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Basic research will spur development of genetic tests that are capable of presymptomatic prediction of disease, disability, and premature death in presently asymptomatic individuals. Concerns have been expressed about potential harms related to the use of genetic test results, especially loss of confidentiality, eugenics, and discrimination. Existing laws and administrative policies may not be sufficient to assure that genetic information is used fairly. To provide factual information and conceptual principles upon which sound social policy can be based, the Human Genome Initiative established an Ethical, Legal, and Social Issues Program. Among the first areas to be identified as a priority for study was insurance. This paper provides a review of life, health, and disability insurance systems, including basic principles, risk classification, and market and regulatory issues, and examines the potential impact of genetic information on the insurance industry.

Following decades of increasing child access to public health insurance, pre-pandemic enrollments fell in many states after 2016 and the number of uninsured children increased. This study provides the first national, quantitative assessment of the role of administrative burdens in driving this drop in child health insurance coverage. In addition, we identify the demographic groups of children who were most affected. We show that regulations that increased administrative burdens placed on families reduced public health insurance coverage by a mean of 5.9 percent within six months following the implementation of these changes. Declines were largest for Hispanic children, children with non-citizen parents, and children whose parents reported that they did not speak English well. These reductions were separate from and in addition to enrollment declines among Hispanic children following the announcement of a new public charge rule in September 2018. [ABSTRACT FROM AUTHOR]

We analyze the effects of a reform of capital regulation for U.S. insurance companies in 2009. The reform eliminates capital buffers against unexpected losses associated with portfolio holdings of MBS, but not for other fixed-income assets. After the reform, insurance companies are much more likely to retain downgraded MBS compared to other downgraded assets. This pattern is more pronounced for financially constrained insurers. Exploiting discontinuities in the reform's implementation, we can identify the relevance of the capital requirements channel. We also document that the insurance industry crowds outs other investors in the new issuance of (high-yield) MBS. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to present a comprehensive integrative review of capitation payment for primary healthcare (PHC) in the Indonesian national health insurance (Jaminan Kesehatan Nasional,JKN). Design/methodology/approach: Whittemore and Knafl's integrative review method is used within this review and analysis framework. Multiple types of academic literature were included in this review, including all studies related to capitation payment in the JKN from 2014 until 2022. Findings: This review found that several practices of capitation payments in the JKN in Indonesia deviate from basic economic concept of capitation. It does not yet incentivize PHC to create a competitive environment in attracting members and it does not incentivize health promotion and prevention. Moreover, the capitation model uses the same scope of primary care services for all PHC throughout the country – which in fact has disparities in providing 155 medical conditions as required competencies for PHC. The authors recommend that the JKN apply bottom-up costing and pricing methods to set market prices of capitation rates. Originality/value: This is the first study that reviews theory-practice gap of the capitation payment model using an integrative review that covers academic literature, journal articles and regulations in Indonesia. [ABSTRACT FROM AUTHOR]

In recent months, pharmaceutical manufacturers have brought legal challenges to a provision of the 2022 Inflation Reduction Act (IRA) empowering the federal government to negotiate the prices Medicare pays for certain prescription medications. One key argument made in these filings is that price negotiation is a "taking" of property and violates the Takings Clause of the US Constitution. Through original case law and health policy analysis, we show that government price negotiation and even price regulation of goods and services, including patented goods, are constitutional under the Takings Clause. Finding that the IRA violates the Takings Clause would radically upend settled constitutional law and jeopardize the US's most important state and federal health care programs. [ABSTRACT FROM AUTHOR]

Managed care arrangements are the dominant form of insurance coverage in the United States today. These arrangements rely on a network of contracted providers to deliver services to their enrollees. After the managed care backlash, governments moved to ensure consumer access by issuing a number of requirements for carriers related to the composition and size of their networks and how this information is shared with consumers. The authors provide a comprehensive review of these state-based efforts to regulate provider network adequacy and provider directory accuracy for commercial insurance markets. In addition to common measures of adequacy, they also include requirements specifically targeted to underserved populations. Their assessment comes on the heels of recent empirical work that has raised significant questions about whether these efforts are effective, particularly considering the limited nature of enforcement. They also provide a brief overview and assessment of recent federal government efforts that replicate these state regulations with a focus on lessons learned from state regulations that may help improve their federal counterparts. Furthermore, they outline a future research agenda focused on a more comprehensive evaluation of efforts to ensure consumer access. [ABSTRACT FROM AUTHOR]

The Medicare Advantage program was created to expand beneficiary choice and to reduce spending through capitated payment to private insurers. However, many stakeholders now argue that Medicare Advantage is failing to deliver on its promise to reduce spending. Three problematic design features in Medicare Advantage payment policy have received particular scrutiny: (1) how baseline payments to insurers are determined, (2) how variation in patient risk affects insurer payment, and (3) how payments to insurers are adjusted for quality performance. The authors analyze the statute underlying these three design features and explore legislative and regulatory strategies for improving Medicare Advantage. They conclude that regulatory approaches for improving risk adjustment and for recouping overpayments from risk-score gaming have the highest potential impact and are the most feasible improvement measures to implement. [ABSTRACT FROM AUTHOR]

The literature has often presented European healthcare systems as being less exposed to the growing dependencies on global finance observed in other areas of social policy. This article explores the sources and dynamics of a regulatory path to healthcare systems' financialization that challenges this depiction. Building on analogies with the case of pension policy, we show that the integration of the private health insurance sector into the European Union financial regulation framework has resulted in perceptible processes of financialization. Notably this manifested in the growing role of financial firms, in non-profit health insurers' adoption of 'financialized' business practices and eventually in a noticeable change of these actors' positioning in domestic healthcare reform. After having discussed the theoretical implications, the article provides an empirical illustration of this argument by documenting the implementation of the Solvency II insurance directive by health insurers in France, and describes its more general consequences and implications beyond this case study. [ABSTRACT FROM AUTHOR]

Non-surgical procedures have been the subject of controversy, in part due to their invasiveness. Professor David Sines from the Joint Council for Cosmetic Practitioners (JCCP) introduces a new non-surgical licensing scheme for England [ABSTRACT FROM AUTHOR]

TABLE OF CONTENTS I. INTRODUCTION 474 II. TAX RISK AND ITS IMPACT ON BUSINESSES 479 A. The Familiar Dilemma 479 B. Sources and Stakes of Uncertainty 480 C. Tax Risk [...]

The article explores the role of traditional, complementary and integrative healthcare (TCIH) toward achieving the goals of the Astana Declaration on primary health care (PHC) and Universal Health Coverage (UHC). Topics covered include the ways on how TCIH can be further integrated into UHC to deliver on the goals of the Astana Declaration, the importance of the development of TCIH human resources for health, and the significance of the regulation of TCIH products.