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History helps us to better understand the particulars of the form and functions of institutions. In this paper we present the case study of the evolution of health care financing in the Netherlands over the past 150 years, through the lens of incremental institutional change. Our historical and political analysis is based on a review of secondary literature as well as relevant policy documents, parliamentary debates and archival material. We use the conceptual framework of incremental institutional change (i.e. layering, conversion, drift and displacement) for our analysis. The constitutional program of the mid-nineteenth century laid down the foundations of a 'private initiative first, government last'-approach to health care financing in the Netherlands. Over the course of 150 years this led to the evolution of a complex layered system of financial arrangements consisting of direct public funding, national, social and private health insurance with complex interdependencies. This was not a conscious strategy, but a result of the fact that the central government in the Netherlands preferred to tackle specific problems in health care financing with very specific measures, so as not to intrude on the trade of civil society and commercial business in health care. Regulatory authority and statist power in and over health care financing is not something that was created through dramatic reform in the Netherlands, but came about through many decades of small, incremental, yet accumulating changes. This provides a case study for further analysis of incremental versus rapid change in health care systems internationally. • Health insurance in the Netherlands expanded gradually, not through big changes. • Dutch politics has always favoured 'private initiative' over state intervention. • The Dutch health care market is far more public than it seems. [ABSTRACT FROM AUTHOR]

The Affordable Care Act changed the regulations governing small firms' health insurance premiums. However, small businesses can avoid many of the new regulations by self-insuring or maintaining grandfathered plans. If small firms with healthy and lower-cost enrollees avoid the regulations, premiums for coverage sold through insurance exchanges could be unaffordable. In this analysis we used the RAND Comprehensive Assessment of Reform Efforts microsimulation model to predict the effects of self-insurance and grandfathering exemptions on coverage and premiums available through the exchanges. We estimate that Affordable Care Act regulations restricting employers' ability to offer grandfathered plans will result in lower premiums on plans available through the exchanges and will have small negative effects on enrollment in the exchanges. Our results suggest that these regulations are essential to keeping premiums on the Small Business Health Options Program (SHOP) exchanges affordable. Our analysis also found that Affordable Care Act regulations limiting self-insurance will reduce enrollment in the exchanges somewhat, without substantially affecting exchange premiums. [ABSTRACT FROM AUTHOR]

As implementation of the Affordable Care Act reshapes the US health insurance market, state policy makers should be prepared to revisit regulation of stop-loss coverage--a form of reinsurance--for small businesses. Aspects of the reform law could motivate small businesses to self-insure, rather than participate in state-regulated markets either inside or outside the new health insurance exchanges. If younger or healthier groups self-insure, premiums for insured plans might rise to an extent that could seriously impair the regulated market. States can influence small businesses to participate in the regulated market by making it more difficult or costly to obtain stop-loss coverage, which self-funded employers rely on to protect their businesses from catastrophic medical costs incurred by one or more insured workers. States can limit the comprehensiveness of stop-loss coverage, ban stop-loss coverage outright, or regulate it as they do primary coverage. But states need federal guidance about how to exercise this authority if they are to promote, or prevent the undermining of, important aspects of federal health care reform. [ABSTRACT FROM AUTHOR]

Objectives. We examined employers’ responses to San Francisco, California’s 2007 Paid Sick Leave Ordinance. Methods. We used the 2009 Bay Area Employer Health Benefits Survey to describe sick leave policy changes and the policy’s effects on firm (n = 699) operations. Results. The proportion of firms offering paid sick leave in San Francisco grew from 73% in 2006 to 91% in 2009, with large firms (99%) more likely to offer sick leave than are small firms (86%) in 2009. Most firms (57%) did not make any changes to their sick leave policy, although 17% made a major change to sick leave policy to comply with the law. Firms beginning to offer sick leave reported reductions in other benefits (39%), worse profitability (32%), and increases in prices (18%) but better employee morale (17%) and high support for the policy (71%). Many employers (58%) reported some difficulty understanding legal requirements, complying administratively, or reassigning work responsibilities. Conclusions. There was a substantial increase in paid sick leave coverage after the mandate. Employers reported some difficulties in complying with the law but supported the policy overall. [ABSTRACT FROM AUTHOR]

