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PubMed2001

Analyzing end-of-life care legislation: a social work perspective.

Several policy approaches are currently being considered in an attempt to organize a national response to the crisis surrounding quality end-of-life care. Recent healthcare efforts aimed at supporting individuals facing advanced illness are marked by debate over assisted suicide, untimely referrals to hospice care, inconsistent adherence to advance directives, and substantive amounts of unrelieved pain in end-of-life. Social workers require a clear understanding of the current political and social climate if they are to navigate the ethical dilemmas as they are presented in end-of-life care. This article discusses recently proposed policy responses to the various political and social controversies surrounding end-of-life care for individuals facing advanced illness. The analysis will suggest criteria for evaluating end-of-life policy in general and offer a framework for evaluating proposed legislation. Suggestions for making end-of-life policy more effective and areas for future research will be proposed. Finally, the implications of this policy analysis for social work will be delineated.

Advance Directives↗
PubMed2003

Impact of federal legislation and policy on VR services for consumers who are deaf or hard of hearing: perspectives of agency administrators and program specialists.

The authors report on a national survey of administrators and program specialists at 43 state vocational rehabilitation (VR) agencies concerning the impact of federal employment legislation and rehabilitation policies on the provision of services to consumers who are deaf or hard of hearing. The article focuses on 5 initiatives enacted to enhance efforts to help people with disabilities achieve competitive employment and self-sufficiency: the Workforce Investment Act of 1998, Order of Selection policies established by state agencies, Interagency Agreements between VR and postsecondary programs, the Comprehensive System of Personnel Development, and the Ticket to Work and Work Incentives Improvement Act of 1999. The article concludes with a summary of state agencies' priorities and needs in regard to technical assistance to enhance the provision of VR services.

Communication Devices for People with Disabilities↗
PubMed2005

Comparison of provincial and territorial legislation governing substitute consent for research.

In Canada, provincial and territorial laws address circumstances in which a substitute decision-maker may be appointed for an adult deemed legally incapable of making decisions in one or more areas of life. We searched for provincial and territorial laws that explicitly address substitute decision-making about research participation, and found significant differences among Canadian jurisdictions. In some provinces and territories there is no direct statutory guidance on the issue. Differences among jurisdictions that address substitute decision-making about research in legislation include whether judicial intervention is required to authorize the substitute decision-maker, whether any advance directive in place must explicitly authorize the decision about research in order for a proxy to consent, and how risk and benefit thresholds beyond which substitute consent to research is prohibited are articulated. It is imperative that government, researchers, and the Canadian public revisit the principles underpinning substitute decision-making about research in light of national and international norms, in order to lend clarity and consistency to this area of law and research practice.

Canada↗
PubMed2003

Parental leave: the impact of recent legislation on parents' leave taking.

We use data from the Survey of Income and Program Participation to examine the impact of leave entitlements on unpaid leave usage by men and women after the birth of a child from 1991 to 1999. The results indicate that legislation providing the right to unpaid leave has not affected men's leave usage. The results for women are mixed: in some specifications, leave entitlements are associated with increased leave taking or longer leaves, but the results depend on how we define leave coverage. Our results point to the limited impact of unpaid leave policies and the potential importance of paid-leave policies.

Family Characteristics↗
PubMed1992

The legislative battle over health services research.

Budget reconciliation legislation in 1989 created the new Agency for Health Care Policy and Research (AHCPR), which folded in the National Center for Health Services Research and Health Care Technology Assessment, among the law's other provisions. The creation of the new agency represented a shift in priorities toward outcomes and effectiveness research in medical practice and made explicit the federal government's role in developing practice guidelines. The new agency was born in the midst of an extraordinary bipartisan budget negotiation process in late 1989; its becoming linked to the contentious issue of physician payment reform nearly killed the new agency before it appeared. The narrative of political wrangling that resulted in the creation of AHCPR spans Capitol Hill, the White House, the agencies of the Department of Health and Human Services, and renowed health services researchers on either coast and in Washington, D.C.

Health Policy↗
PubMed1992

Drinkers and their driving: compliance with drinking-driving legislation in four Australian states.

This study replicates work in Norway and the United States in investigating the extent to which Australian drivers attempt to comply with drinking-driving legislation. In a four-state survey of 1,133 drinkers, it was found that people were aware of the need to control their alcohol input before driving, and derived estimates of blood alcohol after a recent away-from-home drinking occasion demonstrated that the amount people drank was influenced by whether or not they were driving. Drivers reported drinking less than nondrivers and were also those who usually consumed less alcohol. These findings were also true of people with different levels of normal consumption. Although these results are encouraging, it is suggested that there is need for further modification of sanctions, and that the community needs more information about the alcohol content of drinks and drink sizes if people are to moderate effectively their drinking before driving.

Accidents, Traffic↗
PubMed2003

[Health policy and legislation concerning traditional indigenous medicine in Mexico].

