Health is a fundamental human right indispensable for the exercise of other human rights. The Article 25 of the Universal Declaration of Human Rights, 1948 mentioned health as part of the right to an adequate standard of living. The International Covenants, Treaties relating to human rights and the Constitutions of various nations recognize that a number of elements would be encompassed by the right to health from prevention to cure to access to drugs. However, health trends indicate that despite progress made in the last 35 years, millions of the people in the developing countries do not have access to the medicines which are required for treating diseases. One of the significant reasons for the lack of access of essential medicines required for needed treatment is the high prices fixed for those drugs. Strong intellectual property protection keeps prices inflated up to one hundred times the cost of manufacture of drugs. Monopolies are created by patents and they restrict competition in pharmaceutical market and permit patentee to set up high prices. It clearly indicates that the linkage between intellectual property rights and health has been the focus of much debate. Much initiative has been taken by World Intellectual Property Organization, World Trade Organization (WHO) and World Health Organization (WTO) through Trade-Related Aspects of Intellectual Property Rights Agreements (TRIPS), Doha Declaration and then the 30 August 2003 Compulsory License Import Export mechanism for providing safeguards to remedy the patent abuse, giving primacy to the public health over private intellectual property and also clarifying the WTO members States’ rights for using TRIPS safeguards. However, such measures failed to resolve the terrific issue ensuring production and export of generic medicines to developing countries that were incapable to produce them and also certain concepts remained un-clarified demanding clear guidelines to be issued in this respect at the international level for removing various types of controversies which still arise between developed and developing member States. Moreover, the intellectual property rules in TRIPS have been observed to be considerably less stringent than the rules developing countries are increasingly adopting in free-trade agreements known as "TRIPS-plus" agreements with the United States and other Western Governments which put greater restrictions on the use of TRIPS flexibilities like, compulsory licensing and parallel imports making it much more difficult for generic drugs to enter the market upon patent expiration and then extend patent periods beyond twenty years. Consequently, the developing countries that attempt to bring the price of the medicines down have to come under pressure from the industrialized countries and multi-national pharmaceutical industry for implementing patent legislation that goes beyond the obligations of TRIPS. However, in India Glivec case is remarkable because the judgment has a p
{"title":"Intellectual Property Rights Vis-A Vis Right to Health: A Critique","authors":"A. Chadha","doi":"10.2139/ssrn.2529105","DOIUrl":"https://doi.org/10.2139/ssrn.2529105","url":null,"abstract":"Health is a fundamental human right indispensable for the exercise of other human rights. The Article 25 of the Universal Declaration of Human Rights, 1948 mentioned health as part of the right to an adequate standard of living. The International Covenants, Treaties relating to human rights and the Constitutions of various nations recognize that a number of elements would be encompassed by the right to health from prevention to cure to access to drugs. However, health trends indicate that despite progress made in the last 35 years, millions of the people in the developing countries do not have access to the medicines which are required for treating diseases. One of the significant reasons for the lack of access of essential medicines required for needed treatment is the high prices fixed for those drugs. Strong intellectual property protection keeps prices inflated up to one hundred times the cost of manufacture of drugs. Monopolies are created by patents and they restrict competition in pharmaceutical market and permit patentee to set up high prices. It clearly indicates that the linkage between intellectual property rights and health has been the focus of much debate. Much initiative has been taken by World Intellectual Property Organization, World Trade Organization (WHO) and World Health Organization (WTO) through Trade-Related Aspects of Intellectual Property Rights Agreements (TRIPS), Doha Declaration and then the 30 August 2003 Compulsory License Import Export mechanism for providing safeguards to remedy the patent abuse, giving primacy to the public health over private intellectual property and also clarifying the WTO members States’ rights for using TRIPS safeguards. However, such