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PubMed1988

Intravenous drug abuse and AIDS transmission: Federal and State laws regulating needle availability.

This paper has surveyed the laws restricting the use of hypodermic needles and syringes for injection of illegal drugs. It has reviewed the constitutional basis for these laws and concluded that they are on sound footing. There is a new Federal law regulating needles and syringes in interstate commerce, but it is too early to tell how expansively it will be implemented. A large majority of States have drug paraphernalia laws that govern needles and syringes, and a smaller number have laws that require prescriptions for the sale and possession of needles and syringes. Some local jurisdictions also have laws, but these were not specifically reviewed. Altogether, a breadth of relevant laws govern the manufacture, sale, use or possession, advertisement, and interstate commerce of needles and syringes intended for use with illegal drugs. Any attempt by scientists or public health officials to accurately study the effect of these legal restrictions on the HIV infection rates in differing jurisdictions must comprehensively consider the applicable laws. Likewise, attempts at legislative change must also identify each law that would apply. Prosecutorial discretion has been discussed as it relates to the decision not to prosecute offenses involving the illegal use of needles and syringes. While prosecutorial discretion is most likely to be used by prosecutors in individual cases, it provides a legally sound approach for a prosecutor who decides not to enforce the needle and syringe laws across the board as part of an HIV infection control program. Although this approach has not yet been adopted in this country, a prosecutor's decision not to enforce these laws might allow the establishment of an experimental program, such as one for needle exchange, that could serve as a laboratory for legislative initiatives.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Capitation in California--an analysis of at-risk financing of Medicaid services.

Recent legislative changes have fostered the growth of a highly competitive health care market in California. In addition to selective hospital contracting for Medicaid (Medi-Cal) services, the California Medical Assistance Commission is attempting to initiate pilot projects to capitate Medi-Cal beneficiaries in selected geographic areas throughout the state. Selective contracting with county capitated organized health systems is also underway in Santa Barbara County, with plans for other counties on the drawing boards. This paper describes these capitated programs as well as addressing problems that may arise in this transition from a fee-for-service to a capitated Medi-Cal system. Specifically considered are issues related to underutilization, quality of care, implementation, eligibility and effects on existing patterns of care.

California↗
PubMed1982

Recent trends in the Social Security Disability Insurance Program.

Earlier analysis documented the rapid growth of the Disability Insurance (DI) program from 1966 to 1975; this article discusses trends since 1975. Over the decade of the 1970's, the population insured for disability increased by 34 percent, and women as a proportion of the insured population rose from 32.4 percent in 1970 to 39.1 percent in 1980, reflecting the increase in female labor-force participation. Of disabled workers receiving benefits, the proportion that were women rose from 28.4 percent in 1970 to 32.4 percent in 1979. Although inflation caused total benefit costs to rise over the entire period, the number of DI beneficiaries began to decline in 1978. Disabled-worker awards reached a peak in 1975 and fell subsequently so that the 1969 and 1981 figures are approximately equal. Relative to 1970, the fraction of awards going to women increased, the share for persons aged 50-54 rose, and the proportion received by those aged 60-64 declined. Decreased in total awards, and hence recipients, stemmed primarily from higher rates of denial at both the initial application and the reconsideration stages. Higher denials were countered by substantial rises in the number of hearings and reversals by administrative law judges (ALJ's). in 1980, only 65 percent of all awards came from initial applications, while over a fourth resulted from ALJ reversals. In future years, recent legislative changes may be expected to curtail program expansion further.

Adult↗
PubMed1984

A 10-year review of the Supplemental Security Income program.

January 1, 1974, marked the beginning of the Supplemental Security Income (SSI) program for the aged, blind, and disabled, and also marked the end of a 14-month period of preparation that began on October 30, 1972, when President Nixon signed into law the Social Security Amendments of 1972 (Public Law 92-603). As a way of marking SSI's 10th anniversary, it seems appropriate to review the development of the program since its enactment and compare the program's performance with its original goals and expectations. This article looks at the SSI program in the context of the program's goals as set out by Congress and discusses the legislative changes--and the motives behind those changes--since its implementation. Statistical data are examined to determine whether the program is accomplishing what it was designed to do, and whether, as a result of legislation or because of changes in the characteristics of the recipient population, trends are developing that may have a future impact on the program.

Aged↗
PubMed1980

The dental educator and the law.

Dental educators become vulnerable to student lawsuits if they ignore legislative changes and judicial decisions that affect all academic units in higher education. Issues involving contractual considerations, privacy and grading, and recent copyright revisions are of particular interest to those faculty actively engaged in teaching. Knowledge of these issues as they relate to the course director's daily responsibilities will better prepare the dental educator to avoid litigation and to know when to seek advice of institutional counsel.

