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PubMed1970

CMA's proposal for a voluntary, universally available Health Benefits Program. A socio-economic report of the Bureau of Research and Planning, California Medical Association.

The May 4, 1970 issue of the American Medical News contains an article on a report released in April by the British Medical Association following a two-year study of the British National Health Service. Although the BMA study is oriented to the specific program as it has evolved in Great Britain since 1946, its main thrust is in the development of a system of voluntary health insurance which would provide for greater consumer choice, based upon nationally determined guidelines and regulations. BMA's recommendations would have the NHS utilize a combination of tax-supported and voluntary-supported mechanisms in providing medical services to various segments of the population, based upon categories of illness and income levels. Since the BMA proposal as reported in the AMA News parallels in some respects the one approved by the CMA House of Delegates and submitted to the AMA House of Delegates for its consideration, the reader will be interested in seeing the concept for a Voluntary Universally Available Health Benefits Program, independently developed by the California Medical Association. It is interesting to note that the CMA proposal attempts to avoid many of the problems with which the NHS has been identified, and at the same time would establish a single, coherent, integrated approach for development over the next decade, incorporating public programs into a unified system of medical care which utilizes the multiplicity of voluntary health insurance approaches and mechanisms.

California↗
PubMed1998

The Pollution Prevention Act of 1990: A Policy Whose Time Has Come or Symbolic Legislation?

/ In 1990, the United States officially entered the era of pollution prevention with passage of the Pollution Prevention Act. This paper analyzes EPA's implementation of the Pollution Prevention Act from its passage in 1990 to the present. It examines the barriers EPA must overcome if it is to effectively integrate pollution prevention into its existing regulatory structure, including impediments created by statutory and organizational structure, the existing relationship between EPA and the groups it regulates, the fragmented implementation scheme of national environmental regulation, the balancing of conflicting demands advanced by powerful interests, industry's economic and technical concerns, and institutional inertia. It also examines issues such as industry commitment, the limits of prevention, and measurement concerns. The findings suggest that EPA's efforts at shifting to a pollution prevention regulatory ethic that holds primacy over pollution control are mixed. Its organizational structure, statutory authority, and incentives system still reflect a single-medium pollution control focus, appropriations for pollution prevention programs and activities are paltry compared to traditional pollution control programs, and participation in the program is voluntary. Yet, the findings also point to some promising programs that are working to institutionalize a pollution prevention regulatory ethic, and many states appear very committed to the concept.KEY WORDS: Pollution prevention; Source reduction; Pollution control; Alternative regulatory design; Barriers to implementation

Journal Article↗
PubMed2000

Voluntary counseling, testing, and referral for HIV: new technologies, research findings create dynamic opportunities.

Programs for voluntary counseling and testing (VCT) for HIV play an increasingly important role in comprehensive prevention and care strategies. New technological advancements and behavioral interventions can improve the effectiveness of VCT as a tool for preventing new HIV infections and helping HIV-positive individuals access appropriate care. With growing consensus that early access to HIV therapy increases its effectiveness, and that individuals diagnosed with HIV reduce risk behavior, VCT has become integral to the continuum of HIV primary care. However, federal funding of VCT has declined, with concomitant decreases in numbers of people being tested. An estimated 200,000 people in the United States remain unaware that they are HIV positive, and many at-risk individuals do not seek out standard HIV counseling and testing services. To increase the acceptability and effectiveness of VCT, the authors recommend that VCT programs employ outreach programs offering anonymous testing to reach those at heightened risk of HIV infection, and to make rapid use of new technologies and counseling strategies to improve the reach and efficacy. Given the important role that VCT can play in both prevention and early treatment, the authors recommend significant increases in federal support.

Confidentiality↗
PubMed1991

Efficacy of partner notification for HIV infection.

Since 1985, partner notification has been part of Swedish policy to prevent the spread of human immunodeficiency virus (HIV) infection. Potentially infected partners of a newly diagnosed seropositive patient are notified either by the index patient or by the physician and referred for counselling. The efficacy of this strategy was assessed over 18 months in 1989-90. 365 HIV-seropositive index patients (91% of the 403 patients diagnosed in Sweden during the study period) reported 564 sexual or needle-sharing contacts. 390 contacts were located and counselled and HIV test results are known for 350 of them. In 53 of the 350 cases, previously unknown seropositivity was diagnosed. Partner notification for HIV should be viewed as a strategy to offer counselling and testing to a high-prevalence group of people. In a country where general HIV prevalence is low, the strategy is cost-effective for location and counselling of unknowingly seropositive individuals.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Ethical issues in human genome research.

In addition to provocative questions about science policy, research on the human genome will generate important ethical questions in at least three categories. First, the possibility of greatly increased genetic information about individuals and populations will require choices to be made about what that information should be and about who should control the generation and dissemination of genetic information. Presymptomatic testing, carrier screening, workplace genetic screening, and testing by insurance companies pose significant ethical problems. Second, the burgeoning ability to manipulate human genotypes and phenotypes raises a number of important ethical questions. Third, increasing knowledge about genetic contributions to ethically and politically significant traits and behaviors will challenge our self-understanding and social institutions.

Bioethics↗
PubMed1995

The risk of domestic violence and women with HIV infection: implications for partner notification, public policy, and the law.

Partner notification has emerged as an important strategy in the fight against acquired immunodeficiency syndrome (AIDS), and states have now adopted a plethora of laws that encourage or mandate notification, often without the patient's consent. As human immunodeficiency virus (HIV) infection continues to spread among women, the future development of AIDS control strategies and public health laws must be shaped by concern for the safety and autonomy of patients who face a risk of domestic violence. Three distinct recommendations flow from this premise. First, all HIV-infected women should be assessed for the risk of domestic violence and offered appropriate interventions. Second, where a risk of abuse is indicated, partners should never be notified without the patient's consent. State laws that presently permit involuntary notification should be repealed or amended. Third, laws that punish a patient's refusal to notify partners should also be modified or repealed.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Applying your corporate compliance skills to the HIPAA security standard.

Compliance programs are an increasingly hot topic among healthcare providers. These programs establish policies and procedures covering billing, referrals, gifts, confidentiality of patient records, and many other areas. The purpose is to help providers prevent and detect violations of the law. These programs are voluntary, but are also simply good business practice. Any compliance program should now incorporate the Health Insurance Portability and Accountability Act (HIPAA) security standard. Several sets of guidelines for development of compliance programs have been issued by the federal government, and each is directed toward a different type of healthcare provider. These guidelines share certain key features with the HIPAA security standard. This article examines the common areas between compliance programs and the HIPAA security standard to help you to do two very important things: (1) Leverage your resources by combining compliance with the security standard with other legal and regulatory compliance efforts, and (2) apply the lessons learned in developing your corporate compliance program to developing strategies for compliance with the HIPAA security standard.

Computer Security↗