measures failed to resolve the terrific issue ensuring production and export of generic medicines to developing countries that were incapable to produce them and also certain concepts remained un-clarified demanding clear guidelines to be issued in this respect at the international level for removing various types of controversies which still arise between developed and developing member States. Moreover, the intellectual property rules in TRIPS have been observed to be considerably less stringent than the rules developing countries are increasingly adopting in free-trade agreements known as \"TRIPS-plus\" agreements with the United States and other Western Governments which put greater restrictions on the use of TRIPS flexibilities like, compulsory licensing and parallel imports making it much more difficult for generic drugs to enter the market upon patent expiration and then extend patent periods beyond twenty years. Consequently, the developing countries that attempt to bring the price of the medicines down have to come under pressure from the industrialized countries and multi-national pharmaceutical industry for implementing patent legislation that goes beyond the obligations of TRIPS. However, in India Glivec case is remarkable because the judgment has a p","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129417001","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 law exerts a significant influence on the quality, accessibility, and affordability of long-term care (LTC) services that are, or that at some future time may be, needed by older Americans. The interaction between the legal system and the various participants involved in the provision and receipt of LTC - consumers, family members, providers, payers, regulators, and advocates - is complex and multi-faceted. This chapter, written for a textbook on long-term care, attempts to outline some of the most salient aspects of this interaction so as to equip the reader both to more fully and accurately appreciate the roles of the law and lawyers in shaping the long-term care environment and to evaluate the actual impact of the legal system on those whom it seeks to benefit, empower, oversee, or punish. Specific topics covered include: the sources and functions of legal authority; specific forms of legal regulation pertaining to long-term care; legal implications of consumer driven home- and community-based LTC; and behavioral manifestations of the regulatory environment.
{"title":"Long-Term Care and the Law","authors":"M. Kapp","doi":"10.2139/SSRN.2477857","DOIUrl":"https://doi.org/10.2139/SSRN.2477857","url":null,"abstract":"The law exerts a significant influence on the quality, accessibility, and affordability of long-term care (LTC) services that are, or that at some future time may be, needed by older Americans. The interaction between the legal system and the various participants involved in the provision and receipt of LTC - consumers, family members, providers, payers, regulators, and advocates - is complex and multi-faceted. This chapter, written for a textbook on long-term care, attempts to outline some of the most salient aspects of this interaction so as to equip the reader both to more fully and accurately appreciate the roles of the law and lawyers in shaping the long-term care environment and to evaluate the actual impact of the legal system on those whom it seeks to benefit, empower, oversee, or punish. Specific topics covered include: the sources and functions of legal authority; specific forms of legal regulation pertaining to long-term care; legal implications of consumer driven home- and community-based LTC; and behavioral manifestations of the regulatory environment.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134272512","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}
Discussions surrounding patient engagement and empowerment often use the terms "patient" and "consumer" interchangeably. But do the two terms hold the same meaning, or is a "patient" a passive actor in the health care arena and a "consumer" an informed, rational decision-maker? Has there been a shift in our usage of the two terms that aligns with the increasing commercialization of health care in the U.S. or has the patient/consumer dynamic always been a part of the buying and selling of health care in the American system? A quick scan of the literature produces discussions of the issue in the popular press by authors such as Paul Krugman and Leana Wen, and in social media forums such as TEDMED, but no direct analyses in the academic literature of the ethical, legal, and policy ramifications of this possible shift in terminology. This paper will analyze our usage of the terms and any recent changes in the dynamic as well as discuss the ethical, legal, and policy implications of this simple terminology for the physician-patient relationship.
