Why hasn't integrated health care developed widely in the United States and not at all in England?

There have been influential advocates for financing and organizing health care in the United States and England based on the model of integrated health care delivery systems (IHCDSs). Despite good evidence that a few IHCDSs provide high-quality health care economically, such organizations are rare and localized in a few market areas in the United States and are absent in the English National Health Service (NHS). The explanation of why this is so includes various contributory factors: the way the development of the medical profession in each country pursued specialization; the division in British medicine between general practitioners and specialists; and the characteristics that we identify of established successful IHCDSs, which created formidable barriers to entry for a new IHCDS. This explains why currently the most promising organizational developments in U.S. health care are hybrids resulting from vertical integration. In England government policies of an "internal market," as adopted in the 1990s and currently, were and are based on a purchaser-provider split with the objectives that providers would compete and be funded by a system in which "money follows the patient." These policies recognize the division in British medicine, which also means that it is difficult to implement a reorganized English NHS based on high-performing IHCDSs.     

The Olympics: 64 years on

In just over a month's time London will be the centre of international focus as athletes from over 200 countries arrive for the Olympic Games. The last Olympic Games held in London was in 1948 – in the same month the National Health Service (NHS) was established. It is a tragic coincidence that the Olympics returns to London in the same year as the Health and Social Care Act was passed, legislation the chairman of the British Medical Association described as likely to be ‘irreversibly damaging to the NHS as a public service, converting it into a competitive marketplace that will widen health inequalities and be detrimental to patient care’ (Buckman, 2012).     

Ideology, class and the National Health Service

Since the start of the British National Health Service, disputes between the government and the medical profession have become formalized battles with well-recognized rules. But between 1974 and 1976 the consensus underlying the conflict was challenged by the Labour Government's policy on private practice and pay beds. This paper examines the course of the conflict and analyzes the factors underlying the eruption of this issue. It draws attention to the role of the trade-unions in activating the Labour Party's latent ideological commitment on private practice. Although the issue appears to conform to a class-conflict model, this simple symmetry becomes blurred on closer analysis. In conclusion the paper argues that while socio-structural factors extrinsic to the health service explain the appearance of private practice on the political agenda, it is factors endogenous to the NHS which explain the outcome of the dispute. In turn, however, these endogenous factors have little to do with the fact that the NHS is delivering a commodity called "health." Instead, what is important is that the NHS is a complex organization and, as such, depends on the co-operation of a variety of groups--ranging from the medical profession to laundry workers. The analysis, therefore, concludes that the power of the medical profession derives not from its elite status but from its position as an organized group in a complex industry.     

Law and medicine: myths and realities in the medical school classroom.

One way to increase cooperation between the professions of law and medicine is to teach law in medical schools in a way that emphasizes methods of approaching problems, and seeks to dispel the major myths that doctors have about the law. In this Article, Professor George Annas presents an outline of a core course in legal medicine "tailor-made" for inclusion in the medical (and, with appropriate modifications, dental) school curriculum.     

Rape myths and rape by juveniles

Rape committed during adolescence is a vital indicator for predicting the propensity of committing rape in adulthood. Moreover, although numerous studies related juvenile rape have been proposed in Western countries, most of these studies have focused on the impact of personal factors, and have neglected to examine the impact of rape myths. Therefore, in the present study, we investigated the relationship between rape myths and male juvenile rape. This study used an anonymous self-report questionnaire to collect data. Participants included 466 male middle- and high-school students in Taiwan. The results showed that rape myths are associated with juvenile rape. Furthermore, rape victim myths were the myth category relating to juvenile rape, rather than rape perpetrator myths. Among the rape victim myths, the dimension, women secretly wish to be raped, had the strongest association. Discussions pertaining to implications, applications, limitations, and future research are included in the present study.     

