ERISA, agency costs, and the future of health care in the United States

Because so many Americans receive health insurance through their employers, the Employee Retirement Income Security Act (ERISA) of 1974 plays a dominant role in the delivery of health care in the United States. The ERISA system enables employers and insurers to save money by providing inadequate health care to employees, thereby creating incentives for these agents to act contrary to the interests of their principals. Such agency costs play a significant role in the current health care crisis and require attention when considering reform. We evaluate the two major health care reform movements by exploring the extent to which each reduces agency costs. We find that agency cost analysis clarifies the benefits, limits, and uncertainties of each approach.     

Blending reform of tort liability and health insurance: a necessary mix

The thesis of this Article is that making more health insurance benefits available to more people, far from lessening injury victims' proclivity to sue in tort (as conventional wisdom argues), will increase such suits. Thus, it is necessary to accompany any increases in health care coverage with the type of tort reform proposed herein. This reform would allow parties to opt out of the cumbersome and expensive tort claim process with its compensation of noneconomic losses by substituting quicker and surer compensation of any unmet economic losses.     

The constitutionality of current legal barriers to telemedicine in the United States: analysis and future directions of its relationship to national and international health care reform

The current health care crisis in the United States compels a consideration of the crucial role that telemedicine could play towards deploying a pragmatic solution. The nation faces rising costs and difficulties in access to and quality of medical services. Telemedicine can potentially help to overcome these challenges, as it can provide new cost-effective and efficient methods of delivering health care across geographic distances. The full benefits and future potential of telemedicine, however, are constrained by overlapping, inconsistent, and inadequate legal and regulatory frameworks, as well as the repertoire of standards imposed by state governments and professional organizations. Proponents of these barriers claim that they are necessary to protect public health and safety, and that the U.S. Constitution gives states exclusive authority over health and safety concerns. This Article argues that such barriers not only fail to advance these public policy goals, but are unconstitutional when they restrict the practice of telemedicine across state and national borders. Furthermore, the interstate and international nature of telemedicine calls for increasing the centralized authority of the federal government; this position is consistent with the U.S. Constitution and other governing principles. Finally, this Article observes that the U.S. experience bears some similarities to that of other nations, and represents a microcosm of the international community's need and struggle to develop a uniform telemedicine regime. Just as with state governments in the U.S., nations are no longer able to view health care as a traditional domestic concern and must consider nontraditional options to resolve the dilemmas of rising costs and discontent in the delivery of health care to their people.     

The conversion of coroner systems to medical examiner systems in the United States: a lull in the action

Coroner and medical examiner systems in the United States conduct death investigations for most deaths that are sudden and unexplained, or which involve external causes such as injury and poisoning. They play a very important role in the criminal justice, public health, public safety, and medical communities, and they also contribute a substantial portion of autopsy-based mortality data to the state and federal mortality statistics systems. Death investigations often involve complex medical issues and necessarily require the involvement of appropriately trained physicians. Over the years, there has been a trend to replace the elected lay coroner systems with systems run by appointed, physician medical examiners. Presently, about 31% of counties in the United States are served by a medical examiners at the county, district, or state level. Between 1960 and 1989, there was considerable conversion to medical examiner systems, but this trend slowed in the 1990s. Since 2000, only 6 counties in the United States have converted to a medical examiner system, no states have converted since 1996, and 1 county has reverted to a sheriff-coroner system. Possible reasons for this decline are discussed, including legislative, political, geographical, financial, population-based, and physician manpower distribution factors. It is important to ensure that all death investigation systems have appropriate access to medically educated and trained physicians such as forensic pathologists.     

The law and the public's health: a study of infectious disease law in the United States

Law plays crucial roles in the field of public health, from defining the power and jurisdiction of health agencies, to influencing the social norms that shape individual behavior. Despite its importance, public health law has been neglected. Over a decade ago, the Institute of Medicine issued a report lamenting the state of public health administration, generally, and calling, in particular, for a revision of public health statutes. The Article examines the current state of public health law. To help create the conditions in which people can be healthy, public health law must reflect an understanding of how public health agencies work to promote health, as well as the political and social contexts in which these agencies operate. The authors first discuss three prevailing ways in which the determinants of health are conceptualized, and the political and social problems each model tends to create for public health efforts. The analysis then turns to the core functions of public health, emphasizing how law furthers public health work. The Article reports the results of a fifty-state survey of communicable disease control law, revealing that few states have systematically reformed their laws to reflect contemporary medical and legal developments. The Article concludes with specific guidelines for law reform.     

Health care for older persons in England and the United States: a contrast of systems and values

This article extends previous comparisons of access to health care for older persons in England and the United States by comparing rates of avoidable hospital conditions as a proxy for primary care access and by examining the distribution of care within these older populations. Drawing on hospital data from the two countries, we find that older persons in the United States, particularly those over the age of seventy-five, receive far more revascularizations than do older persons in England. Differences in the use of lower-joint replacement are not as great, but we are unable to assess differences in the need for these procedures. Although older persons have greater access to specialty care in the United States, there appears to be much better access to primary care in England. We are unable to draw comparisons on the extent of inequalities in access to health care, although in the United States there is evidence of inequalities in access by race, and in England we confirm earlier studies that find inequalities by level of deprivation. These findings are discussed in the context of the political debates over access to care and rationing in the two countries.     

Toward a criminal justice epidemiology: Behavioral and physical health of probationers and parolees in the United States

Objective

This study explicitly articulates a criminal justice epidemiology by examining the behavioral and physical health of probationers and parolees derived from a nationally representative sample of adults in the United States.