Various Mexican federal and state government agencies dealing with indigenous affairs are trying to establish control over traditional medicine and by recognizing it achieve cost decreases for health care directed towards Indian groups, bolstering it as a first-care level. The result is that the community absorbs the costs of medical care, leading to a reduction in the number of patients seeking government-run health care services. Traditional indigenous healers and their organizations consider the law a two-edged sword. On the one hand it provides them with legal measures for their protection, but on the other, they perceive it as a dangerous threat to their culture and practices. This has led them to seek legal advice, training, and active participation in the drafting process for such legislation. The result of this project is that they have been able to learn about the law, discuss their demands, and work out a proposal which is included in this document.

English Abstract↗
PubMed2005

Legislating "sound science": the role of the tobacco industry.

In the late 1990s, in an effort to dispute the link between secondhand smoke and lung cancer, Philip Morris initiated a campaign to legislate "sound science." The campaign involved enacting data access and data quality laws to obtain previously confidential research data in order to re-analyze it based on industry-generated data quality standards. Philip Morris worked with other corporate interests to form coalitions and work-groups, develop a "data integrity" outreach program, sponsor symposia on "research integrity," and draft language for the new acts. The tobacco industry played a role in establishing laws that increase corporate influence on public health and regulatory policy decisions.

Expert Testimony↗
PubMed1994

A cost-benefit analysis of legislation for bicycle safety helmets in Israel.

Legislation requiring bicyclists to wear helmets in Israel will, over a helmet's 5-year duration (assuming 85% compliancy, 83.2% helmet efficiency for morbidity, and 70% helmet efficiency for mortality), save approximately 57 lives and result in approximately 2544 fewer hospitalizations; 13,355 and 26,634 fewer emergency room and ambulatory visits, respectively; and 832 and 115 fewer short-term and long-term rehabilitation cases, respectively. Total benefits ($60.7 million) from reductions in health service use ($44.2 million), work absences ($7.5 million), and mortality ($8.9 million) would exceed program costs ($20.1 million), resulting in a benefit-cost ratio of 3.01:1.

Adolescent↗
PubMed1995

State legislative strategies to improve the supply and distribution of generalist physicians, 1985 to 1992.

State laws enacted between 1985 and 1992 were reviewed to examine state involvement in influencing the supply and distribution of generalist physicians. Forty-seven states enacted 238 relevant laws during this period. In 1991 and 1992, 36 states enacted 98 laws, as compared with 1985 and 1986, when 8 states enacted 12 laws. Legislation addressed planning and oversight; financial incentives to institutions, students, and residents; and strategies to enhance the practice environment. A new strategy is to link funding to measureable outcomes, such as the career choices of a state medical school's graduates. Few states devoted resources to evaluate their efforts.

Education, Medical↗
PubMed1999

Maternal minimum-stay legislation: cost and policy implications.

OBJECTIVES: Recently, most state legislatures and Congress have passed laws mandating insurance coverage for a minimum period of inpatient care following delivery. This study analyzed the likely cost implications of one state's law. METHODS: Hospital discharge records for Illinois women who gave birth (n = 167,769) and infants born (n = 164,905) during a 12-month period predating the law were analyzed. RESULTS: As a percentage of total spending on birth-related admissions and readmissions, the net effect of the law ranges from a savings of 0.1% to a cost of 20.2%. CONCLUSIONS: There may be large cost implications to this legislation, even with savings from avoided re-admissions.

Adult↗
PubMed1994

The impact of recent legislative change in Germany.

Cost-containment policies introduced in Germany under the 'Health Structure Act' at the beginning of 1993 marked a dramatic turnaround in German healthcare policy. The traditional arms-length approach of government policy makers, under which responsibility for implementation of the measures specified in national legislation was devolved upon the representatives of healthcare providers and statutory health insurance funds, was replaced by government mandates at the national level. These mandates-including price controls, a national pharmaceuticals budget and copayment changes-had a dramatic impact on the German healthcare system and on the German pharmaceutical market in particular. Eventually, these national controls are to be phased out as the associations of healthcare providers and health insurance funds negotiate the terms for implementation of further measures specified in the 'Health Structure Act': regional budgets, prescription guidelines, stricter controls of prescribing behaviour and a positive list. Despite this gradual return to the federalistic principles of the German healthcare system, the German pharmaceutical market will never be the same.

Budgets↗
PubMed1978

Health policy in France: a major issue in the 1978 legislative elections.

For the 1978 legislative elections, all French political parties have, for the first time, a relatively detailed health policy. The right-wing parties of the present government concentrate on the reduction of medical expenditure and the maintenance of the free enterprise tradition of French medicine. The left-wing parties concentrate more on the development of public health institutions and suggest nationalization of the pharmaceutical industry. Within the Left, there is, however, a difference of emphasis: the Socialists propose the setting up of medicosocial centers and abolition of the fee-for-service system; the Communists concentrate rather on industrial health and believe that an improved health service can only come from changes in overall social economic policy. None of these policies is particularly adventurous but their mere existence shows that health is now a major political preoccupation in France. Some of these policies are mainly concerned with individual and public welfare and others with the necessity of maintaining a certain social order. The debate surrounding health policy usually turns around these two issues.

