L. Willmott, B. White, Rachel Feeney, C. Tilse, Jill Wilson, Joanne F. Aitken
The law regulating medical end-of-life decisions aims to support patients to receive high-quality health care. It does so through ensuring treatment received reflects the person's wishes and values and protecting health professionals who provide adequate pain and symptom relief even if that treatment may coincidentally hasten death. However, good decision-making is predicated by those involved, including patients themselves and those supporting patients, being familiar with the law and the role it plays in the decision-making process. This article reports on a study exploring the role that law plays in end-of-life decision-making from the perspective of terminally-ill patients, their substitute decision-makers and family members. While participants' decision-making practices were often underpinned by a legal framework, the role of the law was largely invisible. Community education is needed for the public to know their legal rights and responsibilities, and to understand that the law plays a role in supporting end-of-life decision-making.
{"title":"Role of Law in End-of-Life Decision-Making: Perspectives of Patients, Substitute Decision-Makers and Families","authors":"L. Willmott, B. White, Rachel Feeney, C. Tilse, Jill Wilson, Joanne F. Aitken","doi":"10.2139/ssrn.3909636","DOIUrl":"https://doi.org/10.2139/ssrn.3909636","url":null,"abstract":"The law regulating medical end-of-life decisions aims to support patients to receive high-quality health care. It does so through ensuring treatment received reflects the person's wishes and values and protecting health professionals who provide adequate pain and symptom relief even if that treatment may coincidentally hasten death. However, good decision-making is predicated by those involved, including patients themselves and those supporting patients, being familiar with the law and the role it plays in the decision-making process. This article reports on a study exploring the role that law plays in end-of-life decision-making from the perspective of terminally-ill patients, their substitute decision-makers and family members. While participants' decision-making practices were often underpinned by a legal framework, the role of the law was largely invisible. Community education is needed for the public to know their legal rights and responsibilities, and to understand that the law plays a role in supporting end-of-life decision-making.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115743496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Certificate-of-need (CON) laws in healthcare are currently found in 36 states and the District of Columbia. These laws require those aspiring to offer certain medical services, acquire certain devices, or open or expand particular medical facilities to first obtain authorization from a regulatory authority. Four decades of research show that CON laws are associated with limited access, diminished quality, and higher costs of care. The most promising CON reform, therefore, is complete repeal, a strategy that has been successfully pursued by 15 states comprising nearly 40 percent of the US population. Complete reform, however, is politically difficult, given the outsized influence of incumbent providers, who have an interest in maintaining the current system. In this policy brief we therefore offer a menu of alternative reforms that can limit the anticompetitive effects of CON laws and illuminate a path toward more comprehensive reform in the future.
{"title":"Phasing Out Certificate-of-Need Laws: A Menu of Options","authors":"M. Mitchell, Elise Amez Droz, A. Parsons","doi":"10.2139/ssrn.3562236","DOIUrl":"https://doi.org/10.2139/ssrn.3562236","url":null,"abstract":"Certificate-of-need (CON) laws in healthcare are currently found in 36 states and the District of Columbia. These laws require those aspiring to offer certain medical services, acquire certain devices, or open or expand particular medical facilities to first obtain authorization from a regulatory authority. Four decades of research show that CON laws are associated with limited access, diminished quality, and higher costs of care. The most promising CON reform, therefore, is complete repeal, a strategy that has been successfully pursued by 15 states comprising nearly 40 percent of the US population. Complete reform, however, is politically difficult, given the outsized influence of incumbent providers, who have an interest in maintaining the current system. In this policy brief we therefore offer a menu of alternative reforms that can limit the anticompetitive effects of CON laws and illuminate a path toward more comprehensive reform in the future.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127665781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Scholars who point to political influences and the regulatory function of patent courts in the U.S. have long questioned the courts’ subjective interpretation of what ‘things’ can be claimed as inventions. The present article sheds light on a different but related facet: the role of the courts in regulating knowledge production. I argue that the recent cases decided by the U.S. Supreme Court and the Federal Circuit, which made diagnostics and software very difficult to patent and which attracted criticism for a wealth of different reasons, are fine case studies of the current debate over the proper role of the state in regulating the marketplace and knowledge production in the emerging information economy. The article explains that these patents are prospect patents that may be used by a monopolist to collect data that everybody else needs in order to compete effectively. As such, they raise familiar concerns about failure of coordination emerging as a result of a monopolist controlling a resource such as datasets that others need and cannot replicate. In effect, the courts regulated the market, primarily focusing on ensuring the free flow of data in the emerging marketplace very much in the spirit of the ‘free the data’ language in various policy initiatives, yet at the same time with an eye to boost downstream innovation. In doing so, these decisions essentially endorse practices of personal information processing which constitute a new type of public domain: a source of raw materials which are there for the taking and which have become most important inputs to commercial activity. From this vantage point of view, the legal interpretation of the private and the shared legitimizes a model of data extraction from individuals, the raw material of information capitalism, that will fuel the next generation of data intensive therapeutics in the field of data driven medicine.
