Health Law Research Articles

Peran Hukum Kesehatan dalam Melindungi Peserta Program Badan Penyelenggara Jaminan Sosial Kesehatan Berdasarkan Undang-Undang Nomor 24 Tahun 2011

The role of health law is crucial in ensuring the protection of participants in the National Health Insurance (BPJS Kesehatan) program, as regulated by Law No. 24 of 2011. This law provides a legal basis for the implementation of the national health insurance program, which aims to promote the welfare of society by providing equitable access to quality healthcare services. Health law functions to protect the rights of BPJS participants by ensuring that they receive healthcare services that meet established standards without discrimination.Furthermore, this law mandates the state to provide comprehensive and inclusive health insurance. Through the role of BPJS Kesehatan, health law also regulates the supervision and enforcement of accountability from healthcare providers, both in terms of service quality and financial management. Healthcare institutions collaborating with BPJS are required to comply with professional standards and medical ethics, as well as being responsible for patient safety.In the event of violations, health law provides a mechanism for participants to file complaints and seek justice through legal channels. The application of administrative and criminal sanctions for violators is also part of the legal protection efforts for participants. Therefore, the role of health law not only ensures access to services but also guarantees that the rights of BPJS participants are fulfilled in receiving fair and quality healthcare services.

Personal responsibility for health in Bulgarian public health law and social legislation

BackgroundIn the last decades all health systems have experienced a lack of resources. Against this background, the idea of ​​applying personal responsibility of the patient as a criterion for allocation of resources (PRCAR) is gaining increasing attention. Bulgarian healthcare reform has been marked by the implementation of many new strategies, that grounded our scientific interest towards investigating PRCAR in Bulgarian public health law and social legislation.MethodsThrough a search of national legal databases 7 documents were selected and subjected to content analysis.ResultsProspective responsibility was found in two and retrospective responsibility - in three documents, two of which imposed explicit penalties on the patient. Two documents did not distinguish between the types of patient responsibility. PRCAR was found to be controversial through the prism of the social justice principle. The discussion was conducted through the perspectives of evidence translation of research to law, particularities of social cohesion in Bulgaria, and the interpretation of principles of public health ethics.ConclusionAlthough PRCAR was traceable in Bulgarian legislation, no supporting arguments for its introduction were deduced. The applicability of PRCAR should be further studied and wider public debate should be initiated.

Examining legal challenges in involuntary hospitalisation proceedings: insights from judicial analysis in China

Since the implementation of China’s Mental Health Law, there has been a notable increase in involuntary hospitalisation cases involving individuals with mental health conditions across many provinces, leading to significant social controversy. Moreover, in the process of involuntary hospitalisation litigation, patients with mental health conditions have experienced difficulty initiating legal proceedings, presenting their cases effectively, and prevailing in court, to name a few of the many challenges they face. These obstacles, by impeding them in safeguarding their lawful rights and interests against this legal measure, substantially restrict their personal freedom. To establish a more accessible judicial relief mechanism, a number of steps need to be taken: enhancing the relevant provisions governing the acceptance of involuntary hospitalisation cases, ensuring a balanced distribution of the burden of proof between both parties, and strengthening judicial scrutiny of the legality of involuntary hospitalisation.

Solidarity as a Political Determinant of Health: Insights from EU Competition Policy

Context: The connection between law and political determinants of health is not well understood, but nevertheless it is suggested that the two are inseparable, and this represents an upstream level with scope for influencing other determinants of health (particularly social determinants). Solidarity underpins European health care systems, and given its clear link with redistribution, it can be seen as a means for addressing health inequities. As such, solidarity may be seen as a political determinant of health in the specific context of European Union (EU) competition policy. Methods: A range of EU case law, treaty provisions, and European Commission publications relating to EU competition policy are analyzed. Findings: Solidarity is typically juxtaposed as antithetical to competition and thus as underpinning exceptions to the applicability of prohibitions on anticompetitive agreements, abuse of dominance, and state aid. Case law indicates an additional dynamic between definitions of solidarity at the EU and national levels. Conclusions: This analysis leads to two groups of considerations when framing solidarity as a political determinant of health in the EU competition policy context: first, the predominance of solidarity suggests it may shape competition reforms; second, the EU–member state dynamic indicates less EU-level reach into national competition reforms in health care than may be expected.

