Barriers to achieving a cost-effective workforce mix: lessons from anesthesiology

As pressures to control health care costs increase, competition among physicians, advanced practice nurses, and other allied health providers has also intensified. Anesthesia care is one of the most highly contested terrains, where the growth in anesthesiologist supply has far outstripped total demand. This article explains why the supply has grown so fast despite evidence that nurse anesthetists provide equally good care at a fraction of the cost. Emphasis is given to payment incentives in the private sector and Medicare. Laudable attempts by the government to make Medicare payments more efficient and equitable by lowering the economic return to physicians specializing in anesthesia have created a hostile work environment. Nurse anesthetists are being dismissed from hospitals in favor of anesthesiologists who do not appear "on the payroll" but cost society more, nonetheless. Claims of antitrust violations by nurse anesthetists against anesthesiologists have not found much support in the courts for several reasons outlined in this essay. HMO penetration and other market forces have begun signaling new domestic physician graduates to eschew anesthesia, but, again, Medicare payment incentives encourage teaching hospitals to recruit international medical graduates to maintain graduate medical education payments. After suggesting desirable but likely ineffective reforms involving licensure laws and hospital organizational restructuring, the article discusses several alternative payment methods that would encourage hospitals and medical staffs to adopt a more cost-effective anesthesia workforce mix. Lessons for other nonphysician personnel conclude the article.     

我国司法解释规则的新发展及其再完善——《07规定》与《97规定》的比较分析

与最高人民法院1997年出台的《关于司法解释工作的若干规定》相比,于2007年4月1日起施行的新规则无论在形式体例上还是在具体内容方面均有新的发展:新规则的制定依据有所扩充,从而凸显了依法行使司法解释权的应有宗旨;突出强调了协商一致,为"两高"共同制定司法解释的工作提供了制度雏形;扩大了司法解释的立项来源,拓展了司法解释正当化的社会基础;但新规则也仍然存在一些问题:最高人民法院自己规定其司法解释"具有法律效力"显然是一种"过于自大"的失当宣示;对于司法解释工作的监督机制似乎仅具形式意义。     

法律认知和法律原则：情感、效率与公平

情感、效率、公平是人们认知活动中惯常的三个进程。对应这三个进程,人们对法律的认知有一些基本的原则。这些认知互动既可能形成社会自发秩序,也可能为法学提供一个基于认知背景的分析框架,有助于法学应对实践问题。“公平主导”的一个简单回答是,面对不同场合,情感、效率、公平三种进程被激活的程度不同。大体上,家庭场合激活情感,工程场合激活效率,市场和法律则更激活公平。在实践中,公平主导的法律原则由于比较接近主流社会认知,所以法律规范在社会中往往可能“自执行”,无需全靠外界监督或者激励。公平原则也有其自身的局限。虽然规范和原则很重要,是社会秩序的母体。但是,公平原则并不能解决所有问题。缺乏制度上的法治,光靠情理法是不足的。所以现代社会形成了规则化解决纠纷的机制,这就是二阶意义上的法律。     

再论"法律至上"

中共十六大政治报告中,再次把依法治国,建立社会主义法治国家作为中国共产党人在新的历史时期治国的基本方针加以确认。依法治国的理念已深入人心。而要确立依法治国的治国理念,就必须树立起法律至上的观念,它是实现现代法治的观念基础,也是评价现代民主政治国家的基本准则。对于法律至上观念的理解,不仅要从法律自身来理解,而且要从社会关系的层次上,从人们的理性选择等角度进行深层次的考虑。正试图从现代法治的理性选择的角度论证这一问题。     

反垄断普遍主义法理论、法原则探究

反垄断法作为市场经济社会的“经济宪法,”维护近现代商品生产社会的市场经济秩序、“有效竞争”市场结构。在历经百年的反垄断立法和实践中,确立了“本身违法”原则、合理原则、域外适用的“效果原则”。我国反垄断法的制定,应科学借鉴反垄断普遍主义法理论、法原则,规范我国社会主义市场经济秩序、竞争关系。     

Money laundering laws as a political instrument: the social cost of arbitrary money laundering enforcement

The paper explains the reasons for modern money laundring legislation, namely to reduce the incidence of certain primary offences. Whereas enactment and effectuation of this legislation is costly, its postive effects typically materialize in other jurisdictions (positive external effects). The paper shows that international covenants seek to give direct incentives to overcome the possible underprovision in anti-money laundering legislation and enforcement. The paper also shows how, in such an international context, anti-money laundering legislation can be easily misused as a political weapon in the cross-border fight against "unwanted individuals" and gives concrete examples for such an arbitrary enforcement.

