Showing papers in "Journal of Health Politics Policy and Law in 2010"

Explaining Health Care System Change: Problem Pressure and the Emergence of “Hybrid” Health Care Systems

Abstract: In this article, we will further the explanation of the state's changing role in health care systems belonging to the Organisation for Economic Cooperation and Development (OECD). We build on our analysis of twenty-three OECD countries, which reveals broad trends regarding governments' role in financing, service provision, and regulation. In particular, we identified increasing similarities between the three system types we delineate as National Health Service (NHS), social health insurance, and private health insurance systems. We argue that the specific health care system type is an essential contributor to these changes. We highlight that health care systems tend to feature specific, type-related deficiencies, which cannot be solved by routine mechanisms. As a consequence, non-system-specific elements and innovative policies are implemented, which leads to the emergence of "hybrid" systems and indicates a trend toward convergence, or increasing similarities. We elaborate this hypothesis in two steps. First, we describe system-specific deficits of each health care system type and provide an overview of major adaptive responses to these deficits. The adaptive responses can be considered as non-system-specific interventions that broaden the portfolio of regulatory policies. Second, we examine diagnosis-related groups (DRGs) as a common approach for financing hospitals efficiently, which are nevertheless shaped by type-specific deficiencies and reform requirements. In the United States' private insurance system, DRGs are mainly used as a means of hierarchical cost control, while their implementation in the English NHS system is to increase productivity of hospital services. In the German social health insurance system, DRGs support competition as a means to control self-regulated providers. Thus, DRGs contribute to the hybridization of health care systems because they tend to strengthen coordination mechanisms that were less developed in the existing health care systems.

Programmatic actors and the transformation of European health care States.

Abstract: In France, Germany, Spain, and the United Kingdom, the decades from the late 1980s to the present have witnessed significant change in health policy. Although this has included the spread of internal competition and growing autonomy for certain nonstate and parastate actors, it does not follow that the mechanism at work is a "neoliberal convergence." Rather, the translation into diverse national settings of quasi-market mechanisms is accompanied by a reassertion of regulatory authority and strengthening of statist, as opposed to corporatist, management of national insurance systems. Thus the use of quasi-market tools brings state-strengthening reform. The proximate and necessary cause of this dual transformation is found in the work of small, closely integrated groups of policy professionals, whom we label "programmatic actors." While their identity differs across cases, these actors are strikingly similar in functional role and motivation. Motivated by a desire to wield authority through the promotion of programmatic ideas, rather than by material or careerist interests, these elite groups act both as importers and translators of ideas and as architects of policy. The resulting elite-driven model of policy change integrates ideational and institutionalist elements to explain programmatically coherent change despite institutional resistance and partisan instability.

Playing fair: fairness beliefs and health policy preferences in the United States.

Abstract: Conventional wisdom suggests that the best way to persuade Americans to support changes in health care policy is to appeal to their self-interest - particularly to concerns about their economic and health security. An alternative strategy, framing problems in the health care system to emphasize inequalities, could also, however, mobilize public support for policy change by activating underlying attitudes about the unfairness or injustice of these inequalities. In this article, we draw on original data from a nationally representative survey to describe Americans' beliefs about fairness in the health domain, including their perceptions of the fairness of particular inequalities in health and health care. We then assess the influence of these fairness considerations on opinions about the appropriate role of private actors versus government in providing health insurance. Respondents believe inequalities in access to and quality of health care are more unfair than unequal health outcomes. Even after taking into account self-interest considerations and the other usual suspects driving policy opinions, perceptions of the unfairness of inequalities in health care strongly influence respondents' preferences for government provision of health insurance.

Policy change and health care research.

Abstract: Explaining policy change is one of the most central tasks of contemporary policy analysis. Reacting to overly rigid institutionalist frameworks that emphasize stability rather than change, a growing number of scholars have formulated new theoretical models to shed light on policy change. Focusing on health care reform but drawing on the broader social science literature on policy and politics, this article offers critical perspectives on the institutionalist and ideational literatures on policy change while assessing their relevance for analyzing change in contemporary health care systems. The last section sketches a research agenda for studying policy change in health care.

Inefficiency differences between critical access hospitals and prospectively paid rural hospitals.

