Historically medical profession is regarded as noble, ancient and learned; hence those that practice the profession cut a respectable presence and are well received. Medicine straddles both science and art. Its science is inexact and the creativity of its art is still evolving. Like any other profession, errors of judgment do occur but unlike most other professions such judgment could lead to enormous human suffering and even fatality. The law of negligence do apply to medicine but the interpretation of such negligence and causation of damages could often be complex and complicated. In adjudicating cases in medicine, the historical backdrop of medicine, its influential role in societies and sometimes the covert views held by juries and latterly by judges that the profession should not be driven into a defensive medicine tilt the balance in favour of defendant. This paper will review the paradigm shift in clinical negligence and the reluctance by judges to abandon Bolam due to deferential attitude towards medical opinion. It will also address in detail the Bolam principle, Bolitho and post Bolitho era with reference to standards of care and causation.
{"title":"Clinical Negligence: Is Bolam Still Relevant?","authors":"I. Unachukwu, A. Unachukwu","doi":"10.2139/ssrn.1333165","DOIUrl":"https://doi.org/10.2139/ssrn.1333165","url":null,"abstract":"Historically medical profession is regarded as noble, ancient and learned; hence those that practice the profession cut a respectable presence and are well received. Medicine straddles both science and art. Its science is inexact and the creativity of its art is still evolving. Like any other profession, errors of judgment do occur but unlike most other professions such judgment could lead to enormous human suffering and even fatality. The law of negligence do apply to medicine but the interpretation of such negligence and causation of damages could often be complex and complicated. In adjudicating cases in medicine, the historical backdrop of medicine, its influential role in societies and sometimes the covert views held by juries and latterly by judges that the profession should not be driven into a defensive medicine tilt the balance in favour of defendant. This paper will review the paradigm shift in clinical negligence and the reluctance by judges to abandon Bolam due to deferential attitude towards medical opinion. It will also address in detail the Bolam principle, Bolitho and post Bolitho era with reference to standards of care and causation.","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77638011","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 provides a discussion of the Commission's July 2008 proposal for a Directive on the application of patients' rights in cross-border healthcare (the proposed patient mobility Directive). It does so against the background of an overview of the preceding patient mobility case law of the European Court of Justice that is based on the freedom to provide services of Article 49 EC, from Kohll and Decker in 1998 to Watts in 2006. The findings are that the proposed patient mobility Directive is not a full codification of the case law as it leaves out certain guarantees developed by the Court, while it adds some new elements of harmonisation. The Court had in principle accepted public interest justifications for prior authorisation requirements with respect to hospital treatment and focused on developing substantive and procedural guarantees of patients' rights such as the criteria for "undue delay", in which case authorization for treatment abroad must be granted. The Commission takes a different approach, by both requiring Member States to actually demonstrate the need for a prior authorization regime and at the same time itself providing evidence that this is in most cases unlikely to be warranted. Because the criteria for "undue delay" would no longer be used to determine when authorizations must be granted there will be no clear EU standard to apply if any authorisation requirements survive. The main innovation of the proposal are new patients' rights to accountability and transparency which apply not just to mobile patients but to all patients in each Member State. This represents a first step from negative integration (liberalisation) to positive integration (harmonisation). Moreover transparency and accountability will generate pressure for further change, not just in relation to the cross-border provision of services, but more broadly across the healthcare sector.
