A problem perennially facing scholars of both intellectual property and health law is the need to incentivize appropriately the development of new pharmaceuticals. Although physicians have an arsenal of drugs to treat conditions like high blood pressure or cholesterol, they lack effective treatments for some of the diseases that are most devastating to our healthcare system. For instance, although many mental health disorders may seem to share little in common with the World Health Organization’s list of Neglected Tropical Diseases, each of these areas is dramatically underserved by present pharmaceutical treatments. These gaps in treatment should not be surprising, given the one-size-fits-all structure of patent law and the various exclusivity provisions implemented by the FDA. These two incentive systems have failed to incentivize the development of drugs for diseases with certain features — most notably, those that primarily affect poor populations. Alternative mechanisms can be more narrowly tailored to achieve these goals. One major potential source of incentives has been almost completely absent from the legal literature: prescription drug insurance. This Article examines the ways in which prescription drug insurance might compensate for the innovation distortions created by patent law and FDA regulation. It first explores insurance’s potential theoretically, considering the ways in which it might provide a targeted incentive for innovation. This Article then considers a specific instance of this general principle: prescription drug insurance through Medicaid in the United States. The way in which Medicaid pays for drugs enables needy patients to access existing treatments, but it perversely decreases incentives for innovation into drugs that would primarily be prescribed for low-income Americans — like those for many mental health disorders or Neglected Tropical Diseases. This Article proposes altering Medicaid’s prescription drug rebate system to reward innovators who develop drugs for diseases primarily affecting low-income populations.
{"title":"Prizing Insurance: Prescription Drug Insurance as Innovation Incentive","authors":"R. Sachs","doi":"10.2139/SSRN.2767182","DOIUrl":"https://doi.org/10.2139/SSRN.2767182","url":null,"abstract":"A problem perennially facing scholars of both intellectual property and health law is the need to incentivize appropriately the development of new pharmaceuticals. Although physicians have an arsenal of drugs to treat conditions like high blood pressure or cholesterol, they lack effective treatments for some of the diseases that are most devastating to our healthcare system. For instance, although many mental health disorders may seem to share little in common with the World Health Organization’s list of Neglected Tropical Diseases, each of these areas is dramatically underserved by present pharmaceutical treatments. These gaps in treatment should not be surprising, given the one-size-fits-all structure of patent law and the various exclusivity provisions implemented by the FDA. These two incentive systems have failed to incentivize the development of drugs for diseases with certain features — most notably, those that primarily affect poor populations. Alternative mechanisms can be more narrowly tailored to achieve these goals. One major potential source of incentives has been almost completely absent from the legal literature: prescription drug insurance. This Article examines the ways in which prescription drug insurance might compensate for the innovation distortions created by patent law and FDA regulation. It first explores insurance’s potential theoretically, considering the ways in which it might provide a targeted incentive for innovation. This Article then considers a specific instance of this general principle: prescription drug insurance through Medicaid in the United States. The way in which Medicaid pays for drugs enables needy patients to access existing treatments, but it perversely decreases incentives for innovation into drugs that would primarily be prescribed for low-income Americans — like those for many mental health disorders or Neglected Tropical Diseases. This Article proposes altering Medicaid’s prescription drug rebate system to reward innovators who develop drugs for diseases primarily affecting low-income populations.","PeriodicalId":350526,"journal":{"name":"PRN: Biomedical Ethics (Sub-Topic)","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116807231","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 : 2016-03-21DOI: 10.52131/PJHSS.2016.0401.0016
T. Ahmad, Zeeshan Mustafa, S. Zaidi, Mehwish Naz
A person’s physical and mental well-being or ill-being is an outcome of multi-level (individual, household, neighborhood, local, national, and global) social, economic, environmental and political milieus under which the person is living. The present study is primarily in search of finding the non-income determinants of farmwomen’s health in rural areas of district Bahawalnagar (Punjab-Pakistan). SRH is used to gauge the state of respondents’ health. The study reveals that farmwomen’s health determinants are particular to them and their families. The study concludes that marriages at early age may result in serious health concerns for a farmwoman. More participation in activities relating to livestock management may increase a rural woman’s work burden that may ultimately result in poor health status. The study also reveals that greater the number of pregnancies, higher the chances to have poor health status of that working woman. Living under joint family system, increases a woman’s likelihood to have good health status. Husband’s higher education status is found to be associating with wife’s good health status. Availability of labor-saving home appliances may save efforts and energies of domestic women and are found to be increasing the likelihood to have good health. The study suggests that at household level, a farmwoman’s health concerns could be minimized by lowering her productive and reproductive work burdens. In reducing her burden relating to productive work, the use of labor or effort saving ways of working through the use of technology is imperative. While a woman’s reproductive work burden could be reduced through discouraging early and excessive child bearing. A woman’s level of education and that of her spouse may positively contribute not only for her own health but for the good health of a farm family.
