New developments in genetics threaten, in different ways, the goal of intergenerational solidarity. With artificial reproduction techniques, the transmission of human life has shifted from the mutual donation of man and woman to the field of desire and production. Concomitantly, advances in genetics afford the possibility of selecting the desired traits of children. This can be accomplished by the selection of gametes (for example the choice of a sperm donor with desirable genetic traits), the selection of embryos early in pregnancy (preimplantation diagnosis followed by the elimination of embryos with unwanted characteristics) or the selection of embryos later through eugenic abortion. The problem of who should pay for “bad genes” raises additional questions and generates new pressure to eliminate people who present genetic disadvantages. These developments render intergenerational relations ambivalent. The exercise of this genetic mastery gives the adult generation a new power over the offspring and subjects them to a new form of genetic dependency. The temptations created by the power to shape the genetics of the next generation raises many new issues for the juridical sciences. This article aims to analyze the ways in which this challenge to intergenerational solidarity occurs, the juridical principles involved, and the implications of the value of intergenerational solidarity.
A Legal Approach to Genetics as a Challenge to Intergenerational Solidarity by Jorge Lafferriere :: SSRNApril 9, 2013
How Do Hospitals Respond to Market Entry? Evidence from a Deregulated Market for Cardiac Revascularization by Suhui Li, Avi Dor :: SSRNApril 9, 2013
Regulatory entry barriers to hospital service markets, namely Certificate of Need (CON) regulations, are enforced in many states; although no longer federally mandated, policy makers in other states are considering reinstating CON policies in tandem with service expansions mandated under the Affordable Care Act. While numerous studies have examined the impacts of CON on hospital volumes, demand responses to actual hospital entry into local hospital markets are not well understood. In this paper, we empirically examine the demand-augmenting, demand-redistribution, and risk-allocation effects of hospital entry by studying the cardiac revascularization markets in Pennsylvania, a state in which dynamic market entry occurred after repeal of CON in 1996. Our findings with respect to demand-augmentation are mixed: we find robust evidence that high entrant market share mitigated the declining incidence of coronary artery bypass graft (CABG), but it had no significant effect on the rising trend in percutaneous coronary intervention (PCI) procedures, among patients with coronary artery disease. Consequently, incumbent hospitals experienced a decrease in the likelihood of PCI due to entry, thereby indicating a shift in demand away from incumbents to entrants, namely business-stealing. Results of our analyses further indicate that entry by new cardiac surgery centers tended to sort high-severity patients into the more invasive CABG procedure and low-severity patients into the less invasive PCI procedures. Thus, from a welfare perspective our results are mixed: on the one hand, free-entry may lead to improved access rather than business stealing for CABG procedures; on the other hand, the empirical evidence is in favor of business-stealing for PCI procedures. Moreover, free-entry improves the match between underlying medical risk and treatment intensity. These findings underscore the importance of considering market-level strategic responses by hospitals when regulatory barriers to entry are rescinded.
An inquiry by a U.S. senator has found that three nonprofit hospitals in North Carolina have made millions from a discount drug program intended to help the poor and uninsured.
Hundreds of hospitals nationally, including more than 40 in North Carolina, obtain deep discounts on outpatient drugs under a rapidly growing federal program called 340B. The plan requires drug manufacturers to cut prices to hospitals that treat large numbers of financially needy patients.
New bill in N.C. legislature would take mystery out of hospital prices | Health & Science | NewsObserver.comMarch 28, 2013
At least 14 states – but not North Carolina – require collection of health care cost data for use by consumers. New Hampshire and Maine have published estimates online.
The legislation doesn’t incorporate some proposals that advocates have said could help patients. Among them: prohibiting hospitals from putting liens on the homes of patients with few resources. The newspapers’ investigation found that some hospitals routinely sue those who don’t pay their bills, and place liens against their property.
At least 14 states have set rules about what hospitals can and can’t do to collect on debts. North Carolina is not among them.
Modern Models of Organ Donation: Challenging Increases of Federal Power to Save Lives by Jonathan August :: SSRNMarch 21, 2013
Much of today’s scholarship on noninformed consent organ donation models has focused on either presumed consent or paid donation systems. Recently, however, individual states and foreign countries have begun to rethink their organ donation procedures in an attempt to increase donation rates.
