Risk management and empirical study of the doctor-patient relationship: based on 1790 litigation cases of medical damage liability disputes in China.

BACKGROUND: Compensation for medical damage liability disputes (CMDLD) seriously hinders the healthy development of hospitals and undermines the harmony of the doctor-patient relationships (DPR). Risk management in the DPR has become an urgent issue of the day. The study aims to provide a comprehensive description of CMDLD in China and explore its influencing factors, and make corresponding recommendations for the management of risks in the DPR. METHODS: This study extracted data from the China Judgment Online - the official judicial search website with the most comprehensive coverage. Statistical analysis of 1,790 litigation cases of medical damage liability disputes (COMDLD) available from 2015 to 2021. RESULTS: COMDLD generally tended to increase with the year and was unevenly distributed by regions; the compensation rate was 52.46%, the median compensation was 134,900 yuan and the maximum was 2,234,666 yuan; the results of the single factor analysis showed that there were statistically significant differences between the compensation for different years, regions, treatment attributes, and trial procedures (P < 0.05); the correlation analysis showed that types of hospitals were significantly negatively associated with regions (R=-0.082, P < 0.05); trial procedures were significantly negatively correlated with years (R=-0.484, P < 0.001); compensat- ion was significantly positively correlated with years, regions, and treatment attributes (R = 0.098-0.294, P < 0.001) and negatively correlated with trial procedures (R=-0.090, P < 0.01); regression analysis showed that years, treatment attributes, and regions were the main factors affecting the CMDLD (P < 0.05). CONCLUSIONS: Years, regions, treatment attributes, and trial procedures affect the outcome of CMDLD. This paper further puts forward relevant suggestions and countermeasures for the governance of doctor-patient risks based on the empirical results. Including rational allocation of medical resources to narrow the differences between regions; promoting the expansion and sinking of high-quality resources to improve the level of medical services in hospitals at all levels; and developing a third-party negotiation mechanism for medical disputes to reduce the cost of medical litigation.

Dispute between the family of the very seriously ill patient and the doctors.

The decided cases on disputes between the doctor and the family of the patient. A consideration of the relevant factors, such as the prognosis, the quality of life, the wishes of the patient, the tolerability of the patient, futility, dignity. Discussion of possible alternatives, such as wait and see. Ultimately the best interests of the patient must prevail.

New Zealand Policy on Frozen Embryo Disputes.

Disputes between separated couples over whether frozen embryos can be used in an attempt to create a child create a moral dilemma for public policy. When a couple create embryos intending to parent any resulting children, New Zealand's current policy requires the consent of both people at every stage of the ART process. New Zealand's Advisory Committee on Assisted Reproductive Technology has proposed a policy change that would give ex-partners involved in an embryo dispute twelve months to come to an agreement before the embryos are destroyed. New Zealand's current policy and the proposed policy both favour the person who wishes to avoid procreation. Two alternative policy approaches that do not favour procreative avoidance are considered. Using pre-fertilisation contracts to determine the decision reached in embryo disputes allows the couple's wishes at the time the embryos are created to determine what happens to the embryos if they separate. However, pre-fertilisation contracts are agreements about healthcare and personal relationships, and changing circumstances can make enforcing such agreements unjust. Finally, it is argued that New Zealand's Family Court system should be used to reach decisions that balance the interests of those involved in the dispute.

USA aid policy and induced abortion in sub-Saharan Africa: an analysis of the Mexico City Policy.

BACKGROUND: The Mexico City Policy, first announced by US President Ronald Reagan and since lifted and reinstated by presidents along partisan lines, prohibits US foreign assistance to any organisation that performs or provides counselling on abortion. Many organisations affected by this policy are also providers of modern contraception. If the policy reduces these organisations' ability to supply modern contraceptives, it could have the unintended consequence of increasing abortion rates. METHODS: We empirically examined patterns of modern contraception use, pregnancies, and abortion among women in 26 countries in sub-Saharan Africa in response to the reinstatement and subsequent repeal of the Mexico City Policy across three presidential administrations (William Clinton, George W Bush, and Barack Obama). We combine individual-level data on pregnancies and abortions from 743 691 women, country-year data on modern contraception use, and annual data on development assistance for family planning and reproductive health in a difference-in-difference framework to examine relative changes in use of modern contraception, pregnancy, and abortion in response to the policy. FINDINGS: We found that when the Mexico City Policy was in effect (2001-08), abortion rates rose among women in countries highly exposed to the policy by 4·8 abortions per 10 000 woman-years (95% CI 1·5 to 8·1, p=0·0041) relative to women in low-exposure countries and relative to periods when the policy was rescinded in 1995-2000 and 2009-14, a rise of approximately 40%. We found a symmetric reduction in use of modern contraception by 3·15 percentage points (relative decrease of 13·5%; 95% CI -4·9 to -1·4; p=0·0006) and increase in pregnancies by 3·2 percentage points (relative increase of 12%; 95% CI 1·6 to 4·8; p<0·0001) while the policy was enacted. INTERPRETATION: Our findings suggest that curbing US assistance to family planning organisations, especially those that consider abortion as a method of family planning, increases abortion prevalence in sub-Saharan African countries most affected by the policy. FUNDING: The William and Flora Hewlett Foundation, the Doris Duke Charitable Foundation, the David and Lucile Packard Foundation, and the Stanford Earth Dean's Fellowship.

How Intense Policy Demanders Shape Postreform Politics: Evidence from the Affordable Care Act.

