All-payer rate-setting and the provision of hospital care to the uninsured: the New Jersey experience

The New Jersey all-payer prospective payment system compensates hospitals for charity care and bad debts. This study examines its impact on the provision of care to self-pay patients. Self-pay patients include two types of uninsured individuals: (1) patients who cannot afford to pay their bill and (2) more affluent patients who can afford to pay but who evade collection. Using data for the period 1979-85, the study employed a sample of seventy-nine New Jersey hospitals that entered the all-payer system during the years 1980-82. A regression equation, which included independent variables to control for the community's pool of uninsured residents and the hospital's share of this pool, was estimated for the number of self-pay discharges. The results indicate that the volume of care provided to self-pay patients increased when the New Jersey all-payer system was introduced. The results also show that teaching hospitals and facilities in urban areas discharge a disproportionately large number of self-pay patients. Analysis of the operating margin ratio suggests that the all-payer system helped to restore the financial viability of hospitals that tend to provide larger amounts of services to the uninsured.     

我国国家赔偿归责原则之反思与重构

按国家赔偿法的规定,国家赔偿的归责原则是违法原则。这个原则存在着自相矛盾、与刑事诉讼法规定不一致、过于严格限制受害人获得国家赔偿以及与国际上国家赔偿归责原则多样化趋势不协调等缺陷。国家赔偿的归责原则应当是一个归贵原则体系,在这个体系中,有一般性的、具有普适性的一般原则,又有特殊性的、仅针对特殊事项适用的特殊原则。一般原则仍然是违法原则,而特殊原则包括过错原则、无过错原则和结果原则等,各项原则所适用的具体范围又有着一定的差异和不同。     

The Constitutional State and its Reform Requirements

In the first part, the author characterizes the fundamental contents (principles) of the constitutional state. In the second part, he describes the necessary reforms both at the level of the national constitutional state and at the global and humanity level. In the third part, he examines the methods and procedures of reform in the constitutional state, analysing: a) constitutional formation or complete revision; b) constitutional amendments or partial revision; c) parliamentary constitutional legislation; d) constitutional interpretation; e) government and non‐governmental “outlook” commissions. 1 Abstract by Giorgio Bongiovanni.
     

Survival at what cost? Origins and effects of the modern controversy on treating severely handicapped newborns

This paper examines the background of technological innovation, ethical debate, and social change, against which the 1980s debate over how to treat severely handicapped newborns in general, and Baby Jane Doe in particular, took place. A commentary follows examining the relative place of government, practitioners, hospital ethics committees, and parents in making decisions about treatment for handicapped newborns.     

State Medicaid managed care enrollment: understanding the political calculus that drives Medicaid managed care reforms

The objective of this article is to understand the political motivations underlying Medicaid managed care reforms by examining the determinants of enrollment of beneficiaries in managed care plans in the fifty states. To highlight the role of the model variables, including measures of the political environment, public interest, and special interests, a distinction is made between capitated and fee-for-service managed care enrollment. The results show that cost containment within the context of the Medicaid program is perceived as strongly favored by voters. Accordingly, the relative cost and tax price of providing Medicaid services are important factors in states' decision to enroll Medicaid beneficiaries in managed care plans, particularly capitated ones. The results also indicate a surprisingly significant influence by labor unions that generally oppose managed care enrollment for fears of lost jobs. The recipient population and provider groups also play an important role in shaping the Medicaid managed care landscape. The influence of variables measuring states' ability and willingness to pay and median voter preferences suggest that, within the context of Medicaid managed care enrollment, the public's interests are being served; however, the results also point toward inequities within the program and implications concerning financing arrangements between states and the federal government.     

Work-related stress in Australia: The effects of legislative interventions and the cost of treatment

The Australian Institute of Health and Welfare data published in 2002 shows a continued rise in health care costs to the Australian community due to the growing number of people diagnosed with mental health disorders. Those mental health disorders may originate from a number of sources, including work and non-work-related factors. The so called work-related stress claims in all Australian jurisdictions are the most expensive form of workers compensation claim. In the most part this is due to the lengthy period of absence (duration) and complicated medical care which are characteristic of these claims. In Australia, in the last decade, attempts have been made to reduce the costs of compensable stress-related claims by imposing special legislative thresholds on such claims. This ‘back end’ approach to cost reduction has resulted in an array of legislative formula designed to exclude work-related stress claims. This article surveys the various legislative provisions dealing with work-related stress claims in Australia and provides an analysis of their effectiveness. A range of options are presented as alternatives to the exclusion of particular forms of work-related stress claims. The use of a corporate citizenship approach to the prevention and management of stress claims is also discussed as a proactive alternative to occupational safety and health legislative provisions and the workers compensation legislative exclusions.     

The effects of health care advertising

This paper begins by assessing the current status of health care advertising and its potential for growth, arguing that this form of marketing is not just a passing fad among a few clinics and hospitals. It then describes the opposing schools of thought concerning the economics of advertising, and considers both theory and evidence on the effects of advertising on prices, profits, quality, utilization, and innovation.     

Between the Scylla and Charybdis: physicians and the clash of liability standards and cost cutting goals within accountable care organizations

This article seeks to examine the conflict between non-cost-conscious medical malpractice liability standards and health care cost cutting measures within the context of Accountable Care Organizations ("ACOs") under the new health care reform law. This article begins by providing an overview of the high level of health care spending within the United States health care system in order to provide a context for better understanding policymakers' push for cost cutting measures, including ACOs. This article then examines the tension between cost containment efforts and medical liability standards through an examination of the "stuck in the middle" mentality that physicians face when they are forced to meet both liability standards that do not take into account cost concerns and cost cutting standards imposed by or through managed care organizations, pay-for-performance programs and consumer-driven healthcare. This article then introduces the concept of the ACO and describes elements of the ACOs envisioned under the new health care reform legislation. This article concludes by examining and analyzing whether and how ACOs will exacerbate the cost containment/liability standard tension, and how that tension may impact the effectiveness of ACOs.     

Recovery of cost of hospital and medical care and treatment furnished by the United States--Department of Justice. Final rule

This order amends Department of Justice regulations to increase the settlement and waiver authority delegated to heads of departments and agencies of the United States responsible for the furnishing of hospital, medical, surgical, or dental care. This change responds to the increase in medical costs since 1978, when the current level of delegated settlement and waiver authority was fixed, and will further the efficient operation of the government.     

交易成本与专利强制许可问题研究

专利强制许可同专利自愿许可都属于专利技术转移的形式,而交易成本理论可以应用于分析专利强制许可适用的原因和事由.专利制度对于减少技术交易成本具有重要贡献,但是由于其独占性特点可能导致专利阻遏或者反公地悲剧情况的出现,并产生成本上升.专利强制许可可以在上述情况下发挥克服交易成本,促进技术转移的作用.