{"title":"The Proposed Patient Mobility Directive and the Reform of Cross-Border Healthcare in the EU","authors":"W. Sauter","doi":"10.2139/ssrn.1277110","DOIUrl":"https://doi.org/10.2139/ssrn.1277110","url":null,"abstract":"This paper provides a discussion of the Commission's July 2008 proposal for a Directive on the application of patients' rights in cross-border healthcare (the proposed patient mobility Directive). It does so against the background of an overview of the preceding patient mobility case law of the European Court of Justice that is based on the freedom to provide services of Article 49 EC, from Kohll and Decker in 1998 to Watts in 2006. The findings are that the proposed patient mobility Directive is not a full codification of the case law as it leaves out certain guarantees developed by the Court, while it adds some new elements of harmonisation. The Court had in principle accepted public interest justifications for prior authorisation requirements with respect to hospital treatment and focused on developing substantive and procedural guarantees of patients' rights such as the criteria for \"undue delay\", in which case authorization for treatment abroad must be granted. The Commission takes a different approach, by both requiring Member States to actually demonstrate the need for a prior authorization regime and at the same time itself providing evidence that this is in most cases unlikely to be warranted. Because the criteria for \"undue delay\" would no longer be used to determine when authorizations must be granted there will be no clear EU standard to apply if any authorisation requirements survive. The main innovation of the proposal are new patients' rights to accountability and transparency which apply not just to mobile patients but to all patients in each Member State. This represents a first step from negative integration (liberalisation) to positive integration (harmonisation). Moreover transparency and accountability will generate pressure for further change, not just in relation to the cross-border provision of services, but more broadly across the healthcare sector.","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77080391","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}
Abstract The objective of the paper is to estimate the effects of immigration on natives’ probability of having private coverage and being uninsured. To examine whether immigrants affected employers’ decisions to offer health benefits the study estimates immigration effects on natives’ probability of being offered, eligible for, and a policy-holder of health insurance. Although in many cases the effects are statistically significant, most effects are very small. The increase in immigrant labor supply from 1995 to 2005 increases natives’ uninsurance rates by about 0.7 percentage points and reduces the natives’ probability of being offered and a holder of coverage by 0.8 and 1.9 percentage points, respectively. Immigrants’ weaker preferences for coverage relative to natives’ may be the key factor in this result.
{"title":"Effects of Immigration on Health Insurance Status of Natives","authors":"Yuriy Pylypchuk","doi":"10.2139/ssrn.1250302","DOIUrl":"https://doi.org/10.2139/ssrn.1250302","url":null,"abstract":"Abstract The objective of the paper is to estimate the effects of immigration on natives’ probability of having private coverage and being uninsured. To examine whether immigrants affected employers’ decisions to offer health benefits the study estimates immigration effects on natives’ probability of being offered, eligible for, and a policy-holder of health insurance. Although in many cases the effects are statistically significant, most effects are very small. The increase in immigrant labor supply from 1995 to 2005 increases natives’ uninsurance rates by about 0.7 percentage points and reduces the natives’ probability of being offered and a holder of coverage by 0.8 and 1.9 percentage points, respectively. Immigrants’ weaker preferences for coverage relative to natives’ may be the key factor in this result.","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89398053","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}
Between 1970 and 1992 growth in spending on health care services in the U.S. outpaced total consumption growth by 3.5 percent per year, and the share of spending devoted to health services doubled from 7.3 percent to 14.6 percent. Since 1992 the growth rate of spending on health care services has averaged only 0.5 percentage points faster than growth in total consumption, and thus the share devoted to health services rose much more modestly, to 15.6 percent as of 2006. This break in trend cost growth can be traced directly back to quantities and relative prices of factor inputs. Between 1970 and 1992 the share of the labor force working in health services and the relative earnings of health workers both rose dramatically, causing total health spending to surge. After 1992, the share of the labor force working in health services grew more slowly while the relative price of labor in health services stabilized at the new higher level.