{"title":"The Patient as Consumer: Empowerment or Commodification?","authors":"M. Goldstein, Daniel Bowers","doi":"10.2139/ssrn.2441786","DOIUrl":"https://doi.org/10.2139/ssrn.2441786","url":null,"abstract":"Discussions surrounding patient engagement and empowerment often use the terms \"patient\" and \"consumer\" interchangeably. But do the two terms hold the same meaning, or is a \"patient\" a passive actor in the health care arena and a \"consumer\" an informed, rational decision-maker? Has there been a shift in our usage of the two terms that aligns with the increasing commercialization of health care in the U.S. or has the patient/consumer dynamic always been a part of the buying and selling of health care in the American system? A quick scan of the literature produces discussions of the issue in the popular press by authors such as Paul Krugman and Leana Wen, and in social media forums such as TEDMED, but no direct analyses in the academic literature of the ethical, legal, and policy ramifications of this possible shift in terminology. This paper will analyze our usage of the terms and any recent changes in the dynamic as well as discuss the ethical, legal, and policy implications of this simple terminology for the physician-patient relationship.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121290289","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}
Disruption theory tells us that certain innovations can undermine existing products, firms, or even entire industries. Classic examples include the Kodak camera, the Bell telephone, and the Ford Model T. Modern examples abound. The market entrant’s innovation ultimately displaces industry incumbents. Regulators, too, are challenged by such disruptive innovations. The new product, technology, or business practice may fall within an agency’s jurisdiction but not square well with the agency’s existing regulatory framework. Call this “regulatory disruption.”Most scholars intuit that regulators should be cautious rather than firm in such situations. Tim Wu, in Agency Threats, argues that agencies confronting disruptive innovations should avoid traditional rulemaking and adjudication, and instead rely on “threats” packaged in guidance documents, warning letters, and the like. Threats, he argues, are less burdensome, more flexible, and avoid regulation that is miscalibrated or premature. However, this Article argues that a flexible initial posture based primarily on “threats” can calcify, creating weak defaults that lead to suboptimal regulation in the long term. Regulatory inertia can be hard to break without an external shock, usually a tragedy or some other massive failure that reignites interest in regulation. As a case study, this Article shows how the FDA’s approach to a disruptive technology (computerized medical devices) twenty-five years ago fits the threat framework strikingly well, and how it failed. The FDA’s threats became stale and counterproductive — during a profound computer revolution, no less. This Article counterposes the FDA’s approach to software with the FCC’s approach to the Internet, which initially relied on threats, but later codified them via binding regulations and enforcement shortly thereafter.This Article argues that agencies need not be so tentative with innovations. If agencies are concerned about regulating prematurely or in error, then they can experiment with timing rules, alternative enforcement mechanisms, and other variations on traditional interventions. If agencies do choose to proceed by making threats, then they should use them as a short-term precursor to more decisive, legally binding action, as the FCC did, and avoid relying on them as a long-term crutch, as the FDA did.
{"title":"Regulating Disruptive Innovation","authors":"Nathan Cortez","doi":"10.2139/ssrn.2436065","DOIUrl":"https://doi.org/10.2139/ssrn.2436065","url":null,"abstract":"Disruption theory tells us that certain innovations can undermine existing products, firms, or even entire industries. Classic examples include the Kodak camera, the Bell telephone, and the Ford Model T. Modern examples abound. The market entrant’s innovation ultimately displaces industry incumbents. Regulators, too, are challenged by such disruptive innovations. The new product, technology, or business practice may fall within an agency’s jurisdiction but not square well with the agency’s existing regulatory framework. Call this “regulatory disruption.”Most scholars intuit that regulators should be cautious rather than firm in such situations. Tim Wu, in Agency Threats, argues that agencies confronting disruptive innovations should avoid traditional rulemaking and adjudication, and instead rely on “threats” packaged in guidance documents, warning letters, and the like. Threats, he argues, are less burdensome, more flexible, and avoid regulation that is miscalibrated or premature. However, this Article argues that a flexible initial posture based primarily on “threats” can calcify, creating weak defaults that lead to suboptimal regulation in the long term. Regulatory inertia can be hard to break without an external shock, usually a tragedy or some other massive failure that reignites interest in regulation. As a case study, this Article shows how the FDA’s approach to a disruptive technology (computerized medical devices) twenty-five years ago fits the threat framework strikingly well, and how it failed. The FDA’s threats became stale and counterproductive — during a profound computer revolution, no less. This Article counterposes the FDA’s approach to software with the FCC’s approach to the Internet, which initially relied on threats, but later codified them via binding regulations and enforcement shortly thereafter.This Article argues that agencies need not be so tentative with innovations. If agencies are concerned about regulating prematurely or in error, then they can experiment with timing rules, alternative enforcement mechanisms, and other variations on traditional interventions. If agencies do choose to proceed by making threats, then they should use them as a short-term precursor to more decisive, legally binding action, as the FCC did, and avoid relying on them as a long-term crutch, as the FDA did.