Health Law and Policy Commons^™

Community-Based Long-Term Care: Wisconsin Stays Ahead, Judith D. Moore, Carol O'Shaughnessy, Lisa Sprague

National Health Policy Forum

This report describes a site visit to Wisconsin in August 2007 that focused on the use of home and community-based services, both public and private, to delay or avoid the need for institutional care. Wisconsin was chosen because it has long been a leader among states in developing such services for the elderly and persons with disabilities. At the time of the visit, a managed long-term care program, Family Care, was operating on a pilot basis in five counties. The Partnership Program, a four-site demonstration integrating acute and long-term care for the dual eligible population (both frail elderly and younger …

Shrinking Inpatient Psychiatric Capacity: Cause For Celebration Or Concern?, Eileen Salinsky, Christopher Loftis

National Health Policy Forum

This issue brief examines reported capacity constraints in inpatient psychiatric services and describes how these services fit within the continuum of care for mental health treatment. The paper summarizes the type and range of acute care services used to intervene in mental health crises, including both traditional hospital-based services and alternative crisis interventions, such as mobile response teams. It reviews historical trends in the supply of inpatient psychiatric beds and explores the anticipated influence of prospective payment for inpatient psychiatric services under Medicare. The paper also considers other forces that may affect the need for and supply of acute mental …

Health Information Technology Adoption Among Health Centers: A Digital Divide In The Making?, Adil Moiduddin, Daniel S. Gaylin

National Health Policy Forum

This background paper describes the current status of efforts to implement health information technology in community health centers. It summarizes the benefits experienced by health centers that have pioneered the use of information technology and examines the challenges that have hindered wider adoption. The paper identifies a range of policy options that have been considered to promote broader use of information technology by health centers.

Newsletter, Summer 2007

Newsletter

No abstract provided.

What Do Nonprofits Maximize? Hospital Service Provision And Market Ownership Mix, Jill R. Horwitz, Austin Nichols

Law & Economics Working Papers Archive: 2003-2009

Conflicting theories of the nonprofit firm have existed for several decades yet empirical research has not resolved these debates, partly because the theories are not easily testable but also because empirical research generally considers organizations in isolation rather than in markets. Here we examine three types of hospitals – nonprofit, for-profit, and government – and their spillover effects. We look at the effect of for-profit ownership share within markets in two ways, on the provision of medical services and on operating margins at the three types of hospitals. We find that nonprofit hospitals’ medical service provision systematically varies by market …

An Administrative Law Perspective On Government Social Service Contracts: Outsourcing Prison Health Care In New York City, Alfred C. Aman

Indiana Journal of Global Legal Studies

This paper explores how administrative law can mitigate the democracy deficit that may occur when privatization shifts political debate into relatively private arenas, changes its focus, or precludes debate altogether.I t also argues that the prevailing form and key terms of globalization in the United States derive from neo-liberalism, particularly in the binary division of public/private and their conflation with legal regulation and market responsiveness, respectively. This paper centers specifically on a case study involving the outsourcing of health care for prisoners by a private, for-profit health care provider, Prison Health Services, using it as a means for exploring how …

The Cash Nexus, Carl E. Schneider

Articles

Courts and legislatures have labored for decades to protect patients' choice of medical treatments, even though patients seize that gift less eagerly than lawmakers expect. Yet while courts have rushed to build the whited sepulchre of informed consent, they have fled from a related problem that patients actually yearn to solve and that actually can be ameliorated the plight of patients who perforce agree to a treatment before they know its costs and who receive a bill both unrelated to the treatment's value and several times what an insured patient would pay. Increasingly, patients must be consumers in the medical …

A Condom Versus The Philippine Aids Prevention And Control Act Of 1998: Which Has Holes Leaving Filipinos Unprotected?, David M. Iseminger

Washington International Law Journal

In 1998, the Philippine legislature passed pioneering HIV/AIDS legislation in Southeast Asia called the AIDS Prevention and Control Act (“APCA” or “Act”). This comprehensive legislation sought, in part, to ensure access to health care information and to stop the spread of diseases like HIV/AIDS. Regulations were promulgated by the Philippine National AIDS Council in 1999 to implement the Act. APCA effectively addresses several important HIV/AIDS issues, including prohibiting discrimination and mandatory HIV testing, while ensuring access to basic health care. However, both the regulations and the Act fail to ensure that all scientifically accurate information regarding HIV/AIDS prevention reaches Filipinos. …

Imaging The Mind, Minding The Image: An Historical Introduction To Brain Imaging And The Law, Laura Stephens, Shahram Khoshbin

Faculty Scholarship

Since ancient times, people have yearned to attribute human behaviors to a physical source within the head. Recently, neuroimaging technologies have given us the technical ability to look at the living brain, its structures, and some of its functions without the need for invasive procedures. However, the science has a long way to go before these technologies can allow us fully to appreciate the anatomical and physiologic underpinnings of human thoughts, states of mind, motives, will, or behaviors.

