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Comments on legal column.

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Health Benefit Plans, Employee↗
PubMed2002

Are medical savings accounts a viable option for funding health care?

AIM: To summarize the international experience of medical savings accounts (MSAs), make a preliminary evaluation of the impact of MSAs, and assess their feasibility in other countries, particularly Central and Eastern Europe. METHOD: A review of published literature in academic journals, books, Internet sources, and other "gray" literature. RESULTS: Most published studies were theoretical. Advocates argued that MSAs improved the efficiency of insurance, increased consumer choice, and reduced health care expenditures. Critics argued that MSAs led to adverse selection, reduced equity, resulted in cost inflation, and deterred necessary utilization. MSAs have been implemented in China, Singapore, the United States of America, and South Africa. The organization of MSAs varied between countries. MSAs were combined with either a public or private insurance element to cover catastrophic expenses. Few empirical studies of MSAs have been conducted and, therefore, the evidence on their impact is limited. CONCLUSION: More empirical evaluations are needed on the impact of MSAs. Results of empirical evaluations cannot be easily generalized but depend on the complementary systems of financing and the extent of state regulation. MSAs are not likely to be feasible in countries where the unemployment rate is high, savings rates and average earnings low, and the state weak.

China↗
PubMed2002

Impact of Medicare managed care market withdrawal on beneficiaries.

The 2001 Survey of Involuntary Disenrollees was conducted to investigate the impact of Medicare+Choice (M+C) plan withdrawals on Medicare beneficiaries. Eighty-four percent of a total of 4,732 beneficiaries whose Medicare managed care (MMC) plan stopped serving them at the end of 2000 responded to the survey. Their responses indicated that the withdrawal of plans from Medicare affected beneficiaries in terms of concerns about getting and paying for care, increased payments for premiums and out-of-pocket costs, and changes in health care arrangements. Of particular concern were the impacts on those in vulnerable subgroups such as the disabled, less educated, and minorities.

Aged↗
PubMed2003

Preventive care in managed care and fee-for-service plans: is it cost effective?

Lack of coverage, knowledge, and physician guidance, and low socioeconomic status are major barriers to receiving preventive care. Compared with fee-for-service insurance, managed care promotes prevention through more generous coverage, physician incentives, and patient education, and members of MCOs use more preventive services than do members of fee-for-service plans. However, cost effectiveness of prevention has not been previously examined. A study of seven preventive services suggests that managed care enrollees more frequently obtained four preventive services, including two less-effective ones. For less-effective services, it may be prudent to base disease-risk assessment on key factors other than age and sex, and screen only patients at high risk. Effective screening strategies must be identified, especially for the underserved, low-income population.

Cost-Benefit Analysis↗
PubMed2000

Selective justice, genetic discrimination, and insurance: should we single out genes in our laws?

This article discusses the desirability of legislation focusing on genetic discrimination, in particular in the context of insurance. Many American states and some European countries as well as the Council of Europe have introduced protective measures against discrimination on the basis of genetic susceptibility. The author questions their effectiveness and queries whether they may be inequitable, because they fail to address more fundamental underlying issues related to the nature of insurance, access to health care, and unequal distribution of wealth. There is also a problem of definition in these statutes. They fail to capture what constitutes genetic information. Nonetheless, the author argues it is important to consider the social consequences of genetic testing. Michael Walzer's theory of justice is used to examine the role of insurance and health care. Using this approach, the author finds the American system of distribution for health care to be problematic. This is then used to inform the author's discussion of the future of health care in Canada. Anti-discrimination provisions could be used in a way that is consistent with Walzer's theory of justice. They would encompass both genetic and non-genetic health factors. These can be modelled on current anti-discrimination statutes in Canada. The author then proposes administrative committee structures to regulate the use of genetic data in Canada.

Advisory Committees↗
PubMedDate not supplied

Medical privacy: from the 4th Amendment to HIPAA. Right to privacy vs. public health: showdown looms over patient genetic information.

Newly adopted federal privacy regulations set a high standard for control of medical information that all medical offices and clinics must meet. Yet, the federal government can't even secure its own database of medical information. We have less than two years to come into full compliance with regulations that may well change over the coming months, making compliance a moving target. Learn the history of our privacy rights and regulations. And preview the privacy debates and dilemmas that await our digital society.

Confidentiality↗
PubMed1992

Genetic discrimination and the law.

The use of genetic tests can lead to genetic discrimination, discrimination based solely on the nature of an individual's genotype. Instances of the discriminatory uses of genetic tests by employers and insurance companies have already been reported. The recently enacted Americans with Disabilities Act of 1990 (ADA), together with other federal and state laws, can be used to combat some forms of this discrimination. In this article we define and characterize genetic discrimination, discuss the applicability of the various relevant federal and state laws, including the ADA, in the areas of employment and insurance discrimination, explore the limitations of these laws, and, finally, suggest some means of overcoming these limitations.

Civil Rights↗