Health care of the disadvantaged: the elderly

This paper explores threats to the maintenance and expansion of public commitment to financing health care for the elderly. Threats come from rising costs that increase financial burdens, especially on low-income elderly; efforts to contain costs that may undermine benefits; and financing initiatives that treat the elderly as the sole revenue source for addressing problems in that age group. A review of these threats provides lessons not only for sustaining and improving health care for the elderly, but also for policy toward equally or more disadvantaged groups.     

Health Resources and Services Administration. Final eligibility criteria, preferences, and priorities for scholarships for disadvantaged students

The Health Resources and Services Administration (HRSA) announces final eligibility criteria, preferences, and priorities for the Scholarships for Disadvantaged Students (SDS) program, under the authority of section 737 of the Public Health Service Act (the Act), Title VII, Part B, as amended by the Health Professions Education Partnerships Act of 1998. Pub. L. 105-392, dated November 13, 1998. A notice which proposed eligibility criteria, preferences, and priorities for the SDS program was published in the Federal Register at 64 FR 29660, dated June 2, 1999. A period of 30 days was established to allow public comment concerning the proposed eligibility criteria, preferences, and priorities. Five comments were received. This notice discusses these comments and sets forth the final eligibility criteria, preferences, and priorities.     

Research, policy, and the National Health Service

The National Health Service is a system designed to bring about a rational use and distribution of resources yet which largely ignores the contribution of the research community. With a relatively closed health policy arena, there are few customers for policy-oriented research. With responsibility for funding research concentrated at the center and responsibility for delivering services at the periphery, the research community finds itself in limbo. In comparison to both the U.S. and Canada, Britain therefore offers an example of research both underfinanced and undervalued. However, research has made some significant contributions in areas where there has been a perceived use for its findings to support service developments. And the changes now being introduced in Britain's NHS are likely to create a new market for research as the system adopts some North American ideas and becomes less consensual and more pluralistic.     

Health policy and the politics of research in the United States

During the past decade research has been more important to the health policy-making process in the United States than at any time in the past. This article describes and assesses three competing normative models for research on health affairs: economizing, social conflict, and collective welfare. The three models provide a context for the history of research bearing on health policy in the past half century, with particular pertinence to the years since 1980. The article concludes with a discussion of some of the consequences of the new legitimacy of research.     

Health economists' views of health policy

This article reports the views of a national survey of U.S. health economists on a series of questions ranging from mergers among health care providers to the profits of pharmaceutical manufacturers to fundamental health care reform. We find a high degree of agreement on issues of fact but considerable disagreement on issues that depend on values. Additional research may help to resolve some remaining disagreement about issues of fact but may do little to resolve disagreement over values. Results from this fall 2005 survey are compared with those from surveys conducted in 1989 and 1995.     

Justice and emotional reactions to the disadvantaged

Various attitutidinal, cognitive, emotional, and actional reactions to problems and needs of less fortunate people (unemployed, poor people in the developing countries, foreign workers in West Germany) were assessed in a questionnaire study with 865 respondents. The external validity of self-report data was established by external ratings. The focus was on emotional reactions (existential guilt, sympathy, moral outrage because of unjust disadvantages, anger about the disadvantaged, contentment with one's own advantages, fear of losing these, hopelessness with respect to the fate of the less fortunate). Several justice-related variables (beliefs, views, appraisals) as well as responsibility-related variables and social attitudes were assessed as predictors of emotions. The importance of justice-related variables for the arousal of different social emotions was clearly shown. The use and usefulness of cognitive models of discrete emotions is discussed. The impact of emotions on the readiness to various forms of prosocial activities in favor of the less fortunate was also shown: Moral outrage and existential guilt proved to be much more salient predictors than sympathy. Crucial differences between these three prosocial emotions as well as the impact of justice-related variables on readiness to prosocial activities are discussed.     

Health policy and ERISA: interest groups and semipreemption

This paper is a history of the health policy results of the Employee Retirement and Income Security Act of 1974, particularly section 514, which preempts state laws "which relate to any employee benefit plan" but permits states to continue to regulate the business of insurance. This history exemplifies how health policy is often made outside conventional arenas. On the basis of published primary sources and interviews with a number of key participants, the paper describes how interest groups which rarely act together coalesced to create and sustain semipreemption and its effects on state and federal health policy. The paper concludes with an assessment of recent state legislative efforts to address the problems created by ERISA semipreemption. The ironical results of semipreemption occurred because of the absence of a coalition of interest groups that was sufficiently strong to resolve the fundamental questions raised by our commitment to linking health insurance to employment.     