公司相互持股的法律问题探讨

两个或两个以上的公司,基于某种特定目的,互相持有对方公司发行的股份,称之为公司法人之间的相互持股。公司相互持股虽然在某种程度上可以促进规模经济的发展,但是它也会给现行法律带来许多制度构架和适用上的问题,涉及到公司法、证券法、反垄断法、税法、会计等诸多方面。世界各国或地区的法律大都对公司相互持股有所规制,以期尽可能减少公司相互持股对经济发展和法律制度的不利影响,而发挥其有利的一面。本文通过对我国现行立法的检讨,提出了对我国公司相互持股的立法完善之构思。     

Has the erosion of the medical marketplace ended?

This paper updates tests of the validity of three models of medical price inflation: a standard model, in which changes in demand press against inelastic supply; a dynamic version of the standard model, in which high levels of insurance induce high rates of product innovation and development; and a model of increasing inefficiency, in which consumers have weak incentives to search out efficient suppliers. Earlier statistical support for the third model has weakened, which provides some evidence that the regulatory and competitive initiatives of the last decade are having their intended effects. But time series measures of medical prices upon which the statistical evidence relies have important methodological problems, so other types of evidence are useful. Trends in expenditure in other countries and in HMOs suggest that the most important explanation of medical price inflation is the dynamic version of the standard model, although the other models have some validity as well.     

Legal protection of the genetic heritage in Brazil (comments on the new "Biosafety Law" of March 24, 2005)]

The purpose of the current article is to outline and comment the most important aspects of the regulation of Brazil's criminal legislation about the protection of the human genome, which establishes crimes related to genetic manipulation and to the dissemination of transgenics in the environment. It also refers to the problems related to the application of the old legal text (Law 8.974/1995), which punished conducts that stayed without the enough development. These gaps complicated so much the application of those rules that the Brazilian Parliament has recently proposed the complete modification of the present legislation by a new Biosecurity Law (Law 11.105/2005). This law for the first time authorizes research with human embrionyc stem cells in Brazil, trying thus to solve in this way the problem of cryoconserved human embryos produced by in vitro fertilization programmes. The new law is analyzed here from a legal and ethical view point.     

网络服务提供者“转通知”义务的适用研究

网络服务提供者的"转通知"义务,起源于美国《数字千年版权法》创设的"避风港"制度,其价值定位是作为沟通"通知-删除"规则与"反通知-恢复"规则之间的"辅助性措施"。随着网络技术与商业实践的持续更迭,传统"避风港"立法列举的"删除、断开链接"等制止网络侵权的必要措施难有用武之地。鉴于此,我国司法实践率先作出破局实验,将传统的辅助性的"转通知"义务扩展为网络服务提供者必须采取的制止网络侵权的"必要措施"。但是,司法对"转通知"义务的扩展,不仅与我国相关立法违背,而且在制度体系、制度平衡及实施效果等方面存在诸多质疑,不宜继续被采纳。我国《民法典》新规总概性地将"转通知"义务界定为独立于制止网络侵权"必要措施"之外的前置性措施。对此,本文建议,未来除应以《民法典》新规为基础,还应进一步深入明晰其适用的主体范围,扫清其实施的技术障碍,强化其执行的制度保障。     

