Neurovisualization methods in diagnostics of consequences in light craniocerebral trauma

The purpose of the case study was to elucidate the frequency rate of pathological changes as registered by computer tomography (CT) and magnetic-resonance tomography (MRT) of the head in patients with chronic cerebral blood-circulation deficiency (CBD), functional disorders and vegetative nervous pathologies in presence (in their medical histories) of closed-type cranial trauma concomitant with concussion of the brain (CB) or without such trauma. A comparative analysis revealed a minor prevalence in the number of pathological changes in patients with CBD concomitant with CB. As for other nosological forms, the quantities of changes, expressed in percent, were virtually identical. A conclusion was made on the need to examine the patients of the discussed category by neurovisualization in the acute and remote periods of trauma.     

我国农村医疗保障立法中的政府职能定位

政府介入农村社会保障领域是为克服市场机制下城乡收入分配缺陷以体现公平,降低成本以提高效率及体现农村医疗社会保障的公共性。目前我国中央政府对农村医疗保障政策的投入不足,导致不公平加剧,中央政府各职能部门对政策的执行缺乏有效支持,县乡两级地方政府对推动农村医疗保障制度建立的作用甚微。政府对农村医疗社会保障的职能是为农村医疗保障制度提供完备的法律框架;提供财政支持;合理布局卫生资源,切实减低医疗费用;加强公共卫生保健工作,完善公共卫生保健体系;建立医疗救助制度,加强卫生扶贫工作;强化政府机构的管理职能。     

基本医疗服务法制化研究

获取基本医疗服务是公民保障生命健康的基本权利,应当通过法律加以明确,使之成为"拟制公共产品"。公共卫生服务与基本医疗服务是两种性质不同的服务,不宜用一部法律来统一规定,因此全国人大《基本医疗卫生保障法》的立法模式是不适宜的,应当单独出台《基本医疗服务法》。政府提供基本医疗服务的范围主要包括基本医疗保险、基本医疗救助、基本药物和基本诊疗项目、基本医疗服务体系和基本医疗设施、基本医疗服务人力。公民的医疗服务请求权可以通过诉讼救济,医疗服务请求诉讼的类型属于行政给付之诉。     

The false claims act and the eroding scienter in healthcare fraud litigation

This article addresses the federal government's expansive methods in tackling healthcare fraud, particularly in misapplying the False Claims Act. Although tasked with the obligation to curtail the fraudulent submission of Medicare & Medicaid claims, the U.S. government must rein in the current trend to utilize the False Claims Act against smaller medical providers. As the Act's original focus has ebbed in significance, the government has increasingly applied the False Claims Act to circumstances that do not evince actual fraud. In doing so, federal courts have effectively eroded the statute's critical scienter requirement. The federal common-law doctrines of "payment by mistake" and "unjust enrichment" adequately address the payment of non-fraudulent, albeit false, Medicare & Medicaid claims. Yet the federal government pursues these appropriate remedies only rarely and in the alternative, essentially when the government fails under the False Claims Act. Thus, this article argues for reform, calling for a clearer delineation between remedial and punitive measures. In cases involving smaller medical providers, courts should strictly limit the False Claims Act to those instances where fraud is clearly manifest.     

Homicide by decubitus ulcers

Traditionally, the only penalties for poor treatment of nursing home patients have been civil lawsuits against nursing homes and their employees by families, or fines and license suspension by government organizations. Recently, government agencies have become much more aggressive in citing institutions for the development of decubitus ulcers (pressure sores) in their patients. A few government institutions have concluded that in some cases, the development of ulcers with resultant death is so grievous that there should be criminal prosecution of the individuals and/or institutions providing care. A leader in this concept has been the State of Hawaii. In November 2000, the State of Hawaii convicted an individual of manslaughter in the death of a patient at an adult residential care home (a form of nursing home) for permitting the progression of decubitus ulcers without seeking medical help, and for not bringing the patient back to a physician for treatment of the ulcers.     