{"title":"Caring the Primary Care-Givers — Determinants of Farmwomen’s Health: A View from Rural Punjab-Pakistan","authors":"T. Ahmad, Zeeshan Mustafa, S. Zaidi, Mehwish Naz","doi":"10.52131/PJHSS.2016.0401.0016","DOIUrl":"https://doi.org/10.52131/PJHSS.2016.0401.0016","url":null,"abstract":"A person’s physical and mental well-being or ill-being is an outcome of multi-level (individual, household, neighborhood, local, national, and global) social, economic, environmental and political milieus under which the person is living. The present study is primarily in search of finding the non-income determinants of farmwomen’s health in rural areas of district Bahawalnagar (Punjab-Pakistan). SRH is used to gauge the state of respondents’ health. The study reveals that farmwomen’s health determinants are particular to them and their families. The study concludes that marriages at early age may result in serious health concerns for a farmwoman. More participation in activities relating to livestock management may increase a rural woman’s work burden that may ultimately result in poor health status. The study also reveals that greater the number of pregnancies, higher the chances to have poor health status of that working woman. Living under joint family system, increases a woman’s likelihood to have good health status. Husband’s higher education status is found to be associating with wife’s good health status. Availability of labor-saving home appliances may save efforts and energies of domestic women and are found to be increasing the likelihood to have good health. The study suggests that at household level, a farmwoman’s health concerns could be minimized by lowering her productive and reproductive work burdens. In reducing her burden relating to productive work, the use of labor or effort saving ways of working through the use of technology is imperative. While a woman’s reproductive work burden could be reduced through discouraging early and excessive child bearing. A woman’s level of education and that of her spouse may positively contribute not only for her own health but for the good health of a farm family.","PeriodicalId":350526,"journal":{"name":"PRN: Biomedical Ethics (Sub-Topic)","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127058974","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}
Elderly people are suffering from various physical, mental, social and economic problems. Hence the study was conducted to assess the health morbidity among the rural elderly persons in Tuticorin town. The present study is based on both primary and secondary data. 300 elderly persons aged 60 years and over were selected for primary data collection by adopting simple random sampling method. Secondary data have been collected from books, journals, newspapers, internet and periodicals. The reference period of survey was 2015. Percentage analysis, averages, F test, chi square test and probability analysis were used. The table indicate that more than half of the elderly represented by a slightly (more number of women than men) reported various physical problems. The problem of skin diseases is common for both men and women. However, it is evident that the male elderly having sugar complaints form 81.33 per cent to the total. It was found that 45.33 per cent of the male elderly in the study area had heart complaints, followed by nervous disorders (33.33 per cent) whereas general weakness and joint pains is found to report mostly by women. Disorders relating to chest like tuberculosis and asthma, nervous disorders and problems relating to urinary tract infection are more common in men. The urinary problems percentage was higher among male elderly (48.00 per cent) than among female elderly (15.33 per cent) respectively, showed no significant difference. This study has highlighted that the elderly suffers from multiple morbidities, which they often attribute to ageing. It requires the strengthening of geriatric health care services in accordance with the common existing problems in the community. The elderly should be encouraged to undergo periodic medical checks at a clinic for routine appraisal of their health status, so as to allow early detection and treatment of their morbidities. These services should be accessible & affordable to them.
{"title":"An Analysis of Health Problems Among the Elderly in Tuticorin Town","authors":"D. Amutha","doi":"10.2139/ssrn.2712391","DOIUrl":"https://doi.org/10.2139/ssrn.2712391","url":null,"abstract":"Elderly people are suffering from various physical, mental, social and economic problems. Hence the study was conducted to assess the health morbidity among the rural elderly persons in Tuticorin town. The present study is based on both primary and secondary data. 300 elderly persons aged 60 years and over were selected for primary data collection by adopting simple random sampling method. Secondary data have been collected from books, journals, newspapers, internet and periodicals. The reference period of survey was 2015. Percentage analysis, averages, F test, chi square test and probability analysis were used. The table indicate that more than half of the elderly represented by a slightly (more number of women than men) reported various physical problems. The problem of skin diseases is common for both men and women. However, it is evident that the male elderly having sugar complaints form 81.33 per cent to the total. It was found that 45.33 per cent of the male elderly in the study area had heart complaints, followed by nervous disorders (33.33 per cent) whereas general weakness and joint pains is found to report mostly by women. Disorders relating to chest like tuberculosis and asthma, nervous disorders and problems relating to urinary tract infection are more common in men. The urinary problems percentage was higher among male elderly (48.00 per cent) than among female elderly (15.33 per cent) respectively, showed no significant difference. This study has highlighted that the elderly suffers from multiple morbidities, which they often attribute to ageing. It requires the strengthening of geriatric health care services in accordance with the common existing problems in the community. The elderly should be encouraged to undergo periodic medical checks at a clinic for routine appraisal of their health status, so as to allow early detection and treatment of their morbidities. These services should be accessible & affordable to them.","PeriodicalId":350526,"journal":{"name":"PRN: Biomedical Ethics (Sub-Topic)","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121798760","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}
I give a brief summary of the institutional details of the U.S. healthcare sector with a special emphasis on healthcare finance. In addition to its large size, U.S. healthcare has four unique features that can be used to help answer corporate finance questions: segmented markets, variation in corporate type, extensive data requirements and recent consolidation. I explain how changes over the last 100 years have led to each of these features. Next, I delve deeper into bargaining between insurance companies and hospitals, Medicare pricing, and hospital capital structure decisions during 2008-2012. Finally, I conclude with a brief discussion on how the Affordable Care Act has contributed to these factors.