{"title":"Prospect Patents, Data Markets and the Commons in Data Driven Medicine. Openness and the Political Economy of Intellectual Property Rights","authors":"K. Sideri","doi":"10.1093/scipol/scaa011","DOIUrl":"https://doi.org/10.1093/scipol/scaa011","url":null,"abstract":"Scholars who point to political influences and the regulatory function of patent courts in the U.S. have long questioned the courts’ subjective interpretation of what ‘things’ can be claimed as inventions. The present article sheds light on a different but related facet: the role of the courts in regulating knowledge production. I argue that the recent cases decided by the U.S. Supreme Court and the Federal Circuit, which made diagnostics and software very difficult to patent and which attracted criticism for a wealth of different reasons, are fine case studies of the current debate over the proper role of the state in regulating the marketplace and knowledge production in the emerging information economy. The article explains that these patents are prospect patents that may be used by a monopolist to collect data that everybody else needs in order to compete effectively. As such, they raise familiar concerns about failure of coordination emerging as a result of a monopolist controlling a resource such as datasets that others need and cannot replicate. In effect, the courts regulated the market, primarily focusing on ensuring the free flow of data in the emerging marketplace very much in the spirit of the ‘free the data’ language in various policy initiatives, yet at the same time with an eye to boost downstream innovation. In doing so, these decisions essentially endorse practices of personal information processing which constitute a new type of public domain: a source of raw materials which are there for the taking and which have become most important inputs to commercial activity. From this vantage point of view, the legal interpretation of the private and the shared legitimizes a model of data extraction from individuals, the raw material of information capitalism, that will fuel the next generation of data intensive therapeutics in the field of data driven medicine.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125727059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
With the advent of the End of Life Choice Bill 2019, the matter of assisted dying has again come to the forefront of current political debate. This Bill, like past attempts to create an assisted dying framework, lacks a strong underlying value guiding its approach. In 2017, Germany confronted the topic of assisted dying. Unlike New Zealand’s legislature-driven approach, the German situation came about following a judicial challenge to laws which impeded the claimant’s wife’s right to uphold her dignity. This paper argues that the German approach to assisted dying, with its underlying value of dignity, results in a better assisted dying scheme than the New Zealand Bill. This focus on dignity leads to two major benefits which this paper investigates. The first is that it results in a process which legalises only medically assisted suicide and not euthanasia. This distinction, if incorporated into the New Zealand Bill, could result in a safer and more Bill of Rights Act-compliant approach. The second benefit is that having dignity as a cornerstone leads to a principled and non-arbitrary set of eligibility criteria. This paper also examines and recommends a further aspect of the German approach: its prohibition on the commercialisation of assisted dying.