Abstract: The Medicare prospective payment system (PPS) contains incentives for hospitals to improve efficiency by placing them at financial risk to earn a positive margin on services rendered to Medicare patients. Concerns about the financial viability of small rural hospitals led to the implementation of the Medicare Rural Hospital Flexibility Program (Flex Program) of 1997, which allows facilities designated as critical access hospitals (CAHs) to be paid on a reasonable cost basis for inpatient and outpatient services. This article compares the cost inefficiency of CAHs with that of nonconverting rural hospitals to contrast the performance of hospitals operating under the different payment systems. Stochastic frontier analysis (SFA) was used to estimate cost inefficiency. Analysis was performed on pooled time-series, cross-sectional data from thirty-four states for the period 1997-2004. Average estimated cost inefficiency was greater in CAHs (15.9 percent) than in nonconverting rural hospitals (10.3 percent). Further, there was a positive association between length of time in the CAH program and estimated cost inefficiency. CAHs exhibited poorer values for a number of proxy measures for efficiency, including expenses per admission and labor productivity (full-time-equivalent employees per outpatient-adjusted admission). Non-CAH rural hospitals had a stronger correlation between cost inefficiency and operating margin than CAH facilities did.

The End of Insurance? Mexico's Seguro Popular, 2001–2007

Abstract: Health system reforms that introduce insurance principles into public health systems (such as national health insurance, internal markets, and separation of purchasers and providers) have been popular in the last two decades. Little is known, however, about the political complexities of transforming existing health services into health insurance systems in developing countries. Mexico's Seguro Popular (Popular Health Insurance) program, introduced in 2003, was an attempt to do exactly this: radically alter the country's existing health service and convert it into health insur- ance. Popular Health Insurance (PHI) has garnered international attention and has been held up as a model for other countries to follow. Yet little has been written about the political process that led to the reform or the difficulties of implementing it. This article fills that lacuna, offering an assessment of the reform context as well as of the process of formulating, adopting, and implementing it. It argues that, while the reform has improved Mexico's public health service, it has thus far failed to transform that health service into a true insurance system. Limited institutional reform has also left PHI severely underfinanced. The Mexican case is a cautionary tale for reformers who want to transform extant health services into health insurance systems.

Community Benefit Activities of Private, Nonprofit Hospitals

Abstract: The definition of hospital community benefits has been intensely debated for many years. Recently, consensus has developed about one group of activities being central to community benefits because of its focus on care for the poor and on needed community services for which any payments received are low relative to costs. Dis-agreements continue, however, about the treatment of bad debt expense and Medicare shortfalls. A recent revision of the Internal Revenue Service’s Form 990 Schedule H, which is required of all nonprofit hospitals, highlights the agreed-on set of activities but does not dismiss the disputed items. Our study is the first to apply definitions used in the new IRS form to assess how conclusions about the adequacy of nonprofit hospi-tal community benefits could be affected if bad debt expenses and Medicare shortfalls are included or excluded. Specifically, we examine 2005 financial data for California and Florida hospitals. Overall, we find that conclusions about community benefit adequacy are very different depending on which definition of community benefits is used. We provide thoughts on new directions for the current policy debate about the treatment of bad debts and Medicare shortfalls in light of these findings.

Federal trade commission regulation of food advertising to children: possibilities for a reinvigorated role.

Abstract: Growing awareness of the role that food and beverage advertising plays in the epidemic of childhood obesity has prompted calls for stricter oversight of adver- tising practices. The food and beverage industries have taken voluntary steps in this direction, but many commentators have called for increased government regulation. The mission of the Federal Trade Commission (FTC) makes it an obvious candidate to lead a new regulatory effort. However, the FTC has a troubled history in the area of children's advertising regulation, and several political and legal factors constrain its ability to act. This article reviews those obstacles as well as the opportunities that exist at present to expand FTC oversight of food advertising to children. The FTC has considerable latitude to regulate individual food advertisements more rigorously, either on the basis that they are deceptive or on the basis that they are unfair. Broader rule making under the unfairness authority would require congressional intervention to expand the FTC's scope of authority, but there exist possibilities for rule making under the deception doctrine. Finally, the FTC could strengthen its efforts to encour- age the food industry to regulate its own advertising practices more stringently and could provide mechanisms for making voluntary initiatives more meaningful.