{"title":"The Evolution of Healthcare and Corporate Finance","authors":"Mitch Towner","doi":"10.2139/ssrn.2658822","DOIUrl":"https://doi.org/10.2139/ssrn.2658822","url":null,"abstract":"I give a brief summary of the institutional details of the U.S. healthcare sector with a special emphasis on healthcare finance. In addition to its large size, U.S. healthcare has four unique features that can be used to help answer corporate finance questions: segmented markets, variation in corporate type, extensive data requirements and recent consolidation. I explain how changes over the last 100 years have led to each of these features. Next, I delve deeper into bargaining between insurance companies and hospitals, Medicare pricing, and hospital capital structure decisions during 2008-2012. Finally, I conclude with a brief discussion on how the Affordable Care Act has contributed to these factors.","PeriodicalId":350526,"journal":{"name":"PRN: Biomedical Ethics (Sub-Topic)","volume":"232 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134497058","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}
Dominant paradigms of fertility choice either ignore or assume small, unchanging costof fertility limitation. Inspired by the historical English experience that is contrary to suchassumptions,we modify the Beckerian paradigm to incorporate costly, societal influence oncontraception. In the model economy, heterogeneous, generationally-linked householdschoose between "traditional" and "modern" contraception. The modern has a higher fixedcost (reflecting social opprobrium) but a lower variable cost of averting childbirths. Initially,the rich adopt the modern, and in doing so, unleash a social diffusion process. Eventuallyeveryone switches lowering fertility further and across society. What hastens the switch isthe decline in child mortality. The model is broadly consistent with important features ofthe English transition and has implications for more recent transitions.
{"title":"Contraception and the Fertility Transition","authors":"Joydeep Bhattacharya, Shankha Chakraborty","doi":"10.2139/ssrn.2385309","DOIUrl":"https://doi.org/10.2139/ssrn.2385309","url":null,"abstract":"Dominant paradigms of fertility choice either ignore or assume small, unchanging costof fertility limitation. Inspired by the historical English experience that is contrary to suchassumptions,we modify the Beckerian paradigm to incorporate costly, societal influence oncontraception. In the model economy, heterogeneous, generationally-linked householdschoose between \"traditional\" and \"modern\" contraception. The modern has a higher fixedcost (reflecting social opprobrium) but a lower variable cost of averting childbirths. Initially,the rich adopt the modern, and in doing so, unleash a social diffusion process. Eventuallyeveryone switches lowering fertility further and across society. What hastens the switch isthe decline in child mortality. The model is broadly consistent with important features ofthe English transition and has implications for more recent transitions.","PeriodicalId":350526,"journal":{"name":"PRN: Biomedical Ethics (Sub-Topic)","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117144836","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 interests of the patient for medico-legal purposes have variously been depicted as, 'bests interests', best clinical judgment, welfare, and substituted judgement. For the purpose of this essay, the interests of the patient will be used interchangeably with best interests of patients. There are overarching ramifications of best interests not only to the patients but families; health care professionals and society at large and as such merit a little drift into the often overlooked philosophical underpinnings. Bioethics antedates the paradigm shift to autonomy seen in 1990s. For competent adults in most socio-medical situations, the law provides a good guide on how to proceed in decision making arising in the context of patient-doctor relationships. This is irrespective of whether the ethical argument is utilitarian or non utilitarian (Kantian) based.
{"title":"The Interest of the Patient Must Be the Predominant Interest to Be Considered in English Law","authors":"A. Unachukwu","doi":"10.2139/ssrn.1321373","DOIUrl":"https://doi.org/10.2139/ssrn.1321373","url":null,"abstract":"The interests of the patient for medico-legal purposes have variously been depicted as, 'bests interests', best clinical judgment, welfare, and substituted judgement. For the purpose of this essay, the interests of the patient will be used interchangeably with best interests of patients. There are overarching ramifications of best interests not only to the patients but families; health care professionals and society at large and as such merit a little drift into the often overlooked philosophical underpinnings. Bioethics antedates the paradigm shift to autonomy seen in 1990s. For competent adults in most socio-medical situations, the law provides a good guide on how to proceed in decision making arising in the context of patient-doctor relationships. This is irrespective of whether the ethical argument is utilitarian or non utilitarian (Kantian) based.","PeriodicalId":350526,"journal":{"name":"PRN: Biomedical Ethics (Sub-Topic)","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114695756","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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