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Youth engagement is often purported as a critical dimension of health promotion for young people, but the strategies used to facilitate this engagement are seldom evaluated or studied. This study explored the strategies used to engage youth in a strategic planning process to develop comprehensive health and wellness plans in 28 US school districts. Participating school districts conducted listening sessions, administered anonymous surveys, included youth on a district task force, and employed other strategies to engage youth. Following this initiative, semi-structured interviews were conducted with representatives from all school districts (n = 34) to enumerate the use of these strategies across districts and understand their perspectives related to the effectiveness and importance of these strategies for engaging youth in health promotion. The most prevalent strategy used by districts was listening sessions (27 districts; 564 youth), followed by including youth on the task force (19 districts; 39 youth), anonymous surveys (18 districts; 1988 youth) and other methods (5 districts). Interviewees clarified the benefits and challenges of each strategy and provided commentary on youth engagement for health promotion. The results stress the importance of building trusting relationships with youth, using multiple strategies to engage youth, and embodying an equity mindset throughout the development and implementation of youth engagement efforts. [ABSTRACT FROM AUTHOR]

Disability benefits function by demarcating categories of need (the administrative category of disability) and determine eligibility using assessments of functioning. In the UK, these assessments are the Work Capability Assessment and PIP assessment. Inherently technical and abstruse processes, these assessments have been opportune sites for welfare reform in recent years. Disability benefits have also been a central point of contention between disability studies and sociology. Sociology has traditionally favoured an 'incomes approach' and called for more adequate financial support from the state. Early figures in the disabled people's movement rejected this position, and aligned with an oppression paradigm, argued for a more radical economic and social inclusion. We contend that this divide, set out in the Fundamental Principles of Disability, remains relevant for researching welfare reform today. This article treats benefits assessments as epistemic practices—interactional processes wherein claimants, their personal health professionals and commercial assessment providers come together in the production of knowledge about disability. Data include 50 in‐depth interviews with benefit claimants and a discourse analysis of official texts directed at claimants, personal health professionals and commercial assessment providers. We outline a phenomenon we term 'epistemic sabotage', whereby the knowledge claims of claimants and their health professionals are systemically disqualified. [ABSTRACT FROM AUTHOR]

The article presents the position statement of the Royal College of Physicians and the National Institute of Health and Care Research about clinical research. Topics discussed include how the Covid-19 pandemic illustrated the importance of clinical research, ways in which doctors and other healthcare professionals can engage with research, and information on the Health and Care Act 2022.

Adult safeguarding is characterised by competing debates related to core concepts including policy and legislative frameworks. In some countries, to reconcile the dualism of agency and structure, conflict and ambiguity are legislated for through the introduction of adult safeguarding legislation (ASL). This study set out to explore how the absence of ASL in the Irish context impacts safeguarding processes. A qualitative approach involving semi-structured interviews (N  = 14) and focus groups (N  = 2) with social workers, explored variables from adult safeguarding cases that contribute to positive outcomes in the absence of ASL, and where legislation could have helped, using a critical incident technique. Four themes emerged: practices and processes; coercive control and undue influence; information sharing and multiagency cooperation; and inability to access services. Whilst in the majority of cases existing policy and legislation achieved successful outcomes, legislative powers such as a duty to cooperate, to share information and powers of entry were deemed necessary. This study suggests limits to safeguards and protections within current policy. It illustrates the dualism that often exists between the agency of social workers to act to safeguard adults at risk and the structural rules, relationships and resources that can restrict the context of action in absence of legislation. [ABSTRACT FROM AUTHOR]

Background: Cities globally have started to make substantial investment in more sustainable forms of transportation. We aimed to evaluate whether the construction of new cycling infrastructure in Paris and Lyon, France, affected population cycling activity along new or improved routes. Methods: Routinely collected cycle count data from January 2014 to March 2020 were acquired for the cities of Paris and Lyon. Improvements were identified at 15 locations with 6 months of pre- and post-intervention data. Comparison streets were chosen within Paris or Lyon for which pre-intervention trends in cycling were similar to those at intervention sites. Controlled interrupted time series analyses and autocorrelation were performed adjusting for seasonality. Random-effects meta-analysis combined results across streets within each city and overall. Results: On average, cycling counts/day increased on both intervention and control streets in Paris and Lyon. In general, results of the ITS analysis indicated no significant change in the level or trend as a result of the improvements in either city. Meta-analysis suggested that intervention streets in Paris had a larger positive pooled effect size for level change (218 cycle counts, 95% CI -189, 626, I2 = 0%) compared to Lyon (34, 95% CI -65, 133, I2 = 14%); however, confidence intervals for both cities were wide and included no effect. Conclusions: The findings suggest that improving or constructing new cycle lanes may be necessary but not sufficient to induce significant changes in cycling levels. There is a need to understand how context, intervention design and other complementary interventions can improve the effectiveness of new cycling infrastructure. [ABSTRACT FROM AUTHOR]