Methods

Using public-use data from the 2009 National Survey on Drug Use and Health (NSDUH), this study employed binary logistic regression with adjustments for complex survey sampling and compared probationers and parolees to the general population with respect to past-year substance use, risk perception, treatment experiences, and health.

Results

After controlling for the effects of age, gender, race, income, and education probationers and parolees are far more likely to report using alcohol and drugs in the past year, have reduced risk perception, and are far more likely to have had some kind of treatment for substance abuse or dependence. Probationers and parolees are also significantly more likely to experience anxiety and depression, asthma, and sexually transmitted diseases.

Conclusions

This criminal justice epidemiology study indicates that the behavioral health of probationers and parolees hamper efforts to increase public safety goals. Forging closer ties between criminal justice and public health systems is necessary to reach these goals.     

Asian transnational organized crime and its impact on the United States: Developing a transnational crime research agenda

Undertaken on behalf of the National Institute of Justice between July 2003 and August 2004, the research goals of this study were to (a) determine high priority areas for research on Asian transnational organized crime (TOC); (b) assess the impact of Asian TOC on the United States; (3) identify relevant data and information sources in Asia; and (4) identify potential collaborative research partners and institutions in Asia. The aim was thus not to examine in detail the organized crime situation in this region, but rather to lay the foundation for a research agenda and strategy that would accomplish that purpose. In seeking to achieve this aim, the researchers used a variety of techniques as part of an overall exploratory methodology. They included four months of interviews (andfield observations) with experts in eight Asian sites, including law enforcement officials, policymakers, and scholars, as well as American officials in each site. Meetings were also held with Asian crime experts in the United States. Interviews and site visits were supplemented with surveys and analyses done by local Asian researchers, an analysis of U.S. indictments, and the review of a large volume of literature. The sites covered by this research are China, Hong Kong, Macau, Taiwan, Japan, Philippines, Thailand, and Cambodia. The major findings are first, that there is little consensus among the Asian authorities on just wliat their main organized crime problems are. Whereas the Asian authorities give higher priority to traditional organized crimes, e.g., gambling, extortion, prostitution, etc., the American authorities focus more on transnational crimes. Consistent with this view, Asian authorities do not see much linkage between the local or regional crime groups about which they are most concerned, and transnational organized crime. Next, contrary to the views and expectations of some American authorities, the commonly expressed view among the respondents in this study is that there is no collaboration or linkage between transnational organized crime groups and terrorists. Finally, the transnational organized crime networks operating in the region are said to be highly specialized, with any overlapping of criminal activities occurring mostly at the level of transportation of goods or people. It is recommended that future collaborative research efforts focus on trafficking in women and children, human smuggling, and drug production and trafficking. These are likely to continue to have the most impact upon the United States and upon U.S. interests in the region. It is further recommended that these research efforts be both bi-lateral (principally with China) and multi-lateral in nature. A wide variety of potentially willing research partners are identified and their strengths and weaknesses are assessed. Finally, a specific strategy for accomplishing the research agenda is proposed. Support for this research was provided by TDL# 1700-215 from the National Institute of Justice. The opinions are those of the authors and do not reflect the policies or views of the National Institute of Justice.     

Hospitals, finance, and health system reform in Britain and the United States, c. 1910-1950: historical revisionism and cross-national comparison

Comparative histories of health system development have been variously influenced by the theoretical approaches of historical institutionalism, political pluralism, and labor mobilization. Britain and the United States have figured significantly in this literature because of their very different trajectories. This article explores the implications of recent research on hospital history in the two countries for existing historiographies, particularly the coming of the National Health Service in Britain. It argues that the two hospital systems initially developed in broadly similar ways, despite the very different outcomes in the 1940s. Thus, applying the conceptual tools used to explain the U.S. trajectory can deepen appreciation of events in Britain. Attention focuses particularly on working-class hospital contributory schemes and their implications for finance, governance, and participation; these are then compared with Blue Cross and U.S. hospital prepayment. While acknowledging the importance of path dependence in shaping attitudes of British bureaucrats toward these schemes, analysis emphasizes their failure in pressure group politics, in contrast to the United States. In both countries labor was also crucial, in the United States sustaining employment-based prepayment and in Britain broadly supporting system reform.     

How the pace of change affects the scope of reform: pharmaceutical insurance in Canada, australia, and the United kingdom

When policy change is considered, what determines its success or failure? Why do plans for broad reforms often fall short, and why do certain types of change become more difficult over time? This article addresses these questions by examining health policy development in Canada, Australia, and the United Kingdom - specifically, why Canada alone failed to adopt nationwide, public pharmaceutical insurance. It demonstrates that the pace of change has significant implications for the scope of policy development. It provides new mechanisms to explain why incremental reforms stall based on the reciprocal relationship between elite ideas and public expectations and suggests that similar factors can explain how barriers to policy change develop and the conditions under which those barriers may be overcome.     

Incentivizing professionals and patients: a consideration in the context of the United Kingdom and the United States

We are at the beginning of an era in which the pressure to secure the biggest possible "bang" for the health care "buck" is perhaps higher than it ever has been, on both sides of the Atlantic, and within the health policy discourse, incentives, for both professionals and patients, are occupying an increasingly prominent position. In this article, we consider issues related to motivating the professional and the patient to perform targeted actions, drawing on some of the evidence that has thus far been reported on experiences in the United Kingdom and the United States, and we present an admittedly somewhat speculative taxonomy of hypothesized effectiveness for some of the different methods by which each of these two broad types of incentives can be offered. We go on to summarize some of the problems of, and objections to, the use of incentives in health and health care, such as those relating to motivational crowding and gaming, but we conclude by positing that, following appropriate consideration, caution, and methodological and empirical investigation, health-related incentives, at least in some contexts, may contribute positively to the social good.