{"title":"Grandma Got Run Over by the Doctor: An Examination of the End of Life Choice Bill with Reference to the German Approach","authors":"M. Noakes","doi":"10.2139/ssrn.3623589","DOIUrl":"https://doi.org/10.2139/ssrn.3623589","url":null,"abstract":"With the advent of the End of Life Choice Bill 2019, the matter of assisted dying has again come to the forefront of current political debate. This Bill, like past attempts to create an assisted dying framework, lacks a strong underlying value guiding its approach. In 2017, Germany confronted the topic of assisted dying. Unlike New Zealand’s legislature-driven approach, the German situation came about following a judicial challenge to laws which impeded the claimant’s wife’s right to uphold her dignity. This paper argues that the German approach to assisted dying, with its underlying value of dignity, results in a better assisted dying scheme than the New Zealand Bill. This focus on dignity leads to two major benefits which this paper investigates. The first is that it results in a process which legalises only medically assisted suicide and not euthanasia. This distinction, if incorporated into the New Zealand Bill, could result in a safer and more Bill of Rights Act-compliant approach. The second benefit is that having dignity as a cornerstone leads to a principled and non-arbitrary set of eligibility criteria. This paper also examines and recommends a further aspect of the German approach: its prohibition on the commercialisation of assisted dying.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131284169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
How do defaults and bankruptcies affect optimal health insurance policy? I answer this question using a life-cycle model of health investment with the option to default on emergency room (ER) bills and financial debts. I calibrate the model for the U.S. economy and compare the optimal health insurance in the baseline economy with that in an economy with no option to default. With no option to default, the optimal health insurance is similar to the health insurance system in the baseline economy. In contrast, with the option to default, the optimal health insurance system (i) expands the eligibility of Medicaid to 22 percent of the working-age population, (ii) replaces 72 percent of employer-based health insurance with a private individual health insurance plus a progressive subsidy, and (iii) reforms the private individual health insurance market by improving coverage rates and preventing price discrimination against people with pre-existing conditions. This result implies that with the option to default, households rely on bankruptcies and defaults on ER bills as implicit health insurance. More redistributive healthcare reforms can improve welfare by reducing the dependence on this implicit health insurance and changing households’ medical spending behavior to be more preventative.
{"title":"Credit, Default, and Optimal Health Insurance","authors":"Youngsoo Jang","doi":"10.2139/ssrn.3429441","DOIUrl":"https://doi.org/10.2139/ssrn.3429441","url":null,"abstract":"How do defaults and bankruptcies affect optimal health insurance policy? I answer this question using a life-cycle model of health investment with the option to default on emergency room (ER) bills and financial debts. I calibrate the model for the U.S. economy and compare the optimal health insurance in the baseline economy with that in an economy with no option to default. With no option to default, the optimal health insurance is similar to the health insurance system in the baseline economy. In contrast, with the option to default, the optimal health insurance system (i) expands the eligibility of Medicaid to 22 percent of the working-age population, (ii) replaces 72 percent of employer-based health insurance with a private individual health insurance plus a progressive subsidy, and (iii) reforms the private individual health insurance market by improving coverage rates and preventing price discrimination against people with pre-existing conditions. This result implies that with the option to default, households rely on bankruptcies and defaults on ER bills as implicit health insurance. More redistributive healthcare reforms can improve welfare by reducing the dependence on this implicit health insurance and changing households’ medical spending behavior to be more preventative.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"299 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130552554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
State governments have been passing laws mandating insurers to allow young adults to stay on their parents' health insurance plans past the age of 19 since the 1970s. These laws were intended to increase coverage, but research has been inconclusive on whether they were successful. We reconsider the issue with an improved approach featuring three key elements: a new, accurate dataset on state mandates; recognition that effects could differ greatly by age due to take up rate differences; and avoidance of endogenous characteristics when identifying mandate eligible young adults. We find the impact of the state mandates was concentrated among the 19 to 22 age group, for which dependent coverage increased sharply by about 6 percentage points. Overall coverage increased by almost 3 percentage points, with the difference explained by crowd out of public insurance. Crowd out of coverage through young adults own jobs was negligible. For those above age 22, we find little evidence of changes in coverage. We incorporate these insights into analysis of the Affordable Care Act (ACA) dependent coverage mandate, showing its effects were focused among those whom were previously ineligible for state mandates, or were eligible but older than 22. We argue the ACA's impact was broader because it had fewer eligibility conditions that implied parental dependence; young adults could be on their parents' insurance but still be relatively independent.