Irrationality, evidence-based medicine and the standard of care

The determination of the legal standard of care in Australia for medical diagnosis and treatment has gone through three apparent phases in modern times: the Bolam era, the post-Rogers v Whitaker era, and the current Civil Liability Acts era. It is conventionally accepted that the two shifts linking these phases were a jettisoning of the Bolam principle in Rogers and a return to a modified Bolam principle in the Civil Liability legislation, with the post-Rogers interregnum being a time of a court-imposed standard. This story is somewhat inaccurate. The Bolam test relied more on practice accepted at the time as proper by a responsible body of medical opinion rather than the practice of a "responsible body of medical men". The ability of post-Rogers courts to override medical evidence was more a rhetorical power than an actual one. And the irrationality condition, which reserves the right to override medical opinion under the Civil Liability Acts, is more dependent on sound evidence than the terminology might suggest. It is not so much that the legal standard of care has changed in dramatic ways as that the content of competent professional opinion has evolved as medical research and practice have developed. There is greater continuity than is usually granted, throughout the three phases, of the standard's reliance on current best evidence and opinion. This is more easily seen with the advent of evidence-based medicine.     

The psychiatrist's guide to right and wrong: Part III: Postpartum depression and the "appreciation" of wrongfulness

Whether or not the psychiatrist testifies on the ultimate issue in insanity defense cases, it is critically important that he familiarize himself with the applicable legal standards and interpretations in order properly to relate his clinical findings to the relevant criteria for insanity and thereby enhance the probative value of his testimony. This is the third in a series of articles which attempts to explicate judicial and statutory standards of insanity and correlate them with the psychiatrist's findings of psychopathology. This article analyzes the Model Penal Code formulation of insanity, with special emphasis on the all important distinction between "know" and "appreciate." This formulation permits the defendant possessed of mere surface knowledge or cognition to be exculpated, requiring that he have a deeper affective appreciation of the legal and moral import of the conduct involved if he is to be held criminally responsible. The Model Penal Code approach more readily lends itself to application as a standard of responsibility in cases involving affective disorders. An important disorder within this group, postpartum depression, is discussed in the context of raising the insanity defense in a case of infanticide.     

Incapacity,the Labour Market and Social Security: Coercion into ‘Positive’ Citizenship

The article examines the likely evolution of the social security system in the United Kingdom in the aftermath of the Welfare Reform Act 2007. This recent legislation is paradigmatic of the new ideology and modes of thought which currently form the foundation of the modern welfare state, an institution increasingly viewed as a facilitator for individual self‐sufficiency, as opposed to its traditional role of providing temporary financial support in periods of need. In addition, it is likely that the Act has promoted at least some changes in the concept of citizenship, in particular the contemporary emphasis on responsibilities as much as on rights. The article considers whether the Act itself has succeeded in meeting the rhetorical claims made for it by legislators during the passage of the Welfare Reform Bill through Parliament. The question of whether the Act contains a punitive or even coercive element is also examined.     

Power,Policy and Co-ordination in Law Reform: a Civil Servant and Town Planning Law, 1929–1930

The process of turning policy into legislation has been the subject of intense debates with some emphasising 'pressure groups', some pointing to Members of Parliament and others stressing the importance of civil servants with their own strong beliefs. This article argues that a particular type of civil service role has not been explored: we need to look at the civil servant who co-ordinates the process of reform. He or she starts with no particular commitment but seeks to provide a framework for legislation which can respond to contrasting and, on some occasions, even mutually inconsistent ideas. Co-ordination is in itself a form of power, and its significance can be seen in the compromises and gaps which are often found in government legislation and which are frequently the product of the co-ordinating role with its search for some minimal level of agreement and 'workable' drafts. The case-study for this analysis of law-making is the strained attempt to reform planning law in the years 1929–1932 in such a way as to make the law an instrument for preserving the countryside and improving housing and city conditions. It was a major attempt at social engineering and highly contentious for contemporaries. It is the essence of this type of law-reform that it simultaneously changes past law and, because it is an administratively co-ordinated compromise, it also produces problems which demand further reform within a few years.     

“经、权”论与传统法律文化

"执经达权"是中国哲学重要的方法论思想.用现在的话说,"经"是原则性;"权"是灵活性;"执经达权"就是要处理好原则性与灵活性、守常与应变的关系."经、权"方法论对中国传统法律文化产生了深刻影响.中国古代的法律思想、立法、司法都打上了"经、权"论的烙印.特别是中国古代"例以辅律并发展入律"的法律有机生长模式,更是"经、权"方法论的生动写照.     