Purpose: While absence and dropout represent challenges to the implementation of vocational rehabilitation programs in Norway, sanctions are rarely used in practice. The purpose of the article was to investigate the extent to which vocational rehabilitation managers and professionals experience that the absence regulations support a viable implementation of vocational rehabilitation programs. Methods: An open-ended question, asking vocational rehabilitation managers about their experiences in handling absence, was presented as part of an electronic questionnaire sent to all vocational rehabilitation companies in Norway. 72 managers (59%) responded to the open-ended question, and a qualitative content analysis was conducted. Insight from ten focus group interviews were included as part of the analyses. Results: Five thematic categories were created, which in their various ways demonstrate challenges associated with absence management in vocational rehabilitation programs: (i) failure of the Labour and welfare administration to react against unfounded absence; (ii) difficulties in distinguishing valid from nonvalid absence; (iii) uncertainty concerning the role of the general practitioner and medical documentation in the rehabilitation process; (iv) the prevalence of diffuse disorders and symptoms, and (v) lack of incentives and motivation among participants. Conclusions: Sound absence management requires a clarification of the role of the general practitioner in the vocational rehabilitation process and closer cooperation between general practitioners and vocational rehabilitation companies, to reduce unnecessary breaks in the process due to hasty issuing of sicknotes. Further, as absence management appears to be most difficult in relation to those with mental and social problems, a comprehensive view on disability and follow-up is needed, where physical, mental, social and contextual factors are seen together. Absence and dropout represent challenges to the implementation of vocational rehabilitation programs in Norway, While a sound regulation of absence could impact positively on both the work-related and rehabilitation outcomes of vocational rehabilitation programs, evidence suggest that absence management is scarce, and that it becomes particularly difficult in relation to participants with mental health problems and social challenges. Clarification of the role of the general practitioner and the medical certificates they issue and strengthening the dialog between vocational rehabilitation companies and general practitioners to prevent unnecessary sick-listing and interruptions in the vocational rehabilitation process, could improve the follow-up of absence. Moreover, a flexible and sensible approach is needed, where absence management is seen in conjunction with the overall follow-up that is provided, and where awareness to individual challenges and needs should be in focus. [ABSTRACT FROM AUTHOR]

Objective: In spite of the effectiveness of the individual placement and support model of supported employment (IPS) for the recovery of people with mental illness, the implementation and dissemination of IPS in Japan have not been straightforward. This paper summarizes barriers against the implementation of IPS in Japan and discusses potential strategies to overcome them. Method: We reviewed IPS research performed in Japan through literature search, and summarized current employment services and policies in Japan along with a practice report of an ongoing IPS program in a local city in Japan. Results: Barriers against the implementation of IPS in Japan included: (a) systems designed mainly for group-based services, (b) weak recognition of IPS, and (c) cultural background. Nevertheless, we identified 4 intervention studies of IPS in Japanese settings, and all found that more than 40% of the participants gained their employment through IPS. By utilizing available services, the IPE program in Hamada City achieved ∼50% employment rate and sufficient fidelity. Conclusions and Implications for Practice: The present data indicate that, by combining currently available services, IPS can be implemented successfully in Japan. Impact and Implications: In Japan, employment of people with mental illness has lagged far behind employment for people with other disabilities. The present paper summarizes the evidence regarding effects of the individual placement and support model of supported employment (IPS) in Japan to elucidate the structural and cultural barriers that are impeding the implementation of IPS. This paper also illustrates potential strategies for implementing IPS in Japan. [ABSTRACT FROM AUTHOR]