Clinical Competence↗
PubMed1982

How children travel in cars in New Zealand.

Two years ago a nationwide observation survey of children (0-14 years) in cars demonstrated that only 20 percent were appropriately restrained. Parent education material was prepared and the law was altered so that children over eight years of age were required to use a seat belt. A repeat observation study was undertaken to determine what effect, if any, these measures had produced. Altogether 21 554 children 0-14 years were observed. Twenty-five percent were appropriately restrained. The older the child, the less likely he was to be restrained. Fifty-six percent of children over eight years of age, and travelling in the front seat were wearing seat belts--unchanged from 1978. However only 23 percent of a random sample of 1000 adults correctly identified the new traffic rule. It is necessary to improve current attempts at health education. Any future legislative changes should be widely publicised.

Adolescent↗
PubMed1981

Psychiatric problems of physicians and their families.

Motivation for medicine is a complex issue, as is the motivation for other accomplishments in life. There are both conscious and unconscious factors that impel an individual to pursue the long and arduous training necessary to become a physician. Some of these factors meet neurotic needs of the individual and may set the stage for the later development of overt conflicts and psychiatric problems. The most common difficulties of physicians and their families are depression, alcohol and drug dependency, and marital conflicts. These and other issues may involve conflicts concerning unresolved dependency needs. Unfortunately, once problems develop in the physician, attempts at formal evaluation and therapy are often met with denial and resistance. An increased awareness of the problem, and guides for appropriate management of the psychiatrically ill physician by the American Medical Association Council on Mental Health and subsequent legislative changes in a few states, accompanied by an enlightened view by state medical boards, have helped in dealing with this difficult problem. Further, attempts to evaluate impaired physicians objectively and provide helpful and understanding therapy are needed. The prevention of psychiatric difficulties among physicians and their families is an important yet poorly studied area. Likewise, retirement poses special problems for many physicians and efforts should be made by organized medicine to develop educational programs directed toward the prevention of problems at all stages of the professional career.

Alcoholism↗
PubMed1995

Informed consent by children: the new reality.

Recent legislative changes in British Columbia and New Brunswick allow children to make their own decisions about health care, something that used to be the prerogative of their parents. In this article, Eike-Henner Kluge argues that the changes hold profound implications for physicians. He says they increase the responsibility placed on doctors, who must now consider whether a child is indeed competent, and whether the decision made by a competent child is indeed in the child's best interests.

Adolescent↗
PubMed1995

Workers' compensation introduction for physicians.

Workers' compensation is an important part of the employment system in this country, and its development was born out of necessity. In 1991, over 93 million employees were covered by workers' compensation statutes and laws for work related injuries and conditions. The costs over the past 20 years have increased at an overwhelming rate. These increases are being met by various cost containment strategies that are not omnipresent in all jurisdictions but instead, are being accepted and structured independently by each jurisdiction. Legislative changes are expected in the next few years to deter rising costs. The emerging patterns of cost containment are: limited initial provider choice, limited provider change, medical fee schedule, hospital payment regulation, utilization review, and bill review. The medical evaluation of impairment is a process that is not precise; however, impressive gains have arisen in this area through the use of the AMA Guides and DSM-IV.

Cost Control↗
PubMedDate not supplied

The dilemma in saving children from child labor: reform and casework at odds with families' needs (1900-1938).

Early in this century, reformers lobbied for regulation of child labor and compulsory school attendance. This article draws on their publications, agency case records, professional literature, and historical studies to examine the role of social workers in implementing the new reforms and the reactions of parents and children in low-income households who were affected by the legislative changes. The precarious nature of family self-sufficiency and social workers' ambivalence toward child labor led to conflict between professionals and client families. Missing at the time was professional acknowledgment of economic security for families as a fundamental necessity for children's welfare.

Adolescent↗
PubMed1994

Disability trends in the United States: a national and regional perspective.

Between 1978 and 1993, the number of persons receiving disability benefits under either the Supplemental Security Income program or the Old-Age, Survivors, and Disability Insurance program increased more than 43 percent--from 4.7 million to 6.7 million. In 1993, 4.08 percent of the U.S. resident population aged 18-64 were receiving a disability benefit under one or both of the programs, compared with 3.37 percent in 1978. This ratio had declined to 2.93 percent in 1983. The article examines the change in growth since 1975 in each of the two disability programs and provides an overview of key legislative changes occurring during the period. The emphasis is on regional and State changes during the 1987-92 period, identifying those areas where growth has been the most dramatic.

