Controlling large malpractice claims: the unexpected impact of damage caps.

Indiana's comprehensive malpractice reforms, inaugurated in 1975, include a cap on damages, a mandated medical review before trial, and a state insurance fund to pay claims equal to or greater than $100,000. We have found that the amount of compensation going to claimants with such large malpractice claims in Indiana is, on average, substantially higher than in Michigan and Ohio. Indiana's mean claim severity between 1977 and 1988 was $404,832, while the means for Michigan and Ohio were $290,022 and $303,220, respectively, with the difference between these three means being highly significant. Although data on claim and claimant characteristics reveal considerable interstate variation, the results of regression analyses show that Indiana claim payment amounts are higher than Michigan or Ohio payments, independent of the effect of factors such as sex, age, severity of injury, allegations of negligence, and year of settlement.     

Comparative effectiveness research under the Patient Protection and Affordable Care Act: can new bottles accommodate old wine?

The Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act of 2010, initiated comprehensive health reform for the healthcare sector of the United States. PPACA includes strategies to make the American healthcare sector more efficient and effective. PPACA's comparative effectiveness research initiative and the establishment of the Patient-Centered Outcomes Research Institute are major strategies in this regard. PPACA's comparative effectiveness research initiative is one in a long line of federal initiatives to address the rising costs of healthcare as well as to obtain better value for healthcare expenditures. The key question is whether the governance and design features of the institute that will oversee the initiative will enable it to succeed where other federal efforts have faltered. This Article analyzes the federal government's quest to ensure value for money expended in publically funded healthcare programs and the health sector generally. This Article will also analyze what factors contribute to the possible success or failure of the comparative effectiveness research initiative. Success can be defined as the use of the findings of comparative effectiveness to make medical practice less costly, more efficient and effective, and ultimately, to bend the cost curve.     

Sumptuary administration: How contested market actors shape the trajectory of policy when regulated under fragmented governance

In contemporary society, sumptuary laws regulate contested markets by delegating enforcement responsibilities to the private sector. This can decouple the intention behind policies from the practices to implement them. When state interests do not align concerning the legality of a market, can policy and practice recouple, and if so, how? This article reports on a case study of commercial cannabis in the United States to answer this question. Interviews with 56 cannabis industry stakeholders in California, Arizona, and Texas reveal that policy and practice recoupled through a patterned process that I call sumptuary administration. In each state, regulators drew on a unique set of schemas, or “framework of accountability,” that prioritized a subset of cannabis market participants during the policy-making process. This resulted in missing or ambiguous sumptuary laws. To address business challenges that were tethered to this regulatory environment, cannabis businesses drew on similar schemas to identify appropriate practices. I show how grounding practices in these frameworks legitimized the preferences of the cannabis industry in the eyes of state authorities and influenced specific program policy revisions. Sumptuary administration represents a novel mechanism for understanding the social construction of legality in markets that are regulated under fragmented governance.