The Government Built It, and the Private Sector Came: For-Profit Health Care, Government Support, and the Road from Public Service to Private Equity

Commercial determinants of human rights: for-profit health care and housing.

Because for-profit conversions of nonprofit organizations are regulated under trust law at the state level, their health policy implications have generally not been part of the process. This paper provides a health policy framework for assessing conversions of hospitals and health maintenance organizations (HMOs). It begins with basic differences in ownership forms and identifies considerations on both sides of the conversion question. The analysis turns on the extent of the social benefits of nonprofits: the regulatory tool provided by tax exemptions, trustworthiness in the presence of informational asymmetries, and community benefit activities. The analysis and the evidence suggest that the nonprofit form continues to hold significant advantages in health care that bear consideration by policymakers faced with conversion proposals.

THIS paper derives and tests some implications about differences in behavior resulting from differences in property right arrangements, and in particular, between proprietary for-profit and nonproprietary not-for-profit hospitals (hereafter referred to as proprietary and nonproprietary hospitals respectively) . The arrangements in nonproprietary nonprofit enterprises are different from those in proprietary profit-seeking organizations because (1) certain rights or claims to benefits in nonproprietary organizations are not transferable by sale as they are in proprietary organizations, and (2) managers or workers in nonprofit organizations do not have exclusive claim on residual products (the current flows of money and nonmoney benefits) that is characteristic of for-profit enterprises.

The ethical implications of the growth of for-profit health care institutions are complex. Two major moral criticisms of for-profit medicine are analyzed. The first claim is that for-profit health care institutions fail to fulfill their obligations to do their fair share in providing health care to the poor and so exacerbate the problem of access to health care. The second claim is that profit seeking in medicine will damage the physician-patient relationship, creating conflicts of interest that will diminish the quality of care and erode patients' trust in their physicians and the public's trust in the medical profession. The authors conclude that while the continued expansion of for-profit health care may exacerbate in some respects problems of access, trust and conflicts of interest, it is a mistake to consider these problems as unique to for-profit health care; they are problems for not for-profit health care as well. Though these issues justify continuing moral concern, they do not at this time provide decisive grounds for substantially curbing or eliminating for-profit enterprise in health care.

Can Cyprus overcome its health-care challenges?

Objective: To determine, by way of an exhaustive, systematic, and comprehensive review and summary of all scientific published studies, whether or not there are any performance differences between private for-profit and private nonprofit home health care providers. The second objective is to discover the proportion of all research on this topic that is devoted to home health care services compared to all other health services providers. Data Sources: Computerized bibliographic searches of relevant databases and published indexes and abstracts were undertaken. They included Medline (Ovid and Pubmed versions), Web of Science (Social Sciences Citation Index and Science Citation Index), ABI/Inform, and Sociological s. Follow-up searches of reference lists in each article obtained from the computerized search were then completed. Study Design: This systematic review retained for analysis all published studies that compared the performance of for-profit and nonprofit health care providers on access, quality, cost/efficiency, and/or amount of charity care, based on data collected after 1980. As a quality control measure only studies published in peer reviewed journals were included. Studies were coded according to the article's stated conclusions: for-profit superiority, nonprofit superiority, or no difference/mixed results. Principal Findings: The comparative performance of for-profit and nonprofit home health service organizations is one of the most understudied areas of health care provider services in the US today. Only 6 of the over 1030 comparisons of the two concerned home health care. No data on this topic have been collected since 1991, and no articles about it have been published in a peer-reviewed journal since 1995. Conclusion: Research on the relative performance of for-profit and nonprofit home health care services is a research priority urgently in need of attention.

From Hippocrates to HIPAA: Privacy and confidentiality in Emergency Medicine—Part I: Conceptual, moral, and legal foundations

South Africa is an upper middle–income country with a population of 59.6 million people (1). Gauteng is the most densely populated province, and houses 26% of the population, followed by KwaZulu-Natal (19%), and the Western Cape (12%). About 29% of the population are <15 years old and 9% are ≥60 years. Approximately 13% of the population are seropositive for HIV. Life expectancy is estimated at 68.5 years for females and 62.5 years for males, whereas the infant mortality rate is 23.6 per 1000 live births. In 2019, the gross national income per capita was approximately $6040 (Atlas method, current US$), with 8% of the country’s gross domestic product spent on health care (2). Despite the transition to democracy in 1994, a high level of inequality remains, reflected in a Gini coefficient of 0.63 and an unemployment rate of 30% (2,3). This inequality is also reflected in a two-tiered health system. Access to a well-resourced private health care sector depends on the ability to pay for services, usually via medical insurance. Treatment for CKD is included in the set of “prescribed minimum benefits” that all registered medical insurance schemes in South Africa are obliged to provide for their members. The majority of South Africans (84%), however, are dependent on an under-resourced, government-funded, public health care sector. Public health care facilities use a sliding scale, where the fees charged are dependent on income. Indigent patients are able to access services free of charge (4). South Africa is faced with a high burden of infectious diseases (such as tuberculosis and HIV infection), noncommunicable diseases, maternal and childhood diseases, and injury-related diseases (5). These factors drive an epidemic of AKI and CKD. Two studies have estimated the population prevalence of CKD in South Africa. Adeniyi et al. (6) reported the …

