卫生法地位研究

卫生法是否为独立的法律部门,是卫生法学研究的热点问题。本文在对划分法律部门的目的、意义和标准重新构思的基础,认为卫生法在职能、调整对象和调整方法上都不足以成为一个独立的法律部门。尽管作为独立的卫生法法律部门难以成立,但完全可以形成一个以卫生法律规范和卫生法律问题为研究对象的独立、综合的卫生法学学科。     

警察职业特点与警察心理应激反应及警察身心健康的探究

警察职业特点所带来的心理应激反应对警察身心健康的影响较大,从某种程度讲,如果没有妥善的应对之策,它将对我们的公安工作产生巨大的负面影响。因此,从警察这一特殊职业群体的特点入手,分析警察心理应激反应的特点及其危害性,从而有助于解决此类问题的对策。     

Reimbursement schemes for hospitals, malpractice liability, and intrinsic motivation

We develop a simple multi-task principal-agent model to analyze the interplay between optimal reimbursement schemes for hospitals and liability rules (basic model). We then extend our model and assume that the hospital is intrinsically motivated to exert positive effort for quality and cost reduction. This effort, however, is biased towards quality. Moreover, the intrinsic motivation may be crowded out by monetary incentives. In such a setting, we find that a pure prospective payment system (PPS) that has become widespread in recent years can only be optimal in the unlikely case where malpractice liability holds hospitals fully responsible for expected harm. For other cases, we confirm the prejudice that PPS may lead to inefficiently low quality. Then, the traditional fee-for-service (FFS) system is superior if the intrinsic motivation is high and relatively little biased towards quality, whereas mixed systems should be chosen otherwise. Our model sheds light on why countries like the USA with a tough liability system haven been less reluctant to switch from FFS to PPS than Germany, for instance.     

TRIPS-Plus Free Trade Agreements and Access to Medicines

The battle over access to essential medicines revolves around the rights to issue compulsory licenses and to manufacture and export generic versions of brand name drugs to expand access. Global brand name pharmaceutical firms have sought to ration access to medicines and have used their economic and political clout to shape United States trade policy. They have succeeded in getting extremely restrictive TRIPS-Plus, and even US-Plus, intellectual property provisions into regional and bilateral free trade agreements. Asymmetrical power relations continue to shape intellectual property policy, reducing the amount of leeway that poorer and/or weaker states have in devising regulatory approaches that are most suitable for their individual needs and stages of development. While the overall trend is disturbing, some recent activities in the World Health Organization and evidence of greater unity behind health-based TRIPs flexibilities provide some grounds for cautious optimism.     

Public Involvement in NHS Inquiries

Opportunities for engaging the public have changed over the fifty years since the inquiry into the Ely Hospital, Cardiff. NHS inquiries, and inquiries more widely, tend to be called where events have led to public concern and loss of public confidence. Involvement of the public could therefore be assumed to form a part of restoring that public confidence. This paper explores the mechanisms for public involvement in NHS inquiries over the past fifty years, assessing the roles played by the public. It uses the framework outlined by Geoffrey Howe to examine how members of the public have been involved in four NHS inquiries. Findings suggest that the roles and mechanisms have varied, but that understanding the extent of public involvement is a dimension to assessing each of the potential functions of an NHS inquiry.     

An Elementary Primer for Politicians and Potential Chairs on Public Inquiries

There is relatively little central government guidance available on how to set up and run a public inquiry. This short piece seeks to set out the very basic questions that politicians considering creating one—and potential chairs—will need to address. Including, crucially, whether a public inquiry is even the right answer. In the context of the National Health Service, on which this analysis focusses, it also argues that money may be far better spent on applying what is already known from the many previous inquiries—that is, spend it on prevention—rather than waiting to spend it on future similar inquiries that will, more than likely, produce similar findings and recommendations.     

Stewardship of health security: The challenges of applying the One Health approach

Experience with the control of epidemics, notably the 2004 outbreaks of avian influenza, has demonstrated that a “One Health approach,” that recognizes that human, animal, and environmental health are interdependent, is the most effective way of dealing with threats from emerging infectious diseases (EID). However, introducing and applying a One Health approach is challenging for many countries. One of the key challenges relates to stewardship. The evolution of the strategies and policies used to introduce and adopt the One Health approach in the detection and response to EID over the period 2005 to 2017 is described at global level and in country case studies of Thailand and Indonesia. Both countries experienced significant outbreaks of H5N1 avian influenza from 2004 and have sought to adopt the One Health approach in their response strategies. The challenges for stewardship of health systems in introducing a One Health approach are described, and key lessons identified in regard to national level agency coordination, engagement of the broader civil society outside government, and developing a reliable, credible, and impartial decision‐making process. The concept of stewardship provides valuable insights for policymakers on how to incorporate a One Health approach into their EID response systems.     

Personalizing solidarity? The role of self-tracking in health insurance pricing

Can data-driven innovations, working across an internet of connected things, personalize health insurance prices? The emergence of self-tracking technologies and their adoption and promotion in health insurance products has been characterized as a threat to solidaristic models of healthcare provision. If individual behaviour rather than group membership were to become the basis of risk assessment, the social, economic and political consequences would be far-reaching. It would disrupt the distributive, solidaristic character that is expressed within all health insurance schemes, even in those nominally designated as private or commercial. Personalized risk pricing is at odds with the infrastructures that presently define, regulate and deliver health insurance. Self-tracking can be readily imagined as an element in an ongoing bio-political redistribution of the burden of responsibility from the state to citizens but it is not clear that such a scenario could be delivered within existing individual private health insurance operational and regulatory infrastructures. In what can be gleaned from publicly available sources discussing pricing experience in the individual markets established by the Patient Protection and Affordable Care Act 2010 (ACA), widely known as ‘Obamacare’, it appears unlikely that it can provide the means to personalize price. Using the case of Oscar Health, a technology driven start-up trading in the ACA marketplaces, I explore the concepts, politics and infrastructures at work in health insurance markets.     

‘Just kidding. I'm white!’ knowledge,perceptions and attitudes of white and Indian male university students towards HIV prevention

This article reports the findings of a qualitative study that explored what white and Indian students at a South African university felt and knew about HIV prevention. The study explored the knowledge, perceptions and attitudes of white and Indian male students at the University of KwaZulu-Natal's (UKZN) Howard College towards medical male circumcision (MMC) as an HIV prevention procedure. The study was prompted, in part, by a cynical tweet by Justine Sacco, which implied that HIV is an exclusively black disease. More substantially, the research aimed to fill a gap in studies of non-black student demographics with regard to HIV prevention. The level of knowledge and the attitudes of white and Indian male students were explored to establish the acceptability of HIV prevention amongst these two demographics. To what extent do non-black students care about HIV prevention and prevalence amongst themselves? The prevention method selected for the study was MMC - a choice informed by UKZN's formal adoption and roll out, in 2013, of MMC as its latest HIV prevention strategy for students and staff. The study, which sampled 40 students, was rooted in the Health Belief Model, which explains health behaviour change in terms of barriers, benefits and cues to action, as well as the Social Ecology Model, which recognises the interwoven relationship between individuals and their greater environment. A qualitative, interpretive, exploratory research design was employed. Data were collected using semi-structured interview questions, and analysed thematically. The findings suggest a relatively widespread perception that white and Indian students are not at risk of HIV, demonstrating that the association of HIV with a specific race is both a sad fact and a sign of enduring prejudice and stigma.