[Meeting the needs of the European working time directive in german medical profession]. / Sollarbeitszeit und maximale Arbeitszeit bei angestellten Ärzten.

The legal obligation of the European Working Time Directive with its implementation into a German Working Hours Act requires German hospitals to give up old structures and requires the implementation of new working time models. The failure of the revision of the European Working Time Directive in April 2009 prevented that any changes of status quo might happen in the near future. Fundamental terms of the working law for the medical area have been elucidated and have been implemented into concrete calculation formulas. The planned working time has been clearly determined. Particularly, on-call duties and a signed "OptOut-declaration" have huge effects on the upper limit of the working time that is to be determined. Shift duty leads to the greatest limitations of the upper limit of the working time. The Working Hours Act defines the maximal, available, individual working time budget and thus the working time budget of a hospital and it limits the maximal availability of the service providers of a hospital as well as defining the maximal personnel costs. Transparency in this area lays the foundation for an effective time management and the creation of new working time models in accordance with the European Working Time Directive as well as the Working Hours Act and the "TVÄ" (labour contract for doctors at municipal hospitals). It is possible, with the knowledge of the maximal working time budget and the thereof resulting personnel costs, to calculate the economical revenues better. The reallocation of the working time of doctors enables efficiency enhancement. It is necessary to demand a clear definition of the tasks of doctors with the consequential discharge of tasks that should not/do not belong to the responsibilities of a doctor. This would lead to a more attractive working environment for doctors at hospitals and thus to an improvement of the care of the patients. The implementation of the European Time Directive is not to be seen as unrealizable, as has been generally heard; instead, it enables the urgently necessary structural reform at German hospitals.

Health care reform: what it might mean to urban public hospitals.

Health care reform proposals may affect public hospitals in a number of ways. To insure that such proposals benefit the underserved communities within which public hospitals operate, reform initiatives should be evaluated against 10 criteria that emphasize prevention and primary care, community health education, cost control, tort reform, and community values.

Right to abortion: the courts versus the legislatures.

PIP: The U.S. Supreme Court found the right of privacy in various amendments to the Constitution so that a competent woman in the first trimester has an unrestricted right to an abortion if she can find a licensed, willing doctor to perform the procedure. The Court ruled that a state may not adopt legislation to impede the implementation of this desire. National, state, and city governments, however, have tried to block or restrict the right to abortion by imposing conditions. However, 1 in every 11 women of reproductive age had a legal abortion between 1969-77. More than a million abortions were performed in 1975. Few rural hospitals offer abortion. No Catholic institutions permit them, and less than one-third of all non-Catholic, short-term general hospitals do. Most abortions are conducted in clinics. New York and California account for 1 of every 3 abortions. The Supreme Court did not include a government obligation to pay for abortions. When Medicaid was adopted in 1965, nontherapeutic abortions were illegal, therefore, the Court found no reason to cover elective abortions. The Danforth court majority in 1976 concluded that parental consent could not be required of a minor prior to abortion. State laws must offer an alternative procedure, without parental involvement, in which the minor may show that she is mature and responsible enough to make her own decision.^ieng