White Paper Report of the 2012 RAD-AID Conference on International Radiology for Developing Countries: Planning the Implementation of Global Radiology

Changes And Challenges In Health Care

Universal Health Insurancewill it control the cost of U.S. health care?* William P. Gunnar Plain and simple, the cost of health care in the United States is at the core of the debate over health care reform in the months leading to the 2008 U.S. Presidential election. U.S. health care costs too much, and the cost of paying for health care can be blamed for unacceptably high corporate overhead, record numbers of uninsured, and increasing demands on the federal and state governments to limit entitlement programs. David F. Drake's Mandate for 21st Century America: Universal Health Insurance proposes an income-based tax-financed catastrophic universal health insurance benefit with government oversight on provider activity. In theory, such health care reform would allow free-market forces to bring the cost of health care under control. However, universal health insurance as Drake describes will do little to control health care costs; moreover, implementation of this plan may have unintended deleterious consequences. Drake and I approach the debate over health care reform from different perspectives. [End Page 285] Drake holds a doctorate in business administration, has written on health economics, finance, and regulation, and has published this book following 25 years with the American Hospital Association, from which he retired as Senior Vice President and Secretary-Treasurer. I, on the other hand, have recently graduated from law school with a certificate in health law while continuing, as I have for 16 years, to actively practice thoracic and cardiovascular surgery. In the past three years, I have published a handful of law review articles and essays on topics related to health care reform. We thus bring varied backgrounds, experiences, and interests to this discussion. Drake predicts that the U.S. health care system must undergo reform because the current system is too costly to American business, fails to provide unqualified access, and is associated with poor patient safety. He argues that the federal government, whose duty it is to protect the citizen from risks beyond their control, must indemnify those with catastrophic illness through a universal health insurance (UHI) program. Specifically, the federal government should cover all health care expenditures above a means-tested deductible, proposed to be between 10 and 20% of the family income (presumably net annual income), and should provide long-term loans to those unable to pay the assessed deductible. For those impoverished, first-dollar (zero-deductible) coverage would be guaranteed. To finance this program, Drake proposes the elimination of health spending deductions for health savings accounts and the elimination of the tax-exempt status of employer contributions for health insurance benefits. Under Drake's UHI program, individuals desiring health insurance with first-dollar coverage could do so affordably, since the federal government would absorb the risk of adverse selection; the insurance premium need only apply to covering risk for the deductible amount. With regard to the employer, Drake opines that the marked reduction in health insurance premiums would offset any new tax on employee health benefits, encouraging employers to maintain employee health benefits as a wage benefit. More than likely, however, the tendency for employers would be to limit non-tax-deductible overhead, thereby effectively eliminating employer-sponsored health benefits. Drake goes on to propose the introduction of a private agency, called the Health Care Financing Agency (HCFA), accredited and supervised by the Department of Health and Human Services to act as a consumer advisor, enhancing the consumer's ability to find and purchase health care services, certifying that health care expenditures are appropriate, and ensuring the correctness of deductible calculations and federal benefits. The cost associated with the HCFA would be proportioned between the federal government and the consumer. Alternatively, each state would be responsible for developing a plan for monitoring and controlling the health care costs of the catastrophically ill, either through managed-care organizations or rationing of specific high-cost treatments. If implemented by Congress, Drake's version of UHI would have tremendous impact on American business but little impact on the overall cost of health care, [End Page 286] the access to health care, or the quality of health care delivered. More importantly, the introduction of such sweeping health care...

T public’s nightmare image of for-profit public-sector managed care is one of an opportunistic, financially driven company siphoning public money away from needy citizens to line the pockets of greedy investors and lavishly paid executives. A recent nationwide survey asked a random sample of adults if they were “worried that your health plan would be more concerned about saving money than about [providing] the best treatment for you if you are sick” (1). Sixty-one percent of respondents who were enrolled in “heavy managed care” said they were somewhat or very worried, compared with only 34 percent of those in “traditional” plans. Backlash against managed care is substantial enough to be the subject of an entire 400-page issue of the Journal of Health Politics, Policy, and Law (2). Since 1995 Iowa has addressed these fears head-on through the evolving design of its Medicaid behavioral health program. This column, which is the sixth in a series on public-sector managed behavioral health care and the second focusing on Iowa (3), addresses the lessons other states can learn from Iowa’s strategy of capping profits and mandating community reinvestment.

