Employers: passive purchasers or provocateurs?

This article addresses the potential role of business leadership in diverse efforts to reform health care financing: exploring managers efforts to alter health care markets in their role as large purchasers of health insurance, their potential contributions to future national policy proposals, and their involvement with community-level activities to control local health costs and quality. I argue that managers' leadership in market restructuring and community health initiatives will be difficult to reproduce in the realm of major national health policy initiatives due to constraints related to ideas, interests, and organization.     

Insurance Issues for Green Start-ups: What Every Entrepreneur Needs to Know

This article is a case study based upon a business entrepreneur's efforts to obtain specialized insurance coverage for a clean-energy start-up business. The article identifies and discusses some of the potential liabilities of insurance brokers in the event that the insurance coverages they obtain do not adequately protect the interests of the client's business. The article concludes that, at least in New York State, the rule is “Let the buyer beware!” and that a business person cannot safely rely upon advice given by an insurance broker in obtaining complex or specialized insurance coverage.     

The changing process and politics of health policy in Korea

Korea recently introduced three major health care reforms: in financing (1999), pharmaceuticals (2000), and provider payment (2001). In these three reforms, new government policies merged more than 350 health insurance societies into a single payer, separated drug prescribing by physicians from dispensing by pharmacists, and attempted to introduce a new prospective payment system. This essay compares the three reforms in Korea and draws important lessons about the country's changing process and politics of health care policy. The change of government, the president's keen interest in health policy, and democratization in the public policy process toward a more pluralist context opened a policy window for reform. Civic groups played an active role in the policy process by shaping the proposals for reform-a major change from the previous policy process that was dominated by government bureaucrats. The three reforms also showed important differences in the role of interest groups. Strong support by the rural population and labor unions contributed to the financing reform. In the pharmaceutical reform, which was a big threat to physician income, the president and civic groups succeeded in quickly setting the reform agenda; the medical profession was unable to block the adoption of the reform but their strikes influenced the content of the reform during implementation. Physician strikes also helped block the implementation of the payment reform. Future reform efforts in Korea will need to consider the political management of vested interest groups and the design of strategies for both scope and sequencing of policy reforms.     

机动车第三者责任强制保险的利益衡平问题研究

为配合我国《道路交通安全法》的实施,有关部门正在抓紧制定《机动车第三者责任强制保险条例》(以下简称“《强制保险条例》”)。而条例制定过程中最棘手的问题恐怕就是相关诸主体的利益冲突与衡平问题。就机动车第三者责任强制保险(以下简称“强制保险”)涉及的各方主体利益诉求及其博弈来说,应该坚持以公平正义、着重权利保护、有利于预防交通事故和适应我国国情等为原则,以妥善衡平各方利益,建立健全我国的强制保险制度。     

Health reform and employee health benefits programs

The impact of health reform on employee health benefits programs could be dramatic. Depending on the health reform program adopted, employers could face significant new regulatory and economic burdens in operating employee health benefits programs or could find themselves greatly relieved of such burdens. President Clinton's proposal, in particular, would dramatically alter today's practices. This article focuses on how the Clinton proposal would change employee health benefits programs. Although President Clinton has indicated a willingness to compromise, his legislation may prove to be a house of cards, with all provisions interdependent. Employers should study all pending proposals carefully and weigh in on the debate so as to ensure that lawmakers are fully educated before making potentially irreversible decisions.     

A policy transformed by politics: the case of the 1973 Australian Community Health Program

During an era of health policy reform in Australia, community health advocates believed that community health centers (CHCs) could form a solid foundation for a new system of health care delivery. Instead, a proposal for national health insurance (Medibank) emerged as the predominant structural reform. Community health proposals were not abandoned, however, and a policy designed to give federal grant assistance for the establishment of CHCs was implemented in 1973. The historical account of how the 1973 Australian Community Health Program (CHP) was developed in the early 1970s is relevant to dilemmas faced by contemporary policy makers. Specifically, how did the CHP "survive" even though government leaders had moved away from traditional direct service models, choosing to focus more attention on indirect insurance reimbursement?     

