In India, it was the 1970s which saw rapid growth in the formation of formally registered NGOs and the process continues to this day. Most NGOs have created their respective thematic, social group and geographical priorities such as poverty alleviation, community health, education, housing, human rights, child rights, women’s rights, natural resource management, water and sanitation; and to these ends they put to practice a wide range of strategies and approaches. Primarily, their focus has been on the search for alternatives to development thinking and practice; achieved through participatory research, community capacity building and creation of demonstrable models. When we review some of the work done by NGOs over the past 3 decades, we find that they have contributed greatly to nation building. Many NGOs have worked hard to include children with disability in schools, end caste-based stigma and discrimination, prevent child labour and promote gender equality resulting in women receiving equal wages for the same work compared to men. During natural calamities they have played an active role in relief and rehabilitation efforts, in particular, providing psycho-social care and support to the disaster affected children, women and men. NGOs have been instrumental in the formation and capacity building of farmers and producers’ cooperatives and women’s self-help groups. Recent years have seen a growing capacity of nongovernmental organizations to develop patterns of cooperation among themselves locally, nationally, and internationally, for consultation and exchange of information, or for joint action. In the area of Primary Health Care and Development NGOs can play pivotal roles in the two major developmental approaches as: 1. Integrated Human Development 2. Community Participation This study paper attempts to look at the Non-Government Organisation played and can continue to play in the area of development of primary health care in India with an integrated and combined approach to poverty and health, especially in the context of the Millenium Development Goals to improve the well being of the poor masses.
{"title":"Looking at the Role of the Non-Governmental Organizations in Primary Health Care Field in India to Meet the Millennium Development Goals","authors":"Dr. Gautam Ghosh","doi":"10.2139/ssrn.2316649","DOIUrl":"https://doi.org/10.2139/ssrn.2316649","url":null,"abstract":"In India, it was the 1970s which saw rapid growth in the formation of formally registered NGOs and the process continues to this day. Most NGOs have created their respective thematic, social group and geographical priorities such as poverty alleviation, community health, education, housing, human rights, child rights, women’s rights, natural resource management, water and sanitation; and to these ends they put to practice a wide range of strategies and approaches. Primarily, their focus has been on the search for alternatives to development thinking and practice; achieved through participatory research, community capacity building and creation of demonstrable models. When we review some of the work done by NGOs over the past 3 decades, we find that they have contributed greatly to nation building. Many NGOs have worked hard to include children with disability in schools, end caste-based stigma and discrimination, prevent child labour and promote gender equality resulting in women receiving equal wages for the same work compared to men. During natural calamities they have played an active role in relief and rehabilitation efforts, in particular, providing psycho-social care and support to the disaster affected children, women and men. NGOs have been instrumental in the formation and capacity building of farmers and producers’ cooperatives and women’s self-help groups. Recent years have seen a growing capacity of nongovernmental organizations to develop patterns of cooperation among themselves locally, nationally, and internationally, for consultation and exchange of information, or for joint action. In the area of Primary Health Care and Development NGOs can play pivotal roles in the two major developmental approaches as: 1. Integrated Human Development 2. Community Participation This study paper attempts to look at the Non-Government Organisation played and can continue to play in the area of development of primary health care in India with an integrated and combined approach to poverty and health, especially in the context of the Millenium Development Goals to improve the well being of the poor masses.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"4 9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116826345","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 purpose of this Comment is to illustrate how states are attempting to circumvent the ACA contraceptive mandate through state law; and moreover, if successful, how these laws will likely be deemed unconstitutional due to preemption issues. Further, despite the ACA contraceptive mandate coming under intense scrutiny by religious conservatives and federalists, as a public policy matter, states should cease attempts to legislate around the mandate. Part II of this Comment offers a background on the particulars of the ACA, the contraceptive mandate and its exemptions, and ends with a look at the criticism and state action opposing the mandate. Part III of this Comment analyzes the specific states that are attempting to pass bills that circumvent the mandate and then explores federalist arguments supporting state action. Part III concludes with the notion that these state bills will likely be preempted if passed into law, and further, that as a public policy matter, states should cease opposition of the ACA contraceptive mandate.
