Journal of health politics, policy and law
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J Health Polit Policy Law · Jan 1996
ReviewAllocating health care: cost-utility analysis, informed democratic decision making, or the veil of ignorance?
Assuming that rationing health care is unavoidable, and that it requires moral reasoning, how should we allocate limited health care resources? This question is difficult because our pluralistic, liberal society has no consensus on a conception of distributive justice. In this article I focus on an alternative: Who shall decide how to ration health care, and how shall this be done to respect autonomy, pluralism, liberalism, and fairness? I explore three processes for making rationing decisions: cost-utility analysis, informed democratic decision making, and applications of the veil of ignorance. I evaluate these processes as examples of procedural justice, assuming that there is no outcome considered the most just. ⋯ Existing structures of government cannot creditably assimilate the information required for sound rationing decisions, and grassroots efforts are not representative. Applications of the veil of ignorance are more useful for identifying principles relevant to health care rationing than for making concrete rationing decisions. I outline a process of decision making, specifically for health care, that relies on substantive, selected representation, respects pluralism, liberalism, and deliberative democracy, and could be implemented at the community or organizational level.
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J Health Polit Policy Law · Jan 1996
Physicians' personal malpractice experiences are not related to defensive clinical practices.
Whether personal malpractice experience is part of a tort signal prompting physicians to practice defensively is unclear. To explore this issue further, we assessed how physicians' malpractice experiences affect clinical decision making. We surveyed 1,540 physicians from four specialty groups (cardiologists, surgeons, obstetrician-gynecologists, and internists) using specialty-specific clinical scenarios. ⋯ For example, similar percentages of internists in the top and bottom claims rate quartiles admitted a patient with syncope (78 percent versus 73 percent; p = 42), discharged a patient with nonspecific chest pain (80 percent versus 80 percent; p = .88), and delayed surgery in a patient with nonspecific changes on a electrocardiograph (58 percent versus 68 percent; p = .18). Attitudes about malpractice also did not differ with varying malpractice experience. Personal malpractice experience is not a predominant factor in the tort signal that prompts physicians to engage in defensive practices, to the extent that such practices exist.
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J Health Polit Policy Law · Jan 1996
Historical ArticleFrom piety to platitudes to pork: the changing politics of health workforce policy.
Policy to subsidize the education of health professionals in the United States has become contentious and uncertain. This article examines the politics of workforce policy in the twentieth century, emphasizing the years since World War II. ⋯ Recently, decision makers outside health care institutions have come to regard workforce policy as serving particular rather than general interests. Thus health workforce policy, like other policies outside of health affairs, may be said, perhaps oversimply but not inaccurately, to have gone through three stages: from piety to platitudes to pork.
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We analyzed the factors determining the amount of the recovery on claims based on medical malpractice. Our data set, which previously was not explored, consists of 20,428 claims arising within Michigan that were closed between 1978 and 1990. During this period, major changes were made in the law governing malpractice litigation. ⋯ This statute was initially successful in curbing such activity, but its effect seems to be diminishing. In addition, we compare mediation awards with settlement payments, and settlement payments with the expected value of claims in litigation. Evidence suggests that a mediation award is the mediation panel's estimate of a settlement payment appropriate for the case, and that cases are settled for substantially less than their expected value at trial.
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J Health Polit Policy Law · Jan 1996
Changing trends in mental health legislation: anatomy of reforming a civil commitment law.
In this article, we discuss changing trends of mental health legislation in the United States using a case study of the process of reforming the civil commitment law in New Jersey. That state's new commitment law, commonly called the "screening law," was enacted after a thirteen-year legislative process. Changes in the orientation of the proposed legislation and the dynamics of the process of reforming the commitment law in the state exemplify changing national trends in civil commitment legislation. ⋯ Our analysis of the process shows that changes in the social and political environment were the decisive factors that stimulated the process of reforming the civil commitment laws. Many of these changes occurred outside the mental health system and could be neither anticipated nor controlled by the various parties. Our examination of the process and the final outcome of this legislation reveals how organizations and interest groups, in their efforts to adapt to changing conditions, shaped the legislative outcome according to their interests.