Journal of Health Politics Policy & Law

Journal of Health Politics, Policy and Law
Volume 27, Number 5, October 2002



    Foote, Susan Bartlett.
  • Why Medicare Cannot Promulgate a National Coverage Rule: A Case of Regula Mortis
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    Subject Headings:
    • Medicare -- Law and legislation -- Case studies.
      For over twenty-five years, Medicare has tried to promulgate a rule to implement the broad congressional directive to pay only for items and services that are "reasonable and necessary." A rule would clarify legal authority and describe specific criteria for evaluation of new technology in Medicare. This case study is an intractable example of a larger issue of regula mortis or dead rule. Regula mortis occurs when a mobilized interest group blocks legitimate administrative agency action, causing a regulatory stalemate. In this case, the medical device industry has prevented the implementation of a rule. The article diagnoses the condition of regula mortis, explains its effects in the Medicare case, and draws on principles of administrative law to propose remedies to break the logjam.

      While the case of coverage criteria is important in its own right, it has wider relevance. All health systems must grapple with the challenge of evaluating new technologies. Medicare efforts provide a starting point for the policy discussion. In our current political environment, regula mortis may be an increasingly common phenomenon and the proposed cures for it broadly applicable.

    Gusmano, Michael K.
    Schlesinger, Mark.
    Thomas, Tracey.
  • Policy Feedback and Public Opinion: The Role of Employer Responsibility in Social Policy
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    Subject Headings:
    • Medical policy -- United States -- Public opinion.
    • Public opinion -- United States.
    • Employer-sponsored health insurance -- United States.
      This study extends the literature on policy feedback and explores the extent to which public attitudes reflect learning from past government initiatives. We analyze the ways in which feedback mechanisms affecting public attitudes may differ from those earlier identified in the literature. We apply this general analytic framework to help explain variation in public attitudes toward private employer involvement in health care, explore possible causal pathways, and offer some preliminary empirical tests of these hypotheses. There are different levels of public support for the notion of employer obligation involving medical care, long-term care, and the treatment of substance abuse. Our evidence suggests that lessons about the performance of institutions in each of these policy domains represent the most important effect of existing policy on public attitudes. Furthermore, these differences correspond to what one would expect based on our model of policy feedback and cannot be explained by other plausible sources of policy legitimacy.
    McSween, Jean.
  • The Role of Group Interest, Identity, and Stigma in Determining Mental Health Policy Preferences
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    Subject Headings:
    • Mental health policy -- United States -- Public opinion.
    • Public opinion -- United States.
    • Group identity -- United States.
    • Stigma (Social psychology)
      Public attitudes toward mental health present an interesting puzzle. While mental health is one aspect of general health and well-being, it receives less support for government spending increases than does health care. One explanation lies with the stigma that is attached to mental illness. This stigma produces more negative attitudes on policy issues related to persons with mental illness such as government spending for mental health. However, group identification, as defined by personal experience or a family member who has experienced a mental illness, may have a strong effect on these attitudes. Using data from the 1996 General Social Survey's module on mental health, I examine this and other hypotheses and find evidence that group identification increases the likelihood of increased support for government spending for mental health. These robust findings exist even in quantitative models, which include politically relevant variables and measure identification with mental illness in two different ways. These findings suggest that mental health is policy for the few because those most supportive of government spending increases are persons who share the common identity of experiencing mental illness.
    Wolff, Nancy, 1955-
  • Risk, Response, and Mental Health Policy: Learning from the Experience of the United Kingdom
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    Subject Headings:
    • Mental health policy -- Great Britain.
    • Mental health laws -- Great Britain.
      Policy makers in the United States and the United Kingdom recognize that mentally disordered offenders present special challenges to law enforcement, mental health, and social service systems, as well as the community. Although various policy initiatives have advanced over the past twenty years to improve the management of mentally disordered offenders, mental health policy has chronically failed in both countries.Because safety concerns have emerged as the mental health system has been "deinstitutionalized," debate is growing about whether the community-care approach works—for the community. This study argues that mental health policy fails because policy makers focus on the wrong risks and design policies that manage these risks in ways that increase the possibility of adverse clinical and economic outcomes. The argument made here uses the case of persons with severe mental illness in the United Kingdom as an example of the complex relationship between risk and policy making in democratic governance. Emphasis is on the nature of risk in mental health policy and how government responds to policy and political risks. Mental health policy in Britain is then analyzed in terms of its response to and management of risks. Mental health policy has historically mismanaged the risk issue in the United Kingdom and as such has set in motion the growing community-care backlash. The path to a better outcome lies in the responsible management of the right risks. Lessons from the United Kingdom experience can be usefully applied to mental health issues in many industrial democracies.
    Davis, Peter, 1947 Apr. 25-
    Lay-Yee, Roy.
    Fitzjohn, Julie.
    Hider, Phil.
    Briant, Robin.
    Schug, Stephan Heinrich, 1958-
  • Compensation for Medical Injury in New Zealand: Does "No-Fault" Increase the Level of Claims-Making and Reduce Social and Clinical Selectivity?
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    Subject Headings:
    • Medical personnel -- Malpractice -- New Zealand.
    • Insurance, Malpractice -- New Zealand.
      The issues of patient safety and quality of care have gained policy attention with a growing appreciation of the scale and impact of medical injury in health systems. While the focus is clearly on the prevention of iatrogenic injury, the question of patient compensation is now also considered important, if only because in fault-based tort systems the fear of litigation may itself be a barrier to the disclosure and open discussion of medical error. No-fault systems, by contrast, do not require proof of culpability, and thus may both reduce barriers to compensation and increase disclosure of error. Little evidence, however, is available on the performance of such systems.

