Equity and the allocation of health care resources: Proposition or oxymoron?

The rate of changes in the allocation of health care resources has escalated in the past decade in an attempt to provide for cost containment and a more equitable distribution while retaining quality of care. In this issue, economists, physicians, psychologists, and sociologists examine the current health care environment for evidence relevant to the effect of these changes and provide a guideline for future direction.     

Equity,health, and health care

Equity goals, such as equal treatment for equal need or equality of access, commonly take pride of place among the aims of health policy. But do these conceptions, or others derived from more fundamental philosophical systems such as those of the utilitarians or John Rawls, successfully capture the way in which the term equity is generally used? If not, is it possible to find some interpretation that can command a greater consensus? This paper answers no to the first question and yes to the second. It is argued that the standard conceptions of equity ignore the processes by which health states are determined and hence the extent to which they arise from factors beyond individual control. An alternative conception is proposed that directly incorporates these considerations.     

Justice in Medicare: recent changes to the public health care system

This article sets out and examines a number of changes proposed by the Commonwealth Government to the Australian Medicare system as part of the 2003-2004 and 2004-2005 federal budgets, and the 2004 federal election campaign. In assessing the suitability of these reforms, the idea of justice is discussed. Health, as a basic good, is argued to be a matter of distributional and rectificatory justice. A number of popular material principles of justice are also examined and shown to be unsuited as sole determinants of health care resource allocation decisions. In light of this, various problems with the reforms are identified and improvements suggested.     

Compulsory mental health care in Norway: The treatment criterion

The Norwegian government has chosen to retain a treatment criterion in the Mental Health Care Act despite the opposition of several user organizations. From a critical user perspective, the only reason for using coercion to require mental health treatment is that the individuals are in a state where they are an immediate danger to themselves and/or their surroundings. This articles aims, first, to provide an overview of research studies concerning the benefits or harmfulness of involuntary treatment after coerced admission and, second, to evaluate studies that try to compare involuntary with voluntary treatment. A systematic overview of studies of compulsory mental health care with regard to treatment criteria, coercion in mental health, and involuntary admission published over the last decade was examined in detail, along with a secondary manual search of references cited in identified publications. Few studies have been conducted on the effect of compulsory mental health care, and the results have been contradictory. More randomized studies are needed to document the kinds of effects that the use of compulsory treatment has on treatment results. Another issue that needs further examination is whether the use of coercion should be transferred to legal bodies with an adjudicatory process.     

Sanctioning risky life-styles: Attitudes toward solidarity or equitable distribution of health care

Rising costs of medical care and increasing knowledge about behavior-related health risks favor the use of the equity principle in health care allocation. This paper deals with attitudes to the question of whether or not one's payments should be contingent upon the risks one takes. From an explorative analysis of arguments espoused by letter writers from a Dutch health magazine, it becomes apparent that equity plays a major role in the respondents' views of the distribution of health care facilities. Next, the role of attribution in adopting attitudes toward risky life-styles is studied on the basis of a survey using a representative sample of Dutch households. Beliefs about the individual ability to influence health have no effect on risk solidarity, whereas beliefs about the proper amount of effort to avoid health risks do have an effect.     

Equity,access, and outcomes: The status of the art

A rationale for including analyses of outcome in evaluation of the impact and equity of changes in health care policy for the poor is presented. We first discuss problems in defining equity in and access to health care. Equity in access to health care requires equality of access only to those services that are believed to be efficacious. Three cost-containment strategies (restrictions in eligibility, coinsurance, and capitation) are then examined, and their limitations are discussed. Finally, directions for future research focusing on outcomes are suggested. Rather than using access to care to assess outcome, outcome is viewed as the framework for assessing access and equity.     

