In the U.S., Great Britain and in many other countries, the gap between the demand and the supply of human organs for transplantation is on the rise, despite the efforts of governments and health agencies to promote donor registration. In some countries of continental Europe, however, cadaveric organ procurement is based on the principle of presumed consent. Under presumed consent legislation, a deceased individual is classified as a potential donor in absence of explicit opposition to donation before death. This article analyzes the impact of presumed consent laws on donation rates. For this purpose, we construct a dataset on organ donation rates and potential factors affecting organ donation for 22 countries over a 10-year period. We find that while differences in other determinants of organ donation explain much of the variation in donation rates, after controlling for those determinants presumed consent legislation has a positive and sizeable effect on organ donation rates. We use the panel structure of our dataset to test and reject the hypothesis that unmeasured determinants of organ donation rates confound our empirical results.
{"title":"The Impact of Presumed Consent Legislation on Cadaveric Organ Donation: A Cross Country Study","authors":"Alberto Abadie, S. Gay","doi":"10.2139/ssrn.562841","DOIUrl":"https://doi.org/10.2139/ssrn.562841","url":null,"abstract":"In the U.S., Great Britain and in many other countries, the gap between the demand and the supply of human organs for transplantation is on the rise, despite the efforts of governments and health agencies to promote donor registration. In some countries of continental Europe, however, cadaveric organ procurement is based on the principle of presumed consent. Under presumed consent legislation, a deceased individual is classified as a potential donor in absence of explicit opposition to donation before death. This article analyzes the impact of presumed consent laws on donation rates. For this purpose, we construct a dataset on organ donation rates and potential factors affecting organ donation for 22 countries over a 10-year period. We find that while differences in other determinants of organ donation explain much of the variation in donation rates, after controlling for those determinants presumed consent legislation has a positive and sizeable effect on organ donation rates. We use the panel structure of our dataset to test and reject the hypothesis that unmeasured determinants of organ donation rates confound our empirical results.","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72863321","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 primary focus of the paper is to assess whether the US, which spends significantly more than any other country in health care, has better health outcomes. It has long been clear that mortality as a whole is not better in the US than in other countries. We focus our analysis on the US performance for the treatment of non-fatal health outcomes and we compare the health of the United States to that of Canada, the United Kingdom and Spain. Our results indicate a discrepancy between high quality of life for some outcomes and low quality of life for others. Such discrepancy is not attributable to measurement issues in determining a person's quality of life, nor is it attributable to differing performance by income. Our results suggest that the discrepancy is due to the fact that the US does better for the treatment of conditions where high-tech medicine is a key to better health and worse in conditions requiring substantial chronic disease management.
{"title":"Comparing Non-Fatal Health Across Countries: Is the US Medical System Better?","authors":"David M. Cutler, Núria Mas","doi":"10.2139/ssrn.493644","DOIUrl":"https://doi.org/10.2139/ssrn.493644","url":null,"abstract":"The primary focus of the paper is to assess whether the US, which spends significantly more than any other country in health care, has better health outcomes. It has long been clear that mortality as a whole is not better in the US than in other countries. We focus our analysis on the US performance for the treatment of non-fatal health outcomes and we compare the health of the United States to that of Canada, the United Kingdom and Spain. Our results indicate a discrepancy between high quality of life for some outcomes and low quality of life for others. Such discrepancy is not attributable to measurement issues in determining a person's quality of life, nor is it attributable to differing performance by income. Our results suggest that the discrepancy is due to the fact that the US does better for the treatment of conditions where high-tech medicine is a key to better health and worse in conditions requiring substantial chronic disease management.","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2004-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90086319","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}
{"title":"AIDS and adolescents.","authors":"Rhonda Gay Hartman","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24840181","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}
{"title":"Medicate-to-execute: current trends in death penalty jurisprudence and the perils of dual loyalty.","authors":"Daniel S Shaivitz","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40906019","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}
{"title":"Bioethical malpractice: risk and responsibilities in human research.","authors":"Barbara A Noah","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24840180","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}
Thousands die each year in the United States alone due to a severe shortage of organs available for transplantation. In this article, I propose that we encourage people to register to donate organs upon death by offering them some priority to receive an organ should they need one during life. Such an incentive would save lives by encouraging many more people to donate, yet would not violate federal laws that prohibit organ donors from receiving financial compensation. In addition, I describe how priority incentives could, in theory, be structured to guarantee a distribution of organs that is pareto superior to our current one. I respond to critics who say that priority incentives would weaken the altruistic nature of our current donation scheme and would unacceptably commodify the human body. A fuller conception of our property interests in cadaver organs, I argue, reveals the error of elevating such organs to a special place of honor reserved for property that should be inalienable through market-style exchange.