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131239368","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 controversial HHS Mandate, which requires non-exempt employers to include preventive services, including contraceptives and abortifacients, in the healthcare plans provided for their employees, has led to numerous lawsuits by both for-profit and non-profit corporations and organizations. These groups contend that the law is in violation of both the First Amendment's Free Exercise Clause and the Religious Freedom Restoration Act, because compliance with it causes them to violate their religious beliefs. This Note analyzes the constitutionality of the Mandate in the context of the individualized governmental assessment exception, an exception to the Supreme Court's "neutral, generally applicable" rule set forth in Employment Division v. Smith. Part I of this Note explores the state of free exercise jurisprudence prior to Smith, followed by an examination of the Court's decision in Smith, as well as the background of the individualized governmental assessment exception. Part II examines several circuit court decisions representing both the broad and narrow interpretations of the exception. Part III analyzes the interpretations discussed in Part II, particularly in the context of the HHS Mandate, and concludes that while a court analyzing the Mandate under the narrow approach to the individualized governmental assessment exception would not find a violation of the First Amendment's Free Exercise Clause, a court analyzing the Mandate under the broad approach most likely would.
{"title":"May I Be Excused? Smith's Individualized Governmental Assessment Exception and the HHS Mandate","authors":"Mary E. McMahon","doi":"10.2139/SSRN.2403950","DOIUrl":"https://doi.org/10.2139/SSRN.2403950","url":null,"abstract":"The controversial HHS Mandate, which requires non-exempt employers to include preventive services, including contraceptives and abortifacients, in the healthcare plans provided for their employees, has led to numerous lawsuits by both for-profit and non-profit corporations and organizations. These groups contend that the law is in violation of both the First Amendment's Free Exercise Clause and the Religious Freedom Restoration Act, because compliance with it causes them to violate their religious beliefs. This Note analyzes the constitutionality of the Mandate in the context of the individualized governmental assessment exception, an exception to the Supreme Court's \"neutral, generally applicable\" rule set forth in Employment Division v. Smith. Part I of this Note explores the state of free exercise jurisprudence prior to Smith, followed by an examination of the Court's decision in Smith, as well as the background of the individualized governmental assessment exception. Part II examines several circuit court decisions representing both the broad and narrow interpretations of the exception. Part III analyzes the interpretations discussed in Part II, particularly in the context of the HHS Mandate, and concludes that while a court analyzing the Mandate under the narrow approach to the individualized governmental assessment exception would not find a violation of the First Amendment's Free Exercise Clause, a court analyzing the Mandate under the broad approach most likely would.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131096115","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 collateral source rule plays a vital role in both the healthcare financing and legal systems in the United States. While for many years the rule has been under fire from various tort reform advocates, and has taken some severe hits over that time, it remains as important today as it was when first developed over one-hundred and fifty years ago. Long understood as a rule of evidentiary consequence, modern legal scholars seem to have lost track of both the origins and of the real value of the rule and, as such, application has been constricted unnecessarily. While the costs of both the American tort and healthcare structures are undeniably high, abrogating the collateral source rule is neither the best nor the most plausible way to lower those costs.Made necessary by the unique multi-payer cost sharing nature of healthcare financing in the United States, the collateral source rule serves a number of vital roles in supporting the way in which medical providers spread the costs of caring for the uninsured and underinsured. As such, the rule remains vital to balancing medical costs and to ensuring a viable healthcare provider market. Furthermore, in individual cases, the equities of most situations depend on application of the collateral source rule to properly balance competing interests.Warnings about the evils of double recovery from the defendant’s bar are overdramatic and grossly misrepresent the actual facts as viewed from the broader vantage point of sound public policy. In Part I of this paper I review the origin and application of the collateral source rule in California including a brief discussion of the impact of the Howell case. In Part II I discuss the nature of the fragmented healthcare financing system in the United States today. In Part III I argue for a continued application of the collateral source rule, including to the negotiated rate differential, in personal injury cases in California.