In recent years, American workers and retirees have experienced a decline in the health benefits provided by employers. Increased out-of-pocket health care costs have subsequently affected their ability to save, their planned retirement dates, and other aspects of the financial planning process. This article begins with an overview of recent trends in employer-provided health benefits. It also discusses consumer-driven health care, health savings accounts, limited medical benefit plans, health insurance continuation laws, and employer health plan conversions. The article concludes with suggested strategies for financial planners to help their clients cope with the impact of declining employer health benefits. [ABSTRACT FROM AUTHOR]

Objective: Understanding how to successfully implement care coordination programs across diverse settings is critical for disseminating best practices. We describe how we operationalized the Practical Robust Implementation and Sustainability Model (PRISM) to guide the assessment of local context prior to implementation of the rural Transitions Nurse Program (TNP) at five facilities across the Veterans Health Administration (VHA).Methods: We operationalized PRISM to create qualitative data collection techniques (interview guides, semi-structured observations, and a group brainwriting premortem) to assess local context, the current state of care coordination, and perceptions of TNP prior to implementation at five facilities. We analyzed data using deductive-inductive framework analysis to identify themes related to PRISM. We adapted implementation strategies at each site using these findings.Results: We identified actionable themes within PRISM domains to address during implementation. The most commonly occurring PRISM domains were "organizational characteristics" and "implementation and sustainability infrastructure." Themes included a disconnect between primary care and hospital inpatient teams, concerns about work duplication, and concerns that one nurse could not meet the demand for the program. These themes informed TNP implementation.Conclusions: The use of PRISM for pre-implementation site assessments yielded important findings that guided adaptations to our implementation approach. Further, barriers and facilitators to TNP implementation may be common to other care coordination interventions. Generating a common language of barriers and facilitators in care coordination initiatives will enhance generalizability and establish best practices.Impact Statements: TNP is a national intensive care coordination program targeting rural Veterans. We operationalized PRISM to guide implementation efforts. We effectively elucidated facilitators, barriers, and unique contextual factors at diverse VHA facilities. The use of PRISM enhances the generalizability of findings across care settings and may optimize implementation of care coordination interventions in the VHA. [ABSTRACT FROM AUTHOR]

Priority setting is the process through which a country's health system establishes the drugs, interventions, and treatments it will provide to its population. Our study evaluated the priority-setting legal instruments of Brazil, Costa Rica, Chile, and Mexico to determine the extent to which each reflected the following elements: transparency, relevance, review and revision, and oversight and supervision, according to Norman Daniels's accountability for reasonableness framework and Sarah Clark and Albert Wale's social values framework. The elements were analyzed to determine whether priority setting, as established in each country's legal instruments, is fair and justifiable. While all four countries fulfilled these elements to some degree, there was important variability in how they did so. This paper aims to help these countries analyze their priority-setting legal frameworks to determine which elements need to be improved to make priority setting fair and justifiable. [ABSTRACT FROM AUTHOR]

We developed a conceptual framework exploring pathways between trade and investment and noncommunicable disease (NCD) outcomes. Despite increased knowledge of the relevance of social and structural determinants of health, the discourse on NCD prevention has been dominated by individualizing paradigms targeted at lifestyle interventions. We situate individual risk factors, alongside key social determinants of health, as being conditioned and constrained by trade and investment policy, with the aim of creating a more comprehensive approach to investigations of the health impacts of trade and investment agreements, and to encourage upstream approaches to combating rising rates of NCDs. To develop the framework we employed causal chain analysis, a technique which sequences the immediate causes, underlying causes, and root causes of an outcome; and realist review, a type of literature review focussed on explaining the underlying mechanisms connecting two events. The results explore how facilitating trade in goods can increase flows of affordable unhealthy imports; while potentially altering revenues for public service provision and reshaping domestic economies and labour markets-both of which distribute and redistribute resources for healthy lifestyles. The facilitation of cross-border trade in services and investment can drive foreign investment in unhealthy commodities, which in turn, influences consumption of these products; while altering accessibility to pharmaceuticals that may mediate NCDs outcomes that result from increased consumption. Furthermore, trade and investment provisions that influence the policy-making process, set international standards, and restrict policy-space, may alter a state's propensity for regulating unhealthy commodities and the efficacy of those regulations. It is the hope that the development of this conceptual framework will encourage capacity and inclination among a greater number of researchers to investigate a more comprehensive range of potential health impacts of trade and investment agreements to generate an extensive and robust evidence-base to guide future policy actions in this area. [ABSTRACT FROM AUTHOR]

