Prevention for those who can pay: insurance reimbursement of genetic-based preventive interventions in the liminal state between health and disease

Clinical use of genetic testing to predict adult onset conditions allows individuals to minimize or circumvent disease when preventive medical interventions are available. Recent policy recommendations and changes expand patient access to information about asymptomatic genetic conditions and create mechanisms for expanded insurance coverage for genetic tests. The American College of Medical Genetics and Genomics (ACMG) recommends that laboratories provide incidental findings of medically actionable genetic variants after whole genome sequencing. The Patient Protection and Affordable Care Act (ACA) established mechanisms to mandate coverage for genetic tests, such as BRCA. The ACA and ACMG, however, do not address insurance coverage for preventive interventions. These policies equate access to testing as access to prevention, without exploring the accessibility and affordability of interventions. In reality, insurance coverage for preventive interventions in asymptomatic adults is variable given the US health insurance system''s focus on treatment. Health disparities will be exacerbated if only privileged segments of society can access preventive interventions, such as prophylactic surgeries, screenings, or medication. To ensure equitable access to interventions, federal or state legislatures should mandate insurance coverage for both predictive genetic testing and recommended follow-up interventions included in a list established by an expert panel or regulatory body.     

Why Civil Society Cannot Battle it All Alone: The Roles of Civil Society Environment,Transparent Laws and Quality of Public Administration in Political Corruption Mitigation

ABSTRACT

Utilizing a large-N data that covers about 20000 observations from about 200 countries from 1789 to 2018 from the Varieties of Democracy (V-Dem) project, and anchored on institutionalism as an overarching theory, and the nascent literature on civil-society corruption nexus, the paper looks at the predictive capacity of civil society environment, transparency of laws and predictability of enforcement, and rigorousness and impartiality of public administration in political corruption. Using a four-step hierarchical multiple regression, results show that while civil society and its structure is a significant determinant of the level of political corruption, the introduction of transparency of laws and predictability of enforcement, rigorousness, and impartiality of public administration, and civil society environment in the regression model accounted for additional variance in political corruption. Practical and theoretical implications, particularly on civil society-corruption nexus and the broader corruption-democracy linkage, are discussed.     

Promising Under Duress

Law and Philosophy - In her chapter “Duress and Moral Progress”, Seana Shiffrin offers a novel perspective on coerced promises. According to the dominant view, these promises confer no...     

Research Foundations of Greenbook Interventions to Address the Co‐Occurrence of Child Maltreatment and Adult Domestic Violence

Twenty years ago the National Council of Juvenile and Family Court Judges published Effective Intervention in Domestic Violence and Child Maltreatment: Guidelines for Policy and Practice, which became known as the Greenbook because of its green cover. This article presents the social science research leading up to the Greenbook and the 20 years beyond the publication of this seminal document, including examination of the effect of co‐occurrence of child maltreatment and exposure to domestic violence on child outcomes, the interventions for families to improve the safety of both child and adult victims, and future directions for research.     

The Changing Picture of Depressive Syndromes in Africa

Cet article a pour objectif d'examiner le rôle des arguments identitaires de type ethnique dans la mise en place de la démocratie consociative, à partir du cas mauricien. Les théories de la consociation présentent généralement la surenchère identitaire comme une dérive des systèmes consociatifs. Mais nous verrons qu'à l'île Maurice, où la consociation a permis la transition politique de la société plurale vers l'indépendance (1947–1968), l'argument d'un “péril hindou”, agité par les opposants à l'indépendance, a constitué, malgré son caractère stigmatisant, un mécanisme à part entière, voire même un régulateur du fonctionnement de la démocratie mauricienne.     

The Effects of Product Liability Litigation on the Value of Firms

We use event study methodology to examine the effects of productliability litigation on firms in the automobile and pharmaceuticalindustries. We find that the filing of a lawsuit, or news storiesthat subsequently lead to the filing of a lawsuit, is associatedwith significant losses in firm value. These losses are approximatelyequal to the upper bound of the direct loss in value of thefirms involved. This means that there may also be some reputationeffect from litigation events. We also find that in the automobileindustry competitors lose when one firm is sued, but in thepharmaceutical industry a lawsuit against one firm leads toan increase in value of other firms.     