{"title":"The Vital Role of the Collateral Source Rule in United States Healthcare Financing","authors":"C. Blaylock","doi":"10.2139/SSRN.2369404","DOIUrl":"https://doi.org/10.2139/SSRN.2369404","url":null,"abstract":"The collateral source rule plays a vital role in both the healthcare financing and legal systems in the United States. While for many years the rule has been under fire from various tort reform advocates, and has taken some severe hits over that time, it remains as important today as it was when first developed over one-hundred and fifty years ago. Long understood as a rule of evidentiary consequence, modern legal scholars seem to have lost track of both the origins and of the real value of the rule and, as such, application has been constricted unnecessarily. While the costs of both the American tort and healthcare structures are undeniably high, abrogating the collateral source rule is neither the best nor the most plausible way to lower those costs.Made necessary by the unique multi-payer cost sharing nature of healthcare financing in the United States, the collateral source rule serves a number of vital roles in supporting the way in which medical providers spread the costs of caring for the uninsured and underinsured. As such, the rule remains vital to balancing medical costs and to ensuring a viable healthcare provider market. Furthermore, in individual cases, the equities of most situations depend on application of the collateral source rule to properly balance competing interests.Warnings about the evils of double recovery from the defendant’s bar are overdramatic and grossly misrepresent the actual facts as viewed from the broader vantage point of sound public policy. In Part I of this paper I review the origin and application of the collateral source rule in California including a brief discussion of the impact of the Howell case. In Part II I discuss the nature of the fragmented healthcare financing system in the United States today. In Part III I argue for a continued application of the collateral source rule, including to the negotiated rate differential, in personal injury cases in California.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"17 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117319226","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}
Moral hazard and adverse selection create inefficiencies in private health insurance markets. The authors use claims data from a large firm to study the independent roles of both moral hazard and adverse selection. Previous studies have attempted to estimate moral hazard in private health insurance by assuming that individuals respond only to the spot price, end-of-year price, average price, or a related metric. There is little economic justification for such assumptions and, in fact, economic intuition suggests that the nonlinear budget constraints generated by health insurance plans make these assumptions especially poor. They study the differential impact of the health insurance plans offered by the firm on the entire distribution of medical expenditures without parameterizing the plans by a specific metric. They use a new instrumental variable quantile estimation technique introduced in Powell [2013b] that provides the quantile treatment effects for each plan, while conditioning on a set of covariates for identification purposes. This technique allows us to map the resulting estimated medical expenditure distributions to the nonlinear budget sets generated by each plan. Their method also allows them to separate moral hazard from adverse selection and estimate their relative importance. They estimate that 77% of the additional medical spending observed in the most generous plan in their data relative to the least generous is due to adverse selection. The remainder can be attributed to moral hazard. A policy which resulted in each person enrolling in the least generous plan would cause the annual premium of that plan to rise by over $1,500.