{"title":"A Reevaluation of the Effects of State and Federal Dependent Coverage Mandates on Health Insurance Coverage","authors":"Scott Barkowski, J. McLaughlin, Alex Ray","doi":"10.2139/ssrn.3227212","DOIUrl":"https://doi.org/10.2139/ssrn.3227212","url":null,"abstract":"State governments have been passing laws mandating insurers to allow young adults to stay on their parents' health insurance plans past the age of 19 since the 1970s. These laws were intended to increase coverage, but research has been inconclusive on whether they were successful. We reconsider the issue with an improved approach featuring three key elements: a new, accurate dataset on state mandates; recognition that effects could differ greatly by age due to take up rate differences; and avoidance of endogenous characteristics when identifying mandate eligible young adults. We find the impact of the state mandates was concentrated among the 19 to 22 age group, for which dependent coverage increased sharply by about 6 percentage points. Overall coverage increased by almost 3 percentage points, with the difference explained by crowd out of public insurance. Crowd out of coverage through young adults own jobs was negligible. For those above age 22, we find little evidence of changes in coverage. We incorporate these insights into analysis of the Affordable Care Act (ACA) dependent coverage mandate, showing its effects were focused among those whom were previously ineligible for state mandates, or were eligible but older than 22. We argue the ACA's impact was broader because it had fewer eligibility conditions that implied parental dependence; young adults could be on their parents' insurance but still be relatively independent.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122266578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Reproductive interventions and technologies have the capacity to generate profound societal unease and to provoke hostile reactions underpinned by various moral concerns. This paper shows that this position currently goes relatively unchecked by the European Court of Human Rights, which allows the margin of appreciation and consensus doctrines significantly to limit the scope of reproductive rights under the right to respect for private and family life under Article 8. This occurs both in relation to the interest in avoiding reproduction at stake in abortion, and that in achieving it at stake in medically assisted reproduction. The paper demonstrates significant flaws in the Court's framing and deployment of these doctrines in its reproductive jurisprudence. It argues that, as regards existing and upcoming reproductive interventions and technologies, the Court should attend to the concept of reproductive health, long recognised in international conventions and policy materials.
{"title":"Reproductive Health: Morals, Margins and Rights","authors":"R. Scott","doi":"10.1111/1468-2230.12340","DOIUrl":"https://doi.org/10.1111/1468-2230.12340","url":null,"abstract":"Reproductive interventions and technologies have the capacity to generate profound societal unease and to provoke hostile reactions underpinned by various moral concerns. This paper shows that this position currently goes relatively unchecked by the European Court of Human Rights, which allows the margin of appreciation and consensus doctrines significantly to limit the scope of reproductive rights under the right to respect for private and family life under Article 8. This occurs both in relation to the interest in avoiding reproduction at stake in abortion, and that in achieving it at stake in medically assisted reproduction. The paper demonstrates significant flaws in the Court's framing and deployment of these doctrines in its reproductive jurisprudence. It argues that, as regards existing and upcoming reproductive interventions and technologies, the Court should attend to the concept of reproductive health, long recognised in international conventions and policy materials.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127941906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Last year’s presidential campaign marked one of the most dramatic and unpredictable presidential elections in recent decades. As each party’s campaign became a topic of discussion for families across the country, so did marijuana, with the election marking the first presidential campaign where mainstream candidates openly endorsed ending federal marijuana prohibition. As party candidates battled it out election night — November 8, 2016 — the biggest winner seemed to be marijuana. Nine states voted on marijuana-related measures that night — four related to medical marijuana and five calling for recreational use — eight of them passed. Today, over half of the country has comprehensive medical marijuana laws and one fifth of Americans live somewhere where adults twenty-one and older can legally consume recreational marijuana. The 84th Legislative Session was historic in the movement to regulate marijuana in Texas, with five bills proposed to reduce penalties for possession of marijuana and four additional bills proposed to provide legal access to medical marijuana. Only one bill was signed into law, however, and advocates worry the program may soon prove ineffective. For now, Texans remain among the minority as the largest of nineteen states without legal access to marijuana. In June of 2015, Texas Republican Governor Greg Abbot signed into law the Texas Compassionate-Use Act, allowing for the prescription of low-THC marijuana (“CBD”) to patients with intractable epilepsy. Before signing the bill, Abbot emphasized it would not open the door for broader marijuana legalization, but would “provide healing and hope for children that are afflicted by unrelenting seizures.” Critics, however, warned the bill was “unworkable” as enacted, pointing predominantly to its requirement that doctor’s ‘prescribe’ the CBD treatment its patients, which is federally illegal and unlikely to entice physicians to participate in the program. Since then, administrative rules and proposed amendments to the rules have further complicated the law’s potential. This article identifies the law’s shortcomings and ultimately suggest for Texas legislators reconvene to amend the law’s wording and for rule-makers to revert back to the rules proposed in December of 2015. Part I of this article describes the law’s history and legislative intent. Part II briefly describes the law’s basic structure and purpose. Part III discusses the financial barriers to the laws effectiveness, focusing on unreasonable security standards, market potential, and the burden of passing cost down to critically ill patients. Part IV discusses the criminal barriers to the Act’s effectiveness, focusing on the administrative seed sourcing requirements, the prescription requirement, and the law’s registry program.