{"title":"Circumventing the Affordable Care Act Contraceptive Mandate","authors":"Genna Fasullo","doi":"10.2139/SSRN.2252874","DOIUrl":"https://doi.org/10.2139/SSRN.2252874","url":null,"abstract":"The purpose of this Comment is to illustrate how states are attempting to circumvent the ACA contraceptive mandate through state law; and moreover, if successful, how these laws will likely be deemed unconstitutional due to preemption issues. Further, despite the ACA contraceptive mandate coming under intense scrutiny by religious conservatives and federalists, as a public policy matter, states should cease attempts to legislate around the mandate. Part II of this Comment offers a background on the particulars of the ACA, the contraceptive mandate and its exemptions, and ends with a look at the criticism and state action opposing the mandate. Part III of this Comment analyzes the specific states that are attempting to pass bills that circumvent the mandate and then explores federalist arguments supporting state action. Part III concludes with the notion that these state bills will likely be preempted if passed into law, and further, that as a public policy matter, states should cease opposition of the ACA contraceptive mandate.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133698430","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 : 2013-02-15DOI: 10.1017/CBO9781139814768.008
Everaldo Lamprea
Unwanted outcomes of Colombia’s 1993 health reform produced a marked escalation of health rights litigation, and coincided with deregulation of Colombia’s health sector, in areas such as pharmaceutical pricing and the updating of the basket of health services. The result was considerable financial trauma to the health-sector and a potential curtailment of the right to health of vulnerable sectors of Colombia’s population.This paper explores the unwanted consequences of the “encounter” between the 1993 health overhaul and the escalation of right to health litigation at loggerheads with equity. It concludes that right to health litigation is the “canary in the coalmine” that signals deeper institutional dysfunctions within Colombia’s health system.
{"title":"Colombia's Right-to-Health Litigation in a Context of Health Care Reform","authors":"Everaldo Lamprea","doi":"10.1017/CBO9781139814768.008","DOIUrl":"https://doi.org/10.1017/CBO9781139814768.008","url":null,"abstract":"Unwanted outcomes of Colombia’s 1993 health reform produced a marked escalation of health rights litigation, and coincided with deregulation of Colombia’s health sector, in areas such as pharmaceutical pricing and the updating of the basket of health services. The result was considerable financial trauma to the health-sector and a potential curtailment of the right to health of vulnerable sectors of Colombia’s population.This paper explores the unwanted consequences of the “encounter” between the 1993 health overhaul and the escalation of right to health litigation at loggerheads with equity. It concludes that right to health litigation is the “canary in the coalmine” that signals deeper institutional dysfunctions within Colombia’s health system.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129325331","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}
In 2011, the Institute of Medicine (IOM) released a major report on the nursing profession and its present and potential roles in U.S. health care: The Future of Nursing: Leading Change, Advancing Health. According to the IOM, nurses’ regulatory scope of practice often proves to be narrower than the ideal, socially desirable, or medically prudent scope of practice; and the space between the regulatory standard and the ideal is large enough that it is a substantial health policy problem. To ameliorate the problem the IOM suggests, among other things, that regulatory restrictions on the scope of practice receive attention from the federal antitrust agencies. This paper considers what such antitrust therapy might entail, chiefly by explaining some of what antitrust law and policy have had to say about licensure and scope of practice already. We focus, in particular, on a species of soft antitrust intervention employed by one of the nation’s two competition authorities, the Federal Trade Commission (FTC). Recent years have seen the issuance of a series of competition policy analyses addressing the IOM’s concern about over-strict limits on nurses’ scope of practice. In these, the staffs of the FTC’s Office of Policy Planning, Bureau of Economics, and Bureau of Competition have observed that (1) many geographic areas (or markets) are subject to primary care workforce or manpower shortages, (2) market forces may be slow to clear those shortages for reasons that include, among others, regulatory impediments to competition; (3) such shortages may impinge upon both price and non-price competition between health care service providers; (4) in some places, such shortages may impede patient access to primary care services and may, in the limit, drive the supply of certain services to nil; and (5) certain licensing or scope of practice restrictions on APRNs appear under-rationalized (at best), where they purport to rest upon patient protection concerns that are unsupported either by demonstrated patient harms or empirically grounded assessments of substantial patient risks. Because regulatory restrictions on APRNs’ licensure and scope of practice may come at a substantial competitive cost, FTC staff have recommended that such limits not be more stringent than patient protection requires. In broad strokes, they have asked that state policy makers account for competitive costs when considering scope of practice restrictions, and they have suggested that certain costs should not be imposed on the public absent an evidence-based promise of countervailing consumer protection benefits.The paper synthesizes these various advocacy comments, expands upon their bases in competition law and economics, and describes future research pertinent to the access issues of concern to both the IOM and the FTC.