Health planning is generally considered a technical subject, primarily the domain of health officials with minimal involvement of community representatives. The National Rural Health Mission launched in India in 2005 recognized this gap and mandated mechanisms for decentralized health planning. However, since planning develops in the context of highly unequal power relations, formal spaces for participation are necessary but not sufficient. Hence a project on capacity building for decentralized health planning was implemented in selected districts of Maharashtra, India during 2010-13. This process developed on the platform of officially supported community-based monitoring and planning, a process for community feedback and participation towards health system change. A specific project on capacity building for decentralized planning included a structured learning course and workshops for major stakeholders. An evaluation of the project, including in-depth interviews of various participants and analysis of change in local health planning processes, revealed positive changes in intervention areas, including increased capacity of key stakeholders leading to preparation of evidence-based, innovative planning proposals, significant community oriented changes in utilization of health facility funds, and inclusion of community-based proposals in village, health facility-based block and district plans. Transparency related to planning increased along with responsiveness of health providers to community suggestions. A key lesson is that active facilitation of decentralized health planning and influencing the health system to expand participation, are essential to ensure changes in planning. Effective strategies included: identifying people's health service related priorities through community-based monitoring, capacity building of diverse stakeholders regarding local health planning, and advocacy to enable participation of community-based actors in the planning process. This combination of strategies draws upon the framework of 'empowered participatory governance' which necessitates combining a degree of 'countervailing power' and acceptance of participation by the system, for new forms of governance to emerge. [ABSTRACT FROM AUTHOR]

Objective: Fortification of food-grade (edible) salt with iodine is recommended as a safe, cost-effective and sustainable strategy for the prevention of iodine-deficiency disorders. The present paper examines the legislative framework for salt iodization in Asian countries.Design: We reviewed salt iodization legislation in thirty-six countries in Asia and the Pacific. We obtained copies of existing and draft legislation for salt iodization from UNICEF country offices and the WHO's Global Database of Implementation of Nutrition Actions. We compiled legislation details by country and report on commonalities and gaps using a standardized form. The association between type of legislation and availability of iodized salt in households was assessed.Results: We identified twenty-one countries with existing salt iodization legislation, of which eighteen were mandatory. A further nine countries have draft legislation. The majority of countries with draft and existing legislation used a mandatory standard or technical regulation for iodized salt under their Food Act/Law. The remainder have developed a 'stand-alone' Law/Act. Available national surveys indicate that the proportion of households consuming adequately iodized salt was lowest in countries with no, draft or voluntary legislation, and highest in those where the legislation was based on mandatory regulations under Food Acts/Laws.Conclusions: Legislation for salt iodization, particularly mandatory legislation under the national food law, facilitates universal salt iodization. However, additional important factors for implementation of salt iodization and maintenance of achievements include the salt industry's structure and capacity to adequately fortify, and official commitment and capacity to enforce national legislation. [ABSTRACT FROM AUTHOR]

Objectives: Gaps in vaccination coverage leave populations vulnerable to illnesses. Since the 1990s, there has been a growing movement to improve vaccination access by giving pharmacists the authority to administer vaccines according to state laws. Understanding the variation of pharmacist vaccination laws over time is critical to understanding the effect of improving access to vaccination services.Methods: We identified relevant statutes and regulations with the use of Westlaw legal databases. A 4-stage coding process identified 220 legal variables of pharmacist vaccination authority. Each jurisdiction's laws were coded against these 220 legal variables. The resulting legal dataset was then evaluated to determine whether jurisdictions expanded or restricted pharmacist vaccination authorities over time.Results: From 1971 to 2016, jurisdictions made 627 changes to statutes and regulations relating to pharmacist vaccination authority. There were 85 expansions, 3 restrictions, and 22 regulatory clarifications. Eight changes were deemed to be unclear, and 479 changes did not substantively alter the scope of pharmacist vaccination authority.Conclusion: Collectively, the laws in 50 states and DC paint a clear picture: the scope of pharmacists' vaccination authority is expanding. Jurisdictions are allowing pharmacists to administer more vaccines to younger patients with less direct prescriber oversight. This clear expansion of pharmacist vaccination authority stands in contrast to the reservations expressed by some physician groups for pharmacists as vaccination providers. However, laws in some states still do not permit pharmacists to vaccinate according to the Advisory Committee on Immunization Practices recommendations. [ABSTRACT FROM AUTHOR]