Analytical units in federal and provincial governments: origins,functions and suggestions for effectiveness

Abstract: This paper presents an overview of the organizational entities (individuals and groups) within government which provide information, analysis, and advice to senior officials and politicians. These entities are referred to as analytical units. Much of the existing Canadian literature on such units has focused on policy units and evaluation units at the federal level. This paper extends the analysis to the provincial level and to a wider range of analytical activities. A major focus of this paper is on social policy ministries at the federal and provincial levels. A historical overview of the development of analytical units, based on the existing literature, is presented. As little has been written about these units in Canada since the early 1980s, the authors provide an update to the 1990s and project some possible future trends. The reasons for the development of analytical units are presented along with a discussion of their structural location and how they function within their host organizations. A considerable overlap exists in the analytical functions carried out by these units. A mapping of this overlap is presented and discussed. There appears to be a clustering of analytical activities into a three-part continuum of: forward-looking activities such as policy formulation/analysis and planning; ongoing activities to ensure organizational efficiency and effectiveness such as internal audit and operational review; and technical and evaluative activities such as research and evaluation. Based on their analysis, the authors present five suggestions regarding how staff in analytical units may be able to increase their contribution to their organizations and five suggestions, for the consideration of senior officials, regarding how they may be able to enhance the quality of the analysis they receive from their analytical units. Sommaire: Cet article présente un aperçu des entités organisationnelles (personnes ou groupes) situées au sein du gouvernement et fournissant renseignements, analyse et conseils aux hauts fonctionnaires et aux politiciens. On donne ici à ces entités le nom d» unités d'analyse «. Une forte proportion des articles et études existant au Canada à leur sujet porte sur les unités de politiques et les unités d'évaluation à l'échelon fédéral. Le présent article étend la portée de cette littéature à l'échelon provincial ainsi quà une gamme plus vaste d'activités d'analyse. Il présente un aperçu historique du développement de ces unités, basé sur la littérature existante. Puisque trés peu a étéécrit sur ce sujet au Canada depuis le début des années 1980, les auteurs offrent une mise à jour allant jusquaux années 1990 et présentent une projection de tendances futures possibles. Ils expliquent les raisons justifiant le développement de ces unités et examinent leur place ainsi que leur mode de fonctionnement au sein des organismes hôtes. Il y a un chevauchement considérable des fonctions analytiques exécutées par ces unités. Les auteurs délimitent ce chevauchement et l'examinent de plus prés. Les activités analytiques se regroupent dans un continuum comportant trois parties distinctes: les activités prévisionnelles telles que la formulation, l'analyse et la planification des politiques, les activités courantes visant à assurer l'efficacité organisationnelle, telles que la vérification interne et la révision opérationnelle; enfin, les activités techniques et d'évaluation telles que la recherche et l'évaluation. Les auteurs présentent certaines propositions qui permettraient au personnel des unités d'analyse d'améliorer leur apport à leurs organisations. En conclusion, l'article offre certaines suggestions à l'intention des hauts fonctionnaires, pour leur permettre éventuellement d'ameéliorer la qualité des analyses qu'ils reçoivent de leur propre organisation.     

Workers' compensation in Canada: a case for greater public accountability

Abstract: In this article, the authors argue that workers' compensation policies in Canada should be made more accountable to elected governments. The changing nature of occupational risks has created a range of workplace injuries against which current workers' compensation programs do not adequately insure. The existence of workers' compensation alongside the other components of the social‐safety net may have created significant numbers of individuals who are either not receiving compensation when they should be or are receiving compensation when they should not be. The implication is that other programs bear some of the costs that should be borne by workers' compensation and, conversely, that some of the costs borne by workers' compensation should be borne by other social programs. These “gaps and overlaps” indicate that workers' compensation should be better integrated with the rest of the programs that make up the Canadian social‐safety net. The article concludes with a menu of reforms, including the establishment, through legislation, of a formal reporting relationship; changes to the composition and size of governance structures; the introduction of strategic planning; and the establishment of performance measurement processes. Sommaire: Selon les auteurs de cet article, les politiques concernant les accidents du travail au Canada devraient relever davantage des gouvernements élus. L'évolution des risques professionnels a Créé toute une gamme d'accidents du travail pour lesquels l'assurance des régimes actuels d'indemnisation est inadéquate. L'existence des régimes d'assurance contre les accidents du travail parallèlement aux autres éléments de sécurité sociale aurait pour effet de multiplier le nombre de personnes quisoit ne reçoivent pas de prestations lorsqu'elles devraient en recevoir, soit l'inverse. Par conséquent, d'autres programmes défraient certains des coûts qui incombent au régime des accidents du travail, tandis que ce dernier défraie des coûts imputables a d'autres programmes sociaux. Ces lacunes et chevauchements indiquent que le régime d'assurance contre les accidents du travail devrait être mieux intégré au reste des programmes qui constituent le filet de sécurité sociale au Canada. L'article propose une série de réformes, dont l'adoption légiférée d'une relation formelle de compte rendu, la modification de la composition et de la taille des structures de gouvernance, l'adoption de la planification stratégique, et l'établissement de processus de mesure du rendement.