{"title":"Smoke and Mirrors: Barriers to Compassionate-Use of Marijuana in Texas","authors":"Cielo Fortin-Camacho","doi":"10.2139/SSRN.2893809","DOIUrl":"https://doi.org/10.2139/SSRN.2893809","url":null,"abstract":"Last year’s presidential campaign marked one of the most dramatic and unpredictable presidential elections in recent decades. As each party’s campaign became a topic of discussion for families across the country, so did marijuana, with the election marking the first presidential campaign where mainstream candidates openly endorsed ending federal marijuana prohibition. As party candidates battled it out election night — November 8, 2016 — the biggest winner seemed to be marijuana. Nine states voted on marijuana-related measures that night — four related to medical marijuana and five calling for recreational use — eight of them passed. Today, over half of the country has comprehensive medical marijuana laws and one fifth of Americans live somewhere where adults twenty-one and older can legally consume recreational marijuana. The 84th Legislative Session was historic in the movement to regulate marijuana in Texas, with five bills proposed to reduce penalties for possession of marijuana and four additional bills proposed to provide legal access to medical marijuana. Only one bill was signed into law, however, and advocates worry the program may soon prove ineffective. For now, Texans remain among the minority as the largest of nineteen states without legal access to marijuana. In June of 2015, Texas Republican Governor Greg Abbot signed into law the Texas Compassionate-Use Act, allowing for the prescription of low-THC marijuana (“CBD”) to patients with intractable epilepsy. Before signing the bill, Abbot emphasized it would not open the door for broader marijuana legalization, but would “provide healing and hope for children that are afflicted by unrelenting seizures.” Critics, however, warned the bill was “unworkable” as enacted, pointing predominantly to its requirement that doctor’s ‘prescribe’ the CBD treatment its patients, which is federally illegal and unlikely to entice physicians to participate in the program. Since then, administrative rules and proposed amendments to the rules have further complicated the law’s potential. This article identifies the law’s shortcomings and ultimately suggest for Texas legislators reconvene to amend the law’s wording and for rule-makers to revert back to the rules proposed in December of 2015. Part I of this article describes the law’s history and legislative intent. Part II briefly describes the law’s basic structure and purpose. Part III discusses the financial barriers to the laws effectiveness, focusing on unreasonable security standards, market potential, and the burden of passing cost down to critically ill patients. Part IV discusses the criminal barriers to the Act’s effectiveness, focusing on the administrative seed sourcing requirements, the prescription requirement, and the law’s registry program.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133813696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The primary goal of the federal dependent coverage mandate was to increase health insurance coverage among young adults, the group with the lowest prevalence of health insurance coverage. To understand the full impacts of the federal dependent coverage mandate, it is important to evaluate how the mandate affects labor market activities and time spent away from work among young adults. Using data from the Consumer Population Survey (CPS) and the American Time Use Survey (ATUS) and implementing a difference-in-differences framework, we find: 1) Young adults substitute employer sponsored insurance for dependent coverage, 2) Affected individuals reduce their work time and switch from full- to part-time employment, and 3) The additional time from reduced labor market activity is reallocated towards more time spent on leisure activities. The effects of the mandate on labor market activities are stronger in later years. Furthermore, we show that young adults do not increase the time they spend on activities that could enhance their human capital such as education and health, which reemphasizes potential unintended consequences of the mandate. These findings suggest that future work is necessary to fully understand the overall welfare effects of the policy.