This symposium, The Intersection of Immigration Law and Health Policy, could not be timelier. Almost every day since President Trump’s inauguration, the news has brought yet another story about immigration and health: we hear about children dying while in the custody of the border patrol and about the long-term health effects of children who were separated from their parents at the border. We read about immigrant minors being denied access to reproductive health services, and about children being stopped by Immigration and Customs Enforcement (“ICE”) on their way for emergency surgery. Physicians report that fearful patients are failing to show up for their medical appointments, and researchers report that immigrants have refused to enroll their infants in child nutrition programs for fear that doing so could lead to their own deportation. Hospitals and other health care providers worry about workers, whose ability to remain employed may be threatened by the possible termination of DACA, or who may be unable to come to this country and provide care because of the travel ban or cut backs on visas. Meanwhile the Administration has proposed new proposed public charge regulations, which if promulgated, may cause millions of lawfully present immigrants to forego a broad array of programs that support health, including Medicaid and food stamps. All of these incidents, and many more, illustrate that when nativist immigration policy meets health law, health policy and public health tend to suffer. The health care system covers fewer people, while becoming costlier and less efficient. Public health is also jeopardized as punitive and futile efforts to keep diseases out by excluding or punishing newcomers replace evidence-based public health solutions. More subtly, when immigration and health policy meet, we lose sight of why the health policy exists in the first place is lost. This essay explores these issues, examining why and how laws and policies at the intersection of health and immigration are frequently problematic for both health policy and public health. Part I begins by noting that the troubling relationship between immigration and health law is both longstanding and international in scope. Parts II and III explore the impact of the interjection of immigration policy into health law, discussing in Part II how it adds to the complexity and inefficiency of the health care system and in Part III, how it harms public health. Part IV elucidates those claims further by exploring the potential health impact of the proposed public charge regulations. Part V concludes by arguing that the battles over immigration and health both reflect and shed light on deeply-seated divisions over the nature of community, the scope of solidarity, and the underlying rationale for health policy and law. I also argue that health laws’ treatment of immigrants forces us to consider the basic rationales for health law. That inquiry offers the possibility of a richer and deeper appreciation of the ethical foundations for health law.

Health care is one of the most important spheres of activities of the state and society. The functioning and development of health care require proper legal support that is possible if there are enough qualified lawyers equipped with profound knowledge and skills in the health law area. The paper discusses the concept of health law that is new for the Ukrainian legal science as well as its integral components – medical law, public health law, and pharmaceutical law. The experience of teaching courses pertaining to the realm of health law at the Taras Schevtchenko National University of Kyiv that is the leader of Ukrainian higher education, particularly the legal one, is examined. It is the law faculty (currently – the Institute of Law) of the said University whereat the innovative discipline "Legal regulation of public health" ("Public Health Law") started to be taught for the first time in Ukraine. In 2019, the LLM specialization (the elective block of courses) "Health Law" that was unique for Ukraine, was introduced. The article mentions the key goals at the attainment of which the courses studied within the framework of the "Health Law" LLM program (totally ISSN 1728-2195 ЮРИДИЧНІ НАУКИ. 3(118)/2021 ~ 21 ~ 12 disciplines), are targeted. It analyzes the list and content of the courses belonging to the said LLM specialization that can be conditionally divided into three blocks: the key disciplines covering the "components" of health law; the disciplines ensuring understanding of the peculiarities of activities in the sphere of health care and the legal tools used for the governance in health care and management of healthcare institutions; and the courses directed at covering the topical issues of law and ethics in health care and at acquiring practical skills of protection of rights of healthcare actors. The paper points out that while teaching courses falling within the "Health Law" LLM specialization, major stress was made on getting students acquainted with the realities of practice. It pays attention to the use of modern methods and approaches to teaching as well as education technologies that allowed ensuring high efficiency of education, particularly under the conditions of lockdown caused by the spread of coronavirus disease COVID-19. The article also outlines major components of the education and scientific activity carried out at the Taras Shevtchenko National University of Kyiv, including that of the Education and Research Center for Medical Law of the Institute of Law. The conclusion is made that а scientific school of health law has been established at the Taras Shevtchenko National University of Kyiv. Keywords: health law, medical law, pharmaceutical law, health care, public health, public health law, LLM specialization, education, science.

The emergence of Covid‐19 in the United States has revealed a critical weakness in the health care system in the United States. The majority of people in the nation receive health care via employment‐based health insurance from providers in a competitive market. However, neither employment‐based health care nor a competitive health care market can adequately provide treatment during a global pandemic. Employment‐based health care will fail to provide care for a large number of people in any destabilizing economic event, including a pandemic. Competitive for‐profit health care systems distribute limited goods based on markets rather than health care needs. If a global pandemic results in unusually high demand for specific medical supplies, then these will be distributed suboptimally. The combined risk of suboptimal distribution of needed goods and a significant drop in health care access in a global pandemic indicates that the U.S. health care system has serious vulnerabilities that need to be addressed.