Do provincial drug benefit initiatives create an effective policy lab? The evidence from Canada.

Abstract: Although the costs of doctors' visits and hospital stays in Canada are covered by national public health insurance, the cost of outpatient prescription drugs is not. To solve problems of access, Canadian provinces have introduced provincial prescription drug benefit programs. This study analyzes the prescription drug policymaking process in five Canadian provinces between 1992 and 2004 with a view to (1) determining the federal government's role in the area of prescription drugs; (2) describing the policymaking process; (3) identifying factors in each province's choice of a policy; (4) identifying patterns in those factors across the five provinces; and (5) assessing the federal government's influence on the policies chosen. Analysis shows that despite significant differences in policy choices, the ideological motivations of the provinces were unexpectedly similar. The findings also highlight the importance of institutional factors, for example, in provinces' decision to compete rather than to collaborate. We conclude that, to date, Canada's federalism laboratory has only partly benefited the Canadian public. Cost pressures may, however, eventually overcome barriers to cooperation between the provincial and the federal governments, enabling them to capitalize on Canada's federal structure to improve the accessibility and affordability of drugs.

Health care reform and federalism.

Abstract: Health policy debates are replete with discussions of federalism, most often when advocates of reform put their hopes in states. But health policy literature is remarkably silent on the question of allocation of authority, rarely asking which levels of government ought to lead. We draw on the larger literatures about federalism, found mostly in political science and law, to develop a set of criteria for allocating health policy authority between states and the federal government. They are social justice, procedural democracy, compatibility with value pluralism, institutional capability, and economic sustainability. Of them, only procedural democracy and compatibility with value pluralism point to state leadership. In examining these criteria, we conclude that American policy debates often get federalism backward, putting the burden of health care coverage policy on states that cannot enact or sustain it, while increasing the federal role in issues where the arguments for state leadership are compelling. We suggest that the federal government should lead present and future financing of health care coverage, since it would require major changes in American intergovernmental relations to make innovative state health care financing sustainable outside a strong federal framework.

The French Health Care System: Liberal Universalism

Abstract: This article analyzes the reforms introduced over the last quarter century into the French health care system. A particular public-private combination, rooted in French history and institutionalized through a specific division of the policy field between private doctors and public hospitals, explains the system's core characteristics: universal access, free choice, high quality, and a weak capacity for regulation. The dual architecture of this unique system leads to different reform strategies and outcomes in its two main parts. While the state has leverage in the hospital sector, it has failed repeatedly in attempts to regulate the ambulatory care sector. The first section of this article sets out the main characteristics and historical landmarks that continue to affect policy framing and implementation. Section 2 focuses on the evolution in financing and access, section 3 on management and governance in the (private) ambulatory care sector, and section 4 on the (mainly public) hospital sector. The conclusion compares the French model with those developed in the comparative literature and sets out the terms of the dilemma: a state-run social health insurance that lacks both the legitimacy of Bismarckian systems and the leverages of state-run systems. The French system therefore pursues contradictory policy goals, simultaneously developing universalism and liberalism, which explains both the direct state intervention and its limits.

Health care system change and the cross-border transfer of ideas: influence of the Dutch model on the 2007 German health reform.

Abstract: To increase understanding of the cross- border transfer of ideas through a case study of the 2007 German health reform, this article draws on Kingdon's approach of streams and follows two main objectives: first, to understand the extent to which the German health reform was actually influenced by the Dutch model and, second, in theoretical terms, to inform inductively on how ideas from abroad enter government agendas. The results show that the streams of problem recognition and policy proposals have not been predominantly influenced by the cross- border trans- fer of ideas from the Netherlands to Germany. The Dutch experience was taken into consideration only after a policy window opened by a shift in politics in the third, the political, stream: the change of government in 2005. In many respects, the way Germany learned from the Netherlands in this case sharply contrasts with an image of solving policy problems by either lesson drawing or transnational deliberation. Instead, the process was dominated by problem solving in the sphere of politics, that is, finding a way to prove the grand coalition was capable of acting.