{"title":"The Effect of Health Insurance Mandate on Labor Market Activity and Time Allocation: Evidence from the Federal Dependent Coverage Provision","authors":"Vinish Shrestha, Otto Lenhart","doi":"10.2139/ssrn.2584093","DOIUrl":"https://doi.org/10.2139/ssrn.2584093","url":null,"abstract":"The primary goal of the federal dependent coverage mandate was to increase health insurance coverage among young adults, the group with the lowest prevalence of health insurance coverage. To understand the full impacts of the federal dependent coverage mandate, it is important to evaluate how the mandate affects labor market activities and time spent away from work among young adults. Using data from the Consumer Population Survey (CPS) and the American Time Use Survey (ATUS) and implementing a difference-in-differences framework, we find: 1) Young adults substitute employer sponsored insurance for dependent coverage, 2) Affected individuals reduce their work time and switch from full- to part-time employment, and 3) The additional time from reduced labor market activity is reallocated towards more time spent on leisure activities. The effects of the mandate on labor market activities are stronger in later years. Furthermore, we show that young adults do not increase the time they spend on activities that could enhance their human capital such as education and health, which reemphasizes potential unintended consequences of the mandate. These findings suggest that future work is necessary to fully understand the overall welfare effects of the policy.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"09 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115074596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The determination of moral views has been frequently reduced to the effects of religiosity, although the effect of human values was acknowledged. This paper attempts to answer the question whether traditional religiosity is still the major regulator of moral attitudes and whether non-religious values have an independent impact. This is studied using attitudes toward euthanasia as a representative case of moral attitudes, since it is still widely discussed. At first, four hypotheses regarding the justifiability of euthanasia are reformulated regarding traditional religiosity, the values of autonomy, their interactions and effects of vulnerability. The multilevel analysis of the data from the 5th wave of World Values Survey showed that across 35 countries both traditional religiosity and human values have significant and independent impacts on the recognition of the right to euthanasia. Multilevel path analysis demonstrated that the effect of religiosity is partially mediated by the both values of autonomy and conservative ones. In addition, as a result of the low level of general public awareness of the topic, different kinds of capital have an inconsistent impact. We conclude with a discussion of the competing and additive roles of religiosity and the values of autonomy as modern regulators of public moral attitudes
{"title":"Public Support for the Right to Euthanasia: The Competing Roles of Values and Religiosity Across 35 Nations","authors":"M. Rudnev, Alexandra Savelkaeva","doi":"10.2139/ssrn.2757670","DOIUrl":"https://doi.org/10.2139/ssrn.2757670","url":null,"abstract":"The determination of moral views has been frequently reduced to the effects of religiosity, although the effect of human values was acknowledged. This paper attempts to answer the question whether traditional religiosity is still the major regulator of moral attitudes and whether non-religious values have an independent impact. This is studied using attitudes toward euthanasia as a representative case of moral attitudes, since it is still widely discussed. At first, four hypotheses regarding the justifiability of euthanasia are reformulated regarding traditional religiosity, the values of autonomy, their interactions and effects of vulnerability. The multilevel analysis of the data from the 5th wave of World Values Survey showed that across 35 countries both traditional religiosity and human values have significant and independent impacts on the recognition of the right to euthanasia. Multilevel path analysis demonstrated that the effect of religiosity is partially mediated by the both values of autonomy and conservative ones. In addition, as a result of the low level of general public awareness of the topic, different kinds of capital have an inconsistent impact. We conclude with a discussion of the competing and additive roles of religiosity and the values of autonomy as modern regulators of public moral attitudes","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134594458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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