This Article critiques the prevailing justification for subsidies for the charitable sector, and suggests a new alternative. According to contemporary accounts, charity corrects the failure of the private market to provide public goods, and further corrects the failure of government to provide goods other than those demanded by the median voter.However, the claim that government can meet the needs only of a single “median voter” neglects both federalism and public choice theory. Citizens dissatisfied with the services of one government can move to or even create another. Alternatively, they may use the threat of exit to lobby for local change. Subsidies for charity inefficiently distort the operation of these markets for legal rules.Nonetheless, there remains a strong case for subsidizing charity, albeit on grounds new to the literature. Charity serves as gap-filler when federalism mechanisms break down. For example, frictions on exit produce too little jurisdictional competition, and excessively easy exit produces too much competition - a race to the bottom. At the same time, competition from government constrains inefficient charities. Thus, charity and government each perform best as complements to the other.Finally, this Article sketches the normative legal consequences of these claims. Most significantly, I respond to the claims by Malani and Posner that for-profit charity would be superior to current arrangements. That suggestion would fatally weaken competition between charity and government, defeating the only persuasive purpose for charitable subsidies.
{"title":"The Role of Charity in a Federal System","authors":"Brian Galle","doi":"10.2139/ssrn.1473107","DOIUrl":"https://doi.org/10.2139/ssrn.1473107","url":null,"abstract":"This Article critiques the prevailing justification for subsidies for the charitable sector, and suggests a new alternative. According to contemporary accounts, charity corrects the failure of the private market to provide public goods, and further corrects the failure of government to provide goods other than those demanded by the median voter.However, the claim that government can meet the needs only of a single “median voter” neglects both federalism and public choice theory. Citizens dissatisfied with the services of one government can move to or even create another. Alternatively, they may use the threat of exit to lobby for local change. Subsidies for charity inefficiently distort the operation of these markets for legal rules.Nonetheless, there remains a strong case for subsidizing charity, albeit on grounds new to the literature. Charity serves as gap-filler when federalism mechanisms break down. For example, frictions on exit produce too little jurisdictional competition, and excessively easy exit produces too much competition - a race to the bottom. At the same time, competition from government constrains inefficient charities. Thus, charity and government each perform best as complements to the other.Finally, this Article sketches the normative legal consequences of these claims. Most significantly, I respond to the claims by Malani and Posner that for-profit charity would be superior to current arrangements. That suggestion would fatally weaken competition between charity and government, defeating the only persuasive purpose for charitable subsidies.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133111830","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}
An unprecedented number of Europeans are living longer. In the next decade, most 'baby boomers' will retire from the workforce. Meanwhile, the birth rate in Europe continues to fall and, as a result, there will be fewer people to contribute to social security systems, jeopardising the financial support base for our health insurance. Seniority brings new health challenges, often in the form of age-related and/or chronic diseases, requiring long-term medical interventions. European governments are eyeing their pharmaceutical expenditure to cut costs, while expensive brand or originator medicines compound health care bills. Some patients and consumers, particularly those in Eastern Europe, pay out-of-pocket expenses for the medicines they are prescribed. This disparity raises questions about equitable access across the European Union. Because of their integral importance to our health and wellbeing, essential medicines need to be affordable and accessible for all European consumers in spite of cuts to social services and health budgets. This article examines how governments could guarantee access to high quality, safe and effective medicines in the face of Europe's aging population, changing health needs and rising pharmaceutical expenses.
{"title":"Anti-Competitive Strategies Hamper Access to Medicines in Europe","authors":"K. Perehudoff, Sophie Bloemen","doi":"10.37974/alf.165","DOIUrl":"https://doi.org/10.37974/alf.165","url":null,"abstract":"An unprecedented number of Europeans are living longer. In the next decade, most 'baby boomers' will retire from the workforce. Meanwhile, the birth rate in Europe continues to fall and, as a result, there will be fewer people to contribute to social security systems, jeopardising the financial support base for our health insurance. Seniority brings new health challenges, often in the form of age-related and/or chronic diseases, requiring long-term medical interventions. European governments are eyeing their pharmaceutical expenditure to cut costs, while expensive brand or originator medicines compound health care bills. Some patients and consumers, particularly those in Eastern Europe, pay out-of-pocket expenses for the medicines they are prescribed. This disparity raises questions about equitable access across the European Union. Because of their integral importance to our health and wellbeing, essential medicines need to be affordable and accessible for all European consumers in spite of cuts to social services and health budgets. This article examines how governments could guarantee access to high quality, safe and effective medicines in the face of Europe's aging population, changing health needs and rising pharmaceutical expenses.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129187574","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 : 2011-02-01DOI: 10.22329/WYAJ.V29I0.4482
Mona Paré
Recognition of people's right to consent to health care is linked to legal capacity and to respect for physical and mental integrity. Traditionally, children and persons with mental illness have been denied this right and substitute decision-making systems have been used for their protection. Today, respect for rights and freedoms forces courts and legislators to find a balance between autonomy and protection. However, domestic law lacks vision and objectives, often ending up breaching both protection and autonomy rights, or prioritizing one to the detriment of the other. One should turn to the supported decision-making model, which addresses protection concerns while respecting people's integrity and autonomy.