Communism↗
PubMed2000

Legislative proposals for reversing the cancer epidemic and controlling run-away industrial technologies.

An interlocking legislative complex is proposed for the control of carcinogenic and other adverse impacts of established run-away petrochemical and radionuclear technologies, with particular reference to winning the losing war against cancer. These proposals are also applicable to the poorly recognized, potentially adverse public health and environmental hazards of emerging technologies, particularly genetically engineered food production. The proposals embody fundamental democratic rights--the right to know and balanced and transparent decision making--the "Precautionary Principle," reduction in the use of toxics, incentives for the development of safe industrial technologies, and criminal sanctions for suppression or manipulation of information.

Adult↗
PubMed2002

Compliance with prompt payment legislation: the initial experiences of New Jersey radiologists.

OBJECTIVE: Prompt payment has emerged as a dominant issue in managed care reform, with 47 states passing laws or regulations requiring prompt remuneration for medical services. The New Jersey Prompt-Pay Act, effective on December 28, 1999, requires payment within 30 days of electronic submission and within 40 days for nonelectronic submission. This study was undertaken to assess compliance with the New Jersey Prompt-Pay Act for radiology claims submitted 1 and 5 months after implementation (7-11 months after passage of the statute). MATERIALS AND METHODS: A retrospective prompt payment analysis was undertaken of all claims submitted in February and June 2000 to six major payers by a common third-party billing company on behalf of 11 radiology practices of various sizes, settings, and locations in New Jersey. A total of 33,537 claims were assigned to one of six time periods on the basis of timeliness of payment: less than or equal to 30 days, 31-40 days, 41-50 days, 51-60 days, 61-90 days, and greater than 90 days or a separate unpaid category after 170 days had elapsed. A detailed analysis of 3156 claims from one practice was performed to estimate a clean claims submission rate. RESULTS: The overall percentage of claims paid within 40 days was 70%. After 170 days, the overall percentage of paid claims was 93%. The annualized interest lost on delayed payments was $23,939 for the practice analyzed. CONCLUSION: Prompt payment for radiology services remains an elusive goal in New Jersey, despite passage and implementation of prompt payment legislation.

Guideline Adherence↗
PubMed1992

Changes in smoking legislation, attitudes, and behavior.

Legislative changes and attitude campaigns are generally acknowledged to be effective in the battle against smoking and its health hazards. In some instances it seems as if these means are insufficient to produce necessary change. In this study, the following general hypotheses were posed: (1) an advertising ban leads to reduced tobacco sale and (2) to reduced smoking; (3) attitude campaigns improve attitudes about regulation of smoking and (4) reduce smoking. In addition, two national hypotheses were formulated. The results supported neither hypothesis! It is concluded that it is important to follow the development closely with scientific methods of high quality. Further, smoking campaigns must include a broad spectrum of interventions to be sufficiently effective.

Adolescent↗
PubMed1995

Self-interest and attitudes about legislation controlling alcohol.

A stratified random sample of 505 adult Indiana residents living in households with telephones was surveyed using random-digit dialing to assess their attitudes about nine specific legislative proposals to control drunk driving or underage drinking and to assess the effects of self-interest on those attitudes. A two-stage Mitofsky-Waksberg design was used in the computer-assisted telephone-interview process. There was widespread support for all nine proposals, but self-interest, related to personal vulnerability for enforcement of those measures, reduced the support of regular drinkers for drunk-driving controls compared with nondrinkers' support. Parents of children aged 18 and younger were less likely than nonparents to support imposing parental liability for the consequences of children's underage drinking.

Accidents, Traffic↗
PubMed1986

The contest between psychiatrists and lawyers over involuntary detention: the effects of recent changes in mental health legislation in New South Wales.

New mental health legislation was enacted in New South Wales in 1983 and, although the reformed Act remains unproclaimed, some of the new procedures have already been introduced into psychiatric hospitals. The spirit of the Act is clearly aimed at protecting the rights of the mentally ill, who are often unable to act as their own advocates. To ensure this protection, it is now routine for solicitors to represent detained patients in their pleas for release. In this report we describe three recent cases that illustrate the difficulties that arise when solicitors and psychiatrists contest the legitimacy of detention orders. The atmosphere of judicial hearings is becoming increasingly adversarial and the public disclosure of sensitive information can provoke unnecessary distress in patients and their families. In the zeal to preserve civil rights, the special needs of psychiatric patients can be obscured, sacrificing the patients' rights to confidentiality, privacy and appropriate treatment. While the involuntary detention of patients is a matter of the utmost seriousness, current procedures, which seem to be modelled on those of the criminal legal system, are proving to be inappropriate to the needs of psychiatric patients.

Adolescent↗