{"title":"Antitrust and the Future of Nursing: Federal Competiton Policy and the Scope of Practice","authors":"D. Gilman, J. Fairman","doi":"10.2139/SSRN.2207108","DOIUrl":"https://doi.org/10.2139/SSRN.2207108","url":null,"abstract":"In 2011, the Institute of Medicine (IOM) released a major report on the nursing profession and its present and potential roles in U.S. health care: The Future of Nursing: Leading Change, Advancing Health. According to the IOM, nurses’ regulatory scope of practice often proves to be narrower than the ideal, socially desirable, or medically prudent scope of practice; and the space between the regulatory standard and the ideal is large enough that it is a substantial health policy problem. To ameliorate the problem the IOM suggests, among other things, that regulatory restrictions on the scope of practice receive attention from the federal antitrust agencies. This paper considers what such antitrust therapy might entail, chiefly by explaining some of what antitrust law and policy have had to say about licensure and scope of practice already. We focus, in particular, on a species of soft antitrust intervention employed by one of the nation’s two competition authorities, the Federal Trade Commission (FTC). Recent years have seen the issuance of a series of competition policy analyses addressing the IOM’s concern about over-strict limits on nurses’ scope of practice. In these, the staffs of the FTC’s Office of Policy Planning, Bureau of Economics, and Bureau of Competition have observed that (1) many geographic areas (or markets) are subject to primary care workforce or manpower shortages, (2) market forces may be slow to clear those shortages for reasons that include, among others, regulatory impediments to competition; (3) such shortages may impinge upon both price and non-price competition between health care service providers; (4) in some places, such shortages may impede patient access to primary care services and may, in the limit, drive the supply of certain services to nil; and (5) certain licensing or scope of practice restrictions on APRNs appear under-rationalized (at best), where they purport to rest upon patient protection concerns that are unsupported either by demonstrated patient harms or empirically grounded assessments of substantial patient risks. Because regulatory restrictions on APRNs’ licensure and scope of practice may come at a substantial competitive cost, FTC staff have recommended that such limits not be more stringent than patient protection requires. In broad strokes, they have asked that state policy makers account for competitive costs when considering scope of practice restrictions, and they have suggested that certain costs should not be imposed on the public absent an evidence-based promise of countervailing consumer protection benefits.The paper synthesizes these various advocacy comments, expands upon their bases in competition law and economics, and describes future research pertinent to the access issues of concern to both the IOM and the FTC.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115132138","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 Patient Protection and Affordable Care Act (“ACA”), as amended by the Health Care and Education Reconciliation Act of 2010, has made many changes in the Medicare program as part of comprehensive health reform for the US health care sector. This article reviews the changes that ACA is making and will make in the Medicare program in the years to come. Described in detail are the changes to improve the quality and efficiency of Medicare services as well as to improve program integrity and transparency. The article evaluates the current efforts of the Medicare program to reduce Medicare expenditures. The article concludes with an assessment of the potential effectiveness of these reforms to bend the proverbial cost curve and make the Medicare program sustainable over the long term.