Introduction: There have been numerous global calls to action to utilize human resources information systems (HRIS) to improve the availability and quality of data for strengthening the regulation and deployment of health workers. However, with no normative guidance in existence, the development of HRIS has been inconsistent and lacking in standardization, hindering the availability and use of data for health workforce planning and decision making (Riley et al., 2012). CDC and WHO partnered with the Ministry of Health in several countries to conduct HRIS functional requirements analyses and establish a Minimum Data Set (MDS) of elements essential for a global standard HRIS. As a next step, CDC advanced a study to examine the alignment of one of the HRIS it supports (in Zimbabwe) against this MDS.Method: For this study, we created a new data collection and analysis tool to assess the extent to which Zimbabwe's CDC-supported HRIS was aligned with the WHO MDS. We performed systematic "gap analyses" in order to make prioritized recommendations for addressing the gaps, with the aim of improving the availability and quality of data on Zimbabwe's health workforce.Results: The majority of the data elements outlined in the WHO MDS were present in the ZHRIS databases, though they were found to be missing various applicable elements. The lack of certain elements could impede functions such as health worker credential verification or equitable in-service training allocation. While the HRIS MDS treats all elements equally, our assessment revealed that not all the elements have equal significance when it comes to data utilization. Further, some of the HRIS MDS elements exceeded the current needs of regulatory bodies and the Ministry of Health and Child Care (MOHCC) in Zimbabwe. The preliminary findings of this study helped inspire the development of a more recent HRH Registry MDS subset, which is a shorter list of priority data elements recommended as a global standard for HRIS.Conclusion: The field-tested assessment methodology presented here, with suggested improvements to the tool, can be used to identify absent or unaligned elements in either an HRH Registry or a full HRIS. Addressing the prioritized gaps will increase the availability of critical data in the ZHRIS and can empower the MOHCC and councils to conduct more strategic analyses, improving health workforce planning and ultimately public health outcomes in the country. [ABSTRACT FROM AUTHOR]

In countries that have experienced decentralisation processes, the role that central and sub-national authorities play in the governance of some social policies may vary considerably across regions. In Italy, for instance, whereas some regions (and municipalities) have been very active in financing social assistance programmes, others still overwhelmingly rely on resources directly allocated by the central government. This indicates that, in a ‘regionalised’ system, the development of a sub-national social dimension is not a territorially homogeneous phenomenon. Interestingly, cross-regional variation is mainly explained by differences in the strength of regionalist parties. The share of total social assistance spending allocated by sub-national authorities has increased significantly in those areas of the country where regionalist parties are stronger and does not seem to depend on ideological shifts on the left-right spectrum. Surprisingly, the positive effect of regional economic development on sub-national spending is not as strong as expected. On the other hand, female employment and population ageing seem to explain part of territorial divergence, the former having a positive effect and the latter a negative one on the dependent variable. [ABSTRACT FROM PUBLISHER]

The article focuses on the issues of use of irrevocable trusts in long-term Medicaid care planning in the U.S. Topics discussed include Medicaid laws concerning an individual's ability to use irrevocable trusts in long-term care planning; limiting State Medicaid agency in Massachusetts; and Doherty v. Director of the Office of Medicaid court case on same.

Objectives To describe processes and preliminary outcomes from the implementation of a systematic advance care planning ( ACP) intervention in the nursing home setting. Design Specially trained project nurses were embedded in 19 nursing homes and engaged in ACP as part of larger demonstration project to reduce potentially avoidable hospitalizations. Setting Nursing homes. Participants Residents enrolled in the demonstration project for a minimum of 30 days between August 2013 and December 2014 (n = 2,709) and residents currently enrolled in March 2015 (n = 1,591). Measurements ACP conversations were conducted with residents, families, and the legal representatives of incapacitated residents using a structured ACP interview guide with the goal of offering ACP to all residents. Project nurses reviewed their roster of currently enrolled residents in March 2015 to capture barriers to engaging in ACP. Results During the initial implementation phase, 27% (731/2,709) of residents had participated in one or more ACP conversations with a project nurse, resulting in a change in documented treatment preferences for 69% (504/731). The most common change (87%) was the generation of a Physician Orders for Scope of Treatment form. The most frequently reported barrier to ACP was lack of time. Conclusion The time- and resource-intensive nature of robust ACP must be anticipated when systematically implementing ACP in the nursing home setting. The fact that these conversations resulted in changes over 2/3 of the time reinforces the importance of deliberate, systematic ACP to ensure that current treatment preferences are known and documented so that these preferences can be honored. [ABSTRACT FROM AUTHOR]

