Health Policy Commons^™

Conditional Spending And The Conditional Offer Puzzle, Mitchell N. Berman

All Faculty Scholarship

No abstract provided.

Layers Of Law: The Case Of E-Cigarettes, Eric A. Feldman

All Faculty Scholarship

This paper, written for a symposium on "Layers of Law and Social Order," connects the current debate over the regulation of electronic cigarettes with socio-legal scholarship on law, norms, and social control. Although almost every aspect of modern life that is subject to regulation can be seen through the framework ‘layers of law,’ e-cigarettes are distinguished by the rapid emergence of an unusually dense legal and regulatory web. In part, the dense fabric of e-cigarette law and regulation, both within and beyond the US, results from the lack of robust scientific and epidemiological data on the behavioral and health consequences …

Mass Shootings And Mental Health Policy, Jessica Rosenberg

The Journal of Sociology & Social Welfare

Research suggests that mass shootings can increase mental health stigma, reinforce stereotypes that people with mental illness are violent, and influence public policy. This article examines mental health policy initiatives resulting from the mass shootings in Sandy Hook, Connecticut and Aurora, Colorado within the context of existing research about mental illness, suicide, substance abuse and gun violence. Previous legislation that restricts access to firearms among persons with mental illness is reviewed. The article suggests that gun control legislation that focuses on persons with mental illness is not supported by research, may create barriers to treatment, and may have limited efficacy …

Right-Skilling: Rabbis And The Rabbinic Role For A New Century, Barak D. Richman, Daniel Libenson

Faculty Scholarship

This chapter applies Clayton Christensen's model of organizational innovation to Jewish contexts. It observes a parallel between the many challenges that currently confront U.S. healthcare and American Jewry: a mismatch in the skills acquired by professionals and the needs expressed by the broader public; expensive institutions with high fixed costs that are struggling to provide value and maintain sustainable revenues; a failure to respect individual autonomy and cultural mores; and a disenfranchised public that suffers from high costs and unmet demand for meaningful services. It then applies Christensen's adapted model for the healthcare sector to American Jewish institutions, suggesting reforms …

Protocol For Culturally Responsive Organizations, Ann Curry-Stevens, Marie-Elena Reyes, Coalition Of Communities Of Color

Center to Advance Racial Equity Publications and Reports

Communities of color have long been marginalized in mainstream service delivery – invisible in terms of their access to resources and services, the adequacy of such services, and in the types of interventions available to members of the community. When available, organizations have been ripe with inequitable outcomes. Today, greater attention to racial equity exists, with local leaders of color having been able to leverage influence to ensure that stronger accountability exists among mainstream organizations in terms of how well communities of color are served, with heightened emphasis on the cultural responsiveness of the entire organization. At the request of …

Protocol For Culturally Responsive Organizations: Literature Review And Standards For Performance, Marie-Elena Reyes, Ann Curry-Stevens

Center to Advance Racial Equity Publications and Reports

At the request of the Coalition of Communities of Color, the Center to Advance Racial Equity (CARE) was asked to assist in the development of a Protocol for Culturally Responsive Organizations (also called the Protocol) that it would use to improve the quality of services available to communities of color in mainstream health and human services. To achieve this, we have researched the literature available that provides evidence of the effectiveness of various interventions. Priority has been given to the literatures on culturally-responsive service delivery (which has been thin) and culturally-competent services (which while abundantly written about, relatively little exists …

Aging In Falmouth: Assessing Current And Future Needs Of Our Aging Population, Jan E. Mutchler, Bernard A. Steinman, Hayley Gleason, Caitlin E. Coyle

McCormack Graduate School Gerontology Faculty Publication Series

This report describes the collaborative efforts undertaken by the Town of Falmouth Council on Aging Senior Center and the Center for Social and Demographic Research on Aging, within the McCormack Graduate School at the University of Massachusetts Boston. Beginning in Spring 2013, these organizations joined to conduct a needs assessment to investigate the needs, interests, preferences and opinions of the Town’s older resident population, with respect to aging in Falmouth. The focus of this report is on two cohorts of Falmouth residents—those aged 45 to 59 (referred to as “Boomers”), and the cohort of individuals who are currently aged 60 …