Adolescent↗
PubMed1994

Motor vehicle occupant injuries in New Zealand children, 1981-90.

AIM: To determine the incidence of motor vehicle occupant injuries in New Zealand children and to consider future directions for prevention. METHODS: The Ministry of Health's national mortality and morbidity files for the years 1981-1990 were examined to identify all deaths and hospital discharges for motor vehicle occupant injuries in children between the ages of 0-14 years. RESULTS: Over the 10 year period, there was an average of 26 deaths and 433 hospitalisations annually. Fatality rates were highest for the age group 0-2 years, whereas hospitalisation rates were highest for those aged 3-4 years. Although mortality rates were similar for Maori and nonMaori children, the hospitalisation rate for Maori children was more than three times that for nonMaori children. No significant trends in either fatality or hospitalisation rates were evident. DISCUSSION: Motor vehicle occupant injury is an important public health problem in New Zealand children. Reductions in the numbers of motor vehicle occupant deaths and hospitalisations will require not only legislative changes aimed at increasing restraint use, but also the development of strategies to ensure compliance with the legislation. The identification of barriers to the use of child restraints is likely to facilitate the development of effective strategies aimed at increasing occupant restraint use.

Accidents, Traffic↗
PubMed1994

Projecting future drug expenditures--1994.

The use of information on inflation, generic competition, market introduction of new drug entities, institution-specific drug-use patterns, and federal legislation to project drug expenditures is discussed. Inflation of pharmaceutical prices has been decreasing over the past few years. Increases in the producer price index for drugs and pharmaceuticals diminished from 6.9% in 1991 to 4.3% in the first half of 1993; the specter of government regulation may be one reason. Pharmacy group purchasing organizations (GPOs) predicted that in 1994 expenditures would increase an average of 2.1% for contracted drug items and 8.3% for noncontracted items. Expenditures for biotechnology drugs in January through July 1993 increased 16% over the same period in 1992; such agents are now hospital pharmacies' third most costly drug category, at 10% of total expenditures. Future price competition by generic drug products can be predicted from information on patent or market-exclusivity expiration. To predict the market release of new drug products, new-drug applications filed with FDA can be monitored. The most important component in projecting drug expenditures is a specific institution's pattern of use of high-cost drugs. Mechanisms that can be used to monitor changes in therapeutic strategies and drug-use protocols include drug cost indexes, assessment of drug-use patterns by outside companies, and computerized models for specific high-cost drugs. Drug expenditures can be affected by legislative changes such as the Medicaid rebate provisions of the Omnibus Budget Reconciliation Act of 1990 and the Medicare outpatient drug benefit in the proposed American Health Security Act. The accuracy of projections of drug expenditures can be improved by examining inflation, generic competition, the introduction of new drug entities, institution-specific drug-use patterns, and legislative issues. Pharmacy managers need better methods for estimating institution-specific use of high-cost drugs.

Drug Approval↗
PubMed1993

Developing policy in an administrative health region.

The paper presents recent English health and social care legislation as observed by a dentist, in a post which carries no dental remit, but involves responsibility in a Regional Health Authority for a variety of care groups, including mental health, learning disabilities and geriatrics, for interagency working and implementation of legislative changes. It poses a series of questions for dentistry which might arise from these changes, from the perspective of an informed 'outsider' of the dental world working at a strategic level.

Catchment Area, Health↗
PubMed1995

[Social legislative and structural deficits of ambulatory management of chronic psychiatric and handicapped patients].

In the past 25 years, psychiatric care for the chronically mentally ill in Germany has improved steadily. However, has improved steadily. However, this patient group continues to be discriminated against, especially in the sphere of outpatient care. The mentally ill often do not meet the requirements that the respective social security agencies, i.e. in particular pension and health insurance, set out for the granting of benefits. Moreover, contrary to scientific knowledge, measures aimed at the treatment of social disabilities are defined not as psychiatric rehabilitation measures, but as measures of social integration. For these reasons welfare is highly overrepresented in the financing of rehabilitation for the mentally ill. In recent years, legislators have attempted to compensate certain cases of discrimination. Significant legislative changes and administrative developments are described and discussed in terms of their implications.

Ambulatory Care↗
PubMed1993

Restructuring federalism: the impact of Reagan policies on the family planning program.

Through fiscal cutbacks and structural changes, Reagan's federalism assaulted the ethos of public health. In assessing the effects of Reagan policies on a basic public health program, family planning services, we find a substantial decrease in spending for this program, a reduction in the numbers of patients served, and increased variation among the states in the provision of services to low-income women. These effects are comparable with findings from other studies on the impact of Reagan's federalism upon social programs and have manifold implications for public health.

Capital Financing↗