The implementation of the Affordable Care Act (ACA) has been a politically volatile process. The ACA's institutional design and delayed feedback effects created a window of opportunity for its partisan opponents to launch challenges at both the federal and state level. Yet as recent research suggests, postreform politics depends on more than policy feedback alone; rather, it is shaped by the partisan and interest-group environment. We argue that "intense policy demanders" played an important role in defining the policy alternatives that comprised congressional Republicans' efforts to repeal and replace the ACA. To test this argument, we drew on an original data set of bill introductions in the House of Representatives between 2011 and 2016. Our analysis suggests that business contributions and political ideology affected the likelihood that House Republicans would introduce measures repealing significant portions of the ACA. A secondary analysis shows that intense policy demanders also shaped the vote on House Republicans' initial ACA replacement plan. These findings highlight the role intense policy demanders can play in shaping the postreform political agenda.

Of patents and patent disputes - The TNFα patent files. Part 2: Enbrel, Remicade, Cimzia and Simponi.

This article is the second part of a trilogy that discusses IP issues related to anti-Tumor Necrosis factor α (TNFα) biologics. TNFα is the world's most valuable target, with accumulated sales of TNFα biologics of 34 bn USD in 2014. While in the first part of this trilogy, Humira was discussed, this second parts discusses the patent strategies of Enbrel, Remicade, Cimzia and Simponi.

Legal access to medications: a threat to Brazil's public health system?

BACKGROUND: In Brazil, health is fundamental human right guaranteed by the Constitution of 1988, which created the Brazilian Universal Health System (Sistema Único de Saúde - SUS). The SUS provides medications for outpatient care via policy of pharmaceutical assistance (PA) programmes. Despite the advances in PA policies which include the improvement in access to medications, there has been a significant increase in lawsuits related to health products and services. This study aimed to characterize the medication processes filed between 2010 and 2014 against the Secretary of State for Health of São Paulo (State Health Department of São Paulo - SES/SP), in Brazil, following PA policies. METHODS: This descriptive study used secondary data on medication lawsuits filed against the SES/SP between 2010 and 2014. The data source was the S-Codes computerized system. RESULTS: In the period evaluated, the number of lawsuits filed concerning health-related products increased approximately 63%; requests for medications were predominant. Approximately 30% of the medications involved in court proceedings were supplied via PA programmes. With regard to medications supplied via specialized component, 81.3% were prescribed in disagreement with the protocols published by the Ministry of Health. Insulin glargine was the most requested medication (6.3%), followed by insulin aspart (3.3%). Because there is no scientific evidence that either of these medicines is superior for the treatment of diabetes, neither of them has been incorporated into the SUS by the National Commission for Technology Incorporation. The judicial data showed that most of the lawsuits involved normal proceedings (i.e., individual demands), were filed by private lawyers, and named the State of São Paulo as the sole defendant, demonstrating the individual nature of these claims. The data indicate inequality in the distribution between the number of cases and lawyers and the number of lawsuits and prescribers, evidencing the concentration of lawyers and physicians in filing lawsuits. CONCLUSION: The judicialization of health in the State of São Paulo with the characteristics presented herein is a threat to the SUS.

Lessons from the MOHW compensation pilot program on birth incidents: First step and looking forward.

OBJECTIVE: In Taiwan, the number of medical disputes and litigation has increased dramatically over the past 20 years. The seriousness of medical disputes continuing grows in clinical practice, especially in obstetricians. This study provided a possible solution to the medical dispute litigation issue. MATERIALS AND METHODS: The Ministry of Health and Welfare (MOHW) compensation program for birth incidents has been implemented since 2012 and it provided pecuniary compensation for mothers, newborns, and fetuses who got injured or died in birth-related medical incidents. We analyzed the amount and distribution of compensation, and assessed the effect of compensation on the number of medical dispute litigation. RESULTS: From 2012 to 2015, a total of 348 applications was received, 322 of which were examined by the committee. Among the examined cases, 278 were approved for compensation. The total amount of compensation had reached 266.16 million NTD (8.32 million USD). For the medical dispute litigation, a dramatic decrease in number was observed after the implementation of this compensation pilot program. CONCLUSION: Prompt compensation provided instant economic and spiritual support for patients and families. Pecuniary compensation could be an alternative choice of justice, which might encourage the injured to receive economic compensation, instead of filing a lawsuit against the physician or hospital institution. As a result, the number of dispute litigation has decreased. This indicates that the compensation program is an efficient way to improve medical dispute litigation difficulties.

Telehealth Wave: Surf's Up for Fed, State Policymakers.

If millions of Americans lose Medicaid or private health insurance coverage because of the unACAing of American health care, telehealth may seem like a gimmicky sideshow rather than a good-faith effort to bring health care into the digital century.

What ACA repeal could mean for mental health coverage.

Rolling back the ACA's coverage expansions and essential benefits could undermine the mental health protections established in other legislation that won bipartisan support.

Changes needed in our healthcare system, but we can't revert to life before the ACA.

Everything changed for healthcare in 2010 with the signing of the Affordable Care Act. While admittedly flawed and laden with complexities, the ACA eliminated some of the worst practices in the insurance industry.

'My position is, when it comes to the risk side, you've got to partner'.

Anthony Tersigni, the CEO of Ascension, oversees a sprawling empire of 141 Catholic hospitals in 24 states and the District of Columbia with 150,000 employees over 2,500 care sites. At a time of potentially far-reaching political changes, the $21 billion organization is going through its own transition, having recently tapped Chief Operating Officer Patricia Maryland to succeed Robert Henkel as CEO of Ascension Health, the holding company's largest operating division. During January's J.P. Morgan Healthcare Conference in San Francisco, Modern Healthcare finance reporter Dave Barkholz spoke with Tersigni about the drama in Washington over repealing and replacing the Affordable Care Act, what the nation's largest not-for-profit healthcare group has planned regarding mergers and acquisitions and the transition underway at Ascension. The following is an edited transcript.

Playing with fire on cost-sharing subsidies.

It's time to check in with the governing party to see how its plan to replace Obamacare is progressing.