The Logic of Policy Change: Structure and Agency in Political Life

Abstract: Policy universes are usually characterized by stability, even when stability represents a suboptimal state. Institutions and processes channel and cajole agents along a policy path, restricting the available solution set. Herein, structure is usually to the fore. But what of agency? Do no actors choose? In fact, they do, even in policy environments of incrementalism, even amid hostility. But where agency makes for momentous change is during the punctuations of long policy equilibriums, perfect storms enabling nonincremental movement onto a new policy trajectory, departing from the old path. On both levels, the interaction effects of both structure and agency make a difference--incrementally in the first case, nonincrementally in the second. It's not just one damn thing after another, nor does just anything go.

Images of Illness: How Causal Claims and Racial Associations Influence Public Preferences toward Diabetes Research Spending

Abstract: Despite the salience of health disparities in media and policy discourse, little previous research has investigated if imagery associating an illness with a certain racial group influences public perceptions. This study evaluated the influence of the media's presentation of the causes of type 2 diabetes and its implicit racial associations on attitudes toward people with diabetes and preferences toward research spending. Survey participants who viewed an article on genetic causation or social determinants of diabetes were more likely to support increased government spending on research than those viewing an article with no causal language, while participants viewing an article on behavioral choices were more likely to attribute negative stereotypes to people with diabetes. Participants who viewed a photo of a black woman accompanying the article were less likely to endorse negative stereotypes than those viewing a photo of a white woman, but those who viewed a photo of a glucose-testing device expressed the lowest negative stereotypes. The effect of social determinants language was significantly different for blacks and whites, lowering stereotypes only among blacks. Emphasizing the behavioral causes of diabetes, as is common in media coverage, may perpetuate negative stereotypes. While drawing attention to the social determinants that shape these behaviors could mitigate stereotypes, this strategy is unlikely to influence the public uniformly.

Why institutions are not the only thing that matters: twenty-five years of health care reform in New Zealand.

Abstract: The literature on the causes of health care reform is dominated by institutionalist accounts, and political institutions are among the most prominent factors cited to explain why change takes place. However, institutionalist accounts have difficulty explaining both the timing and the content of reforms. By applying a range of explanatory approaches to a case study of health reform in New Zealand since the 1970s, this article explores some of the theories of reform beyond institutionalism, particularly those that take into account problem pressure, policy ideas, and the more agency-centered factor of partisan ideology. The aim is not to dismiss institutionalism but to try to fill some of the gaps that cannot be addressed with institutionalist theories alone. The detailed analysis shows that various factors played a role in conjunction, namely, problem pressure, policy ideas, and the ideology of parties in government. Partisan ideology, in particular, has perhaps been prematurely ignored by health care scholars.

The New Institutionalist Approaches to Health Care Reform: Lessons from Reform Experiences in Central Europe

Abstract: This article discusses the applicability of the new institutionalism to the politics of health care reform in postcommunist Central Europe. The transition to a market economy and democracy after the fall of communism has apparently strengthened the institutional approaches. The differences in performance of transition economies have been critical to the growing understanding of the importance of institutions that foster democracy, provide security of property rights, help enforce contracts, and stimulate entrepreneurship. From a theoretical perspective, however, applying the new institutionalist approaches has been problematic. The transitional health care reform exposes very well some inherent weaknesses of existing analytic frameworks for explaining the nature and mechanisms of institutional change. The postcommunist era in Central Europe has been marked by spectacular and unprecedented radical changes, in which the capitalist system was rebuilt in a short span of time and the institutions of democracy became consolidated. Broad changes to welfare state programs were instituted as well. However, the actual results of the reform processes represent a mix of change and continuity, which is a challenge for the theories of institutional change.

Pedestrian paths: why path-dependence theory leaves health policy analysis lost in space

Abstract: Path dependence, a model first advanced to explain puzzles in the diffusion of technology, has lately won allegiance among analysts of the politics of public policy, including health care policy. Though the central premise of the model-that past events and decisions shape options for innovation in the present and future-is indisputable (indeed path dependence is, so to speak, too shallow to be false), the approach, at least as applied to health policy, suffers from ambiguities that undercut its claims to illuminate policy projects such as managed care, on which this article focuses. Because path dependence adds little more than marginal value to familiar images of the politics of policy-incrementalism, for one-analysts might do well to put it on the back burner and pursue instead "thick descriptions" that help them to distinguish different degrees of openness to exogenous change among diverse policy arenas. Language: en

Interest-Based Mediation of Medical Malpractice Lawsuits: A Route to Improved Patient Safety?