      This article reports on the analysis of two data sources—a sample of hospital admissions and a complete set of compensation claims for medical injury. Both are for the same year and region of New Zealand, a country that has maintained a no-fault system of accident compensation for a quarter of a century. Just over 2 percent of hospital admissions were associated with an adverse event that was potentially compensable under scheme criteria. While the claims process was well targeted, the level of claims making and receipt was low, with the ratio of successful claims to potentially compensable events being approximately 1:30. Comparison of social and clinical characteristics of the two data sets revealed a degree of selectivity. Compared with the hospital events, the typical successful claimant was younger and female and was much more likely to have experienced a surgical adverse event that, while unexpected, was not due to substandard care.

      It is concluded that, in interpreting these results, account needs to be taken of a number of features unique to the New Zealand system. These include: the limited payoff for a compensation claim (no pain and suffering or lump sum, free hospital care); the relative complexity of the grounds for claim (either rarity and severity or practitioner error); and a history of limited litigation for medical error. This suggests that, while the New Zealand system is well targeted, cheap, and free of financial and legal barriers, a change in legal doctrine alone has not in itself been sufficient to remove completely the selective and low level of claims making traditionally associated with patient compensation under tort.


    Teles, Steven Michael.
  • Commitment, Conservatism, and the Welfare State
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    Subject Headings:
    • Patashnik, Eric M. Putting trust in the U.S. budget: federal trust funds and the politics of commitment.
    • Pension trusts -- United States.
    Fox, Daniel M.
  • Medical Care Output and Productivity (review)
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    Subject Headings:
    • Cutler, David M., ed. Medical care output and productivity.
    • Berndt, Ernst R., ed.
    • Medical care -- Cost effectiveness -- Econometric models -- Congresses.
    Gonyea, Judith.
  • Age through Ethnic Lenses: Caring for the Elderly in a Multicultural Society (review)
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    Subject Headings:
    • Olson, Laura Katz, 1945-, ed. Age through ethnic lenses: caring for the elderly in a multicultural society.
    • Minority aged -- Government policy -- United States.
    Jacobs, Lawrence R.
  • The Shadow Welfare State: Labor, Business, and the Politics of Health Care in the United States (review)
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    Subject Headings:
    • Gottschalk, Marie. Shadow welfare state: labor, business, and the politics of health care in the United States.
    • Labor unions and health insurance -- United States.
    Moss, David A., 1964-
  • The Wages of Sickness: The Politics of Health Insurance in Progressive America (review)
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    Subject Headings:
    • Hoffman, Beatrix Rebecca. Wages of sickness: the politics of health insurance in progressive America.
    • Insurance, Health -- United States -- History -- 20th century.
    Smith, David Barton.
  • An American Health Dilemma: Race, Medicine, and Health Care in the United States 1900-2000 (review)
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    Subject Headings:
    • Byrd, W. Michael. American health dilemma: race, medicine, and health care in the United States 1900-2000.
    • Clayton, Linda A.
    • African Americans -- Health and hygiene -- History.

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