{"title":"Will the Slowdown in U.S. Health Cost Growth Continue? A Factor Market Perspective","authors":"J. Sabelhaus","doi":"10.2139/ssrn.1105033","DOIUrl":"https://doi.org/10.2139/ssrn.1105033","url":null,"abstract":"Between 1970 and 1992 growth in spending on health care services in the U.S. outpaced total consumption growth by 3.5 percent per year, and the share of spending devoted to health services doubled from 7.3 percent to 14.6 percent. Since 1992 the growth rate of spending on health care services has averaged only 0.5 percentage points faster than growth in total consumption, and thus the share devoted to health services rose much more modestly, to 15.6 percent as of 2006. This break in trend cost growth can be traced directly back to quantities and relative prices of factor inputs. Between 1970 and 1992 the share of the labor force working in health services and the relative earnings of health workers both rose dramatically, causing total health spending to surge. After 1992, the share of the labor force working in health services grew more slowly while the relative price of labor in health services stabilized at the new higher level.","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86630956","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}
We offer evidence of gender selection within the United States. Analysis of comprehensive birth data shows unusually high boy-birth percentages after 1980 among later children (most notably third and fourth children) born to Chinese and Asian Indian mothers. Based upon linked data from California, Asian Indian mothers are found to be significantly more likely to have a terminated pregnancy and to give birth to a boy when they have previously only given birth to girls. The observed boy-birth percentages are consistent with over 2,000 "missing" Chinese and Indian girls in the United States between 1991 and 2004. (JEL J11, J16)
{"title":"Are There Missing Girls in the United States? Evidence from Birth Data","authors":"Jason Abrevaya","doi":"10.2139/ssrn.824266","DOIUrl":"https://doi.org/10.2139/ssrn.824266","url":null,"abstract":"We offer evidence of gender selection within the United States. Analysis of comprehensive birth data shows unusually high boy-birth percentages after 1980 among later children (most notably third and fourth children) born to Chinese and Asian Indian mothers. Based upon linked data from California, Asian Indian mothers are found to be significantly more likely to have a terminated pregnancy and to give birth to a boy when they have previously only given birth to girls. The observed boy-birth percentages are consistent with over 2,000 \"missing\" Chinese and Indian girls in the United States between 1991 and 2004. (JEL J11, J16)","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79932192","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 report offers the first comprehensive analysis of FDA approvable actions. During 1998 through 2005, 87 NME drug-product NDAs (NME-NDAs) received at least one approvable action by CDER prior to final approval. The proportion of NME-NDAs receiving at least one approvable action increased from 1998 through 2002 then abruptly fell in 2003 and remained at the lower relative level through 2005. Compared with CDER-approved products never receiving an approvable letter during first NDA review, NDAs issued an approvable letter were associated with longer mean time to first FDA review action: 10.1 versus 8.07 months and with longer mean total review time: 23.1 versus 9.02 months. Compared with CDER-approved products never receiving an approvable letter during first NDA review, drug programs receiving an approvable letter were significantly less likely to have been granted priority review or to have been designated as fast-track. CDER review division was the only analyzed variable independently predicting whether an NME-NDA was ultimately approved following an approvable action. NME-NDAs requiring a new clinical trial following the first review cycle were associated with prolongation of total review time. A total of 19 therapeutic recombinant protein BLAs were issued the CBER-equivalent of an approvable letter prior to approval. There was a strong correlation between the number of review cycles and total review time (R = 0.72). Compared with CBER-approved therapeutic programs not receiving an approvable letter during first BLA review, programs deemed approvable were significantly more likely to have been granted orphan-drug status. Approvable BLAs were associated with significantly longer mean time to first FDA review action: 8.97 versus 7.05 months and with significantly longer mean total review time: 21.3 versus 7.05 months. Issues delaying BLA approvals were qualitatively similar to those delaying NDA approvals. The strategic and tactical implications of these findings are discussed.