Development and Validation of a Scale to Measure Violence against Women among Myanmar Migrant Women in Thailand

Introduction: Violence against women (VAW) is a serious human rights violation with significant implications for public health. VAW affects the well-being of women, children, and families. This study aims to develop and validate a scale specifically designed for identifying and assisting migrant women who have experienced violence. Methods: A cross-sectional survey using stratified sampling was conducted among 295 Myanmar migrant women in Thailand. Violence among these women was assessed using self-administered questionnaires with data collection taking 15–20 min per participant between September and December 2023. The construct validity of the Violence against Migrant Women Scale (VAMWS) was confirmed through exploratory factor analysis (EFA) estimated by weighted least squares means and variance with Geomin rotation in Mplus software. Results: The EFA revealed a 13-item scale with a four-factor structure that fit the data exceptionally well, as indicated by the high comparative fit index of 0.99 and low root mean square error of approximation value of 0.02. Communalities ranged from 0.58 to 0.99 and rotated factor correlations between 0.36 and 0.53. The four dimensions were as follows: F1 – physical (4 items, loadings 0.51–0.73), F2 – sexual (2 items, loadings 0.66–0.99), F3 – psychological (3 items, loadings 0.57–0.73), and F4 – economic (3 items, loadings 0.50–0.78). VAMWS had Cronbach’s alpha of 0.90 and corrected item–total correlation values from 0.53 to 0.74. Physical violence, experienced by 50% of respondents, was most common, primarily by spouses, then siblings, acquaintances, employers, parents, and friends. Conclusion: VAMWS is applicable for assessing violence prevalence across multiple sectors, including health care, social services, law enforcement, and future research endeavors.

Curso de Especialização em Direito Sanitário: uma formação necessária

The review presents the work 'Specialization Course in Health Law – EAD: A Virtual Journey of Reflections and Knowledge,' the result of an important pedagogical initiative developed in the field of Health Law, which made the outcome of this work available to the general public. The book, available electronically and free of charge, stimulates critical thinking and contributes to the consolidation of knowledge on relevant health issues. Submission: 09/12/24| Review: 09/12/24| Approval: 09/12/24

UNVEILING THE LEGAL COMPLEXITIES SURROUNDING DUAL USE OF CHEMICAL IN GLOBAL AND INDONESIAN CONTEXTS

The use of white phosphorus as a weapon is highly dangerous, causing direct physical damage to victims and environmental harm. White phosphorus is just one of many dual-use chemicals that have industrial benefits but also pose significant health and environmental risks. This situation leads to violations of fundamental human rights. This study discusses the legal complexities related to the use of dual-use chemicals in both global and Indonesian contexts, with a focus on Indonesia’s Health Law No. 17 of 2023. The research aims to identify legal gaps in the regulation of hazardous chemical use, from both international and national perspectives, and to provide recommendations for improving national regulations to better protect the public from the threats posed by dual-use chemicals. This study uses a normative legal approach with descriptive-analytical methods. It evaluates the gaps between national and international regulations on dual-use chemicals and the practical impact of these differences on public health protection in Indonesia. The study finds significant gaps between national and international regulations, particularly in terms of oversight and regulation of dual-use chemicals. The implementation of current health laws in Indonesia remains weak. International regulations are stricter, but they have not been fully integrated into national policies, resulting in gaps in public health protection from the threats posed by these chemicals.

The Power of Cultural Validation: A Global Strategy for Combating Infectious Diseases

Cultural Validation is a technique that works to increase access and break down barriers for what many policymakers and public health officials identify as “hard to reach populations.” During the COVID-19 Pandemic, policymakers and public health officials often cited “vaccine hesitancy” as a key challenge to reaching vulnerable populations, including immigrants, Spanish-speaking communities, and others who have been marginalized. Yet, community-based programs utilizing “Cultural Validation” techniques demonstrated that barriers to access – not hesitancy – were the true culprits. In fact, public health partnerships, laws, policies and funding that support the full integration of Cultural Validation techniques can ensure vaccine equity across the board. Cultural Validation can be applied to any community, and its success is made possible by four 4 key factors: • Researching and getting to know people in the community through genuine and authentic relationship-building prior to engagements. • Developing culturally relevant materials and marketing strategies. • Hosting events at places that are familiar to the community. • Providing genuine, authentic care in service delivery