Arthropod vectors transmit organisms that cause many emerging and reemerging diseases, and their control is reliant mainly on the use of chemical insecticides. Only a few classes of insecticides are available for public health use, and the increased spread of insecticide resistance is a major threat to sustainable disease control. The primary strategy for mitigating the detrimental effects of insecticide resistance is the development of an insecticide resistance management plan. However, few examples exist to show how to implement such plans programmatically. We describe the formulation and implementation of a resistance management plan for mosquito vectors of human disease in Zambia. We also discuss challenges, steps taken to address the challenges, and directions for the future. [ABSTRACT FROM AUTHOR]

The question of who counts and how we construct just who can ‘be disabled’ is central to our concerns in disability studies. As Stone makes clear, disability is exactly what a state deems it to be; the very malleable nature of the category has been exploited to widen or more commonly to narrow just who counts as disabled. This article will apply and adapt Stone’s thesis to current plans to revise the Personal Independence Payment extra costs benefit. Using official and disabled people’s narratives, the article will make clear the force with which new definitions of disability are being put forward. This process arguably risks doing state violence to a number of disabled people. These reforms have also used the language of independence in a way that fundamentally distorts the origins and potential of the term in an enabling society. [ABSTRACT FROM AUTHOR]

The article presents the advance care planning tools that educate, engage, and empower the directives for treatment preferences in the end-of-life care. The concept of advance care planning is legally recognized by the Institute of Medicine (IOM) as part of the directive law that protect and provide advocacy to patients. It explains that documenting a dying person's wishes and goals is a unique approach both mentally and emotionally to death and dying.

The article discusses several court cases addressing employee benefits law. Cases discussed include the U.S Supreme Court case US Airways Inc. v. McCutchen based on accident-related damage claims, the U.S Court of Appeals for the Seventh Circuit case Larson v. United Healthcare Insurance Co. and Court of Appeals for the Ninth Circuit case Tibble v. Edison International. It mentions the U.S District Court for the Eastern District of Missouri case Hellman v. Cataldo addressing health plans.

The civil False Claims Act (FCA) imposes harsh penalties against parties who misappropriate federal funds. The statute's qui tam whistle-blower provisions create strong financial incentives for private individuals to bring and pursue FCA cases against health providers on the government's behalf--even where government attorneys decline to intervene. FCA cases where the government declined to intervene account for less than 2 percent of all recoveries in health care FCA cases. Yet the costs of defending such cases may be very high, especially for rural providers with small operating margins. Federal provider self-referral and anti-kickback laws carve out various exceptions to support the financial viability of rural providers. The FCA, however, contains no such exceptions. Although Department of Justice (DOJ) policy directs officials to take into account community access to care in pursuing FCA cases against rural providers, the ability for private whistleblowers to pursue cases where the government declines to intervene undermines the DOJ's ability to achieve that aim. This Article highlights the liability risks rural providers commonly face under the FCA and argues for amending the FCA to allow a whistleblower claim to proceed against providers serving designated underserved areas only where government authorities intervene in the case. [ABSTRACT FROM AUTHOR]

Copyright of Revista Terceiro Setor is the property of Revista Terceiro Setor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Health care benevolence laws, a form of tort reform law, mandate statements of sympathy or apology by health care providers and facilities in cases of medical mistakes. These laws create a shared language and sense of meaning for individuals involved in the legal aftermath of medical mistakes. Structuration theory guides this textual analysis to explore how benevolence laws discursively create and structure shared meaning about apology. This analysis highlights how benevolence laws structure apology and discursively discipline medical practitioners, underscoring the importance of ambiguity in law interpretation. [ABSTRACT FROM AUTHOR]

The article discusses developments in government health care policy in the U.S. According to the author, health care policy lacked innovation in the 1960s using only tax dollars to duplicate the financing of Blue Cross and Blue Shield. He adds that legislative issues focused on health manpower during the early part of 1960. In 1965, the policy put emphasis on linking research with community health care. The Comprehensive Health Planning Act passed in 1966 contributed to the highest level of public health in the country.