{"title":"FDA's Approvable and Related NDA/BLA Actions","authors":"F. Cohen","doi":"10.2139/SSRN.1105509","DOIUrl":"https://doi.org/10.2139/SSRN.1105509","url":null,"abstract":"This report offers the first comprehensive analysis of FDA approvable actions. During 1998 through 2005, 87 NME drug-product NDAs (NME-NDAs) received at least one approvable action by CDER prior to final approval. The proportion of NME-NDAs receiving at least one approvable action increased from 1998 through 2002 then abruptly fell in 2003 and remained at the lower relative level through 2005. Compared with CDER-approved products never receiving an approvable letter during first NDA review, NDAs issued an approvable letter were associated with longer mean time to first FDA review action: 10.1 versus 8.07 months and with longer mean total review time: 23.1 versus 9.02 months. Compared with CDER-approved products never receiving an approvable letter during first NDA review, drug programs receiving an approvable letter were significantly less likely to have been granted priority review or to have been designated as fast-track. CDER review division was the only analyzed variable independently predicting whether an NME-NDA was ultimately approved following an approvable action. NME-NDAs requiring a new clinical trial following the first review cycle were associated with prolongation of total review time. A total of 19 therapeutic recombinant protein BLAs were issued the CBER-equivalent of an approvable letter prior to approval. There was a strong correlation between the number of review cycles and total review time (R = 0.72). Compared with CBER-approved therapeutic programs not receiving an approvable letter during first BLA review, programs deemed approvable were significantly more likely to have been granted orphan-drug status. Approvable BLAs were associated with significantly longer mean time to first FDA review action: 8.97 versus 7.05 months and with significantly longer mean total review time: 21.3 versus 7.05 months. Issues delaying BLA approvals were qualitatively similar to those delaying NDA approvals. The strategic and tactical implications of these findings are discussed.","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72491577","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 recently-enacted Japanese long-term care (LTC) system was implemented to reduce so-called social hospitalization or warehousing of the elderly in expensive medical facilities. This paper seeks to evaluate recent patterns in Japanese LTC use and examine the factors associated with LTC utilization patterns. We show that the demand for LTC in Japan - particularly home care - is growing rapidly, as elderly consumers find subsidized LTC care preferable to and more available than hospitalization. At the same time, regional disparities in care persist and are likely to grow.
{"title":"Developments in Long-Term Care Insurance in Japan","authors":"O. Mitchell, J. Piggott, Satoshi Shimizutani","doi":"10.2139/ssrn.1115186","DOIUrl":"https://doi.org/10.2139/ssrn.1115186","url":null,"abstract":"The recently-enacted Japanese long-term care (LTC) system was implemented to reduce so-called social hospitalization or warehousing of the elderly in expensive medical facilities. This paper seeks to evaluate recent patterns in Japanese LTC use and examine the factors associated with LTC utilization patterns. We show that the demand for LTC in Japan - particularly home care - is growing rapidly, as elderly consumers find subsidized LTC care preferable to and more available than hospitalization. At the same time, regional disparities in care persist and are likely to grow.","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88567687","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 advent of new scientific reproductive technologies has conjured up novel and seemingly intractable normative debates about bioethics and contemporary values in the field of family law. Surrogacy, incontrovertibly, is the most controversial of them all. In recent times, India is witnessing a spurt in cases of commercial surrogacy due to two factors: a medical tourism boom fuelled by low medical costs and a status-conscious middle class seeking to fulfill its financial needs. Commercial surrogacy, however, is against public policy enshrined in Article 23 of the Constitution of India and Section 23 of the Indian Contract Act, 1872. The courts are still to grapple with the legal implications of surrogacy agreements and the state of law, as a whole, remains inadequate due to complex ethical and moral questions involved. Thus, there is a need for the legislature to shed its odious inertia and balance individual rights against public policy considerations through legislation. This paper endorses the need for legalization of non-commercial surrogacy from the perspective of positive fundamental right of procreation guaranteed under Article 21 of the Constitution of India and the compelling state interest in maintaining the "rule of law" supported by international practice. Furthermore, it suggests a legal framework consisting of elements which are indispensable for addressing moral and ethical concerns surrounding surrogacy.
