Journal of health politics, policy and law
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J Health Polit Policy Law · Jan 1989
No-fault cerebral palsy insurance: an alternative to the obstetrical malpractice lottery.
Sixty percent of malpractice premiums paid by obstetricians go to cover suits for alleged birth-related cerebral palsy (CP). Yet substantially less than half of that money goes to CP victims, and less than 10 percent of children with CP receive any compensation at all from tort suits. ⋯ This proposal would be more equitable than current systems. It would also be less expensive, since it would avoid costly litigation and decrease the cost of obstetrical malpractice insurance.
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J Health Polit Policy Law · Jan 1988
Regulating physician supply: the evolution of British Columbia's Bill 41.
This paper traces the development of British Columbia's controversial Bill 41, which empowers that province's Ministry of Health to restrict the issuance of billing numbers entitling physicians to seek payment from the provincial medical services plan. The bill and its predecessors have been the subjects of two court challenges by the medical profession, and the legal battles continue. The bill has also taken on a role in the evolving interpretation of Canada's new Charter of Rights and Freedoms. Meanwhile, the policy appears to be slowing the rate of growth in physician supply in the province, but its impact on the real target--medical care costs--is still uncertain.
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In response to dramatic rises in health care costs, policymakers have been debating the relative merits of regulatory and competitive strategies as a means of containing costs. One major activity espoused by proponents of competition is the growth of health maintenance organizations (HMOs) which, in their opinion, will result in the market better determining efficient levels of utilization and costs. Extending this argument, the larger the percent of the population in a market area who enroll in HMOs, the greater the market-forcing effect of HMOs in reducing overall hospital expenditures; that is, if HMOs are providing lower-cost care, then the fee-for-service system will be forced to reduce costs in order to be competitive. ⋯ They conclude that neither competition nor regulation had a significant impact in reducing overall hospital costs. While there may have been some impact in specific communities, no generalizable effect could be observed. However, the authors did find that increases in costs and utilization were essentially driven by supply factors such as the number of hospital beds or medical specialists in a given community.
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J Health Polit Policy Law · Jan 1986
Civil rights and regulatory wrongs: the Reagan administration and the medical treatment of handicapped infants.
Beginning in 1982 the Reagan administration tried to impose federal regulations (based on the civil rights approach of Section 504) on the medical treatment of handicapped newborns in the nation's hospitals. After issuing three sets of regulations, the administration found itself rebuffed by the courts and in ill repute with providers and parts of the public, especially after its widely publicized intervention in the case of Baby Jane Doe illustrated the pitfalls of federal regulation in complex medical decisions. ⋯ The episode offers insights into the dynamics of the U. S. system of separated powers, the limitations of the "civil rights" approach, and the importance of negotiating structures for the resolution of private moral dilemmas with public implications.
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This paper demonstrates the application of a mathematical programming model to a longstanding policy issue in the Medicaid reform debate: the redistribution of program funds necessary to achieve equity in eligibility and benefit coverage across states. The model is used to estimate the potential degree of equity achievable in the current Medicaid system given various budgetary and political constraints. ⋯ The results indicate that half or more of the interstate differences in spending for this population group are due to actuarial and efficiency factors rather than deviations from equity potential. The implications of eliminating the remaining differences are discussed.