Reporting Femicide-Suicide in the News: The Current Utilization of Suicide Reporting Guidelines and Recommendations for the Future

Public health officials have developed and disseminated recommendations for the responsible reporting of suicide in an effort to dispel myths about suicide-completers and minimize contagion effects. However, recommendations as to the reporting of homicide-suicide events have not been a priority in these initiatives. The current study assesses the degree to which newspaper coverage of the most commonly occurring type of homicide-suicide event, femicide-suicide, adhere to existing suicide reporting recommendations by examining newspaper coverage (n?=?143) of a population of femicide-suicide cases (n?=?83) from North Carolina for the years 2002–2009. The current study demonstrates the importance of developing and disseminating reporting guidelines to assist in dispelling myths about the victims and perpetrators of lethal intimate partner violence.     

揭批早期教育中的神话与伪科学

长期以来,早期教育领域充斥着许多神话,如早期经验决定论、刺激丰富的神话、右脑开发、识字增智等等.至于许多科学素养差或别有用心的人传播和制造的各种神话,已经成为社会公害.特别是当这些神话打着科学的幌子出现时,更加容易误导社会大众,成为伪科学的主要来源.它不仅严重危害婴幼儿的身心健康,而且为婴幼儿健康成长埋下了隐患.正如世界上不存在包医百病的灵丹妙药一样,绝不存在什么早期教育的"灵丹妙药".     

Measurement Properties of the Communities That Care<Superscript>®</Superscript> Youth Survey Across Demographic Groups

Prevention science has produced information about risk and protective factors that predict adolescent drug use and related problem behaviors. This paper investigates the Communities That Care Youth Survey that measures multiple risk and protective factors. Using a sample of 172,628 students who participated in surveys administered in seven states in 1998, analyses were conducted to test the factor structure of these risk and protective factors and to test the equivalence of the factor models across five racial/ethnic groups (African Americans, Asians or Pacific Islanders, Caucasians, Hispanic Americans, and Native Americans), four grade levels (6th, 8th, 10th, and 12th) and both gender groups. Results support the construct validity of the surveys risk and protective factor scales and indicate that the measures are equally reliable across males and females and five racial/ethnic groups. Implications of these findings for science-based prevention planning are discussed.     

Myths and Mild Traumatic Brain Injury

Despite the fact that patients with mild traumatic brain injuries (TBI) are commonly encountered in clinical practice, there are numerous myths surrounding their diagnosis, assessment, and outcome. The purpose of this paper is to review some of the more common myths related to mild TBI including: (a) there is no Miserable Minority; (b) meta-analytic studies have proven that patients with mild TBI do not experience persistent deficits; (c) personality tests can reliably capture psychological problems in patients with a mild TBI; (d) findings from the sports concussion literature can be directly applied to clinical patients; and (e) in the absence of loss of consciousness, the diagnosis of a mild TBI is uncertain.     

A review of the role of radical feminist theories in the understanding of rape myth acceptance

Abstract

Research into rape myth acceptance (RMA) first emerged in the 1970s, when authors such as Brownmiller (1975) and Burt (1980) proposed that rape was a mechanism that allowed men to exert power over women and that the endorsement of rape myths justified this sexual dominance. These influential theories have meant that subsequent definitions of rape myths have failed to acknowledge male victims of serious sexual assault, despite an increase in prevalence rates. More recent research has attempted to explore RMA in relation to male victims, with results suggesting that men are more likely than women to endorse rape myths regarding male victims when the victim is assumed to be homosexual, or when the victim is heterosexual and the perpetrator is female. Brownmiller's theory is challenged and a more holistic view of the importance of sex-role traditionality is explored, while acknowledging the contribution of individual factors relating to the development of RMA.     