{"title":"Moral Hazard and Adverse Selection in Private Health Insurance","authors":"David Powell, D. Goldman","doi":"10.2139/ssrn.2411219","DOIUrl":"https://doi.org/10.2139/ssrn.2411219","url":null,"abstract":"Moral hazard and adverse selection create inefficiencies in private health insurance markets. The authors use claims data from a large firm to study the independent roles of both moral hazard and adverse selection. Previous studies have attempted to estimate moral hazard in private health insurance by assuming that individuals respond only to the spot price, end-of-year price, average price, or a related metric. There is little economic justification for such assumptions and, in fact, economic intuition suggests that the nonlinear budget constraints generated by health insurance plans make these assumptions especially poor. They study the differential impact of the health insurance plans offered by the firm on the entire distribution of medical expenditures without parameterizing the plans by a specific metric. They use a new instrumental variable quantile estimation technique introduced in Powell [2013b] that provides the quantile treatment effects for each plan, while conditioning on a set of covariates for identification purposes. This technique allows us to map the resulting estimated medical expenditure distributions to the nonlinear budget sets generated by each plan. Their method also allows them to separate moral hazard from adverse selection and estimate their relative importance. They estimate that 77% of the additional medical spending observed in the most generous plan in their data relative to the least generous is due to adverse selection. The remainder can be attributed to moral hazard. A policy which resulted in each person enrolling in the least generous plan would cause the annual premium of that plan to rise by over $1,500.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121330730","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}
Our paper documents the large labor market wedges created by taxes, subsidies, and regulations included in the Affordable Care Act. The law changes terms of trade in both goods and factor markets for firms offering health insurance coverage. We use a multi-sector (intra-national) trade model to predict and quantify consequences of the Affordable Care Act for the patterns of output, labor usage, and employee compensation. We find that the law will significantly redistribute from high-wage workers to low-wage workers and to non-workers, reduce total factor productivity about one percent, reduce per-capita labor hours about three percent (especially among low-skill workers), reduce output per capita about two percent, and reduce employment less for sectors that ultimately pay employer penalties.
{"title":"Wedges, Wages, and Productivity Under the Affordable Care Act","authors":"C. Mulligan, Trevor S. Gallen","doi":"10.3386/W19771","DOIUrl":"https://doi.org/10.3386/W19771","url":null,"abstract":"Our paper documents the large labor market wedges created by taxes, subsidies, and regulations included in the Affordable Care Act. The law changes terms of trade in both goods and factor markets for firms offering health insurance coverage. We use a multi-sector (intra-national) trade model to predict and quantify consequences of the Affordable Care Act for the patterns of output, labor usage, and employee compensation. We find that the law will significantly redistribute from high-wage workers to low-wage workers and to non-workers, reduce total factor productivity about one percent, reduce per-capita labor hours about three percent (especially among low-skill workers), reduce output per capita about two percent, and reduce employment less for sectors that ultimately pay employer penalties.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127031615","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}
Pub Date : 2013-10-16DOI: 10.11575/SPPP.V6I0.42445
J. Emery, Ronald Kneebone
There is a widespread impression among Canadians that their health-care system is universal, comprehensive and equitable. Given this impression, Canadians may be surprised to discover that, for instance, while annual physicals and receiving advice on dealing with cold symptoms are covered by the public plan, the costs of rehabilitation from a brain injury or stroke are not fully covered. While universal, the public plan is not comprehensive nor, arguably, is it equitable. The Canada Health Act (CHA) uses the term “medically necessary” to define medical procedures and treatments to be paid for by the publicly-funded medicare system. In Canada’s health-care system, the term has come to refer almost exclusively to those services provided by a physician, or provided within a hospital setting, by a physician or other staff. Services that a reasonable person might consider “necessary,” but are provided outside those settings, are typically not covered. In many ways the federally-legislated Canada Health Act has been culturally enshrined as a consecrated icon of national identity. But the legislation fails to clearly identify the line between necessary and unnecessary medical services. This has put provincial governments — who are responsible for medical-funding decisions — in the difficult position of having to make this decision, and they have resorted to drawing that line in sometimes surprising places. The line drawn between “necessary” and “unnecessary” medical treatments has been determined by the financial self-interest of medical stakeholders, by hospitals rationing global budgets, and by financially-constrained provincial governments. The result is a relatively narrow definition of medical necessity that undermines the equality goals the CHA is often claimed to uphold. Health care is arguably the most important public-expenditure program in Canada. It is important for Canadians to understand clearly what services and levels of care this program provides so that they can prepare for, and possibly insure against, outcomes that are not covered. We do not argue it is easy to make this demarcation between what is and what is not covered by medicare. We do argue, however, that it is necessary to establish this line and to draw attention to its position.