Endogenous Decentralization In Federal Environmental Policies, Howard F. Chang, Hilary Sigman, Leah G. Traub

All Faculty Scholarship

Under most federal environmental laws and some health and safety laws, states may apply for “primacy,” that is, authority to implement and enforce federal law, through a process known as “authorization.” Some observers fear that states use authorization to adopt more lax policies in a regulatory “race to the bottom.” This paper presents a simple model of the interaction between the federal and state governments in such a scheme of partial decentralization. Our model suggests that the authorization option may not only increase social welfare but also allow more stringent environmental regulations than would otherwise be feasible. Our model also …

Health Care Spending And Financial Security After The Affordable Care Act, Allison K. Hoffman

All Faculty Scholarship

Health insurance has fallen notoriously short of protecting Americans from financial insecurity caused by health care spending. The Patient Protection and Affordable Care Act (“ACA”) attempted to ameliorate this shortcoming by regulating health insurance. The ACA offers a new policy vision of how health insurance will (and perhaps should) serve to promote financial security in the face of health care spending. Yet, the ACA’s policy vision applies differently among insured, based on the type of insurance they have, resulting in inconsistent types and levels of financial protection among Americans.

To examine this picture of inconsistent financial protection, this Article offers …

A Vision Of An Emerging Right To Health Care In The United States: Expanding Health Care Equity Through Legislative Reform, Allison K. Hoffman

All Faculty Scholarship

When asked to write a chapter on how litigation has advanced a right to health in the U.S., I responded skeptically, both because evidence of the existence of any such right is weak and the role of litigation in promoting its development is small at best. A snapshot of the U.S. health care system evinces the absence of even a more narrow right to health care – a guarantee of equitable access to basic medical care. Instead, it reveals a fragmented picture of public and private financing that leaves many people lacking meaningful access to care. More so, the places …

Happiness In Public Policy, Laura Musikanski

Journal of Sustainable Social Change

The happiness movement represents a new paradigm where social, economic, and environmental systems are structured to encourage human well-being in a sustainable environment. Bhutan has adopted Gross National Happiness (GNH) as a way of determining its society’s success in contrast to purely economic goals and the singular use of the gross domestic product indicator. Bhutanese policy promulgation includes use of a GNH screening tool. In the United Kingdom, happiness indicators are being used to collect data and the government is starting to explore their application to policy. The Bhutanese GNH policy screening tool has been adapted for the grassroots activists, …

Governing For Health As The World Grows Older: Healthy Lifespans In Aging Societies, Lawrence O. Gostin, Anna Garsia

Georgetown Law Faculty Publications and Other Works

So much of global health governance focuses intensely on a brief moment in the human lifespan—from a safe birth to infant and child survival. Yet, with all the attention to this early window of life (infancy to age five), the opposite end of the life spectrum is comparatively neglected. The Millennium Development Goals (MDGs) do not mention a healthy lifespan or a healthy old age. This inadequate attention to the older years of the life appears to be a glaring omission given the universal challenges posed by aging societies. Aging is a demographic fact in almost all countries, but it …

Libertarian Patriarchalism: Nudges, Procedural Roadblocks, And Reproductive Choice, Govind Persad

Georgetown Law Faculty Publications and Other Works

Cass Sunstein and Richard Thaler's proposal that social and legal institutions should steer individuals toward some options and away from others-a stance they dub "libertarian paternalism"-has provoked much high-level discussion in both academic and policy settings. Sunstein and Thaler believe that steering, or "nudging," individuals is easier to justify than the bans or mandates that traditional paternalism involves.

