Access to medicine in an era of fractal inequality

This article evaluates the legitimacy and degree of inevitability of unequal access to medicine. The author introduces 'fractal inequality' to the access issue by using the term to describe skewed patterns in distributions of income and wealth that lead to reallocative effects of higher spending on health care by the wealthiest that can cascade down the distributive ladder. 'Fractal inequality' is transposed to the U.S. health care sector to explain the trend away from medical need toward ability to pay. The author cautions U.S. policymakers to consider international access problems instead of exacerbating those issues when domestic access to care policies is debated in a vacuum. The author also analyzes some policy proposals designed to reduce inequities in the global trade of medicine.     

Medical negligence in drug associated deaths

According to epidemiological studies adverse drug events are one of the most frequently encountered complications during medical treatment, a leading cause of hospitalisation and frequent cause of death. However, medical malpractice claims due to medication errors seem to be relatively rare. Based on a retrospective multicentre study on medical malpractice cases with lethal outcome (n = 4450), drug related cases (n = 575) were further evaluated. In 50% of cases a causal connection between drug therapy and death could be ruled out already after autopsy. In 232 cases a causal connection between drug therapy and death could be approved (drug allergies, relative overdose, wrong application, mix-up of drugs and sepsis after injection abscess). However, within the legal context only in 70 cases a medication error was approved which was in 42 cases causal for death, in 28 not. Administration of contraindicated drugs, incorrect application and relative overdose in renal insufficiency are the prevalent mistakes. Concerning the frequency of ADE in epidemiological studies medication errors are underreported in all data sources on medical malpractice; this seems to be due to the fact that even doctors and attending physicians rarely recognize an ADE; furthermore approving the connection between drug effect and death is extremely difficult for the expert witness.     

Dealing with the temporal domain of regime effectiveness: A further conceptual development of the Oslo-Potsdam solution

This paper develops the Oslo-Potsdam solution to measuring regime effectiveness further conceptually. I argue that the temporal domain of regime effectiveness is not adequately dealt with by the current measurement concepts and develop three amendments to the Oslo-Potsdam solution. First, I suggest to measure effectiveness over the time interval the regime is in operation in order to capture welfare gains over time. Second, I propose an amendment that takes the pre-regime phase into account and I suggest a way to assess the loss of potential welfare brought about by delays in negotiating the regime. Third, I take temporal externalities of regime policies into account. Dealing with these three aspects of the temporal domain of regime effectiveness is important for obtaining complete and unbiased measurements. Achieving this is important in itself but also for comparative research, the assessment of regime dynamics, and ultimately for advising on policy.     

Kriminalpolitische Initiative: Mehr Sicherheit durch weniger Haft! Vorschläge Nr 6 – Juni 2011

Die AutorInnen haben als Kriminalpolitische Initiative (KI) seit 2004 in fünf Publikationen konkrete kriminalpolitische Reformvorschl?ge pr?sentiert. Eine Reihe dieser Vorschl?ge wurde vollst?ndig oder zumindest teilweise umgesetzt. Die KI sieht weiterhin Bedarf an der Weiterentwicklung der Strafrechtspflege entsprechend dem Grundsatz: „Mehr Sicherheit durch weniger Haft.“ Deshalb definieren die AutorInnen im Folgenden entsprechend der Systematik des neuen Bundeshaushaltsrechts drei Wirkungszeiele und schlagen neun Ma?nahmen vor, deren Umsetzung ihnen besonders dringlich und wichtig erscheint.