Ação Direta de Inconstitucionalidade nº 5.779: a preponderância da efetividade do direito à saúde sobre a hierarquia das normas jurídicas

Objective: To reflect on whether the hierarchy of legal norms should be used as an infallible method of solution even when an apparent conflict between legal norms involving health law can be better resolved through a technical decision by the competent regulatory agency. Methodology: data was collected. In particular, Resolução de Diretoria Colegiada nº 52/2011, Law nº 13.454/2017 and Ação Direta de Inconstitucionalidade nº 5.779-DF. Specialized legal doctrine was sought on the central and peripheral themes. The data collected was analyzed using the critical-narrative review technique. Results: In Brazil, the adoption of regulatory agencies as normative agents and regulators of economic activities has made it possible to make decisions based less on political criteria than on technical criteria. The legislator, anchored in political criteria, according to the judiciary, cannot go beyond technical criteria. Conclusion: the judgment in Ação Direta de Inconstitucionalidade nº 5.779 shows that today's concept and the legal nature of the right to health impose new legal paradigms that validate the role of regulatory agencies (making technical decisions in favor of maximum effectiveness of the right to health), even to the detriment of politically legitimized decisions by the legislature. The formal paradigm cannot prevent the materialization of the right. Submission: 03/18/24| Review: 08/16/24| Approval: 08/16/24

The Need for Historical Fluency in Pandemic Law and Policy.

The primary claim of this essay is that historical fluency is required for effective work in crafting legal and policy interventions as a part of public health emergency preparedness and response (PHEPR). At a broad level, public health law is explicitly recognized as a key systems-level component of PHEPR practice.1 This essay therefore focuses on the extent to which historical fluency is necessary or at least useful to all aspects of PHEPR that draw on or deploy legal and policy mechanisms (e.g., design, planning, implementation, dissemination, monitoring and evaluation, etc.). The essay collectively refers to these legal and policy mechanisms as epidemic law and policy response (ELAPR). Part I explains the concept of historical fluency. Part II explores the foundations of public health law both as a way of highlighting key structural features of ELAPR and in supporting the claim that historical fluency is critical for ELAPR. Part III applies the previous arguments to a specific case study to highlight the promise and power of historical fluency - the outbreak of bubonic plague in San Francisco in 1900. Tracking this essay's pragmatic focus, part IV offers several recommendations for how specifically historical fluency in public health law and ethics can be operationalized in PHEPR practice and policy. Part V summarizes and concludes.

Implementation and Service Delivery Status of the Mental Health Law in the Province of Zamboanga del Norte

Mental health had been a growing concern while mental illness had been increasing in number worldwide. The enactment of the Mental Health Law or RA 11036 in 2018 hoped to bring about better delivery of mental health services as well as uphold the rights of patients. This led the proponent to investigate the implementation and service delivery status of the mental health law in the province of Zamboanga del Norte. Employing a descriptive-qualitative design, the study assessed the implementation of the various government agencies on the Mental Health Law as well as the delivery of mental health services in the province of Zamboanga del Norte. There were 50 mental health professionals interviewed through phone, messenger, and Google form using a structured interview guide. Data gathered through the interviews were analyzed using thematic analysis. Results revealed that most of the government agencies were able to implement the law rating from 35.72% to 100% of the implementation. Eleven themes emerged such as poor knowledge about the mental health law, no proper seminars/training about mental health law, mental health is not a priority program, lack of coordination with the various agencies involved, difficulty managing mental health crises, non-inclusive mental health program, insufficient mental health services, multitasking of mental health providers, lack of mental health professionals, stigmatized attitude towards mental illness and support from LGU. It was revealed in this study that the implementation of the mental health law in the province is not fully implemented. Furthermore, the delivery of mental health services is also insufficient. As a recommendation, the primary implementing agency must exert more effort in cascading the law to all implementing agencies and mental health professionals down to the barangay level for the law to be understood and implemented. In addition, mental health services should be improved as well as the inclusion of a mental health facility.