{"title":"Affordable Care Act Changes in the Medicare Program: More of the Same but Better","authors":"E. Kinney","doi":"10.2139/SSRN.2170574","DOIUrl":"https://doi.org/10.2139/SSRN.2170574","url":null,"abstract":"The Patient Protection and Affordable Care Act (“ACA”), as amended by the Health Care and Education Reconciliation Act of 2010, has made many changes in the Medicare program as part of comprehensive health reform for the US health care sector. This article reviews the changes that ACA is making and will make in the Medicare program in the years to come. Described in detail are the changes to improve the quality and efficiency of Medicare services as well as to improve program integrity and transparency. The article evaluates the current efforts of the Medicare program to reduce Medicare expenditures. The article concludes with an assessment of the potential effectiveness of these reforms to bend the proverbial cost curve and make the Medicare program sustainable over the long term.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116351722","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}
Many people around the world cannot access essential medicines for diseases like malaria, tuberculosis (TB) and HIV/AIDS. One way of addressing this problem is a Global Health Impact certification system where pharmaceutical companies are rated on the basis of their drugs’ impact on global health. The best companies, in a given year, will then be allowed to use a Global Health Impact label on all of their products – everything from lip balm to food supplements. Highly rated companies will have an incentive to use the label to garner a larger share of the market. If even a small percentage of consumers promote global health by purchasing Global Health Impact products, the incentive to use this label will be substantial. An associated Global Health Impact licensing campaign will also have a big impact. Pharmaceutical companies rely, to a large extent, on university research and development. So, if universities only allow companies that agree to use Global Health Impact practices to benefit from their technology, companies will have an incentive to abide by Global Health Impact standards. The Global Health Impact certification system gives companies a reason to produce medicines that will save millions of lives (like a new malaria or HIV vaccine). This paper presents a model rating system that can provide the basis for Global Health Impact certification. It explores some of the methodological choices underlying the construction of this index and explains how the model can be improved with further research.
{"title":"The Extending Access Index: Promoting Global Health","authors":"Nicole Hassoun","doi":"10.2139/ssrn.2167426","DOIUrl":"https://doi.org/10.2139/ssrn.2167426","url":null,"abstract":"Many people around the world cannot access essential medicines for diseases like malaria, tuberculosis (TB) and HIV/AIDS. One way of addressing this problem is a Global Health Impact certification system where pharmaceutical companies are rated on the basis of their drugs’ impact on global health. The best companies, in a given year, will then be allowed to use a Global Health Impact label on all of their products – everything from lip balm to food supplements. Highly rated companies will have an incentive to use the label to garner a larger share of the market. If even a small percentage of consumers promote global health by purchasing Global Health Impact products, the incentive to use this label will be substantial. An associated Global Health Impact licensing campaign will also have a big impact. Pharmaceutical companies rely, to a large extent, on university research and development. So, if universities only allow companies that agree to use Global Health Impact practices to benefit from their technology, companies will have an incentive to abide by Global Health Impact standards. The Global Health Impact certification system gives companies a reason to produce medicines that will save millions of lives (like a new malaria or HIV vaccine). This paper presents a model rating system that can provide the basis for Global Health Impact certification. It explores some of the methodological choices underlying the construction of this index and explains how the model can be improved with further research.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122442914","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 support from the Robert Wood Johnson Foundation (RWJF), the Urban Institute and Georgetown University's Center on Health Insurance Reforms are undertaking a comprehensive monitoring and tracking project to examine the implementation and effects of the Patient Protection and Affordable Care Act (ACA) of 2010. The project began in May 2011 and will take place over several years. The Urban Institute will document changes to the implementation of national health reform in Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island and Virginia to help states, researchers and policymakers learn from the process as it unfolds. This report is one of a series of papers focusing on particular implementation issues in these case study states. In addition, state-specific reports on case study states can be found on the Robert Wood Johnson Foundation and Health Policy Center websites. The quantitative component of the project is producing analyses of the effects of the ACA on coverage, health expenditures, affordability, access and premiums in the states and nationally. For more information about the Robert Wood Johnson Foundation’s work on coverage, visit their website. This paper describes the status of rate review programs in the 10 states participating in the Robert Wood Johnson Foundation’s monitoring and tracking project. Information is drawn from publicly available sources, state legislation, and site visit interviews in each of the 10 states. We summarize how the 10 case study states have enhanced their rate review authority and processes, increased transparency, and expanded consumer outreach in response to the ACA. Although there has been significant variation, all 10 states took some action to improve their rate review process and ensure that insurers’ proposed rates are justified. To a large extent, the actions taken by these states reflect the diversity of approaches to rate review that exist among states nationwide.
