The development of national medical care programs in the United Kingdom and Canada: applicability to current conditions in the United States

After a hiatus in the early to mid-1980s, a growing number of policy leaders, policy organizations, and citizen groups are advocating programs that ensure basic medical care for all. Although a large literature examines the applicability to the U.S. of national medical care programs that have been established in other countries from the perspective of operations and effectiveness, little attention has been given to the applicability of the experience of other nations in securing these programs. This paper examines the development of national programs in the U.K. and Canada and addresses two questions. First, what factors were critical to the establishment of the British National Health Service and the Canadian hospital and physician insurance programs? Second, how applicable are those factors to current conditions in the U.S.? The paper reviews the roles played by dislocations in society, by established models of state-sponsored medical care programs, by political institutions and leaders, and by the major medical sectors. It shows that the U.S., while differing in many particulars, presents several parallels to the U.K. and Canada. The paper argues that the current environment in the U.S. offers the nation the opportunity to develop at state or local levels government-sponsored programs that guarantee basic medical benefits to all. A new and powerful coalition, moreover, may in the coming years advance the cause of broader, more substantive change at the national level.     

Infectious disease surveillance in the United States and the United Kingdom: from public goods to the challenges of new technologies

Infectious diseases are a long-standing and continuing threat to health and welfare, with their containment dependent on national disease surveillance and response capacities. This article discusses infectious disease surveillance in the United States and the United Kingdom, examining historical national traditions for identifying and controlling infectious disease risks and how globalization and technical advances have influenced the evolution of their respective approaches. The two systems developed in different but parallel ways. In the United States, surveillance remained quite localized at the state level until the early twentieth century and still retains many of those features. The U.K. approach became centralized from the latter part of the nineteenth century and has principally remained so. In both cases, disease surveillance was traditionally conceived as a public good, where national or local authorities held sovereign rights and power to protect public health. With the increasing globalized nature of infectious disease, such notions shifted toward surveillance as a global public good, with countries responding in turn by creating new global health governance arrangements and regulations. However, the limitations of current surveillance systems and the strong hold of national interests place into question the provision of surveillance as a global public good. These issues are further highlighted with the introduction of new surveillance technologies, which offer opportunities for improved disease detection and identification but also create potential tensions between individual rights, corporate profit, equitable access to technology, and national and global public goods.     

Incentivizing professionals and patients: a consideration in the context of the United Kingdom and the United States

We are at the beginning of an era in which the pressure to secure the biggest possible "bang" for the health care "buck" is perhaps higher than it ever has been, on both sides of the Atlantic, and within the health policy discourse, incentives, for both professionals and patients, are occupying an increasingly prominent position. In this article, we consider issues related to motivating the professional and the patient to perform targeted actions, drawing on some of the evidence that has thus far been reported on experiences in the United Kingdom and the United States, and we present an admittedly somewhat speculative taxonomy of hypothesized effectiveness for some of the different methods by which each of these two broad types of incentives can be offered. We go on to summarize some of the problems of, and objections to, the use of incentives in health and health care, such as those relating to motivational crowding and gaming, but we conclude by positing that, following appropriate consideration, caution, and methodological and empirical investigation, health-related incentives, at least in some contexts, may contribute positively to the social good.     

Privatization in the United Kingdom and economic regulation in the United States: Lessons in administrative law

The author would like to recognise Prof. Laksham Guruswamy, Faculty of Law, University of Durham, currently Visiting Professor of Law, University of Iowa, for the suggestions he contributed to this article.     

Unconscionability of E-contracts: A Comparative Study of India,the United Kingdom,and the United States

Liverpool Law Review - Adhesion contracts have a strong likelihood of being unconscionable. The laws and principles are further complicated by the introduction of electronic contracts, specifically...     

Inching toward incrementalism: federalism, devolution, and health policy in the United States and the United Kingdom

In the United States, the recently enacted Patient Protection and Affordable Care Act of 2010 envisions a significant increase in federal oversight over the nation's health care system. At the same time, however, the legislation requires the states to play key roles in every aspect of the reform agenda (such as expanding Medicaid programs, creating insurance exchanges, and working with providers on delivery system reforms). The complicated intergovernmental partnerships that govern the nation's fragmented and decentralized system are likely to continue, albeit with greater federal oversight and control. But what about intergovernmental relations in the United Kingdom? What impact did the formal devolution of power in 1999 to Scotland, Wales, and Northern Ireland have on health policy in those nations, and in the United Kingdom more generally? Has devolution begun a political process in which health policy in the United Kingdom will, over time, become increasingly decentralized and fragmented, or will this "state of unions" retain its long-standing reputation as perhaps the most centralized of the European nations? In this article, we explore the federalist and intergovernmental implications of recent reforms in the United States and the United Kingdom, and we put forward the argument that political fragmentation (long-standing in the United States and just emerging in the United Kingdom) produces new intergovernmental partnerships that, in turn, produce incremental growth in overall government involvement in the health care arena. This is the impact of what can be called catalytic federalism.     

Futile treatment: the need for legislation and uniform policies

As a matter of social policy, providers should place a top priority on educating colleagues and the public, including lawyers and the courts, so that there is genuine understanding that certain medical conditions, like anencephaly and brain death, cannot be ameliorated, changed, or improved through medical treatment even though the patient may continue to breathe with mechanical assistance for years. If health care professionals do not articulate and adhere to clear, universal standards of practice in this area, the courts will continue to define the duty of the medical profession, and, as Baby K illustrates, that is not acceptable.     

发达国家灾难治理基本经验及其启示:以英国、美国、日本为例

发达国家,尤其是英美日在灾难治理方面起步较早,积累了丰富的经验,主要体现在:灾难治理的组织机构日渐完备;灾难治理的运作机制更加协同;灾难治理的法律体系日益完善;灾难治理的资金保障更加有力;灾难治理的信息披露更加透明;灾难治理的参与主体逐渐多元;灾难治理的端口逐渐前移;灾难治理的教训得以及时总结。深入分析并总结这些国家灾难治理举措,目的在于从中找出于我国可资借鉴之处,提升我国政府灾难治理的水平和能力。     

United Kingdom: Sisters and inheritance tax

Joyce and Sybil Burden are two sisters who have lived togethersince birth and currently occupy a UK farmhouse. When one ofthem dies the other will face a large inheritance tax bill andwill have to sell the     

“封网禁令”探析——以英国和澳大利亚为例

“封网禁令”是指版权人向法院提出申请,并由法院签发命令要求并无过错的网络服务提供者封锁侵权网站的一种禁令措施.这是立法规定的网络服务提供者应该担负的防止侵权行为继续发生的义务.国外已出现多起适用“封网禁令”的判例,并且多个国家相继修改版权法增加封网禁令的内容.作为一种由立法特别规定的版权侵权救济方式,其强势保护版权的初衷,必然引发对禁令签发合理性的质疑.因而,法院签发禁令的前提、需要考量的因素、诉讼程序以及成本负担都是研究的对象,也是未来国内立法和司法实践的借鉴.