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161. Medical Disasters and the Growth of the FDA

Author:
Ronald Hamowy
Publication Date:
02-2010
Content Type:
Policy Brief
Institution:
Independent Institute
Abstract:
There is strong evidence that the spectacular growth in the size of the federal government is a result of its expansion following one crisis or another, either real or imagined. After the crisis it gains new powers that become the norm for the next stage of growth. The Food and Drug Administration provides a particularly apt example of this increase in powers as a response to a series of crises, each of which has increased the regulatory authority of the agency. The Food and Drug Administration, which did not even exist before the twentieth century, now possesses massive regulatory powers over products that account for no less than twenty-five cents of every dollar spent by the American consumer, totaling well over $1 trillion annually. Historical investigation shows that the agency has been able to take advantage of several perceived crises, the combined effect of which was to increase its authority to determine what Americans ingest to the point where today, at least in the case of drugs, it is the agency—and not the consumer—that determines when and what is available. A regulatory agency originally established to ensure that consumers would be provided with full and accurate information on the drugs available to them has become one that determines which drugs are available, when they might be administered, and who may ingest them. This essay traces this growth in terms of the legislative reaction to three crises, the diphtheria antitoxin crisis of 1901, the sulfanilamide crisis of 1937, and the thalidomide crisis of 1960.
Topic:
Government and Health Care Policy
Political Geography:
United States

162. Giving developing countries the best shot: An overview of vaccine access and R

Author:
Paul Wilson
Publication Date:
04-2010
Content Type:
Working Paper
Institution:
Oxfam Publishing
Abstract:
Vaccines have made possible some of the greatest public health successes of the past century. Immunisation helps avert an estimated 2.5 million child deaths each year, as well as millions more bouts of illness and disability. Poor countries as well as rich have benefited, although developing countries almost always benefit only after long delays. Basic childhood immunisation is one of the few health interventions to which most of the world's poor have access, free of charge and through the public sector. In fact, immunisation is one of the most equitable health interventions, protecting girls and boys alike, and reaching the poor within countries at higher rates relative to the wealthy than other services.
Topic:
Emerging Markets, Health, International Political Economy, Third World, and Health Care Policy

163. MDG Achievements, Determinants, and Resource Needs: What Has Been Learnt?

Author:
Jann Lay
Publication Date:
06-2010
Content Type:
Working Paper
Institution:
German Institute of Global and Area Studies
Abstract:
This paper reviews the effectiveness and efficiency of key policy instruments for MDG (Millennium Development Goals) achievement. We first demonstrate that average MDG progress is likely to be too slow to meet the education and health sector targets in a number of developing countries. We also show that MDG achievement can be described by a transition path with declining rates of progress. More detailed analysis reveals that the transition towards universal primary enrollment in poor countries with low initial enrollment has accelerated considerably in the more recent past. The paper then focuses on the role of demand‐versus supply‐side factors in social service utilization in education and health. The main policy conclusions of the review reflect some of the key determinants of MDG achievement: First, specific single‐policy interventions can have a considerable impact on social service utilization and specific human development outcomes. For example, improving access to basic health services, in particular to vaccination, has been a key factor in reducing child mortality rates in a number of very poor countries. Second, demand‐side policies have proved extremely effective, for example, in increasing school enrollment and attainment levels. However, there may be more scope for targeting the demand side in the health sector. Third, policy effectiveness and efficiency are highly dependent on initial conditions and the specificities of the respective policy. Fourth, complementarities between MDG targets, in particular social service utilization, are likely to be very important.
Topic:
Health Care Policy

164. Reforming Medical Malpractice Liability through Contract

Author:
Michael F. Cannon
Publication Date:
11-2010
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
This paper discusses the medical malpractice "crisis" and the potential of contract liability to reduce overall malpractice costs as well as improve the quality of and access to care. First, the paper describes the current medical malpractice liability "system" and some of the more common reforms offered. It then discusses the economic rationale of allowing patients and providers to agree in advance of treatment on how the patient will be compensated in the event of simple negligence on the part of providers, explaining how contract liability may offer improvements in the areas of costs, patient preferences, the pursuit of more efficient liability rules, and quality of care. The paper then critiques select objections to contract liability – those based on the superior bargaining power of providers, the lack of information available to patients, and possible reductions in quality – and forwards possible limitations on the right to contract that may allay such concerns.
Topic:
Health, Law, and Health Care Policy
Political Geography:
United States

165. Consumer-Directed Home and Community Services Programs in Five Countries: Policy Issues for Older People and Government

Author:
Alison Evans Cuellar, Jane Tilly, and Joshua M. Wiener
Publication Date:
10-2000
Content Type:
Working Paper
Institution:
Urban Institute
Abstract:
A major innovation in long-term care for elderly persons in the United States and Europe is the development of consumer-directed home care. These governmental programs give consumers, rather than home care agencies, control over who provides services and how these services are delivered. Typically, consumer-directed programs allow the consumer to hire, train, supervise, and fire the home care worker. In some programs, beneficiaries receive cash payments enabling them to purchase the services they want. In contrast, traditional home care programs rely on public or private agencies to supply and supervise the workers who serve program beneficiaries.
Topic:
Economics, Human Welfare, and Health Care Policy
Political Geography:
United States, Europe, France, Germany, Netherlands, and Austria