Policy Points: Frequent data breaches in the US health care system undermine the privacy of millions of patients every year—a large number of which happen among business associates of the health care providers that continue to gain unprecedented access to patients’ data as the US health care system becomes digitally integrated. Implementation of the HIPAA Omnibus Rules in 2013 has led to a significant decrease in the number of privacy breach incidents among business associates. Context: Frequent data breaches in the US health care system undermine the privacy of millions of patients every year. A large number of such breaches happens among business associates of the health care providers that continue to gain unprecedented access to patients’ data as the US health care system becomes digitally integrated. The Omnibus Rules of the Health Insurance Portability and Accountability Act (HIPAA), which were enacted in 2013, significantly increased the regulatory oversight and privacy protection requirements of business associates. The objective of this study is to empirically examine the effects of this shift in policy on the frequency of medical privacy breaches among business associates in the US health care system. The findings of this research shed light on how regulatory efforts can protect patients’ privacy. Methods: Using publicly available data on breach incidents between October 2009 and August 2017 as reported by the Office for Civil Rights (OCR), we conducted an interrupted time‐series analysis and a difference‐in‐differences analysis to examine the immediate and long‐term effects of implementation of HIPAA omnibus rules on the frequency of medical privacy breaches. Findings: We show that implementation of the omnibus rules led to a significant reduction in the number of breaches among business associates and prevented 180 privacy breaches from happening, which could have affected nearly 18 million Americans. Conclusions: Implementation of HIPAA omnibus rules may have been a successful federal policy in enhancing privacy protection efforts and reducing the number of breach incidents in the US health care system. [ABSTRACT FROM AUTHOR]

Many scholars have argued that because consumers are poorly organized, regulatory enforcement will tend to be lax and serve the interests of industry. Considering, however, that elections are one of the main mechanisms by which the public exerts control over policy, surprisingly few studies have examined how electoral incentives may spur the government to regulate vigorously on behalf of consumers. We argue that when the threat of electoral accountability is greater, regulatory activities will serve the interests of the public, even if they impose costs on industry. We test this theoretical expectation by analyzing state regulatory activity in the wake of exogenous storms and natural disasters, which provide us with important theoretical and causal leverage. We find that a more “pro-regulation” electorate and elected chief regulators acting in close proximity to elections are associated with pro-consumer regulatory action. [ABSTRACT FROM AUTHOR]

The article focuses on the campaign by the Australian Traditional Medicine Society (ATMS) to reverse the decision by the federal government to remove modalities from health fund coverage as part of its package to reduce health fund premiums. Topics discussed include the modalities that the government plans to remove from health funds, messages behind the pro-active public relations (PR) and lobbying strategy by the ATMS, and an overview of the campaign.

The article provides an update on the ruling from the Fifth Circuit Court of Appeals on the status of the Affordable Care Act as of October 2019. Topics covered include reports issued by the U.S. Department of Health and Human Services on the risk adjustment program, a decline in individual-market enrollment among unsubsidized consumers since 2016, and the estimated number of people in 50 states and the District of Columbia that affectuated their 2019 Marketplace coverage as of February 2019.

In the early 1970s, Congress considered enacting comprehensive privacy legislation, but it was unable to do so. In 1974, it passed the Privacy Act, applicable only to information in the possession of the federal government. In the intervening years, other information privacy laws enacted by Congress, such as the Health Insurance Portability and Accountability Act, have been weak and sector specific. With the explosion of information technology and the growing concerns about an absence of effective federal privacy laws, the legal focus has shifted to the states. Signaling a new direction in state data privacy and consumer protection law, the California Consumer Privacy Act establishes important rights and protections for California residents with regard to the collection, use, disclosure, and sale of their personal information. The CCPA is certain to spur similar legislation and to affect national and international businesses that collect data from California's residents. Understanding the new law is important for all data‐driven industries, including health care. [ABSTRACT FROM AUTHOR]

Bovine liver supplements are sought after by consumers due to their nutrient-dense profile and high protein content. However, there is a lack of information regarding bovine liver supplement labeling practices. The objective of this study was to assess labeling practices and compliance with U.S. regulatory standards among commercially sold bovine liver supplements. The product labels for 49 bovine liver supplements were examined for required information, including a statement of identity; net quantity of contents; "Supplement Facts" label; ingredient statement; and name and place of business of manufacturer, packer, or distributor with domestic address or telephone number. Any claims made on the supplement labels were also reviewed for compliance. Overall, 59% of the products had at least one instance of noncompliance with U.S. labeling regulations. The main categories of noncompliance were missing a domestic mailing address or phone number (39% of products), noncompliant nutrient content claim (31% of products), and missing/noncompliant disclaimer for a nutritional support statement (6% of products). The lack of a mailing address or phone number is problematic because it prevents consumers from being able to report serious adverse events to the manufacturer. The majority (85%) of the nutrient content observed on product labels was found to be noncompliant. Noncompliant nutrient content claims are a major concern for consumers who rely on these claims to assess the nutritional benefits of a product. Overall, the results of this study revealed a lack of labeling compliance in bovine liver supplements, indicating a need for increased awareness and monitoring. [ABSTRACT FROM AUTHOR]

This paper explains how the current architecture of the pharmaceutical markets has created a misalignment of financial incentives and public health that is a central cause of harmful practices. It explores three possible solutions to address that misalignment: taxes, increased financial penalties, and drug pricing based on value. Each proposal could help to partly realign financial incentives and public health. However, because of the limits of each proposal, there is no easy solution to fixing the problem of financial incentives. [ABSTRACT FROM AUTHOR]

The article focuses on the amendment made by British Health Minister Andrew Lansley to his Health and Social Care Bill, which removes the authority of Monitor to set the maximum tariffs for health care services.