I want my information back: evidentiary privilege following the partial birth abortion cases

In February 2004, privacy concerns captured the public's attention when the United States government, the defendant in a lawsuit challenging the constitutionality of the Partial-Birth Abortion Ban Act of 2003, sought to subpoena the medical records of patients receiving intact dilation and extraction (also known as "partial birth") abortions in six different hospitals and six Planned Parenthood centers across the country. Three different federal court cases explored the enforceability of the subpoenas. This Note explores the rationales used by the three courts in examining the privacy interests involved. It then suggests some possible solutions for systematically protecting medical information: a legal solution; a technological solution; and a combination of both. The legal solution involves creating a federal physician-patient privilege, similar to that enforced in many states and parallel to the federal psychotherapist-patient privilege. The technological solution requires the complicity of multiple jurisdictions to verify the necessity of revealing medical information. Taken together, these solutions can assist the government in protecting its citizens by imposing more checks on itself.     

Memorandum of understanding between the Food and Drug Administration and the Defense Alliance for Advanced Medical Terminology--FDA. Notice

The Food and Drug Administration (FDA) is providing notice of a memorandum of understanding (MOU) between FDA and the Defense Alliance for Advanced Medical Terminology (DAAMT). The purpose of the MOU is to enable government agencies to exchange information and jointly pursue research endeavors related to medical device safety and effectiveness.     

医疗体制改革的法学思考——基于医改成果公平分享的视角

医疗体制改革面临着艰难的抉择。如何正确确定医改的目标,使广大人民共享医改成果,是构建和谐社会的一个重要方面。医改偏离社会目标的原因有四:一是政府干预不足与干预过度;二是医疗市场化过度与市场化不足;三是医疗产品的"三重"属性;四是医患关系具有特殊性。从法学的视角进行检视,医改要达致其预期的目标,就必须在效率与可及性上下功夫。要依法规范政府、医疗市场、医院、医生及患者的关系,造就一种制度安排下的利益均衡关系。     

Government's role in organ transplantation policy

This paper initially considers ways of thinking about organ transplantation: Should it be treated as a catastrophic disease or as an ordinary and accepted medical procedure? The analysis then shifts to the role the government has played in influencing organ transplantation policy. The federal government's involvement initially stemmed from its role as payer for end-stage renal disease services. In recent years, the rationale for intervention has changed, and the mechanism for implementing regulatory oversight has shifted to a private network run for the government by the United Network for Organ Sharing (UNOS). The government has delegated much policymaking authority to UNOS, although the author demonstrates that this is not required by the applicable legislation. The article raises questions about the relationship between UNOS and the federal government, about potential conflicts between UNOS guidelines and state laws under the Uniform Anatomical Gift Act, and about the ideological stance undergirding much of current federal policy in the organ transplantation arena.     

Responding to the immunoglobulin shortage: a case study

In fall 1997, a shortage of intravenous immunoglobulin (IVIG) developed in the United States because of increased demand for the product, reduced supply, and product recalls. This shortage is a useful model for understanding how our health care system responds to scarcity. Although the U.S. government took steps to inform the medical community of the shortage, with few exceptions, the government did not respond to the shortage in a timely or effective manner. Instead, it took a relatively passive role, leaving IVIG manufacturers and distributors, health care institutions, and clinicians to fend for themselves. The shortage likely had an uneven impact on patients, based on the relative market strength of the health care institutions in which they received care and the individual patient's ability to absorb the increasing out-of-pocket costs of scarce IVIG. Market mechanisms have now largely alleviated the shortage and significantly reduced its detrimental impact on patients. However, future shortages of IVIG or other scarce medical products, such as vaccines and antibiotics, would benefit from more immediate and coordinated efforts not only to make sure that scarce health care resources are distributed in a just manner but also to identify and remedy the sources of health product supply problems.     

From shared cost to block funding and beyond: the politics of health insurance in Canada

This paper takes as its starting point recent major changes in arrangements between the federal and provincial government in Canada concerning the sharing of costs for health insurance programs. The switch from a shared cost (conditional grant) to a modified block funding system was motivated by federal desires to limit and make predictable their expenditures, by provincial desires to increase the flexibility of their allocation of funds and by a mutual desire to limit any growth of health care costs as a proportion of GNP. Concerns related directly to improving medical care delivery were insignificant The changes will effectively centralize responsibility for program financing and program delivery, thus providing a powerful incentive for provincial governments to apply very strong measures to control costs. For reasons largely external to the relationship between public sector insurers and the suppliers of medical services, these attempts are unlikely to be successful in the short run. The probable impact of this difficulty on government and members of the health care delivery system is assessed.     