{"title":"A Matter of Priority: Transplanting Organs Preferentially to Registered Donors","authors":"Adam J Kolber","doi":"10.2139/SSRN.453760","DOIUrl":"https://doi.org/10.2139/SSRN.453760","url":null,"abstract":"Thousands die each year in the United States alone due to a severe shortage of organs available for transplantation. In this article, I propose that we encourage people to register to donate organs upon death by offering them some priority to receive an organ should they need one during life. Such an incentive would save lives by encouraging many more people to donate, yet would not violate federal laws that prohibit organ donors from receiving financial compensation. In addition, I describe how priority incentives could, in theory, be structured to guarantee a distribution of organs that is pareto superior to our current one. I respond to critics who say that priority incentives would weaken the altruistic nature of our current donation scheme and would unacceptably commodify the human body. A fuller conception of our property interests in cadaver organs, I argue, reveals the error of elevating such organs to a special place of honor reserved for property that should be inalienable through market-style exchange.","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79274271","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}
Managed care is often faulted for requiring physicians to abandon their traditional fiduciary responsibility to individual patients. Physician loyalty is said to be divided between a concern for patient benefit on the one hand and for financial advantages accruing to the physician personally or to the group of plan participants on the other. A recent U.S. Supreme Court case has supported this development by deciding that physicians are now responsible to function simultaneously as clinical caretakers and benefits administrators. It is granted that this situation gives rise to legitimate concerns about the potential for undermining patient trust in physicians and yet there are also reasons to believe that this is a step in the right direction. Specifically, by requiring doctors to make "mixed" treatment and eligibility decisions, the Court has pointed the way for people to think and make decisions about health and health care without abstracting from the cost of that care.
{"title":"Managed Care and Undividing Loyalties","authors":"D. Maher","doi":"10.2139/SSRN.407122","DOIUrl":"https://doi.org/10.2139/SSRN.407122","url":null,"abstract":"Managed care is often faulted for requiring physicians to abandon their traditional fiduciary responsibility to individual patients. Physician loyalty is said to be divided between a concern for patient benefit on the one hand and for financial advantages accruing to the physician personally or to the group of plan participants on the other. A recent U.S. Supreme Court case has supported this development by deciding that physicians are now responsible to function simultaneously as clinical caretakers and benefits administrators. It is granted that this situation gives rise to legitimate concerns about the potential for undermining patient trust in physicians and yet there are also reasons to believe that this is a step in the right direction. Specifically, by requiring doctors to make \"mixed\" treatment and eligibility decisions, the Court has pointed the way for people to think and make decisions about health and health care without abstracting from the cost of that care.","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86993258","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 Government asked the Productivity Commission to undertake a research study examining the administrative and compliance costs associated with Commonwealth programs directed at medical general practice. The study was commissioned in July 2002. The Commission was asked to report on the nature and magnitude of these costs for individual general practitioners and general practice as a whole, and ways in which these costs may be reduced. The Commission found that general practitioners and their practices face significant costs of complying with a range of Commonwealth Government programs and provides estimates of these costs.
{"title":"General Practice Administrative and Compliance Costs","authors":"Productivity Commission","doi":"10.2139/ssrn.402540","DOIUrl":"https://doi.org/10.2139/ssrn.402540","url":null,"abstract":"The Government asked the Productivity Commission to undertake a research study examining the administrative and compliance costs associated with Commonwealth programs directed at medical general practice. The study was commissioned in July 2002. The Commission was asked to report on the nature and magnitude of these costs for individual general practitioners and general practice as a whole, and ways in which these costs may be reduced. The Commission found that general practitioners and their practices face significant costs of complying with a range of Commonwealth Government programs and provides estimates of these costs.","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81914774","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 Food, Drug and Cosmetics Act of 1938 with amendments in 1962 is inconsistent regarding FDA certification of a drug’s efficacy. The act requires efficacy certification for the drug’s initial (“on-label”) uses, but does not require certification before physicians may prescribe for subsequent (“off-label”) uses. Are there good reasons for this inconsistency? Using a sequential online survey we carried on a “virtual conversation” with some 500 physicians. The survey asked whether efficacy requirements should be imposed on off-label uses, and almost all physicians said no. It asked whether the efficacy requirements for initial uses should be dropped, and most said no. We then gently challenged respondents asking them whether opposing efficacy requirements in one case but not the other involved an inconsistency. In response to this challenge we received hundreds of written commentaries. This investigation taps the specialized knowledge of hundreds of physicians and organizes their insights into challenges to the consistency argument. Thus, it employs a method of structured conversations with experts to test the merit of an argument. Is the consistency argument a case of “foolish consistency,” or does it hold up even under scrutiny?
{"title":"Do Off-Label Drug Practices Argue Against Fda Efficacy Requirements? Testing an Argument by Structured Conversations with Experts","authors":"Daniel Klein, A. Tabarrok","doi":"10.2139/ssrn.425791","DOIUrl":"https://doi.org/10.2139/ssrn.425791","url":null,"abstract":"The Food, Drug and Cosmetics Act of 1938 with amendments in 1962 is inconsistent regarding FDA certification of a drug’s efficacy. The act requires efficacy certification for the drug’s initial (“on-label”) uses, but does not require certification before physicians may prescribe for subsequent (“off-label”) uses. Are there good reasons for this inconsistency? Using a sequential online survey we carried on a “virtual conversation” with some 500 physicians. The survey asked whether efficacy requirements should be imposed on off-label uses, and almost all physicians said no. It asked whether the efficacy requirements for initial uses should be dropped, and most said no. We then gently challenged respondents asking them whether opposing efficacy requirements in one case but not the other involved an inconsistency. In response to this challenge we received hundreds of written commentaries. This investigation taps the specialized knowledge of hundreds of physicians and organizes their insights into challenges to the consistency argument. Thus, it employs a method of structured conversations with experts to test the merit of an argument. Is the consistency argument a case of “foolish consistency,” or does it hold up even under scrutiny?","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73799917","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}
{"title":"Contrary to first impression, genes are patentable: should there be limitations?","authors":"Amanda S Pitcher","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":73765,"journal":{"name":"Journal of health care law & policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40839137","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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