Abstract: Mediation of medical malpractice lawsuits provides savings for the parties by shortening the litigation process. In theory, information that aids emotional healing and improves patient care can also surface through mediation. The study discussed in this article used structured interviews of participants and mediators in thirty-one mediated malpractice lawsuits involving eleven nonprofit hospitals. The study measured perceptions of the process and mediation's effects on settlement, expenses, apology, satisfaction, and information exchange. Defense lawyers were less likely than plaintiff attorneys to mediate. Both plaintiff and defense attorneys were satisfied with the process, as were plaintiffs, hospital representatives, and insurers. Changes in hospitals' practices or policies to improve patient safety were identified. This study demonstrates that major challenges stand in the way of achieving mediation's full benefits. Absence of physician participation minimizes the chances that mediated discussion of adverse events and medical errors can lead to improved quality of care. Change will require medical leaders, hospital administrators, and malpractice insurers to temper their suspicion of the tort system sufficiently to approach medical errors and adverse events as learning opportunities, and to retain lawyers who embrace mediation as an opportunity to solve problems, show compassion, and improve care.

Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System

Abstract: how medical technology costs are destroying our health, taming the beloved beast how medical technology costs are, taming the beloved beast how medical technology costs are, taming the beloved beast how medical technology costs are, notes taming the beloved beast how medical technology, taming the beloved beast how medical technology costs are, taming the beloved beast how medical technology costs, book review is medical technology the villain issues, taming the beloved beast how medical technology costs, taming the beloved beast how medical technology costs are, taming the beloved beast how medical technology costs are, taming the beloved beast how medical technology costs are, taming the beloved beast how medical technology costs are, taming the beloved beast how medical technology costs are, book review taming the beloved beast ieee spectrum, taming the beloved beast how medical technology costs, the health care cost monitor the hastings center, ebook taming the beloved beast how medical technology, taming the beloved beast audiobook by daniel callahan, taming the beloved beast audiobook daniel callahan, project muse taming the beloved beast, taming thebeloved beasthow medical technology bycallahan, taming the beloved beast how medical technology costs are, taming the beloved beast how medical technology costs are destroying our health care system, taming the beloved beast how medical technology costs are, taming the beloved beast how medical technology costs are, taming the beloved beast how medical technology costs are, taming the beloved beast how medical technology costs are, searchworks, the aim of health care november 6 2009 religion, daniel callahan wikipedia, pdf taming the beloved beast how medical technology costs, taming the beloved beast how medical technology costs, chapter 6 medical necessity taming the beloved beast, ethicist callahan set limits on health care kaiser, taming the beloved beast by daniel callahan overdrive, taming the beloved beast how medical technology costs are, go quietly old people econlib, taming the beloved beast how medical technology costs are, does high tech medicine mean higher health care costs, book review taming the beloved beast ieee spectrum, listen to audiobooks written by daniel callahan audible com, project muse taming the beloved beast, taming the beloved beast how medical technology costs are

Reducing the number of drug plans for seniors: a proposal and analysis of three case studies.

Abstract: The Medicare prescription drug benefit relies on private insurers. In most states, there are nearly fifty competing insurance plans available. The sheer number of choices makes it extremely difficult for Medicare beneficiaries, many of whom must cope with declining cognitive abilities, to choose the best plan for themselves. This article proposes an alternative to the current system, where government acts as a broker to winnow the number of choices so that beneficiaries face a small subset of those judged to be best on several dimensions. The study is based on three case studies where government has acted as such a broker. Two are from health (Medicaid's system of competitive bidding in Arizona, and a Medicare demonstration project on selective contracting for medical equipment and supplies), and one from the pension field (so-called 457 plans). The case studies were used to help evaluate the proposal based on competition, choice, quality, simplicity, and stability. We conclude that the proposal meets most of the positive features embodied in these five evaluation criteria. Consideration of this idea can ultimately result in a Medicare prescription drug benefit that best serves the needs of Medicare beneficiaries.