{"title":"Cross-Cutting Issues: Monitoring State Implementation of the Affordable Care Act in 10 States: Rate Review","authors":"S. Corlette, Kevin W Lucia, Katie Keith","doi":"10.2139/SSRN.2160520","DOIUrl":"https://doi.org/10.2139/SSRN.2160520","url":null,"abstract":"With support from the Robert Wood Johnson Foundation (RWJF), the Urban Institute and Georgetown University's Center on Health Insurance Reforms are undertaking a comprehensive monitoring and tracking project to examine the implementation and effects of the Patient Protection and Affordable Care Act (ACA) of 2010. The project began in May 2011 and will take place over several years. The Urban Institute will document changes to the implementation of national health reform in Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island and Virginia to help states, researchers and policymakers learn from the process as it unfolds. This report is one of a series of papers focusing on particular implementation issues in these case study states. In addition, state-specific reports on case study states can be found on the Robert Wood Johnson Foundation and Health Policy Center websites. The quantitative component of the project is producing analyses of the effects of the ACA on coverage, health expenditures, affordability, access and premiums in the states and nationally. For more information about the Robert Wood Johnson Foundation’s work on coverage, visit their website. This paper describes the status of rate review programs in the 10 states participating in the Robert Wood Johnson Foundation’s monitoring and tracking project. Information is drawn from publicly available sources, state legislation, and site visit interviews in each of the 10 states. We summarize how the 10 case study states have enhanced their rate review authority and processes, increased transparency, and expanded consumer outreach in response to the ACA. Although there has been significant variation, all 10 states took some action to improve their rate review process and ensure that insurers’ proposed rates are justified. To a large extent, the actions taken by these states reflect the diversity of approaches to rate review that exist among states nationwide.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"142 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122912477","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 support from the Robert Wood Johnson Foundation (RWJF), the Urban Institute and Georgetown University's Center on Health Insurance Reforms are undertaking a comprehensive monitoring and tracking project to examine the implementation and effects of the Patient Protection and Affordable Care Act of 2010. The project began in May 2011 and will take place over several years. The Urban Institute will document changes to the implementation of national health reform in Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island and Virginia to help states, researchers and policymakers learn from the process as it unfolds. This report is one of a series of papers focusing on particular implementation issues in these case study states. In addition, state-specific reports on case study states can be found at the Robert Wood Johnson Foundation and Health Policy Center websites. The quantitative component of the project is producing analyses of the effects of the ACA on coverage, health expenditures, affordability, access and premiums in the states and nationally. For more information about the Robert Wood Johnson Foundation’s work on coverage, visit their website.This paper describes the implementation of the early market reforms in the 10 states participating in the Robert Wood Johnson Foundation’s monitoring and tracking project. Information is drawn from publicly available sources, state legislation, and site visit interviews in each of the 10 states. Each state took some action to require or encourage insurers to comply with these reforms. Although some challenges were noted, informants in all 10 states reported that insurers are generally complying with the early market reforms; regulators are hearing few consumer concerns, and premiums have not risen substantially because of these reforms. Compliance was largely facilitated through the efforts of state regulators, insurers and consumer advocates. To a large extent, the actions taken by these states reflect the diversity of approaches that exist among states nationwide.