Contract health care services; reimbursement and Medicare allowable rates--Bureau of Prisons, Dept. of Justice. Notice

The Bureau of Prisons is issuing this Statement of Policy to inform the public that when it becomes necessary to supplement the direct delivery system of health care the Bureau provides to persons committed to its custody, the Bureau ordinarily will contract to purchase health services only with those hospitals, physicians and other health care providers which agree to accept, as payment in full, reimbursement at rates no higher than the prevailing Medicare allowable rates (including deductibles and co-payments). This encompasses those rates established by the Health Care Financing Administration as "sole community providers" or "regional referral centers". The Bureau will phase this policy into the administration of its contract health services program.     

个人健康医疗信息和隐私权保护

Personal health care and medical treatment information are both personal information which can be used as a sign to identify each individual. Such information shall be under the control of the owner. The comprehensiveness of personal health care and medical treatment information makes it more valuable than the simplex personal information. The controlling right of personal health care and medical treatment information is irretrievable once deprived. The rights of controlling, managing and using regarding personal health care and medical treatment information can be separated appropriately. The right of privacy is an independent personality right. For the protection of public interests, the right of personal privacy shall be appropriately limited. Meanwhile, the government shall be responsible for the protection of personal health care and medical treatment information. Tang Xiaotian is a professor and supervisor in charge of the development and planning division of Shanghai University of Political Science and Law, and deputy General Secretary-in-chief of the Society of Law of Shanghai, whose main studies is focused on victim science, criminal law and criminology. Till now, he has 8 monographs and over 90 articles published in academic journals.     

The distribution of health care financing in the overall population and among the elderly

This paper focuses on the distribution of health care costs among the elderly. Four revenue sources are considered: income taxes, payroll taxes, user fees, and insurance premiums. The empirical work shows that the heavy reliance on direct payments as a means of collecting revenues among the elderly makes their contribution to the health care financing structure more regressive than for the nonelderly.     

The labor impacts of policy change in health care: how federal policy transformed home health organizations and their labor practices

Health care organizations are highly labor-intensive; policies designed to stimulate organizational change are likely to have labor impacts. This paper examines the labor effects of policy change in home health care. Major federal home care policy trends since 1980 have spurred the evolution of the typical home care provider toward greater organizational and market rationality. Greater managerial sophistication has introduced changes in management/labor relations. Survey data from the 1986 DRG Impact Study are used to show how the pressure of cost-containment policies has pushed agencies to cut labor costs by increasing workloads, managerial supervision, and control of the work process. Research on the effects of recent policy change in health care has to date focused primarily on potential client effects. Labor impacts are rarely examined and are poorly understood at the time that policy is made. Findings in this article suggest that these issues deserve greater, more systematic attention, because unanticipated labor impacts may prove to be significant impediments to the realization of intended policy goals.     

Medicare and Medicaid programs: changes to the hospital and critical access hospital conditions of participation to ensure visitation rights for all patients. Final rule

This final rule will revise the Medicare conditions of participation for hospitals and critical access hospitals (CAHs) to provide visitation rights to Medicare and Medicaid patients. Specifically, Medicare- and Medicaid-participating hospitals and CAHs will be required to have written policies and procedures regarding the visitation rights of patients, including those setting forth any clinically necessary or reasonable restriction or limitation that the hospital or CAH may need to place on such rights as well as the reasons for the clinical restriction or limitation.     

Aging in rural areas of Spain: the influence of demography on care strategies

In the rural areas of Spain the aging population trend is particularly acute, and these regions are also characterized by high sex ratios. These are the demographic consequences of an intense rural exodus that started in 1950. This paper addresses the strategies that families from these areas have put in place to guarantee care for the elderly in these limited demographic contexts. It quantifies the demographic change from 1910 to 2010 and analyzes current mechanisms for organizing social care. The methodology includes semi-structured interviews and secondary information obtained from censuses. The results show the emergence of new care strategies, the diversification of social agents involved in care, and the transformation of traditional gender relations. All these changes are conceptualized as social adaptation strategies that increase resilience in rural areas.