{"title":"Of Minors and the Mentally Ill: Re-Positioning Perspectives on Consent to Health Care","authors":"Mona Paré","doi":"10.22329/WYAJ.V29I0.4482","DOIUrl":"https://doi.org/10.22329/WYAJ.V29I0.4482","url":null,"abstract":"Recognition of people's right to consent to health care is linked to legal capacity and to respect for physical and mental integrity. Traditionally, children and persons with mental illness have been denied this right and substitute decision-making systems have been used for their protection. Today, respect for rights and freedoms forces courts and legislators to find a balance between autonomy and protection. However, domestic law lacks vision and objectives, often ending up breaching both protection and autonomy rights, or prioritizing one to the detriment of the other. One should turn to the supported decision-making model, which addresses protection concerns while respecting people's integrity and autonomy.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114173229","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 study examines the impact of competition on hospital quality. Our panel covers all Dutch hospitals in the period 2004–2008, in which the transparency of hospital quality information increased substantially. The paper contributes to the existing literature by including both outcome and process indicators of quality. We find that competition explains the cross-sectional differences in process indicators, but not in outcome indicators. In particular, more competition in the hospital’s catchment area leads to more operation cancellations at short notice and more delays of hip fracture injury operations for elderly patients. Both results suggest that competition increases the utilization of operation capacity. At the same time, hospitals that face more competition perform check-ups for chronic patients more frequently and organize diagnostic processes more efficiently.
{"title":"The Effect of Competition on Process and Outcome Quality within Hospital Care in the Netherlands","authors":"M. Bijlsma, P. Koning, V. Shestalova","doi":"10.2139/ssrn.1738924","DOIUrl":"https://doi.org/10.2139/ssrn.1738924","url":null,"abstract":"This study examines the impact of competition on hospital quality. Our panel covers all Dutch hospitals in the period 2004–2008, in which the transparency of hospital quality information increased substantially. The paper contributes to the existing literature by including both outcome and process indicators of quality. We find that competition explains the cross-sectional differences in process indicators, but not in outcome indicators. In particular, more competition in the hospital’s catchment area leads to more operation cancellations at short notice and more delays of hip fracture injury operations for elderly patients. Both results suggest that competition increases the utilization of operation capacity. At the same time, hospitals that face more competition perform check-ups for chronic patients more frequently and organize diagnostic processes more efficiently.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130107871","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 Symposium Essay assesses the constitutional challenge to the individual health insurance mandate. The principal argument against the mandate is that Congress is barred from regulating private inaction (or compelling action) under its Commerce Clause authority. Such a "private action" requirement must be judged by comparison to the state action doctrine of the Fourteenth Amendment, which is the only other general limitation on the power of Congress that distinguishes between acts and omissions. Measured against this principle, the attack on the individual mandate is without merit.
{"title":"The Private Action Requirement","authors":"Gerard N. Magliocca","doi":"10.25148/LAWREV.6.1.4","DOIUrl":"https://doi.org/10.25148/LAWREV.6.1.4","url":null,"abstract":"This Symposium Essay assesses the constitutional challenge to the individual health insurance mandate. The principal argument against the mandate is that Congress is barred from regulating private inaction (or compelling action) under its Commerce Clause authority. Such a \"private action\" requirement must be judged by comparison to the state action doctrine of the Fourteenth Amendment, which is the only other general limitation on the power of Congress that distinguishes between acts and omissions. Measured against this principle, the attack on the individual mandate is without merit.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124173935","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}
K. Boozang, C. Coleman, Kate Greenwood, Simone Handler-Hutchinson, C. Finizio
While allowing that transparency should be one of the tools employed to manage clinical researchers' conflicts of interest, this paper disagrees with the numerous recommendations that such information become part of the informed consent process. Empirical research in several areas suggests that the provision of this information to prospective trial participants will too often cause information overload; further, few research participants understand the relevance of the information to them once provided. Because many clinical trial participants do not have viable alternatives to trial participation, the information is not facilitating exit from participation. In short, we conclude that embedding this complicated information will ultimately do more harm than good for most recipients.