The politics of universal access: the Massachusetts Health Security Act of 1988

This article analyzes the passage of an unprecedented state law, promising every resident access to affordable health insurance. The Massachusetts Health Security Act of 1988 was the product of a set of political and financial pressures that had been developing for nearly a decade. Hospital, insurance, and business interests were unable to reach a new accommodation on hospital payment. This logjam created the opportunity for a policy breakthrough, but did not inherently lend itself to progressive reform. It was consumer activism that forced the traditional powers in health policy to address the interests of the uninsured. By imposing a more public-interest agenda on the process, consumers were able to change the configuration of the stalemate, but could not resolve it. The particular terms of the stalemate, however, made possible a new, more aggressive role for state government in health policy. Unable to satisfy their competing interests within a policy framework that had universal access as a goal, traditionally powerful interest groups found themselves increasingly dependent on the state to broker a new agreement. While the many concessions made to these groups are likely to prove to be the bill's undoing, the unraveling of the agreement will not end the story. The same pressures which led to passage of the Massachusetts law and which are now causing other states to act will continue to exert their effect until a more durable solution is found.     

Providing health insurance in rural china: from research to policy

The focus of this case study is utilizing research to influence policy in a large developing country. Our experiences involve the lack of health insurance for China's rural populations and how our research helped shape China's recent policy attention and efforts on this issue. More than 80 percent of China's 700 million rural residents have no health insurance. This has been the case for the past thirty years, since the collapse of the once-successful Rural Cooperative Medical System after the economic reforms of the early 1980s. In 2002, the Chinese government announced a new rural health financing policy to provide health insurance for its rural populations, financed by a matching fund with contributions from central and local governments, as well as from individual households. This article documents the authors' experiences in addressing several critical questions for converting research results into policy actions, including the following: How are researchers to address policy relevant questions? How are they to acquire the attention of top policy makers to a specific problem? When is the issue at hand serious but not yet critical? And lastly, how are researchers to develop policy recommendations that stand a good chance of being accepted and enacted? Major lessons learned include the need to better understand the mandates and institutional constraints of the policy makers, the appropriateness of timing of both research result and policy efforts, how to use a country's cultural context to garner support of the government, how to enhance the policy's impact by combining formal and informal channels of communication for research dissemination, and the importance of following the policy process through the implementation phase to ensure the original objectives are achieved.     

Crabs in a bucket: the politics of health care reform in California

In 1982 the state of California adopted a package of legislation collectively known as "the Medi-Cal reform." This article examines the background of this reform, the process through which it was adopted by the state legislature, and its effects on the various interests involved. In particular, the article focuses on the alteration of power relationships occasioned by the emergence of business interests as an active force in the formulation of health policy.     

The slippery slope of health care finance: business interests and hospital reimbursement in Massachusetts

In 1988 Massachusetts enacted a bill, popularly known as Health Care for All, which promised that by 1992 every Massachusetts resident would have available affordable insurance for basic medical expenses. This legislation was one of a series of laws enacted over a period of six years which progressively improved access to care for the uninsured. The policy process which led to the enactment of these laws was strongly influenced by the interests of large employers. This article describes the series of access-expanding hospital reimbursement changes in Massachusetts in the 1980s and traces the connection between the involvement of business interests in the policy process and the outcomes that occurred; that is, it follows the slide of employers down the slippery slope of health care finance. The article also describes a potential implementation strategy for the Health Care for All legislation.     

Impeding Earl Warren: California's health insurance plan that wasn't and what might have been

It is widely believed that the turning point for U.S. health insurance came in 1949 when Congress failed to adopt President Harry Truman's proposal for a national system. The possibility that a system of state-level health plans might have emerged before Truman's plan has received little attention. Yet several attempts to enact such a plan were made in California by Governor Earl Warren in the mid-1940s. Had Warren succeeded, the California example might have been emulated by other states and the United States might have evolved a system similar to Canada's provincial programs.     

The resistible rise of preventive medicine

The politics of preventive health care have changed dramatically in the last fifteen years. In the late 1960s and early 1970s, prevention was the motherhood issue of health care reform. With only the slightest glimmer of controversy, vaccination, promotion of lifestyle changes, mass screening, and safety regulation all became widely accepted strategies for improving health and reducing medical expenditures. By the mid-1980s, the dark side of each strategy became visible. Vaccinations can cause serious and permanent injuries; lifestyle factors are being used to raise insurance premiums, to deny eligibility for disability insurance benefits, and to deny employment. Screening is similarly used to deny employment, and new technologies for prenatal screening have raised fears of stigma and selective abortion among racial, handicapped, and antiabortion groups. Occupational safety regulation is increasingly focused on excluding the "high-risk" individual from jobs. In the absence of social protections from these economic and social harms, citizens have used tort and civil rights litigation to resist preventive health measures.     