刑法预防性立法对犯罪学之影响:困境与出路

当代风险社会及其构成要素,是互相联系、互相成就和互相影响的刑法学与犯罪学的共同知识场域。预防性立法模式在刑法立法实践中确立,预防型犯罪也被简化为安全的技术辅助。犯罪学研究的犯罪现象、原因和对策随之发生变化,其研究范式也便面临危机和挑战。针对预防刑法的“事前法”特征,对其进行研究的犯罪学也应转向“事前”犯罪学。事前犯罪学在传统的“现象-原因-对策”研究范式的基础上,更应进行问题意识和研究方式的转化,为预防性立法走向理性、科学和合理贡献知识。事前犯罪学理论知识,要进入预防性立法的决策场域,就应寻找适合预防性立法的犯罪学逻辑体系。其展现的知识逻辑和问题意识,不是要和预防刑法知识体系合谋,而是要在既有理论的基础上,整合和构建恰当的研究范式和知识库存、跨学科借新智、打破传统事实学窠臼、遵守法治精神,据此走出困境,也为预防性立法提供根据。     

解读我国《涉外民事关系法律适用法》

《涉外民事关系法律适用法》是我国历史上第一部系统调整冲突法问题的法律,它的实施将会对我国和同我国有着密切民事交往的外国产生深远的影响。通过对该法一般性的规定和几个特定领域的冲突规范的解读,可以看出许多当代国际私法的发展和成就已被其接纳,但一些实施细节有时还不得不求助于旧的规定或有待实践予以补充。总体上讲,它应当受到国内外的一致欢迎。     

我国建立农民医疗保障法律制度的思考

我国的农民医疗保障制度曾有过辉煌,也遭遇过挫折。建立农民医疗保障法律制度是人权事业发展、和谐社会构建、实现农业现代化、解决农民因病返贫、缩小城乡居民健康差距的需要。近几年,农民医疗保障制度—新型农村合作医疗的试点推行,为我们制定《农民医疗保障法》提供了立法经验。建立农民医疗保障法律制度,应坚持科学原则,从法律制度建设入手,依法推进,保持农民医疗保障制度规范、有序、有效。同时,要加强与农民医疗保障法律制度相适应的配套制度改革建设工作,以保证农民医疗保障法律制度落到实处。     

立法后评估对象的选择

立法后评估是指法律实施一段时间以后,有关政府部门、组织或人员对其实施效果等进行评估,根据法律在实施中存在的问题,分析其立法上的原因,从而进一步完善立法。立法后评估对象的选择依据在于立法后评估对象选择的有效性、必要性以及可行性。     

"Legal highs"-Toxicity in the clinical and medico-legal aspect as exemplified by suicide with bk-MBDB administration

The easily available "legal highs", which are products containing psychoactive substances, such as cathinones, piperazines and synthetic cannabinoids, are abused by adolescents in Poland and in the world as alternatives to classic drugs, such as amphetamines or marijuana. The majority of these potentially dangerous substances are still legal and they are associated with a risk of severe poisoning or even death, and provide new challenges in clinical and forensic toxicological practice. Investigations in the field of "designer drugs" may be well illustrated by the case of a suicide of a 21-year old male who ingested a specified dose of a preparation called "Amphi-bi-a" that contains bk-MBDB, chemically 2-methylamino-1-(3,4-methylenedioxyphenyl) butan-1-one, which belongs to the cathinone group, as a synthetic euphoric empathogen and psychoactive stimulant that is chemically similar to MDMA. It is one of more common components of "legal highs" examined in Poland and other countries. The documentation of the case includes a clinical assessment of the patient's health status performed during his almost 4-h hospitalization before death, autopsy and histological examinations supported by toxicological findings revealing bk-MBDB at extremely high concentrations (at 20mg/l in the blood and 33mg/kg in the liver); hence, this body of evidence contributes to knowledge in the field of "designer drugs". Inventions of designers of new psychoactive xenobiotics, which are much in demand, especially in view of the dynamic Internet marketing, which drums up narcobusiness, must be balanced by a national strategy developed by medical, legal and educational circles in the modern civilized world in order to prevent the spreading of the phenomenon.