Journal of health politics, policy and law
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J Health Polit Policy Law · Apr 2003
The skeptic's guide to a movement for universal health insurance.
The social movement has become institutionalized as a form of political action. The aim of this article is to evaluate the possibilities presented by this form as a strategy to bring about universal health insurance in the United States. ⋯ I conclude that the keys to success are, first, a broad-based coalition that combines an ideologically and/or grievance-motivated grass roots with financially and politically well-endowed mainstream organizations; second, a "master frame" that resonates with the American people; and, third, a political window of opportunity. The prospects for such a conjunction are not hopeless, but they are not high.
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J Health Polit Policy Law · Oct 2002
Compensation for medical injury in New Zealand: does "'no-fault" increase the level of claims making and reduce social and clinical selectivity?
The issues of patient safety and quality of care have gained policy attention with a growing appreciation of the scale and impact of medical injury in health systems. While the focus is clearly on the prevention of iatrogenic injury, the question of patient compensation is now also considered important, if only because in fault-based tort systems the fear of litigation may itself be a barrier to the disclosure and open discussion of medical error. No-fault systems, by contrast, do not require proof of culpability, and thus may both reduce barriers to compensation and increase disclosure of error. ⋯ It is concluded that, in interpreting these results, account needs to be taken of a number of features unique to the New Zealand system. These include: the limited payoff for a compensation claim (no pain and suffering or lump sum, free hospital care); the relative complexity of the grounds for claim (either rarity and severity or practitioner error); and a history of limited litigation for medical error. This suggests that, while the New Zealand system is well targeted, cheap, and free of financial and legal barriers, a change in legal doctrine alone has not in itself been sufficient to remove completely the selective and low level of claims making traditionally associated with patient compensation under tort.
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J Health Polit Policy Law · Oct 2002
Risk, response, and mental health policy: learning from the experience of the United Kingdom.
Policy makers in the United States and the United Kingdom recognize that mentally disordered offenders present special challenges to law enforcement, mental health, and social service systems, as well as the community. Although various policy initiatives have advanced over the past twenty years to improve the management of mentally disordered offenders, mental health policy has chronically failed in both countries. Because safety concerns have emerged as the mental health system has been "deinstitutionalized," debate is growing about whether the community-care approach works-for the community. ⋯ Mental health policy has historically mismanaged the risk issue in the United Kingdom and as such has set in motion the growing community-care backlash. The path to a better outcome lies in the responsible management of the right risks. Lessons from the United Kingdom experience can be usefully applied to mental health issues in many industrial democracies.
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J Health Polit Policy Law · Apr 2002
Preventing lethal violence in schools: the case for entry-based weapons screening.
Violence-related behavior in schools has declined in recent years, but the perception of risk remains high. Disturbingly high percentages of students and teachers report staying home out of fear, and many students bring weapons to school for protection. Current proposals for preventing school violence include punishing the violence-prone, expulsion for weapon carriers, and creating a culture of nonviolence through various behavioral methods like conflict resolution. ⋯ This could be achieved by using entry-based weapons detection systems similar to those now used in airports and courts. Decreasing the risk and fear of violence by converting schools into weapons-free zones would also be expected to increase attendance and improve scholastic performance. Randomized, controlled studies should be undertaken to evaluate the efficacy and cost-effectiveness of entry-based weapons detection systems for achieving these outcomes.