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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. 相似文献
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Crockin SL 《Connecticut law review》2004,36(4):1177-1186
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LaPorte GM Wilson JD Cantu AA Mancke SA Fortunato SL 《Journal of forensic sciences》2004,49(1):155-159
Developing and implementing a generally accepted procedure for the dating of ink found on documents using dynamic approaches has been a very formidable undertaking by forensic document examiners. 2-Phenoxyethanol (PE), a common volatile organic compound found in ballpoint inks, has been recognized for over a decade as a solvent that evaporates as ink ages. More recently, investigations have focused on the solvent loss ratio of PE prior to and after heating. To determine how often PE occurs in ink formulations, the authors analyzed 633 ballpoint inks utilizing a gas chromatograph/mass spectrometer. 2-Phenoxyethanol was identified in 85% (237/279) and 83% (293/354) of black and blue inks, respectively. 相似文献
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Culling bad apples, blowing whistles and the Health Practitioners Competence Assurance Act 2003 (NZ)
Rogers S 《Journal of law and medicine》2004,12(1):119-133
The Health Practitioners Competence Assurance Act 2003 (NZ) became New Zealand law on 18 September 2003. This article looks at the background to the Act and reasons for resistance to it. It discusses the record so far on the medical profession's self-regulation of fitness-to-practise issues and the legal duties of practitioners who have reason to believe a colleague is putting patients at risk. It looks at some of the changes the Act brings, compares the experience of English and American medico-legal reforms, where applicable, and attempts to draw some conclusions on the chances for successful change. 相似文献
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