Government delays release of medical marijuana supply

The federal government's initiative to make marijuana available for medical use continues to run into problems and delays. In a recent development, the first crop produced by the government's designated grower turned out to be too impure to use. The delays have led to the launch of a lawsuit against the federal government.     

论医疗风险防范对策

医疗风险是造成患方医疗利益损害的潜在可能性,对医方、政府、社会造成各种损失和负面影响;医疗风险具有的独立性、风险产生和现实转化因素的多元性以及风险可防控性等特征;针对不同原因引起的医疗风险,应当厘清对正常医疗风险的分担规则和非正常医疗风险的分担规则;防范医疗风险应当采取完善医事法律法规、提高防范和应对医疗风险的水平以及增强患方自我维权和对医疗风险的防范能力,这对减少和防范医疗纠纷的发生具有重要的意义。     

‘Hurry no man's cattle’: British rule and suicide in China

The British authorities in the leased territory of Weihaiwei were concerned that too many Chinese, particularly women, resorted to suicide. In response, they made it obligatory to report suicides, educated the public and the police on how to effect rescues, and appointed a medical assistant with special responsibility for suicide rescue work. In spite of being remarkably well informed of the social significance of suicide in China, government efforts to deal with the causes of suicide were limited. In particular, the government did little to alter the circumstances of women in the territory. They provided few opportunities for education and were reluctant to prohibit foot-binding or to discourage families from putting pressure on widows to remarry. The limited response of the government to the problem of suicide was consistent with its general administrative policy of effecting little change to the fabric of life in the Chinese villages. The fact that the magistrates, in their treatment of suicide, expressed a deference to Chinese law, was part and parcel of the same general policy of the British administration of Weihaiwei.     

政府在医疗广告监管中的角色及对策分析

随着我国医疗市场的开放,医疗行业竞争加剧,虚假违法医疗广告屡禁不止,对社会造成了很大的危害和不良影响。本文拟对政府部门在医疗广告监管中承担何种角色以及当前医疗广告政府监管体系存在的问题进行分析讨论,并提出相应的对策建议,以供商讨。     

从一起“医闹”事件思考“医闹”成因与对策

通过某医院处置一起＂医闹＂事件,分析成因,提出实行医疗体制改革、建立第三方医患纠纷调解机制、完善医疗责任保险、设立医疗风险救济、政府部门通力合作、社会各界共同参与等解决＂医闹＂的建议。     

Making Risk-Benefit Assessments of Medical Research Protocols

It is commonly assumed that medical experiments are ethical only if they have favorable "risk-benefit ratios". In this paper it is argued that "risk-benefit ratios" often cannot be calculated, even roughly; and that even if they could, ethical experiments don't need to have favorable "risk-benefit ratios". In addition, a new method of assessing an experiment's risk and benefits is proposed-a method grounded in the principles of liberal government.     

Reasonable charges for medical care or services. Final rule

This final rule amends the Department of Veterans Affairs (VA) medical regulations concerning "reasonable charges" for medical care or services provided or furnished by VA to certain veterans for nonservice-connected disabilities. It changes the process for determining interim billing charges when a new Diagnosis Related Group (DRG) code or Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) code identifier is assigned to a particular type or item of medical care or service and VA has not yet established a charge for the new identifier. This process is designed to provide interim billing charges that are very close to what the new billing charges would be when the charges for the new identifiers are established in accordance with the regulations. This final rule also changes the regulations by removing all of the provisions for discounts of billed charges. This will eliminate or reduce duplicate discounting and thereby prevent unintended underpayments to the government.     

医疗卫生体制改革中完善市场机制的思考

本文从经济学理论入手,分析了我国医疗卫生体制改革中存在问题的主要根源,探讨了完善医疗卫生领域市场机制的具体对策,提出了我国的医疗服务体制改革必须规避市场化过度,走适合中国国情的道路,即充分建立起在政府适当干预下的、完善的医疗卫生市场机制的建议。