In this Article, we use an historical overview to introduce the various new technologies for imaging the brain. Today, the goal of …

Offshore Gambling: Medical Outsourcing Versus Erisa's Fiduciary Duty Requirement, Christopher J. Brady

Washington and Lee Law Review

No abstract provided.

Might The Fact That 90% Of Americans Live Within 15 Miles Of A Wal-Mart Help Achieve Universal Health Care?, William M. Sage

Faculty Scholarship

The subject of this Essay is the retail medical clinic movement. Retail medical clinics-a few hundred exist at the time of this publication-are typically located in national or regional chains of discount stores, pharmacies, and supermarkets. 1 News articles describing this new phenomenon in American health care tend to examine its viability as a business. The symposium for which this Essay was prepared is devoted to the "Massachusetts Health Plan," that state's pioneering effort (in the current political cycle) to achieve near-universal health insurance for its residents. Accordingly, this Essay situates the retail medical clinic movement in overall "health policy," …

Allocating Responsibility For The Failure Of Global Warming Policies, W. Kip Viscusi, Joni Hersch

Vanderbilt Law School Faculty Publications

A recent series of climate change lawsuits has sought to mimic the "regulation through litigation" approach of the claims brought by the states against cigarette manufacturers. What is distinctive about the cigarette cases relative to conventional tort claims is that they were not brought on behalf of individual smokers, but rather sought to recoup the Medicaid-related costs of smoking. A parallel climate change litigation approach seeks payments from public utilities, energy producers, and other parties responsible for greenhouse gas emissions to reflect the long-term societal damages that the plaintiffs claim will be caused by this pollution. While environmental litigation of …

Failure To Connect: The Massachusetts Plan For Individual Health Insurance, Elizabeth Weeks Leonard

Scholarly Works

This Article briefly describes the key features of the Massachusetts Health Care Reform Act, focusing particularly on the Connector. It then offers preliminary thoughts on the expected effect of that mechanism for creating quality, affordable health insurance products for individuals. Observers anticipate that commercial insurers will offer scant coverage and high-premium, high-deductible plans through the Connector, which coverage ultimately may be neither more affordable than products currently or more helpful to covering the cost of health care than no coverage at all. If the Connector fails to facilitate the individual insurance mandate, Massachusetts's promise of universal coverage may begin to …

Trading Places: Real Choice Systems Change Grants And The Movement To Community-Based Long-Term Care Supports, Cynthia Shirk

National Health Policy Forum

The Real Choice Systems Change grant program was created to help states transform their long-term care service systems from ones that rely on institutions to ones that are more community-based. The grants are intended to help states develop the infrastructure needed for seniors and individuals with disabilities to live in integrated community settings. This issue brief provides information about Systems Change grants and the kinds of activities state Medicaid agencies have undertaken to transform their institutionally based systems. In addition, this paper reports on some of the qualitative and quantitative responses to the changes. This brief also raises critical policy …

Integrating The Complexity Of Mental Disability Into The Criminal Law Course, Linda C. Fentiman

Elisabeth Haub School of Law Faculty Publications

No abstract provided.

The Prescription Drug Safety Net: Access To Pharmaceuticals For The Uninsured, Jack Hoadley

National Health Policy Forum

This background paper provides an overview of organized programs that provide access to prescription drug products for uninsured persons, with an emphasis on manufacturer-sponsored pharmacy assistance programs (PAPs) and the federal 340B drug pricing program. It summarizes the chief characteristics of these programs and reviews concerns regarding the reach and efficiency of these efforts. The paper begins with a brief examination of the number of people who lack insurance coverage for prescription drugs and discusses the influence of this gap in coverage on health status. The paper also describes informal mechanisms providers frequently use to help uninsured patients fill their …

Oversight Hearings On Science And Environmental Regulatory Decisions, David Michaels

Health Policy and Management Congressional Testimonies

No abstract provided.

Regulatory Marketing Approval For Pharmaceuticals As A Non-Tariff Barrier To Trade: Analysis Under The Wto's Agreement On Technical Barriers To Trade, Mary Hess Eliason

San Diego International Law Journal

At a fundamental level, pharmaceuticals serve two roles: both as a cure for disease and as a product. As a cure for disease, a drug's value cannot be quantified because it saves lives. As a product, profit analysis shapes every step of a drug's progression to market. In least developed nations the barriers to drug access are not solely economic. National regulatory systems for market approval are being used to prevent external pharmaceutical manufacturers from participating in a national market. This article will address how the regulatory framework of pharmaceutical registration may serve as a barrier to trade in drugs, …

Straddling The Line Of Medical Malpractice: Why There Should Be A Private Cause Of Action Against Physicians Via Emtala, Lawrence Bluestone

Cardozo Law Review

No abstract provided.