{"title":"The Limits of Disclosure as a Response to Financial Conflicts of Interest in Clinical Research","authors":"K. Boozang, C. Coleman, Kate Greenwood, Simone Handler-Hutchinson, C. Finizio","doi":"10.2139/SSRN.1720564","DOIUrl":"https://doi.org/10.2139/SSRN.1720564","url":null,"abstract":"While allowing that transparency should be one of the tools employed to manage clinical researchers' conflicts of interest, this paper disagrees with the numerous recommendations that such information become part of the informed consent process. Empirical research in several areas suggests that the provision of this information to prospective trial participants will too often cause information overload; further, few research participants understand the relevance of the information to them once provided. Because many clinical trial participants do not have viable alternatives to trial participation, the information is not facilitating exit from participation. In short, we conclude that embedding this complicated information will ultimately do more harm than good for most recipients.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127695996","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}
Eric A. Helland, D. Lakdawalla, S. Seabury, A. Malani
Nearly all the empirical literature on tort liability in the healthcare sector focuses on physicians. Yet both drug companies and physicians lose roughly the same portion of revenue (2 percent) to liability expenses.Moreover, the health care system’s expenditures on drugs are rising nearly twice as fast as expenditures on physician and hospital care. In this paper we model and estimate the welfare effects of failure‐to‐warn suits, the most common type of tort litigation involving drug companies. We find that tort liability ‐‐ proxied by punitive damage caps ‐‐ increases drug prices but that it also reduces side effects. Moreover, we find that tort liability increases the equilibrium quantity of drug sales. This suggests that liability not only increases cost and reduces supply, but also increases expected safety and thus demand. Together the increase in equilibrium quantity and reduction in side effects suggests that tort liability improves social welfare.
{"title":"Tort Liability and the Market for Prescription Drugs","authors":"Eric A. Helland, D. Lakdawalla, S. Seabury, A. Malani","doi":"10.2139/ssrn.1641239","DOIUrl":"https://doi.org/10.2139/ssrn.1641239","url":null,"abstract":"Nearly all the empirical literature on tort liability in the healthcare sector focuses on physicians. Yet both drug companies and physicians lose roughly the same portion of revenue (2 percent) to liability expenses.Moreover, the health care system’s expenditures on drugs are rising nearly twice as fast as expenditures on physician and hospital care. In this paper we model and estimate the welfare effects of failure‐to‐warn suits, the most common type of tort litigation involving drug companies. We find that tort liability ‐‐ proxied by punitive damage caps ‐‐ increases drug prices but that it also reduces side effects. Moreover, we find that tort liability increases the equilibrium quantity of drug sales. This suggests that liability not only increases cost and reduces supply, but also increases expected safety and thus demand. Together the increase in equilibrium quantity and reduction in side effects suggests that tort liability improves social welfare.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123404726","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 health insurance coverage trends for youth (age 15-18) and young adults (age 19-29) with work limitations using data from the Current Population Survey. In 2000 those in the young work-limited population were substantially more likely to have insurance coverage than their counterparts in the not work-limited population. They were much more likely to have public coverage and much less likely to have only private coverage. Insurance coverage for this population increased substantially between 1989 and 2000, in contrast to a decline for the not work-limited population. We discuss the probable contributions of policy reforms and the decline in employment of people with work limitations to these trends.
