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.     

Antitrust, health care quality, and the courts

Antitrust law represents the principal legal tool that the United States employs to police private markets, yet it often relegates quality and nonprice considerations to a secondary position. While antitrust law espouses the belief that vigorous competition will enhance quality as well as price, little evidence exists of the practical ability of courts to deliver on that promise. In this Article, Professors Hammer and Sage examine American health care as a vehicle for advancing understanding of the nexus among competition, quality, and antitrust law. The Article reports results of a comprehensive empirical review of judicial opinions in health care antitrust litigation between 1985 and 1999, with specific attention to courts' handling of quality and other nonprice concerns. Professors Hammer and Sage conclude that, although antitrust law cannot be expected to serve as the sole oversight mechanism for industries as complex and quality dependent as health care, courts have been successful incorporating some nonprice factors into antitrust analysis.     

Making sense of the global health crisis: policy narratives, conflict, and global health governance

Health has become a policy issue of global concern. Worried that the unstructured, polycentric, and pluralist nature of global health governance is undermining the ability to serve emergent global public health interests, some commentators are calling for a more systematic institutional response to the "global health crisis." Yet global health is a complex and uncertain policy issue. This article uses narrative analysis to explore how actors deal with these complexities and how uncertainties affect global health governance. By comparing three narratives in terms of their basic assumptions, the way they define problems as well as the solutions they propose, the analysis shows how the unstructured pluralism of global health policy making creates a wide scope of policy conflict over the global health crisis. This wide scope of conflict enables effective policy-oriented learning about global health issues. The article also shows how exclusionary patterns of cooperation and competition are emerging in health policy making at the global level. These patterns threaten effective learning by risking both polarization of the policy debate and unanticipated consequences of health policy. Avoiding these pitfalls, the analysis suggests, means creating global health governance regimes that promote openness and responsiveness in deliberation about the global health crisis.     

The health of health practitioners: remedial programs, regulation and the spectre of the law

The past two decades have seen an emerging awareness by regulators and some of the health professions about the phenomenon of the impaired practitioner. One response, particularly from the medical profession, has been to design various models of health programs principally to cater to psychiatrically unwell and substance dependent practitioners. However, the health conditions of practitioners are more diverse than these categories, particularly in the era of a stressed and ageing health care workforce. The potential exists for practitioners, their treaters and employers to be legally liable for foreseeable risks posed to patients and clients by practitioners whose health is problematic and/or deteriorating. There is much to be said for practitioners, health service administrators, educators and regulators dealing more effectively with all categories of impaired practitioners before the intervention of the civil law which may not be adequately informed or sophisticated and is most unlikely to be collaborative in its approach.     

Obesity, courts, and the new politics of public health

Health care politics are changing. They increasingly focus not on avowedly public projects (such as building the health care infrastructure) but on regulating private behavior. Examples include tobacco, obesity, abortion, drug abuse, the right to die, and even a patient's relationship with his or her managed care organization. Regulating private behavior introduces a distinctive policy process; it alters the way we introduce (or frame) political issues and shifts many important decisions from the legislatures to the courts. In this article, we illustrate the politics of private regulation by following a dramatic case, obesity, through the political process. We describe how obesity evolved from a private matter to a political issue. We then assess how different political institutions have responded and conclude that courts will continue to take the leading role.     

Inequality, privacy, and mental health

The state's mental health power is standardly understood in terms of the state's power to intervene with persons or populations to address mental health problems. This article advances a more expansive view of the state's mental health power, one which seeks to capture those exercises of state power that do not directly concern mental health but that nevertheless can have a profound effect on mental well-being. The article considers two features of contemporary American society that implicate the state in conditions that undermine, or threaten to undermine, mental health. The first concerns the impact of poverty and inequality on mental health. The second concerns the threat to the self posed by measures that would significantly erode privacy. The article argues that a greater commitment to liberal principles of equality and tolerance is crucial to overcoming the perils for mental health that poverty and losses of privacy generate.