This Article considers the connection between libertarian paternalism and the regulation of reproductive choice. I first discuss the use of nudges to discourage women from exercising their right to choose an abortion, or from becoming or remaining pregnant. I then argue that …

Public Health Emergencies: What Counts?, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Vaccines and drugs to prevent and treat Ebola Virus Disease that have never been tested in humans, and in scarce supply raise profound ethical challenges. What if good evidence emerged demonstrating safety and efficacy of drugs? What would be an ethical method of allocating scarce beneficial resources? The apparent preference given to foreign aid workers over West Africans provoked a firestorm. In addition to discussing the ethical allocation of scarce drugs, this article also asks a more fundamental question: Why did it take nearly 40 years after the first Ebola outbreak in 1976 to launch clinical trials?

Navigating The Health Care Labyrinth: Portraits Of The Socioeconomically Disadvantaged, Thomas C. Crawford Phd

Antioch University Full-Text Dissertations & Theses

In 2010, an estimated population of the 311,212,863 Americans generated approximately 1,014,688,290 physician office encounters (Moore, 2010). The frequency and number of professional interactions between caregivers and patients/family members in medical office settings equated to a staggering 1,931 visits per minute. Based on the massive volume of interactions that occurred between patients of different races, ethnicities, genders, sexual orientations, and socioeconomic standings that generated an average household income of $49,445 in 2010 (United States Census Bureau, 2010a) with a physician workforce that the Association of American Medical Colleges (2010) captured as being 75% White that earned (primary care specialties) in …

Future Oversight Of Recombinant Dna Research: Recommendations Of An Institute Of Medicine Committee, Lawrence O. Gostin, Bruce M. Altevogt, Andrew M. Pope

Georgetown Law Faculty Publications and Other Works

The National Institutes of Health (NIH) established the Recombinant DNA Advisory Committee (RAC) in 1974 in response to public concerns about the safety of manipulating genetic material through recombinant DNA. The accumulation of 40 years of experience with gene transfer research has led to a better understanding of the risks. Yet, as gene transfer research has matured, the complexity of the overall regulatory environment has remained. Gene transfer research continues to be subjected to multiple layers of review: the Food and Drug Administration (FDA), institutional review boards, institutional biosafety committees, and the RAC. It is within the context of overlapping …

Sexual Rights For Marginalized Populations, Louis Graham, Mark Padilla

Louis F Graham

Governance And Transparency At Pepfar, Matthew Kavanagh, Brook Baker

Matthew M. Kavanagh

The US President's Emergency Plan for AIDS Relief (PEPFAR) has been one of the most effective foreign aid programmes in history. It reached 6·7 million people with antiretroviral therapy in 2013, and has also strengthened country health systems, provided billions of dollars in aid to biomedical and behavioural prevention programmes, and helped to drive declines in morbidity and mortality in many countries in sub-Saharan Africa. PEPFAR began as an emergency response, after relative inaction by wealthy nations, and rapidly built disease-response capacity by funding non-governmental organisations.

Can Institutional Deliveries Reduce Newborn Mortality? Evidence From Rwanda, Edward Okeke, A.V. Chari

Edward Okeke

Current global health policies emphasize institutional deliveries as a pathway to achieving reductions in newborn mortality in developing countries. There is however remarkably little evidence regarding a causal relationship between institutional deliveries and newborn mortality. In this paper we take advantage of a shock to institutional deliveries provided by the randomized rollout of a government performance-based financing program in Rwanda, to provide the first estimates of this causal effect. We construct an instrumental variables estimator that combines interrupted time-series and difference-in-differences approaches. We do not find any statistically significant effect of an institutional birth on either 7- or 30-day mortality …

Governance And Transparency At Pepfar, Matthew M. Kavanagh, Brook K. Baker

Brook K. Baker

The US President's Emergency Plan for AIDS Relief (PEPFAR) has been one of the most effective foreign aid programmes in history. It reached 6·7 million people with antiretroviral therapy in 2013, and has also strengthened country health systems, provided billions of dollars in aid to biomedical and behavioural prevention programmes, and helped to drive declines in morbidity and mortality in many countries in sub-Saharan Africa. PEPFAR began as an emergency response, after relative inaction by wealthy nations, and rapidly built disease-response capacity by funding non-governmental organisations.