论国际经济制裁对海上保险的影响——以伊朗制裁为例

国际经济制裁是国际社会为实现特定的政治目的而针对特定对象施加的直接或间接限制或禁止其经济活动、资产利益的强制措施.联合国、欧盟、美国均对伊朗实施了经济制裁,涉及贸易、航运领域,相关制裁规则的制定及执行在理论和实践层面对海上保险的提供、理赔等环节均产生了诸多障碍.中国也不可避免地受到了国际经济制裁的影响,欲维持国家能源和经济安全,中国可在制裁规则的框架内或突破制裁规则予以应对.     

The Politics of Racial Disparity Reform: Racial Inequality and Criminal Justice Policymaking in the States

Racial inequalities in criminal justice are pressing problems for policymakers. Prior literature suggests elected officials promulgate punitive, racially disparate criminal justice policies due to partisanship and racial fears, but scholarship has yet to explain how and why elected officials address racial problems in criminal processing. This article introduces the framework of racial disparity reform policymaking. A racial disparity reform is a policy that seeks to reduce distinctions in criminal justice institutions’ treatment of racial groups. Elected officials pursue these policies due to ideological beliefs in civil rights ideals and political interests in appearing to solve social problems. Using an original database of policy enactments, this article first presents the distribution and types of reform measures adopted by elected officials in all 50 states between 1998 and 2011. It then examines social and political explanations for when state legislatures and executives adopt racial disparity reforms. Policy enactment is predicted by worsening problems of racial disproportion in criminal processing, Democratic control of elected branches, and the absence of judicial efforts to improve racial fairness within a state’s criminal justice system. Similar dynamics encourage the development of different measures types within policies. Such ideological and problem-solving explanations for racial disparity reform show a potential for elected officials to forge more racially just criminal justice practices.     

社会本位视野下的高度危险责任限额赔偿制度

《侵权责任法》明确了高度危险责任的限额赔偿制度,这是现代工业文明发展的必然结果。高度危险责任由个人本位走向社会本位,是社会利益与个人利益衡量的结果,为实现其最佳结合,有必要引入高度危险损害赔偿责任的强制保险制度。     

海上强制责任保险研究

强制责任保险在国际海上保险领域中已广泛存在,但中国在该领域的立法仍不完善,对其基本理论的研究也稍显不足。分析了强制责任保险的性质及中国目前强制责任保险投保现状,论证了我国设立强制责任保险制度的必要性,并对构建我国水路液货危险品运输及旅客运输的强制责任保险制度提出建议。     

Back to the future? Health benefits, organized labor, and universal health care

The umbrella of employment-based health benefits is growing increasingly threadbare. As a result, health benefits are once again a major arena of labor-management strife, and once again calls for universal health care by many labor leaders mask important differences between them over health care reform. Some labor leaders advocate a bottom-up mobilization in support of a single-payer solution that would dismantle the system of job-based benefits rooted in private insurance. Others stake their health care strategy on wooing key business leaders to be constructive partners in some kind of unspecified comprehensive reform of the health system. Organized labor faces enormous obstacles, both institutional and ideological, to forging an effective united front to fight for comprehensive, high-quality, affordable health care for all. Two entrenched features of the shadow welfare state of job-based benefits, notably the Employee Retirement Income Security Act (ERISA) of 1974 and the union-run health and welfare funds created under the Taft-Hartley Act, remain daunting barriers on the road to reform, exacerbating tensions and differences within organized labor. Moreover, a dramatic ideological schism in the labor movement about its future direction vexes its stance on health care reform. These ideological differences fuel vastly different views within organized labor about how best to confront the unraveling of job-based health benefits and the growing popularity among business leaders, insurers, and public officials of the "individual-mandate" solution, which would penalize people who do not have adequate health insurance.     

我国交强险立法定位问题研究

交强险的重复投保以及法院处理此类案件中出现的"同案不同判"现象,折射出我国交强险的保障不足及对交强险立法定位的认识分歧,实务中采取解除起期在后交强险合同的裁判方法欠缺保险法的法理依据;重复投保的成因主要在于交强险的封顶式保障模式及事故分项责任限额模式不能为被保险人和受害人提供相对充分的保险保障;而现有保障模式的形成则又受制于交强险的"不盈不亏"费率模式及为商业三责险的运营预留必要盈利空间的立法定位。解决重复投保问题的长远出路在于将商业三责险与强制三责险合二为一,在此基础上取消对三责险的封顶限制,同时改"不盈不亏"的费率模式为"适度盈利"的费率模式。