{"title":"Health Insurance Coverage Among Youth and Young Adults with Work Limitations","authors":"Bonnie O'day, D. Stapleton, Ann E. Horvath-Rose","doi":"10.2139/SSRN.984232","DOIUrl":"https://doi.org/10.2139/SSRN.984232","url":null,"abstract":"This paper explores health insurance coverage trends for youth (age 15-18) and young adults (age 19-29) with work limitations using data from the Current Population Survey. In 2000 those in the young work-limited population were substantially more likely to have insurance coverage than their counterparts in the not work-limited population. They were much more likely to have public coverage and much less likely to have only private coverage. Insurance coverage for this population increased substantially between 1989 and 2000, in contrast to a decline for the not work-limited population. We discuss the probable contributions of policy reforms and the decline in employment of people with work limitations to these trends.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115070236","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 continued interest in public insurance expansions as a means of covering the uninsured highlights the importance of estimates of "crowd-out", or the extent to which such expansions reduce private insurance coverage. Ten years ago, Cutler and Gruber (1996) suggested that such crowd-out might be quite large, but much subsequent research has questioned this conclusion. We revisit this issue by using improved data and incorporating the research approaches that have led to varying estimates. We focus in particular on the public insurance expansions of the 1996-2002 period. Our results clearly show that crowd-out is significant; the central tendency in our results is a crowd-out rate of about 60%. This finding emerges most strongly when we consider family-level measures of public insurance eligibility. We also find that recent anti-crowd-out provisions in public expansions may have had the opposite effect, lowering take-up by the uninsured faster than they lower crowd-out of private insurance.
{"title":"Crowd-Out Ten Years Later: Have Recent Public Insurance Expansions Crowded Out Private Health Insurance?","authors":"J. Gruber, K. Simon","doi":"10.3386/w12858","DOIUrl":"https://doi.org/10.3386/w12858","url":null,"abstract":"The continued interest in public insurance expansions as a means of covering the uninsured highlights the importance of estimates of \"crowd-out\", or the extent to which such expansions reduce private insurance coverage. Ten years ago, Cutler and Gruber (1996) suggested that such crowd-out might be quite large, but much subsequent research has questioned this conclusion. We revisit this issue by using improved data and incorporating the research approaches that have led to varying estimates. We focus in particular on the public insurance expansions of the 1996-2002 period. Our results clearly show that crowd-out is significant; the central tendency in our results is a crowd-out rate of about 60%. This finding emerges most strongly when we consider family-level measures of public insurance eligibility. We also find that recent anti-crowd-out provisions in public expansions may have had the opposite effect, lowering take-up by the uninsured faster than they lower crowd-out of private insurance.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127817589","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 study analyses the effects of some selected demographic and socioeconomic predictor variables on likelihood of immunization of a child for six vaccine-preventable diseases covered under UIP. It focuses on immunization coverage a) in all India, b) in rural and urban areas, c) for DPT, Polio, and partial immunization, d) for three groups of states, namely, Empowered Action Group, North-Eastern and other states, and e) for three states, namely, Bihar, Tamilnadu, and West Bengal. The study applies logistic regression model to National Family Health Survey-2 (1998-99) data. Excepting a few cases, the results are consistent across different models. Likelihood increases with residence, mother's education level, mother's exposure to mass media, mother's awareness about immunization, antenatal care during pregnancy, standard of living index of household, electricity, female household-headship, mother's empowerment index, and sex of the child; it decreases with birth-order irrespective of the sex of the child. Religion, caste/tribe and zone of states also have some effects. Further research with both demand- and supply-side issues and current data will be critical for the policy makers to make the immunization programme justly universal.
{"title":"Universal Immunization Programme in India: The Determinants of Childhood Immunization","authors":"Nilanjan Patra","doi":"10.2139/SSRN.881224","DOIUrl":"https://doi.org/10.2139/SSRN.881224","url":null,"abstract":"The study analyses the effects of some selected demographic and socioeconomic predictor variables on likelihood of immunization of a child for six vaccine-preventable diseases covered under UIP. It focuses on immunization coverage a) in all India, b) in rural and urban areas, c) for DPT, Polio, and partial immunization, d) for three groups of states, namely, Empowered Action Group, North-Eastern and other states, and e) for three states, namely, Bihar, Tamilnadu, and West Bengal. The study applies logistic regression model to National Family Health Survey-2 (1998-99) data. Excepting a few cases, the results are consistent across different models. Likelihood increases with residence, mother's education level, mother's exposure to mass media, mother's awareness about immunization, antenatal care during pregnancy, standard of living index of household, electricity, female household-headship, mother's empowerment index, and sex of the child; it decreases with birth-order irrespective of the sex of the child. Religion, caste/tribe and zone of states also have some effects. Further research with both demand- and supply-side issues and current data will be critical for the policy makers to make the immunization programme justly universal.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"124 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116379355","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：