Criminal Responsibility And The Disappearing Person, Stephen J. Morse

Cardozo Law Review

No abstract provided.

Some Principles Require Principals: Why Banning “Conflicts Of Interest” Won’T Solve Incentive Problems In Biomedical Research, William M. Sage

Faculty Scholarship

This Article seeks to bring greater discipline to the analysis of conflicts of interest in biomedical research, and by doing so to reveal trends and tensions in the research enterprise that require a more deliberate and longer term response. By comparing tensions in biomedical research to those affecting indisputably "relational" professionals such as lawyers, this Article concludes that "conflict of interest" is the wrong language to describe most of these situations, and leads to the wrong solutions. Conflict of interest analysis in law derives from an image of professional obligation running directly from expert agent to dependent principal. Because a …

The Fundamentals Of Health Savings Accounts And High-Deductible Health Plans, Beth Fuchs, Lisa Potetz

National Health Policy Forum

This background paper updates and expands on a previous NHPF document that looked at the fundamentals of health savings accounts (HSAs) and high-deductible health plans (HDHPs), their intellectual and legislative origins, and the ways they work. In addition to updating information on the HDHP/HSA marketplace, this paper presents a description of how the HDHP combined with the HSA works for enrollees. Using a question and-answer format, it then addresses some of the more complicated details of these arrangements, looking first at the HDHPs and then the HSAs. This closer examination suggests some potential policy challenges for lawmakers, the focus of …

What Have You Done For Me Lately? Assessing Hospital Community Benefit, Eileen Salinsky

National Health Policy Forum

This issue brief reviews key aspects of the ongoing policy debate related to not-for-profit hospitals, the advantages they derive from tax exemption, and the benefits they provide to communities served. It provides a historical context for how federal standards for assessing hospitals’ tax-exempt status have evolved and describes recent activities to explore additional policy changes. Legislative and regulatory actions at the state and local level are also examined. Evidence on the performance of not-for-profit hospitals in comparison to their for-profit competitors on measures of cost, quality, and access is summarized, and perspectives on the need to preserve a not-for-profit presence …

Electronic Health Records: Interoperability Challenges Patients' Right To Privacy, Laura Dunlop

Washington Journal of Law, Technology & Arts

President George W. Bush's administration has outlined initial necessary steps to transform the healthcare delivery system through adoption of interoperable electronic health records ("EHRs") by the year 2014. This Article examines the nation's shift toward the use of EHR technology, which largely facilitates patient care by providing clinicians with the ability to review a more complete medical record at the time of treatment. Current legislation calls for financial support and technical standards. However, lawmakers neglect to fully address the Health Insurance Portability and Accountability Act ("HIPAA") and the need to expand its application and enforcement. In addition, healthcare provider Anti-Kickback …

Review Of Access And Quality Of Care In Schip Using Standardized National Performance Measures, Terence A. Partridge

National Health Policy Forum

The State Children's Health Insurance Program (SCHIP) has proven to be a critical addition to public coverage programs for low-income children since its inception ten years ago. Tracking the number of children enrolled, however, is only part of the story. This technical paper reviews access and quality for children enrolled in SCHIP by examining information on four primary and preventive care health measures submitted to the Centers for Medicare & Medicaid Services by states in their 2005 annual reports. The paper concludes that the data examined for this paper indicate that children enrolled in SCHIP are receiving not only coverage …

Competition And Collaboration: The Spirit Of St. Louis, Laura A. Dummit, Lisa Sprague

National Health Policy Forum

The National Health Policy Forum sponsored a site visit to St. Louis, Missouri, on April 3-5, 2007, to consider the relationships between hospitals and physicians—and the degree of alignment in their financial, organizational, and policy goals—as a foundation for a new round of discussions on how to reform the health care system. St. Louis offered an interesting venue for these investigations because it is home to two major medical schools, three large hospital systems, and a physician community dominated by small practices. Site visit participants were able to converse with community, business, medical school, hospital, and physician leaders to learn …

Mid-Atlantic Ethics Committee Newsletter, Spring 2007

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Child Welfare Interventions For Drug-Dependent Pregnant Women: Limitations Of A Non-Public Health Response, Ellen M. Weber

Faculty Scholarship

National drug policy, medical practice and the child welfare system have not kept pace with scientific research that points to effective health interventions to address alcoholism and drug dependence among pregnant women. In its 2003 amendments to the Child Abuse Prevention and Treatment Act, Congress adopted a policy requiring physicians to report to child protective services all patients who give birth to an infant affected by illicit drug use. Drawing on epidemiological, medical and social science research, this Article critiques Congress’s decision to require health professionals to engage in a surveillance role instead of a therapeutic intervention. In seeking to …

Law & Health Care Newsletter, V. 14, No. 2, Spring 2007

Law & Health Care Newsletter

No abstract provided.

Tobacco Regulation Review, V. 6, No. 1, April 2007

Tobacco Regulation Review

No abstract provided.