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.     

Infectious disease surveillance in the United States and the United Kingdom: from public goods to the challenges of new technologies

Infectious diseases are a long-standing and continuing threat to health and welfare, with their containment dependent on national disease surveillance and response capacities. This article discusses infectious disease surveillance in the United States and the United Kingdom, examining historical national traditions for identifying and controlling infectious disease risks and how globalization and technical advances have influenced the evolution of their respective approaches. The two systems developed in different but parallel ways. In the United States, surveillance remained quite localized at the state level until the early twentieth century and still retains many of those features. The U.K. approach became centralized from the latter part of the nineteenth century and has principally remained so. In both cases, disease surveillance was traditionally conceived as a public good, where national or local authorities held sovereign rights and power to protect public health. With the increasing globalized nature of infectious disease, such notions shifted toward surveillance as a global public good, with countries responding in turn by creating new global health governance arrangements and regulations. However, the limitations of current surveillance systems and the strong hold of national interests place into question the provision of surveillance as a global public good. These issues are further highlighted with the introduction of new surveillance technologies, which offer opportunities for improved disease detection and identification but also create potential tensions between individual rights, corporate profit, equitable access to technology, and national and global public goods.     

Priority and rescue financing in the Commonwealth Caribbean: lessons from the United States of America,United Kingdom and European Union

In investigating the operation of the rescue culture in the Commonwealth Caribbean as compared to the United Kingdom administration regime and Chapter 11 of the United States Bankruptcy Code, this paper laments that the Commonwealth Caribbean and the USA fail to consider key issues of post-petition priority for finance. It also delves into a critical, but overlooked, pillar of strong rescue frameworks: access to finance. Taking guidance from the European Union framework on state aid and the UK Funding for Lending and National Loan Guarantee, the author proposes a fair, transparent and efficient framework encompassing state involvement and state-driven private sector engagement.     

Unconscionability of E-contracts: A Comparative Study of India,the United Kingdom,and the United States

Liverpool Law Review - Adhesion contracts have a strong likelihood of being unconscionable. The laws and principles are further complicated by the introduction of electronic contracts, specifically...     

Privatization in the United Kingdom and economic regulation in the United States: Lessons in administrative law

The author would like to recognise Prof. Laksham Guruswamy, Faculty of Law, University of Durham, currently Visiting Professor of Law, University of Iowa, for the suggestions he contributed to this article.     

Inching toward incrementalism: federalism, devolution, and health policy in the United States and the United Kingdom

In the United States, the recently enacted Patient Protection and Affordable Care Act of 2010 envisions a significant increase in federal oversight over the nation's health care system. At the same time, however, the legislation requires the states to play key roles in every aspect of the reform agenda (such as expanding Medicaid programs, creating insurance exchanges, and working with providers on delivery system reforms). The complicated intergovernmental partnerships that govern the nation's fragmented and decentralized system are likely to continue, albeit with greater federal oversight and control. But what about intergovernmental relations in the United Kingdom? What impact did the formal devolution of power in 1999 to Scotland, Wales, and Northern Ireland have on health policy in those nations, and in the United Kingdom more generally? Has devolution begun a political process in which health policy in the United Kingdom will, over time, become increasingly decentralized and fragmented, or will this "state of unions" retain its long-standing reputation as perhaps the most centralized of the European nations? In this article, we explore the federalist and intergovernmental implications of recent reforms in the United States and the United Kingdom, and we put forward the argument that political fragmentation (long-standing in the United States and just emerging in the United Kingdom) produces new intergovernmental partnerships that, in turn, produce incremental growth in overall government involvement in the health care arena. This is the impact of what can be called catalytic federalism.     

The development of national medical care programs in the United Kingdom and Canada: applicability to current conditions in the United States

After a hiatus in the early to mid-1980s, a growing number of policy leaders, policy organizations, and citizen groups are advocating programs that ensure basic medical care for all. Although a large literature examines the applicability to the U.S. of national medical care programs that have been established in other countries from the perspective of operations and effectiveness, little attention has been given to the applicability of the experience of other nations in securing these programs. This paper examines the development of national programs in the U.K. and Canada and addresses two questions. First, what factors were critical to the establishment of the British National Health Service and the Canadian hospital and physician insurance programs? Second, how applicable are those factors to current conditions in the U.S.? The paper reviews the roles played by dislocations in society, by established models of state-sponsored medical care programs, by political institutions and leaders, and by the major medical sectors. It shows that the U.S., while differing in many particulars, presents several parallels to the U.K. and Canada. The paper argues that the current environment in the U.S. offers the nation the opportunity to develop at state or local levels government-sponsored programs that guarantee basic medical benefits to all. A new and powerful coalition, moreover, may in the coming years advance the cause of broader, more substantive change at the national level.     

Intimate Violence in Canada and the United States: A Cross-National Comparison

Using data from the 1985 U.S. National Family Violence Resurvey and the 1986 Canadian National Family Life Survey, this paper compares incidence of intimate violence or “common couple violence” (Johnson, 1995) in both countries. As expected, gender symmetry characterizes common couple violence, which is a product of the privatized setting of many American and Canadian households. Although the United States exhibits significantly higher rates of societal violent crime than Canada, Canadian women and men were more likely than their American counterparts to use severe intimate violence and to inflict it, as well as minor violence, more often, which is contrary to the culture of violence theory that guided the study. Similarly, the higher rates of wife-to-husband severe violence across the life course in both countries are inconsistent with the theory. Several ad hoc explanations are presented to account for these unexpected findings.     

发达国家灾难治理基本经验及其启示:以英国、美国、日本为例

发达国家,尤其是英美日在灾难治理方面起步较早,积累了丰富的经验,主要体现在:灾难治理的组织机构日渐完备;灾难治理的运作机制更加协同;灾难治理的法律体系日益完善;灾难治理的资金保障更加有力;灾难治理的信息披露更加透明;灾难治理的参与主体逐渐多元;灾难治理的端口逐渐前移;灾难治理的教训得以及时总结。深入分析并总结这些国家灾难治理举措,目的在于从中找出于我国可资借鉴之处,提升我国政府灾难治理的水平和能力。     

Phylogenetic Evidence for a Case of Misleading Rather than Mislabeling in Caviar in the United Kingdom

Sturgeons and paddlefish are freshwater fish which are highly valued for their caviar. Despite the fact that every single species of sturgeon and paddlefish is listed under CITES, there are reports of illegal trade in caviar where products are deliberately mislabeled. Three samples of caviar purchased in the United Kingdom were investigated for accurate CITES labeling using COI and cyt b sequencing. Initial species identification was carried out using BLAST followed by phylogenetic analyses using both maximum parsimony and maximum likelihood methods. Results showed no evidence for mislabeling with respect to CITES labels in any of the three samples, but we observed clear evidence for a case of misleading the customer in one sample.