Comparative Studies and the Politics of Modern Medical Care

Abstract: comparative studies and the politics of modern medical care comparative studies and the politics of modern medical care comparative studies and the politics of modern medical care comparative studies and the politics of modern medical care (filesize 64,14mb) doc book comparative studies and the comparative studies and the politics of modern medical care medicine in china a history of ideas comparative studies marmor, theodore r., freeman, richard, and okma, kieke g nan chingthe classic of difficult issues comparative hmp 625: comparative health policy and management date tbd medicine in china a history of ideas comparative studies joseph white center for policy studies medicine in china a history of pharmaceutics comparative nan chingthe classic of difficult issues comparative psci 5915w health policy and politics in comparative the virtues and vices of singlepayer health care new york university robert f. wagner graduate school of comparative studies and healthcare policy: learning and what do i need to learn today? — the evolution of cme medicine in china a history of ideas comparative studies health care systems in the eu a comparative study mark exworthy publications university of birmingham doctor knows best: physician endorsements, public opinion paths to asian medical knowledge comparative studies of comparative studies and the politics of modern medical care land rover 6 cylinder engine service supplement medieval islamic medicine ibn ridwans treatise on the

Medical licensing board characteristics and physician discipline: an empirical analysis.

Abstract: What factors influence the strictness with which regulations are enforced? Does the level of organizational or budgetary autonomy regulators enjoy affect the degree of enforcement? Does public oversight matter for regulatory enforcement? Or is the level of enforcement driven by the total resources available to regulators? We explore these issues using medical licensing board disciplinary actions against physicians as a case study. Specifically, we take advantage of cross-jurisdictional and inter-temporal variation in the structure of medical licensing boards between 1993 and 2003 to determine the effect that organizational and budgetary independence, public oversight, and resource constraints have on the extent to which medical licensing boards discipline physicians. We find that larger licensing boards and boards that have greater resources at their disposal are more likely to discipline physicians. Medical licensing boards that are more organizationally independent from political influence also discipline physicians more frequently. However, public oversight and greater political control over board budgets do not appear to influence the extent to which medical licensing boards discipline doctors.

Public values, health inequality, and alternative notions of a "fair" response.

Abstract: The fact that disadvantaged people generally die younger and suffer more disease than those with more resources is gaining ground as a major policy concern in the United States. Yet we know little about how public values inform public opinion about policy interventions to address these disparities. This article presents findings from an exploratory study of the public's values and priorities as they relate to social inequalities in health. Forty-three subjects were presented with a scenario depicting health inequalities by social class and were given the opportunity to alter the distribution of health outcomes. Participants' responses fell into one of three distributive preferences: (1) prioritize the disadvantaged, (2) equalize health outcomes between advantaged and disadvantaged groups, and (3) equalize health resources between advantaged and disadvantaged groups. These equality preferences were reflected in participants' responses to a second, more complex scenario in which trade-offs with other health-related values - maximizing health and prioritizing the sickest - were introduced. In most cases, participants moderated their distributive preferences to accommodate these other health goals, particularly to prioritize the allocation of resources to the very sick regardless of their socioeconomic status.

Media Framing and Political Advertising in the Patients' Bill of Rights Debate

Abstract: The purpose of this article is to assess the influence of interest groups over news content. In particular, I explore the possibility that political advertising campaigns affect the tenor and framing of newspaper coverage in health policy debates. To do so, I compare newspaper coverage of the Patients' Bill of Rights debate in 1999 in five states that were subject to extensive advertising campaigns with coverage in five comparison states that were not directly exposed to the advocacy campaigns. I find significant differences in coverage depending on the presence or absence of paid advertising campaigns, and conclude that readers were exposed to different perspectives and arguments about managed care regulation if the newspapers they read were published in states targeted by political advertisements. Specifically, newspaper coverage was 17 percent less likely to be supportive of managed care reform in states subject to advertising campaigns designed to foment opposition to the Patients' Bill of Rights. Understanding the ability of organized interests and political actors to successfully promote their preferred issue frames in a dynamic political environment is particularly important in light of the proliferation of interest groups, the prevalence of multimillion-dollar political advertising campaigns, and the health care reform debate under President Barack Obama.