{"title":"The Challenge of Defining Medicare Coverage in Canada","authors":"J. Emery, Ronald Kneebone","doi":"10.11575/SPPP.V6I0.42445","DOIUrl":"https://doi.org/10.11575/SPPP.V6I0.42445","url":null,"abstract":"There is a widespread impression among Canadians that their health-care system is universal, comprehensive and equitable. Given this impression, Canadians may be surprised to discover that, for instance, while annual physicals and receiving advice on dealing with cold symptoms are covered by the public plan, the costs of rehabilitation from a brain injury or stroke are not fully covered. While universal, the public plan is not comprehensive nor, arguably, is it equitable. The Canada Health Act (CHA) uses the term “medically necessary” to define medical procedures and treatments to be paid for by the publicly-funded medicare system. In Canada’s health-care system, the term has come to refer almost exclusively to those services provided by a physician, or provided within a hospital setting, by a physician or other staff. Services that a reasonable person might consider “necessary,” but are provided outside those settings, are typically not covered. In many ways the federally-legislated Canada Health Act has been culturally enshrined as a consecrated icon of national identity. But the legislation fails to clearly identify the line between necessary and unnecessary medical services. This has put provincial governments — who are responsible for medical-funding decisions — in the difficult position of having to make this decision, and they have resorted to drawing that line in sometimes surprising places. The line drawn between “necessary” and “unnecessary” medical treatments has been determined by the financial self-interest of medical stakeholders, by hospitals rationing global budgets, and by financially-constrained provincial governments. The result is a relatively narrow definition of medical necessity that undermines the equality goals the CHA is often claimed to uphold. Health care is arguably the most important public-expenditure program in Canada. It is important for Canadians to understand clearly what services and levels of care this program provides so that they can prepare for, and possibly insure against, outcomes that are not covered. We do not argue it is easy to make this demarcation between what is and what is not covered by medicare. We do argue, however, that it is necessary to establish this line and to draw attention to its position.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130056169","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}
This paper explores the changing role of government involvement in health care financing policy outside the United States. It provides a review of the economics literature in this area to understand the implications of recent policy changes on efficiency, costs and quality. Our review reveals that there has been some convergence in policies adopted across countries to improve financing incentives and encourage efficient use of health services. In the case of risk pooling, all countries with competing pools experience similar difficulties with selection and are adopting more sophisticated forms of risk adjustment. In the case of hospital competition, the key drivers of success appear to be what is competed on and measurable rather than whether the system is public or private. In the case of both the success of performance-related pay for providers and issues resulting from wait times, evidence differs both within and across jurisdictions. However, the evidence does suggest that some governments have effectively reduced wait times when they have chosen explicitly to focus on achieving this goal. Many countries are exploring new ways of generating revenues for health care to enable them to cope with significant cost growth. However, there is little evidence to suggest that collection mechanisms alone are effective in managing the cost or quality of care.
{"title":"The Changing Role of Government in Financing Health Care: An International Perspective","authors":"M. Stabile, S. Thomson","doi":"10.1257/JEL.52.2.480","DOIUrl":"https://doi.org/10.1257/JEL.52.2.480","url":null,"abstract":"This paper explores the changing role of government involvement in health care financing policy outside the United States. It provides a review of the economics literature in this area to understand the implications of recent policy changes on efficiency, costs and quality. Our review reveals that there has been some convergence in policies adopted across countries to improve financing incentives and encourage efficient use of health services. In the case of risk pooling, all countries with competing pools experience similar difficulties with selection and are adopting more sophisticated forms of risk adjustment. In the case of hospital competition, the key drivers of success appear to be what is competed on and measurable rather than whether the system is public or private. In the case of both the success of performance-related pay for providers and issues resulting from wait times, evidence differs both within and across jurisdictions. However, the evidence does suggest that some governments have effectively reduced wait times when they have chosen explicitly to focus on achieving this goal. Many countries are exploring new ways of generating revenues for health care to enable them to cope with significant cost growth. However, there is little evidence to suggest that collection mechanisms alone are effective in managing the cost or quality of care.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121085533","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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