{"title":"An International, Moral & Legal Perspective: The Call for Legalization of Surrogacy in India","authors":"R. Sharma","doi":"10.2139/SSRN.997923","DOIUrl":"https://doi.org/10.2139/SSRN.997923","url":null,"abstract":"The advent of new scientific reproductive technologies has conjured up novel and seemingly intractable normative debates about bioethics and contemporary values in the field of family law. Surrogacy, incontrovertibly, is the most controversial of them all. In recent times, India is witnessing a spurt in cases of commercial surrogacy due to two factors: a medical tourism boom fuelled by low medical costs and a status-conscious middle class seeking to fulfill its financial needs. Commercial surrogacy, however, is against public policy enshrined in Article 23 of the Constitution of India and Section 23 of the Indian Contract Act, 1872. The courts are still to grapple with the legal implications of surrogacy agreements and the state of law, as a whole, remains inadequate due to complex ethical and moral questions involved. Thus, there is a need for the legislature to shed its odious inertia and balance individual rights against public policy considerations through legislation. This paper endorses the need for legalization of non-commercial surrogacy from the perspective of positive fundamental right of procreation guaranteed under Article 21 of the Constitution of India and the compelling state interest in maintaining the \"rule of law\" supported by international practice. Furthermore, it suggests a legal framework consisting of elements which are indispensable for addressing moral and ethical concerns surrounding surrogacy.","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89198163","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 this paper we assess the relative effectiveness of user charges and administrative waiting times as a tool for rationing public healthcare in Italy. We measure demand elasticities by estimating a simultaneous equation model of GP primary care visits, public specialist consultations and private specialist consultations, as if they were part of an incomplete system of demand. We find that own price elasticity of the demand for public specialist consultation is about -0.3, while administrative waiting time plays a less important role. No substitution exists between the demand for public and private specialists, so that user charges act as a net deterrent for over-consumption. The public provision of healthcare does not induce the wealthy to opt out. Moreover our evidence suggests that user charges and waiting lists do not serve redistributive purposes.
{"title":"Rationing the Public Provision of Healthcare in the Presence of Private Supplements: Evidence from the Italian NHS","authors":"D. Fabbri, C. Monfardini","doi":"10.2139/ssrn.950249","DOIUrl":"https://doi.org/10.2139/ssrn.950249","url":null,"abstract":"In this paper we assess the relative effectiveness of user charges and administrative waiting times as a tool for rationing public healthcare in Italy. We measure demand elasticities by estimating a simultaneous equation model of GP primary care visits, public specialist consultations and private specialist consultations, as if they were part of an incomplete system of demand. We find that own price elasticity of the demand for public specialist consultation is about -0.3, while administrative waiting time plays a less important role. No substitution exists between the demand for public and private specialists, so that user charges act as a net deterrent for over-consumption. The public provision of healthcare does not induce the wealthy to opt out. Moreover our evidence suggests that user charges and waiting lists do not serve redistributive purposes.","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87964294","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}
Physicians are supposed to serve patients' interests, but some are more inclined to do so than others. This paper studies how the system of health care provision affects the allocation of patients to physicians when physicians differ in altruism. We show that allowing for private provision of health care, parallel to (free) treatment in a National Health Service, benefits all patients. It enables rich patients to obtain higher quality treatment in the private sector. Because the altruistic physicians infer that in their absence, NHS patients receive lower treatment quality than private sector patients, they optimally decide to work in the NHS. Hence, after allowing for private provision, the remaining (relatively poor) NHS patients are more likely to receive the superior treatment provided by altruistic physicians. We also show, however, that allowing physicians to moonlight, i.e. to operate in both the NHS and the private sector simultaneously, nullifies part of these beneficial effects for the poorest patients.
{"title":"Dedicated Doctors: Public and Private Provision of Health Care with Altruistic Physicians","authors":"J. Delfgaauw","doi":"10.2139/ssrn.958693","DOIUrl":"https://doi.org/10.2139/ssrn.958693","url":null,"abstract":"Physicians are supposed to serve patients' interests, but some are more inclined to do so than others. This paper studies how the system of health care provision affects the allocation of patients to physicians when physicians differ in altruism. We show that allowing for private provision of health care, parallel to (free) treatment in a National Health Service, benefits all patients. It enables rich patients to obtain higher quality treatment in the private sector. Because the altruistic physicians infer that in their absence, NHS patients receive lower treatment quality than private sector patients, they optimally decide to work in the NHS. Hence, after allowing for private provision, the remaining (relatively poor) NHS patients are more likely to receive the superior treatment provided by altruistic physicians. We also show, however, that allowing physicians to moonlight, i.e. to operate in both the NHS and the private sector simultaneously, nullifies part of these beneficial effects for the poorest patients.","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83529840","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：