Genetic structure among 38 populations from the United States based on 11 U.S. core Y chromosome STRs

A DNA database consisting of the 11 Y chromosome short-tandem-repeat (Y-STR) recommended by the Scientific Working Group on DNA Analysis Methods is constructed for 2517 individuals from 38 populations in the United States. The population samples derive from five ethnic groups currently living in 10 states. A multidimensional scaling (MDS) plot places the populations into four discrete clusters (African Americans (AA), European Americans (EA), Hispanic Americans (HA), and Asian Americans (SA)) and one dispersed cluster of Native Americans. An analysis of molecular variance (AMOVA) indicates that a large proportion of the total genetic variance is partitioned among ethnic groups (24.8%), whereas only a small amount (1.5%) is found among-populations within ethnic groups. Separate AMOVA analyses within each ethnic group show that only the NA sample contains statistically significant among-population variation. Pair wise population differentiation tests do uncover heterogeneity among EA and among HA populations; however, this is due to only a single sample within each group. The analyses support the creation of AA, EA, HA, and Asian American databases in which samples from different geographic regions within the United States are pooled. We recommend that separate databases be constructed for different NA groups.     

Rape myth in true and false rape allegations

Abstract

Police records of 38 rape allegations, evenly split into maintained-as-true and withdrawn-as-false categories were compared with 19 generated-false statements from recruited participants. The Illinois Rape Myth Acceptance Scale (IRMAS) was used to assess the attitudes of the participants and a content analysis derived from IRMAS was used to compare the three categories of allegation. Rape myths were present in all three allegation types. The two categories of false allegation both contained more rape myths than the true allegations but no differences were found between the generated and withdrawn false allegations. High scorers in IRMAS also produced more violent false accounts. In addition to these findings, this study provides support for the further examination of rape myths in both false and true statements and use of generated allegations as proxies for real false statements.     

Origin Myths,Contracts, and the Hunt for Pari Passu

We use interviews with corporate lawyers and a data set of contracts to explore an elite area of legal practice: sovereign bond lending. Sovereign debt lawyers work at prestigious global law firms, yet the contracts they produce include some terms that defy explanation. Lawyers often account for the existence of these terms through origin myths. Focusing on one contract term, the pari passu clause, we explore two puzzling aspects of these myths. First, we demonstrate that the myths are inaccurate as to both the clause's origin and the role of lawyers in contract drafting. Second, the myths often are unflattering, inaccurately portraying lawyers as engaged in little more than rote copying. We probe this disjuncture between the myths and lawyers' actual practices and explore why contracts origin myths might hold such appeal for this elite segment of the bar.     

This Time,it's for Real: The Health and Social Care Act 2012

This article examines the Health and Social Care Act 2012 and associated reforms to the National Health Service in England. It focuses on the Act's policy of making the NHS market more ‘real’, by both encouraging and compelling NHS bodies to act as ‘market players’. The article considers whether the reforms are compatible with the constitutional requirements of accountability for the provision of a public service such as the NHS. It argues that the reforms threaten accountability for three reasons: they make the Secretary of State for Health's relationship with the NHS more complex, they create opaque networks of non‐statutory bodies which may influence NHS decision‐making, and (especially in relation to competition) they ‘juridify’ policy choices as matters of law. Taken together, these arguments suggest that there is force in the claim that the reforms will contribute to ‘creeping’ – and thus unaccountable – privatisation of the NHS.     

The Hard Sell: Promoting Human Rights

The Human Rights Act 1998 is one of the most important constitutional reforms to have been implemented by the New Labour administration in Britain. In addition to incorporating the European Convention on Human Rights into domestic law, its main ambition is the creation of a human rights culture. However, while citizens appear to have very little understanding of what the legislation entails, there is a strong tide of negative media publicity which depicts the Human Rights Act as a ‘villains’ charter’. It has been suggested that the government should do more to promote human rights. This paper reflects on how this may be achieved. An important strategy for creating a positive public awareness of human rights involves eradicating myths which have been allowed to flourish in sections of the British press. However, drawing on the work of Roland Barthes, this paper argues that this may be an unattainable goal. Human rights are empty signifiers which invite mythical appropriation. Both proponents and detractors of human rights legislation mobilise this capacity for mythmaking in their rhetoric.     

A Puzzling Paradox: Advancements in Reproductive Technology and New York's Ban on Commercial Surrogacy Agreements

With infertility on the rise in the United States and the legalization of same sex marriage, it has become increasingly difficult for many Americans to start a family. Advancements in modern medicine have addressed this issue and now couples can create their family through surrogacy. However, New York's current laws have not caught up to the changing times and surrogacy agreements are still invalid and unenforceable. This Note proposes the repeal of New York's surrogacy ban and the adoption of legislation to recognize and enforce surrogacy agreements in order to bring New York's laws within the purview of modern medicine.     