{"title":"Cross-Cutting Issues: Monitoring State Implementation of the Affordable Care Act in 10 States: Early Market Reforms","authors":"Kevin W Lucia, S. Corlette, Katie Keith","doi":"10.2139/SSRN.2160523","DOIUrl":"https://doi.org/10.2139/SSRN.2160523","url":null,"abstract":"With support from the Robert Wood Johnson Foundation (RWJF), the Urban Institute and Georgetown University's Center on Health Insurance Reforms are undertaking a comprehensive monitoring and tracking project to examine the implementation and effects of the Patient Protection and Affordable Care Act of 2010. The project began in May 2011 and will take place over several years. The Urban Institute will document changes to the implementation of national health reform in Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island and Virginia to help states, researchers and policymakers learn from the process as it unfolds. This report is one of a series of papers focusing on particular implementation issues in these case study states. In addition, state-specific reports on case study states can be found at the Robert Wood Johnson Foundation and Health Policy Center websites. The quantitative component of the project is producing analyses of the effects of the ACA on coverage, health expenditures, affordability, access and premiums in the states and nationally. For more information about the Robert Wood Johnson Foundation’s work on coverage, visit their website.This paper describes the implementation of the early market reforms in the 10 states participating in the Robert Wood Johnson Foundation’s monitoring and tracking project. Information is drawn from publicly available sources, state legislation, and site visit interviews in each of the 10 states. Each state took some action to require or encourage insurers to comply with these reforms. Although some challenges were noted, informants in all 10 states reported that insurers are generally complying with the early market reforms; regulators are hearing few consumer concerns, and premiums have not risen substantially because of these reforms. Compliance was largely facilitated through the efforts of state regulators, insurers and consumer advocates. To a large extent, the actions taken by these states reflect the diversity of approaches that exist among states nationwide.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123914568","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}
Significant disparities exist between the availability of physicians and health care specialists in urban and rural areas, particularly in developing countries. Emerging telemedicine technologies would enable doctors located in urban areas and elsewhere around the globe to serve rural patients. However, the limited availability of telecommunications infrastructure and technology necessary for telemedicine in rural areas inhibits the deployment of such health care applications. Satellites' ability to bridge gaps in telecommunications infrastructure gives them a unique capacity to also bridge the urban-rural health care divide by making telemedicine applications available to rural patients and medical professionals worldwide. However, international law provides an expansive grant of national sovereignty over electromagnetic spectrum that supersedes state obligations to provide access to health care. As a result, the physical equipment necessary to provide telemedicine services to rural patients is subject to national regulatory regimes that prevent the widespread and cost-effective availability of life-saving technology.This paper identifies the body of international law governing satellite telemedicine including conventions governing economic, social and cultural rights and the right to health care; and international telecommunications law including the ITU Constitution, Tampere Convention, and the Global Mobile Personal Communication by Satellite Memorandum of Understanding. It then concludes that an additional international undertaking to eliminate national barriers to entry for satellite telemedicine technology is necessary.
