: RS was a cochair of the Lancet Commission on the Value of Death, which argued for the demedicalisation of death and it becoming much more a partnership among patients, families, communities, and health professionals with health professionals as supporters rather than leaders.