A common law in space for public health

Beyond the gravitational pull of Earth, space travel poses substantial public health hazards pertaining to the physical and mental well-being of astronauts and passengers, in addition to a possible threat to the populace of Earth upon re-entry. Exposure to cosmic radiation, cranial pressure from microgravity, weakened immunity to contagion, and the potential for depression and psychosis are all risks. Public health crises of this nature are to be expected as the duration of missions extends, as is the case with Mars settlement. In contrast to national space programmes, which have regarded these obstacles as human factors effecting the mission, public health law in common law British nations approaches them from the perspective of social justice and the preservation of human life and societal welfare. Countries including Australia, Canada, the United States, and the United Kingdom continue to apply traditional common law principles of public health law, which provide a sensible and enduring method for reconciling competing public and private interests. Common law permits the violation of civil liberties through the use of force in public health restraint, forced medication, and quarantine, but only if necessary, reasonable, and equitable. While the understanding of the health challenges associated with long-duration spaceflight may be in its infancy for national space programmes and civilian space ventures, the application of common law public health principles could aid in the establishment of health and safety protocols in which human reactions to crises in space resemble those observed on Earth. This may, nevertheless, necessitate the enactment of a more comprehensive federal public health statute. Embedded in both public health common law and international space law, the pre-eminence of preserving and respecting human life and well-being continues to be a cornerstone of humane justice despite the perilous conditions of space.

Evaluation of a voluntary passive surveillance component in cattle through notification of excess mortality

Passive surveillance can be most effective in the early detection of disease outbreaks given that farmers observe their animals daily. The European Animal Health Law states that unexplained excess mortality should be reported to the veterinary authorities. In the Netherlands, in addition to notifications to the competent authority, Royal GD is commissioned a passive surveillance component that consists of a veterinary helpdesk and postmortem examination for early detection of emerging diseases. The aim of this study was to evaluate this voluntary passive surveillance component through excess mortality in cattle.Weekly on-farm mortality was calculated using the cattle Identification and Registration records. Mortality was assessed on regional level for dairy, veal and other beef cattle using a Generalized Linear Model (GLM) (log-link, negative binomial). We used a cumulative sum of the model residuals to identify periods of excess mortality. The mortality was defined as excessive when above five times the standard error. The analysis was also conducted on herd level, but these models did not converge.We checked for an association between the two passive surveillance components elements and excess mortality. A GLM (log-link, negative binomial) with the number of contacts or submissions per region as the dependent variables and excess mortality per region and year as independent variables was carried out.Overall, the models showed significantly higher use of passive surveillance components in periods of excess mortality compared to non-excess periods. In dairy cattle the odds for contact or submission were between 1.72 (1.59–1.86) and 2.02 (1.82–2.25). For veal calves we found the odds of 2.19 (1.18–4.04) and 2.24 (1.78–2.83) relative to periods without excess mortality. Beef cattle operations, other than veal, showed only an increased odds for postmortem submissions in calves of 3.71 (2.74–5.01), submissions for cattle and contact in general was not increased for this farm type.In conclusion, the voluntary passive surveillance component in the Netherlands is used more often in periods of excess mortality in cattle. The chance of getting a timely response is highest for dairy farms. For veal calf operations the chance of receiving a timely response is more likely for postmortem submissions. A comparison with passive surveillance for excess mortality in other countries was not possible because no literature could be found. However, the method of this study can be used by other countries to evaluate their passive surveillance. This would make comparison of the performance of passive surveillance in different countries possible.

Data Modernization Opportunity: Alignment between US Public Health Data Policies and Public Health Ethics

Objective and ApproachModernizing data sharing policies is key to fix deficiencies exposed by COVID-19. Decentralized US public health data collection, with varying state laws, challenges data sharing across governmental entities. Many data protection laws rest on bioethical principles that de-emphasize collective interests, creating challenges for public health data governance. Here, we analyze US state public health data laws with WHO ethical guidelines, using a modified policy surveillance method to examine laws regulating data sharing between public health partners. We assess state law alignment with WHO guidelines for (1) public health data use, (2) research use, (3) emergency use, and (4) law enforcement use. ResultsWe found 34 states with laws explicitly allowing data sharing with federal public health agencies, 16 states permitting data sharing for research, 10 with provisions for emergencies, and 14 states permitting some data sharing for law enforcement. ConclusionsEfficient US public health data modernization needs policies that enable effective data sharing with proper justification and governance. The WHO offers guidance on ethically sharing sensitive data, but many US states' laws don't align with these guidelines, based on public health ethics. Instead, state laws often reflect bioethical standards, which are increasingly seen as unsuitable for managing population data in public health. ImplicationsSupportive policies are crucial for allowing population data to be used for social benefits. Policies that go against ethical guidelines and impose unnecessary obstacles to data sharing can hinder vital activities, like record linkage, that support public health efforts and collective benefits.