Looking specifically at the informed consent model and the brand-new Israeli incentive program, this note first examines the success rates of these programs as potentially viable alternatives to traditional organ donation models. Next, this note argues that adopting these programs at the federal level will not violate the United States constitution under First Amendment and Fourteenth Amendment challenges, respectively. However, successfully avoiding these constitutional traps will require Congress to carefully craft any new potential legislation. This note also briefly discusses new third-party donor-preference programs as an alternative to avoid the United States’ ban on valuable consideration for organ donation under the National Organ Transplant Act.
As public scrutiny intensifies over price transparency in health care, a new report shows 72 percent of the nation, or 36 states, failing to improve information to consumers on what medical treatments and procedures actually cost.The report from two business coalitions representing some of the nation’s largest employers is the latest troubling sign that most prices in health care remain a mystery to consumers, employers and patients picking up the tab for health care services. They cite national studies showing prices for identical procedures can vary more than 700 percent in some cases.
The Next Controversy in Genetic Testing: Clinical Data as Trade Secrets? by Robert Cook-Deegan, John Conley, James Evans, Daniel Vorhaus :: SSRNMarch 14, 2013
Sole-source business models for genetic testing can create private databases containing information vital to interpreting the clinical significance of human genetic variations. But incomplete access to those databases threatens to impede the clinical interpretation of genomic medicine. National health systems and insurers, regulators, researchers, providers and patients all have a strong interest in ensuring broad access to information about the clinical significance of variants discovered through genetic testing. They can create incentives for sharing data and interpretive algorithms in several ways, including: promoting voluntary sharing; requiring laboratories to share as a condition of payment for or regulatory approval of laboratory services; establishing – and compelling participation in – resources that capture the information needed to interpret the data independent of company policies; and paying for sharing and interpretation in addition to paying for the test itself.
US policies have failed to address the data-sharing issue. The entry of new and established firms into the European genetic testing market presents an opportunity to correct this failure.
Chapter 9: Into the Void: The Legal Ambiguities of an Unregulated Medical Tourism Market by Nathan Cortez :: SSRNMarch 11, 2013
This chapter, appearing in the book Risks and Challenges in Medical Tourism: Understanding the Global Market for Health Services (Praeger Publishing 2012), explores how the medical tourism market operates in an environment void of legal and regulatory oversight. Given this void, I address seven legal questions surrounding the medical tourism market: 1. Is it illegal for patients to leave the United States for health care? 2. Can patients injured overseas sue in the United States? 3. Can patients injured overseas sue overseas? 4. How might governments regulate medical tourism? 5. Can U.S.-based institutions regulate foreign hospitals and physicians? 6. Is it legal for U.S. insurers to ask patients to leave the country? 7. How will U.S. health reform affect the medical tourism market?
In confronting these questions, a unifying theme emerges: Very few laws and regulations govern medical tourism transactions, largely because these are cross-border transactions consummated in foreign jurisdictions. This creates legal risks for all parties. And the industry is shifting these risks to perhaps the least sophisticated party: patients.
How Do Hospitals Respond to Negative Financial Shocks? The Impact of the 2008 Stock Market Crash by David Dranove, Craig Garthwaite, Christopher Ody :: SSRNMarch 9, 2013
The theory of cost-shifting posits that nonprofit hospitals respond to negative financial shocks by raising prices for privately insured patients. We examine how hospitals responded to the sharp reductions in their endowments caused by the 2008 stock market collapse. We find that the average hospital did not engage in cost-shifting, but average hospitals that likely have substantial market power did cost-shift. Investigating further how hospitals responded to the financial setback, we found no evidence of reductions in treatment costs. However, hospitals with large endowment losses delayed purchases of health information technology and curtailed the offering of unprofitable services.
For-Profit Status & Industry Evolution in Health Care Market: Evidence from the Dialysis Industry by Nathan Wilson :: SSRNMarch 9, 2013
Over the last 25 years, for-profit facilities have supplanted non-profits as the modal providers of hemodialysis treatment to American sufferers of end-stage renal disease. To understand what may underpin this dramatic change in industry structure, this paper uses a dynamic equilibrium model to develop intuition about how variation in different economic primitives might affect the evolution of industry structure. Subsequently, the paper exploits a comprehensive 20 year panel dataset to examine entry, exit, and output patterns in relation to changes in demand and local market structure. Examining the empirical results in light of the model’s comparative statics suggests that for-profit firms enjoy a significant advantage in static competition, perhaps as a result of lower marginal costs. By comparison, I find negligible evidence that for-profit facilities have lower entry costs. Interestingly, the data also suggest that competition among dialysis clinics may be differentiated.