Health and Human Services policy for protection of human subjects research--HHS. Final rule

The Department of Health and Human Services (HHS) is amending its Human Subjects Protection regulations to rescind the provision requiring prior review and advice from an Ethical Advisory Board for research applications and proposals involving in vitro fertilization (IVF) of human ova as a prerequisite to funding by HHS and its components. The provision was nullified by the National Institutes of Health Revitalization Act of 1993. The regulations are being amended to reflect this statutory nullification. Institutional Review Board (IRB) review and approval of applications and proposals involving in vitro fertilization (IVF) of human ova continues to be required in accordance with other provisions of the Human Subjects Protection regulations. Furthermore, the Secretary may still exercise the option of seeking advice from an Ethical Advisory Board on ethical issues, including IVF, raised by research applications and proposals.     

Health care policy issues in the drug abuser treatment field

As we enter the 1990s drug abuse has once again become a major health concern, and for the first time the drug treatment field has had to address many of the policy, regulation, and planning issues resulting from cost inflation that have become commonplace in other parts of the health care field. To avoid serious errors and confusion, drug abuse health policies must recognize the very different needs of the public and private sectors. The public sector, where poor addicts receive drug treatment provided or purchased by the government, has long suffered from chronically inadequate funding. Although responses to several epidemics (heroin, crack, and AIDS) have produced periods of increased allocations for drug abuse treatment, more often than not long waiting lists at programs have rationed treatment to lower-income addicts seeking care. Low salary levels have limited the quality of public treatment services, and the absence of resources has hindered the development of programs that respond to new technical developments and drug abuse problems, such as the crack epidemic. Despite severe resource shortages, the public drug treatment system has sometimes used resources inefficiently, with little attention to appropriateness of admissions, lengths of stay, ambulatory treatment modalities, or varying levels of care. Public sector goals for the 1990s should include filling current shortages in drug treatment services, developing adequate long-term funding for treating addicts who lack third-party coverage, modernizing the treatment system, developing new patterns of practice that use existing resources more efficiently, and developing a plan for treating intravenous drug users infected with the AIDS virus. In the private sector, the advent of working- and middle-class demand for drug treatment in the 1970s and 1980s has produced a new drug treatment system that suffers from many of the policy problems common to the rest of health care. Drug abuse in the workplace has resulted in much wider coverage of substance abuse services by insurance companies and HMOs. The availability of third-party funds has spawned a for-profit chemical dependency treatment industry. The high cost of private residential treatment services has caused significant cost inflation. Cost-containment measures, which are a new phenomenon for this field and are inappropriate for the public sector, have led to the same confusion and debates that they have produced in other areas of health care.(ABSTRACT TRUNCATED AT 400 WORDS)     

英国精神卫生法修订评介

本文简要介绍了英国精神卫生法修订背景和主要内容 ,分析了该次修订的特点 ,即重视病人个体权利及其差异 ,强调病人的自主权 ,特别重视通过精神卫生法庭的设立等制度设计干涉和监控医务人员的精神疾病诊断和治疗权这一最基本的职业权利 ,注重平衡为保护病人健康和公众安全而必须的医务人员的强制治疗权和属于病人人身自由等基本人权的病人自主权 ,并指出了产生这些特点的原因。     

英国精神卫生法修订评介

本文简要介绍了英国精神卫生法修订背景和主要内容,分析了该次修订的特点,即重视病人个体权利及其差异,强调病人的自主权,特别重视通过精神卫生法庭的设立等制度设计干涉和监控医务人员的精神疾病诊断和治疗权这一最基本的职业权利, 注重平衡为保护病人健康和公众安全而必须的医务人员的强制治疗权和属于病人人身自由等基本人权的病人自主权,并指出了产生这些特点的原因.     

Introduction: International Perspectives on Health Policy

This special issue of Law & Policy examines legal, bioethical, and social science perspectives on the critical problems and choices arising from the rapid changes in the health care systems throughout the industrialized world. Advances in medical technology, the rising costs of health care, and the aging of the industrial populations have made health care a crucible for many of the broader policy concerns facing the world in the new millennium. The purpose of the special issue was for these issues to be addressed in a multidisciplinary forum, to add to the broader spectrum of socio–legal scholarship. Scholars from diverse countries examined a variety of issues from ethical, social science, and clinical perspectives.