Experiences of central child health services teams regarding a special governmental investment in child health services

BackgroundHistorically marked by a high infant mortality rate, Sweden’s healthcare reforms have successively led to a robust, decentralized universal child health system covering over 97% of the population 0–5 years. However, inequities in health have become an increasing problem and the public health law explicitly states that health inequities should be reduced, resulting in various government initiatives. This study examines the experiences of Central Child Health Services (CCHS) teams during the implementation of the Child Health Services Accessibility Agreement between the State and the regions starting in 2017. The agreement aimed to enhance child health service accessibility, especially in socio-economically disadvantaged areas, but broadly stated guidelines and the short-term nature of funding have raised questions about its effectiveness. The aim of this study was to understand the experiences of CCHC teams in implementing the Child Health Services Accessibility Agreement, focusing on investment decisions, implementation efforts, as well as facilitators and barriers to using the funds effectively.MethodsCCHC teams were purposefully sampled and invited via email for interviews, with follow-ups for non-respondents. Conducted from January to October 2023, the interviews were held digitally and recorded with individuals familiar with the agreement’s implementation within these teams. Both authors analyzed the transcripts thematically, applying Braun and Clarke’s framework. Participants represented a cross-section of Sweden’s varied healthcare regions.ResultsThree main themes emerged from the thematic analysis: “Easy come, easy go,” highlighting funding uncertainties; “What are we supposed to do?” expressing dilemmas over project prioritization and partner collaboration; and “Building castles on sand,” focusing on the challenges of staff retention and foundational program stability. Respective subthemes addressed issues like fund allocation timing, strategic decision-making, and the practical difficulties of implementing extended home visiting programs, particularly in collaboration with social services.ConclusionsThis study uncovered the challenges faced in implementing the Child Health Services Accessibility Agreement across different regions in Sweden. These obstacles underline the need for precise guidelines regarding the use of funds, stable financing for long-term project sustainability, and strong foundational support to ensure effective interprofessional collaboration and infrastructure development for equitable service delivery in child health services.

Public Health and Patent Law to Access Medicine in India

India's 1970 decision to include a process patent regime in its patent legislation is regarded as a reformative step that was a well-considered reaction to internal issues including the nation's then-current socioeconomic realities. The primary goal of this research project has been to critically analyse the connections among public health, the global intellectual property law, and the availability of necessary medications, with a particular emphasis on India. The study's main focus is the persistent issue of developing and least developed nations' lack of access to reasonably priced medical care in the post-crisis age. This study aims to investigate the inherent barriers to intellectual property that impact medical access, excluding the impact of non-intellectual property impediments such as distribution, infrastructure, quality, and medical facilities. The purpose of this study is to examine how patent law affects drug accessibility while accounting for drug costs.

Practices and Effects of Child Abuse on Learner’s Academic Performance in Primary Schools

This study investigated the practices and effects of child abuse on learners’ academic performance in selected primary schools in Budaya Sub-county. The study concluded that parents ranked highest in promoting child abuse. They subject their children to both physical and psychological abuse, which consequently affects their performance at home and school. In addition, the study revealed that physically and emotionally, the abused child becomes aggressive towards fellow pupils and elders and suffers stunted physical and mental development. According to the findings, the study calls for social welfare agencies (public and private organizations) to redouble efforts in educating, counseling, and rehabilitating victims of child abuse. These efforts could encourage many victims of child abuse to continue their education or engage in other meaningful activities. Furthermore, the knowledge of both teachers and other school personnel, along with representatives from health care services, social services, and law enforcement, regarding child abuse is severely limited. Therefore, the government should educate all stakeholders about ways to reduce child abuse. Finally, the government should make and enforce strong laws to isolate the abuser from the victim, impose harsh sentences, and provide treatment services to the sexually offended victims. Keywords: Academic performance, Child abuse, Culture, Primary school, Students