{"title":"SATMED: Legal Aspects of the Physical Layer of Satellite-Telemedicine","authors":"Stephen W. Rooke","doi":"10.2139/SSRN.2061392","DOIUrl":"https://doi.org/10.2139/SSRN.2061392","url":null,"abstract":"Significant disparities exist between the availability of physicians and health care specialists in urban and rural areas, particularly in developing countries. Emerging telemedicine technologies would enable doctors located in urban areas and elsewhere around the globe to serve rural patients. However, the limited availability of telecommunications infrastructure and technology necessary for telemedicine in rural areas inhibits the deployment of such health care applications. Satellites' ability to bridge gaps in telecommunications infrastructure gives them a unique capacity to also bridge the urban-rural health care divide by making telemedicine applications available to rural patients and medical professionals worldwide. However, international law provides an expansive grant of national sovereignty over electromagnetic spectrum that supersedes state obligations to provide access to health care. As a result, the physical equipment necessary to provide telemedicine services to rural patients is subject to national regulatory regimes that prevent the widespread and cost-effective availability of life-saving technology.This paper identifies the body of international law governing satellite telemedicine including conventions governing economic, social and cultural rights and the right to health care; and international telecommunications law including the ITU Constitution, Tampere Convention, and the Global Mobile Personal Communication by Satellite Memorandum of Understanding. It then concludes that an additional international undertaking to eliminate national barriers to entry for satellite telemedicine technology is necessary.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133836679","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}
Of the many elements animating structural change under health reform, Accountable Care Organizations (ACOs) have drawn the greatest attention. The ACO strategy entails regulatory interventions that at once aim to reshape the health care delivery system, improve outcomes, promote adoption of evidence based medicine and supportive technology, and create a platform for controlling costs under payment system reform. Ambitious aims to be sure. Implementation, however, has proved a wrenching process. This article looks at the intersection of markets and regulation under the Affordable Care Act. Specifically, it analyzes regulatory interventions under the MSSP designed to foster commercial market competition. Assessing prospects for success, it advances several interrelated arguments. First, in fulfilling the regulatory task of implementing the MSSP, regulators needed to be vigilant to protect against the potential that ACOs may have adverse effects on private markets. It finds that because the Centers for Medicare and Medicaid Services (CMS) was overly preoccupied with Medicare program issues and hyper-sensitive to criticism from powerful hospitals, the agency missed an important opportunity in its implementing regulations to prevent exacerbation of provider market power. Because existing legal regimes, especially antitrust law, are severely constrained in their ability to deal with extant provider market power, regulation of ACOs requires a cross-platform regulatory approach that addresses market issues.
在推动医疗改革下的结构变化的诸多因素中，问责保健组织(ACOs)引起了最大的关注。ACO战略需要监管干预措施，其目的是立即重塑卫生保健提供系统，改善结果，促进采用循证医学和支持性技术，并在支付系统改革下创建控制成本的平台。雄心勃勃的目标是肯定的。然而，事实证明，实施是一个痛苦的过程。本文着眼于《平价医疗法案》(Affordable Care Act)下市场与监管的交集。具体来说，它分析了旨在促进商业市场竞争的MSSP下的监管干预。在评估成功的前景时，它提出了几个相互关联的论点。首先，在履行实施MSSP的监管任务时，监管机构需要保持警惕，防止ACOs可能对私人市场产生不利影响。报告发现，由于医疗保险和医疗补助服务中心(CMS)过于专注于医疗保险计划问题，对来自强大医院的批评过于敏感，该机构在实施法规以防止供应商市场力量加剧方面错过了一个重要机会。由于现有的法律制度，特别是反垄断法，在处理现有供应商市场力量方面受到严重限制，因此对aco的监管需要一种解决市场问题的跨平台监管方法。
{"title":"Regulators as Market-Makers: Accountable Care Organizations and Competition Policy","authors":"T. Greaney","doi":"10.2139/ssrn.2124097","DOIUrl":"https://doi.org/10.2139/ssrn.2124097","url":null,"abstract":"Of the many elements animating structural change under health reform, Accountable Care Organizations (ACOs) have drawn the greatest attention. The ACO strategy entails regulatory interventions that at once aim to reshape the health care delivery system, improve outcomes, promote adoption of evidence based medicine and supportive technology, and create a platform for controlling costs under payment system reform. Ambitious aims to be sure. Implementation, however, has proved a wrenching process. This article looks at the intersection of markets and regulation under the Affordable Care Act. Specifically, it analyzes regulatory interventions under the MSSP designed to foster commercial market competition. Assessing prospects for success, it advances several interrelated arguments. First, in fulfilling the regulatory task of implementing the MSSP, regulators needed to be vigilant to protect against the potential that ACOs may have adverse effects on private markets. It finds that because the Centers for Medicare and Medicaid Services (CMS) was overly preoccupied with Medicare program issues and hyper-sensitive to criticism from powerful hospitals, the agency missed an important opportunity in its implementing regulations to prevent exacerbation of provider market power. Because existing legal regimes, especially antitrust law, are severely constrained in their ability to deal with extant provider market power, regulation of ACOs requires a cross-platform regulatory approach that addresses market issues.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133793712","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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