One woman waiting four months for a knee operation was told by a hospital that her name would drop off the list unless she replied to a letter, while a man had to pay £11,000 for a replacement hip after his doctors repeatedly refused to refer him for treatment. A multiple sclerosis sufferer claimed he had had to wait 18 months just to be added to a waiting list.The examples emerged after The Daily Telegraph disclosed how health service funding bodies are artificially increasing waiting times as they wait for patients to die or go private.
Medical Rationing, Death Panels and the Rising Cost of Health Care: Whittier Law School Health Law Symposium Paper by Edward Larson :: SSRNJuly 29, 2011
This paper, prepared for the 2011 Whittier Law School Health Law Symposium, explores issues raised the partisan debate over charges that the national health-care reform legislation contained “death panels.” Due to these charges, provisions were dropped from the legislation that would have expanded funding under Medicare for end of life consultation. The article argues that these these concerns were made against a backdrop of unsustainable increases in the cost of health care, particularly in the last year of life. The experience of other countries, particularly Britain, with limitations of health care spending and the impact of switching Medicare to a voucher program are also discussed. As a paper intended to introduce this topic for symposium discussion, the article concludes with a call for consideration of the medical, ethical, social, and economic issues raised by end-of-life heath care decisions.
Cross-National Evidence on Generic Pharmaceuticals: Pharmacy vs. Physician-Driven Markets by Patricia Danzon, Michael Furukawa :: SSRNJuly 29, 2011
This paper examines the role of regulation and competition in generic markets. Generics offer large potential savings to payers and consumers of pharmaceuticals. Whether the potential savings are realized depends on the extent of generic entry and uptake and the level of generic prices. In the U.S., the regulatory, legal and incentive structures encourage prompt entry, aggressive price competition and patient switching to generics. Key features are that pharmacists are authorized and incentivized to switch patients to cheap generics. By contrast, in many other high and middle income countries, generics traditionally competed on brand rather than price because physicians rather than pharmacies are the decision-makers. Physician-driven generic markets tend to have higher generic prices and may have lower generic uptake, depending on regulations and incentives. Using IMS data to analyze generic markets in the U.S., Canada, France, Germany, U.K., Italy, Spain, Japan, Australia, Mexico, Chile, Brazil over the period 1998-2009, we estimate a three-equation model for number of generic entrants, generic prices and generic volume shares. We find little effect of originator defense strategies, significant differences between unbranded and unbranded generics, variation across countries in volume response to prices. Policy changes adopted to stimulate generic uptake and reduce generic prices have been successful in some E.U. countries.
‘A Failure to Comply: An Initial Assessment of Gaps in Iom’S Medical Device Study Committee’ by Ralph Hall, Eva Stensvad :: SSRNJuly 29, 2011
The Institute of Medicine (IOM) is increasingly engaged in policy analysis and recommendations including a current project to assess medical devices and the 510(k) process. In addition to internal IOM policies and good practices, any IOM committee commissioned by a federal agency must abide by FACA Sec. 15. This paper examines the issues relating to the composition and processes of the IOM 510(k) committee and concludes that it fails to satisfy FACA Sec. 15. As such FDA is statutorily prohibited from using any report from this committee.
In the run-up to its enactment, the Patient Protection and Affordable Care Act (ACA) elicited howls of protest from opponents who claimed the federal government was, “taking over,” the American healthcare system, “micromanaging,” medicine, and generally exposing the nation to the bête noire of, “socialized medicine.” Hyperbole, misrepresentation and chauvinism aside, these sound bites suffer from a deeper flaw: They mischaracterize the fundamental thrust of the new law. Though the law establishes significant new regulatory authority, this is neither a new development (indeed it can be faulted for preserving pre-existing regulatory regimes) nor does it impair market competition. To the contrary, much of the law aims at improving conditions conducive to effective competition. However, it is far from clear that market competition will work out as scripted by theorists and proponents of the new law. Myriad market imperfections still complicate market interactions and regulation needs to be carefully tailored to assure effective implementation and minimize unintended consequences. Of even greater concern are the problematic market structures that pervade provider and payer markets. Concentration, embedded practices and professional norms may cause markets to operate suboptimally even if reform is implemented smoothly. Further, the ACA’s effectiveness in achieving its goals depends on the executive branch maintaining a steady hand in countless regulatory determinations required under the new law. This article surveys some of the misconceptions about health reform and the challenges it confronts in realizing proponents’ goals.
Unfit for Service: The Implications of Rising Obesity for U.S. Military Recruitment by John Cawley, Johanna Catherine Maclean :: SSRNJuly 28, 2011
This paper contributes to the literature on the labor market consequences of unhealthy behaviors and poor health by examining a previously underappreciated consequence of the rise in obesity in the United States: challenges for military recruitment. Specifically, this paper estimates the percent of the U.S. military-age population that meets, and does not meet, current active duty enlistment standards for weight-for-height and percent body fat for the U.S. Army, using data from the series of National Health and Nutrition Examination Surveys that spans 1959-2008. We calculate that the percentage of military-age adults ineligible for enlistment because they are overweight and overfat doubled for men and tripled for women during that time. We document disparities across race, education, and age in meeting the standards, and finds that a further rise of just 1% in weight and body fat would further reduce eligibility for military service by over 600,000 men and 1 million women of military age. The paper concludes with a discussion of the implications for military recruitment and military policy.
The Impact of Recessionary Politics on Latino-American and Immigrant Families: SCHIP Success and DREAM Act Failure by Mariela Olivares :: SSRNJuly 28, 2011
The current financial crisis affects Americans of all backgrounds. Research shows, however, that the hardest hit families are the same families that struggle to make ends meet even in good times – and many of the most impoverished families in the United States are Black, Latino Americans and immigrants. The U.S. government has responded with only mixed success to meet the needs of these families. As budgets are slashed, the needs of the poor – in particular, the voiceless poor – are often ignored. The resulting policies put additional stress on American families and immigrant families – forcing them to make difficult decisions and sometimes breaking families apart. This essay will examine two government programs that have been targeted in the American recession and comment on how such programs have affected the fabric of Latino and immigrant families living in the United States.
First, this essay will discuss the State Children’s Health Insurance Program and note how Obama’s 2009 reauthorization of the federal program thwarted the years-long efforts to diminish and extinguish this health insurance coverage for children and their families. Second, this essay will consider the demise of the Development, Relief, and Education for Alien Minors (or DREAM) Act, a law that would have provided a path to citizenship for immigrants who were illegally brought to this country as children and succeeded academically and/or through service in the United States military. Through this discussion, this essay will examine how these two federal programs have affected Latino-American and immigrant families in the United States.