Oral Health Status and Oral Healthcare System in Indonesia: A Narrative Review

Abstract Aim: To assess the current situation regarding oral health status and system in Indonesia through the existing literature and government documents, identify challenges, and propose recommendations for the future. Materials and Methods: A literature search was conducted from June to October 2023 through the scientific databases of PubMed, Web of Science, and Google Scholar, including published articles from 2013 to 2023. The following main keywords were used: “Indonesia,” “oral health system,” “oral healthcare system,” “oral health policy,” “oral health promotion,” “oral health coverage,” and “oral health status.” Articles without any restrictions on study design, review articles, regional or national oral health reports, and Indonesian health laws or regulations were included. Data extracted from the included studies were synthesized and presented into several subgroups. Results: Despite the establishment of a health system in 1982, the oral health status of Indonesian people remains unsatisfying. The prevalence of untreated caries and periodontal disease is still high. Several policies and programs have been implemented to tackle those problems; however, Indonesia still has many challenges to overcome, including geographic constraints, uneven distribution of dental personnel, low public awareness and information on oral care utilization, insufficient resource allocation, and lack of prevention and promotion programs. Conclusion: The oral health status of the Indonesian population remains unsatisfactory. Future actions should emphasize on equal access and distribution of dental care, strengthen monitoring and evaluation of ongoing programs, integrate oral health into the national health agenda, and allocate adequate resources to support oral health initiatives.

Legislation and policy for involuntary mental healthcare across countries in the FOSTREN network: rationale, development of mapping survey and protocol.

Several countries are currently revising or have already revised their mental health laws to align with the global movement to reduce the use of coercive care. No government has yet fully implemented the recommendation of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) to eliminate the use of coercion in mental healthcare. Consequently, the international field of mental health law and policy is in a degree of flux. To describe the rationale, development and protocol for a project that will map and examine how mental health laws, policies and service capacity across European countries relate to the use of coercive measures, including involuntary admissions and treatment, restraints and seclusion. This will help to better understand the current situation and explore future directions of policies regarding coercive care. The project is being carried out under the purview of the European Cooperation in Science and Technology (COST) action network, entitled FOSTREN (Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services). A multidisciplinary group of experts developed a comprehensive survey assessing mental health laws, policies and service frameworks, based on World Health Organization and UNCRPD recommendations. The survey was piloted in three countries, revised and disseminated to 30 FOSTREN country representatives. The survey will provide data for three strands of work on legislation, policies and service-level context. A comprehensive evaluation will be conducted, drawing on findings from all work packages. The project could inform the development of strategies, interventions and legislation to address gaps and promote compliance with international standards.

Legal liability of medical personnel and health workers who commit negligence during medical procedures (Normative Study After the Enactment of Law Number 17 of 2023 Concerning Health)

Medical personnel and health workers are part of health human resources who are basically tasked with providing health services to service recipients, in this case patients and/or providing the necessary medical measures. Medical personnel and health workers who commit negligence when carrying out their duties legally can be subject to legal liability. Since the enactment of Law Number 17 of 2023 concerning Health, there have been several important aspects of health law that have changed, one of which is related to legal liability. For this reason, it is necessary to conduct an assessment, especially about legal liability for medical personnel and health workers if they commit negligence when performing medical procedures. The type of research carried out is normative juridical research. The approach taken is a statutory approach and is descriptive analysis. The resources used for secondary data are by processing data from primary legal materials, secondary legal materials and tertiary legal materials. The data collection tool used is document study (library research) and analyzed by qualitative analysis. Based on the results of the study, it is known that the duties and functions of medical personnel and health workers in carrying out medical actions on patients are mainly to provide health services to patients in the form of promotive, preventive, curative, rehabilitative, and/or palliative. Then it is known that the legal responsibility of medical personnel and health workers when committing negligence after the enactment of Law Number 17 of 2023 concerning Health is divided into 3 (three) forms, namely administrative liability, namely the temporary deactivation of STR; and/or recommendations for revocation of SIP, civil liability in the form of compensation and criminal liability in the form of imprisonment and fines.