本土法与外来法:美国的经验

美国法的历史经历了从无到有,从继受外来法到形成发展美国本土法 的漫长过程。这一过程是有机的、渐进的、不可任意割裂。１７世纪早期殖民地的法 制状况具有多元化与创新性相结合的特点。１８世纪殖民地大规模、全面系统地继受 英国法。独立战争至１９世纪中叶美国本土法形成。在移植外来法、形成本土法的过 程中,美国人重视法律本土资源,坚持可适用性原则。在法律移植过程中,最先被本 土化的是初级规划,次级规划则较晚被本土化。     

Population variation in femur subtrochanteric shape

Use of proximal femur shape to determine ancestry has appeal, but its validity is problematic because of unaddressed issues associated with skeletal plasticity, within- and between-population variation, sample selection, and interobserver error. In this paper, I inspect within- and between-group variation in proximal femur shape using five groups (American Blacks, American Whites, Hispanics, Native Americans, and Polynesians), and examine the affect of three environmental variables (subsistence strategy, physical terrain, and geographical region). Finally. I consider the validity of using the proximal femur to assess ancestry. The results show that there is significant within-group variation in proximal femur shape. Among Native Americans, both geographical location and subsistence strategy have a significant affect on proximal femur shape. Nevertheless, this study generally verifies the assertion that the proximal femur can be used reliably to distinguish Native Americans from American Blacks and Whites, but its precision may be reduced in some geographical regions.     

Regulatory Capitalism and the UK Labour Government's Reregulation of Commissioning in the English National Health Service

Today, policy analysts and regulatory governance scholars are sceptical about the capacity of the regulatory state hypothesis to describe change at the institutional level. For many, the hypothesis is a convenient oversimplification that fails to account for the hybridity of institutional arrangements within individual policy sectors and also for the divergence of reform trajectories across different national and sector‐based policy contexts. This article assesses the influence of the key themes of the regulatory state on the UK Labour government's reregulation of National Health Service (NHS) commissioning organizations. Following the critics, it argues that these themes are only partially evident in the programme. While the government has codified previously informal relationships with policies like Patient Choice and has also subjected commissioning organizations to metaregulatory techniques, its reforms have neither displaced public ownership and the direct supply of commissioning services with markets and new mechanisms for rule making and standard setting, nor have the reforms divided labour within the state by creating an independent agency to regulate NHS commissioning organizations via technocratic means. Under the reforms, NHS commissioning continues to take place within a structure of bureaucratic relationships. However, the article suggests that the hybridity of regulatory techniques at work within the UK Labour government's reregulation of NHS commissioning lends weight to the claim that the current era is one of regulatory capitalism. It concludes with a discussion of the consequences of this finding for the public policy and regulatory governance literatures.     

Juridification, medicalisation, and the impact of eu law: patient mobility and the allocation of scarce NHS resources

This article explores the relationship between EU Law and the allocation of scarce NHS resources in the context of the EU's objective of facilitating access to health care for patients within the EU. Focusing on the Watts case and the recently adopted EU Patients' Rights Directive, the article addresses the political and economic aspects of the implications of EU Law for, inter alia, domestic law, medicine, and the NHS. It does so through developing an analytical framework comprising the notions of juridification and medicalisation. Those notions, which are drawn here from the work of Jürgen Habermas, Ivan Illich, and Sheila McLean, are not only helpful as means of thinking through the nature of the specific EU laws considered in the article; by virtue of their broader focus on, and critique of, the welfare state, they offer an opportunity to reflect more generally on the implications of these laws for the role of the welfare state and medical and legal professionals in the development of the EU's internal market in health care services. Having undertaken this analysis, the article argues that, in order to capture the developments and implications of EU Law on patient mobility, it is necessary to update and partially reformulate the notions of medicalisation and juridification.