Copyright of Revista Chilena de Derecho is the property of Revista Chilena de Derecho and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Arguably, three documents epitomize the development of the public health movement in the United States. The 1850 ‘Report of a General Plan for the Promotion of the Public and Personal Health of Massachusetts,’ provided the theoretical and organizational basis for the development of an infrastructure for the American public health movement. The 1932 Report of the Committee on the Costs of Medical Care, ‘Medical Care for the American People,’ laid out a series of challenges for the humane, effective, and economical delivery of health and medical services to the American people, and the 1964 Report of the Advisory Committee to the Surgeon General on ‘Smoking and Health’ provided a paradigm of evidence-based public health policy. All three documents justified their conclusions on epidemiological evidence. Some may not agree that these documents are the most important to explain the American public health movement. Few, however, will disagree that they had an important impact.Journal of Public Health Policy (2009) 30, 40–48. doi:10.1057/jphp.2008.39 [ABSTRACT FROM AUTHOR]

The Employee Retirement Income Security Act of 1974 (ERISA), a federal law regulating private employer-sponsored employee benefit plans, was primarily designed for pension plans, but has had a profound impact on state health care reform efforts. ERISA's broad preemption language has been judicially interpreted to preclude states from most forms of regulation of employer health plans, including benefit design (except through regulation of insurance products) and incorporating employer expenditure requirements in state health reform financing. But since 1974, Congress has never seriously returned to reexamine several fundamental questions: Should employers be required to offer or contribute to employee health coverage? Should ERISA preempt state efforts to take such actions? Or should ERISA incorporate more comprehensive regulation of health plans in these areas? Although the politics of ERISA preemption have thus far blocked federal reform, while allowing state reform activity to be simultaneously curtailed, new health reform efforts may force Congress to address these questions. [ABSTRACT FROM AUTHOR]

The article investigates the impact of Employee Retirement Income Security Act (ERISA) on employee welfare benefit plans and health plans in the U.S. In particular, sections 502(a) and 514 of ERISA, which govern remedies and federal preemption, are considered. The author contends that these provisions, as interpreted by the U.S. Supreme Court, affect the injured plaintiff's ability to obtain proper retribution. A discussion on the impact of ERISA on health care is considered.

There is widespread debate over whether health plans should require enrollees to use “gatekeepers,” which are primary care providers that coordinate care and control access to specialists. However, little is known about whether health plan gatekeeper requirements improve or reduce quality-of-care. Our objective was to examine whether gatekeeper requirements are associated with the utilization of cancer screening for breast, cervical, and prostate cancer. Three linked sources ( N=13,534): (1) 1996 Medical Expenditure Panel Survey (MEPS) Household Survey, a nationally representative, ongoing survey sponsored by the Agency for Healthcare Research and Quality; (2) 1996 MEPS Health Insurance Plan Abstraction, which codes data from health plan booklets obtained from privately insured respondents, and (3) 1995 National Health Interview Survey. Cross-sectional, multivariate logistic regression analysis using secondary data. We found in multivariate analyses that women in gatekeeper plans were significantly more likely to obtain mammography screening (Odds Ratio [OR]=1.22, 95 percent Confidence Interval [CI] 1.07–1.40), clinical breast examinations (OR=1.39, 95 percent CI 1.23–1.57), and Pap smears (OR=1.33, 95 percent CI 1.16–1.52) than women not in gatekeeper plans. In contrast, gatekeeper requirements were not associated with prostate cancer screening (OR=1.11, 95 percent CI 0.93–1.33). We found no association between screening utilization and aggregate plan types (HMO, POS, PPO, FFS). Gatekeeper requirements are associated with higher utilization of widely recommended cancer screening procedures, but not with utilization of a less uniformly recommended cancer screening procedure. Researchers should consider the analysis of specific plan characteristics rather than aggregate plan types in conducting future research, and insurers and policymakers should consider the potential benefits of gatekeepers with respect to preventive care when designing health plans and legislation. [ABSTRACT FROM AUTHOR]

The article discusses several legal issues involving advance care planning (ACP) in New Zealand, and it mentions end-of-life care for elderly people in the country, as well as the New Zealand Ministry of Health's issuance of the "Advance Care Planning: A Guide for the New Zealand Health Care Workforce" publication in 2011. Patient autonomy is mentioned in relation to various ACP research and policy developments. Advance medical directives and a right to refuse medical treatment are examined.