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Biomedical subjects

E J Burger

Publications and source records attributed to E J Burger.

17 recordsLinked to original sources
PubMed1998

From assurance to insurance in Russian health care: the problematic transition.

OBJECTIVES: Given the declining health status of the Russian population and the negative social impact of ongoing economic reforms, it is important to understand the nature and scope of Russia's innovations in health care financing. METHODS: Data on Russian health care and its financing were gathered from Russian newspapers and journals. US government agency reports, recent press accounts, and the authors' observations and interviews in Russia. RESULTS: The 1991 statutory basis for the Russian mandatory medical insurance system replaced the traditional, state-funded medical care system with a regional system principally reliant on an enterprise-based with-holding tax plus supplementation by local government and, to a minor extent, federal funds. The regional agent for distribution and management of these funds is a series of Territorial Health Insurance Funds. Implementation thus far has been highly uneven among territories. CONCLUSIONS: An insurance model patterned after the Western example may not be the optimal solution to Russia's current health financing problems. Given the chaotic nature of political and economic reform, Russia may simply not be ready for market-based medical insurance.

Health Care Reform↗
PubMed1989

Human health: a surrogate for the environment. The evolution of environmental legislation and regulation during the 1970s.

Human health and threat to human health have been used repeatedly and, at times, deliberately, as surrogates for other desirable features of the physical environment in order to make environmental regulatory and legislative initiatives politically attractive. Since the decade of the 1970s, this strategy has been a successful one in terms of providing a persuasive politcal argument for environmental initiatives. At the same time, however, the use of a surrogate or "false colors" has had the unfortunate effect of raising and sustaining public fears and preoccupations which, in at least some cases, have probably diverted our attention away from more important contributors to disease and premature mortality.

Environmental Pollution↗
PubMed1988

Scientific information in judicial and administrative systems.

There has arisen in recent times an increasing concern for the quality and interpretation of scientific and technical facts in both administrative (regulatory) and judicial decisions dealing with environment and health. Members of the scientific community have pointed to the poor quality of the scientific fabric used as the factual basis for decisions. Others fear an erosion of justice (as in the awarding of just compensation) if an excessively rigorous test for judging scientific material is demanded. Perhaps most important, this complex issue has made more explicit a debate over where the boundaries properly lie between scientific and social issues and how broadly those decisions should be shared. The emergence of this issue of how science should articulate with the public policy process follows a number of important trends of the past few years. One is a much augmented degree of public interest in health and risks to health. The rising tide of public concern for the environment of the past two decades turned in great part around issues of health--often as a surrogate for other environmental qualities. This coincided with a period of increasing public demand for more direct public participation in the affairs of government. All of this together brought forth much more scientific and technical detail into broader public discussion than had been the pattern historically. Thirdly, the nation has turned to its courts more frequently and more prominently both to render ultimate decisions for the regulatory process and to review cases brought in the name of compensation for disease and disability. As a result of this latter, increasingly complex scientific and technical evidence has become the centerpiece of adversary proceedings and the court has become the locus for judging and interpreting science. In some cases, science itself has become the principal fodder for argumentation--leading to a debate over a seeming conflict between honoring the integrity of the factual basis for decisions versus the serving of a variety of social goals. In fact, both of these should be well accommodated. Decisions should rest on a respected body of fact and ultimate decisions should serve desired social endpoints. However, that dictates a separation between review and interpretation of scientific factual material from adversary proceedings. This has been the traditional experience in other parts of the western world. To perform in this way, however, does raise fundamental questions about how political power for these decisions should be shared.

Disability Evaluation↗
PubMed1976

Unmatured science and government regulation.

A common feature of much scientific information reflected in government regulation is its passage directly from the laboratory into government decision without benefit of review and interpretation. This pattern can be attributed to a variety of factors. One is the incentives that lead government agencies to act quickly and conservatively in the name of protection of human health. Another is the relatively lengthy process of traditional review and interpretation via professional meetings and scientific publication. Yet, the case appears very strong for preserving, if foreshortening, the stages of peer review of otherwise unmatured data used in regulation. Several schemes of this sort have been tried in the past few years-some with apparent success. These are discussed alongside the proposal for a science court-a quasi-judicial vehicle for rendering judgements about scientific findings.

Decision Making↗
PubMed1975

Science for medicine--time for another reappraisal.

The Amendments to the National Cancer Act of 1974 included a provision for a comprehensive review of the Federal policies and programs for medical research. This would appear to be a particularly timely review since many of the fundamental issues concerning the Government's role in biomedical research are presently in question. These issues include the rationale for public support for basic medical research, public expectations for returns on these investments, establishment of priorities among various research avenues, and a number of derivative as well as ethical questions. Since the professional and scientific communities have been historically successful in gaining public funds for research, a periodic opportunity for public review and consideration would appear to be highly desirable.

National Institutes of Health (U.S.)↗