The Milbank quarterly
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The majority of seriously mentally ill people are unmarried and cannot obtain support from spouses or children. Help from parents is time limited. In the absence of spouses and parents, siblings are often the closest relations for many seriously mentally ill people, but their potentially supportive role has rarely been examined. ⋯ Furthermore, most were willing to increase their current amount of support. Sibling support was greater when both parents were not alive, resulting in the increased importance of siblings over the life course. Policy markers, mental health professionals, and researchers should pay more attention to the question of sibling support.
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Immunizations have been among the most successful of preventive interventions. However, concern exists in the United States that recent epidemics of vaccine-preventable diseases and low rates of childhood immunizations may signal the existence of major underlying problems in immunization policy. Additionally, the effectiveness of national, state, and local public health programs in administering these and other preventive services to children has been called into question. This article examines the current state of childhood immunizations in this country and offers a broad range of suggestions for policy modification.
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The prevailing legal and ethical opinion that rationing decisions must always be disclosed to patients is countered. Although conventional informed consent law could theoretically extend to decisions to decline treatment because of costs, it has not yet done so. ⋯ A new theory of economic informed consent would stipulate that when patients make informed decisions to purchase less expensive health insurance, they are consenting in advance either to limiting marginally beneficial treatment or to waiving their right to be informed of particular decisions not to treat. Whether this will prove workable or will be accepted by the courts depends on the specifics of the enrollment disclosures, the range of choices given to subscribers, and their capacity to understand them.
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Medicare's decision to compensate physicians using a fee schedule based on the relative value of their services was an attempt to rationalize fee-for-service payment of physicians. Reformers hoped also to control the costs of care, improve its quality, and protect access to health services among Medicare beneficiaries. ⋯ In the cost area, for example, the new fee schedule does not affect such factors as the basic incentives built into fee-for-service medicine and the explosion of new medical technologies. The failure of the program to achieve its goals in cost containment and other areas could result in abandonment of fee-for-service compensation of physicians under Medicare.