Regulating private medical institutions: a case study of China.

The expansion of privatisation in health care has been discussed extensively in most European countries and remains a hot topic nowadays. In China, privatisation results in considerable changes in its health care system, especially accelerating the ever-growing private medical institutions (PMIs). The rapid growth of PMIs raises the question of regulation for the Chinese government. Given the fact that few studies are available on the regulation of PMIs in China, I attempted to fill that gap by discussing the development of PMIs with a special focus on legal-regulatory strategies. After assessing current legal-regulatory strategies concerning PMIs, the paper identifies three major concerns regarding effective legal rules (i.e. weak coherence, inconsistency and legislative vacancy) and three difficult issues regarding government capacity (i.e. the negative effects of decentralised political structure, the low professionalism of bureaucrats and lack of reliability) that impede the well-functioning of regulatory agencies in China. As a plausible response, the paper recommends that the newly drafted basic health law should assign a separate chapter to regulate PMIs and also an independent regulatory body should be established to manage the issues of PMIs in China. Detailed recommendations are the practical implications of ICESCR General Comment No. 14.

Preserving social equity in marketized primary care: strategies in Sweden.

A primary care choice reform launched in Sweden in 2010 led to a rapid growth of private providers. Critics feared that the reform would lead to an increased tendency among new, profit-driven, providers, to select patients with lower health risks. Even if open risk selection is prohibited, providers can select patients in more subtle ways, such as establishing their practices in areas with higher health status. This paper investigates to what extent strategies were employed by local governments to avoid risk selection and whether there were any differences between left- and right-wing governments in this regard. Three main strategies were used: risk adjustment of the financial reimbursements on the basis of health and/or socio-economic status of listed patients; design of patient listing systems; and regulatory requirements regarding the scope and content of the services that had to be offered by all providers. Additionally, left-wing local governments were more prone than right-wing governments to adopt risk adjustment strategies at the onset of the reform but these differences diminished over time. The findings of the paper contribute to our understanding of how social inequalities may be avoided in tax-based health care systems when market-like steering models such as patient choice are introduced.

Objeción de conciencia institucional y regulación en salud: ¿existe una excusa legítima frente al aborto en Chile? / Institutional conscientious objection and health regulation: is there a legitimate excuse to abortion in Chile? / Objecció de consciència institucional i regulació en salut: existeix una excusa legítima enfront de l'avortament a Xile?

El objetivo de este trabajo es analizar distintos aspectos de la regulación chilena en materias de salud y la teoría bioética, y esclarecer eventuales conflictos con la objeción de conciencia, en torno a la posibilidad de excusarse de practicar abortos en instituciones privadas de salud. La tesis a desarrollar es que existen poderosos argumentos para que una institución de salud no pueda negarse a la realización de abortos, y que la objeción de conciencia no puede constituirse como excusa para tal negativa a pesar de su reciente consagración normativa para instituciones privadas

The objective of the paper is to analyse the various aspects of Chilean health regulation and Bioethics theory, and to clarify its eventual conflicts with conscientious objection, regarding the possibility of excusing oneself from practising abortions in private health institutions. The idea is to show that there are powerful arguments proving a health institution cannot deny an abortion procedure, and that conscientious objection is not a valid excuse for that denial in spite of its recent legal acceptance

L'objectiu d'aquest treball és analitzar diferents aspectes de la regulació xilena en matèria de salut i la teoria bioètica, i esclarir els eventuals conflictes amb l'objecció de consciència pel que fa a la possibilitat d'excusar-se de practicar avortaments en institucions privades de salut. La tesi que s’hi desenvolupa és que existeixen poderosos arguments perquè una institució de salut no pugui negar-se a la realització d'avortaments, i que l'objecció de consciència no pot constituir-se en una excusa per aquesta negativa malgrat la seva recent consagració normativa per a institucions privades

The effects of regulation and litigation on a large for-profit nursing home chain.

This article examines the effects of state regulation and civil class action litigation on corporate compliance with nurse staffing and quality standards, corporate strategies to manage staffing and quality, and corporate financial status of a large for-profit nursing home chain. A historical case study was used to examine multiple public data sources, focusing on facilities in California from 2003 to 2011 during and after regulatory actions and litigation. The results showed that the state issued numerous deficiencies for violations of the nurse staffing and quality standards with minimal impact on quality compliance with state law. A class action jury trial found that the chain violated the state's minimum staffing standard on one-third of the total days during a six-year period and awarded a $677 million verdict. A court settlement and supervised injunction resulted in compliance with minimum staffing and some improvement in quality measures, but quality levels remained below the average California facilities. The litigation also had some negative financial impact on Skilled Healthcare Group's California facilities and parent company. Civil litigation had more impact on the chain than the regulatory oversight.

[Development of Human Health Discoveries. 10 years results of Young Innovative Company incubation]. / Le développement des découvertes en Santé Humaine. Résultats de 10 ans d'incubation de Jeunes Entreprises Innovantes.

Medicine is evolving every day in its operating procedures and the services offered to patients, emphasizing personalized medicine, safety and medical benefits. The individual patient is more than ever the hub of healthcare organization. Medical innovation is thus a public health priority. However it requires an accurate assessment of medical utility and risk-benefit ratios, and in-depth analysis of economic and organizational impacts. Ten years of experience in the Paris Biotech Santé company incubator has identified key actions for effective support of research projects and the success of innovative companies. Strong expertise is needed to prepare development plans, ensure compliance with regulatory requirements and obtain research funding. During its first decade, this incubator has created 87 innovative companies employing 1500 people, raised more than 90 million euros of funding, and reached a cumulative company value of 1200 million euros. Key factors of success have been identified, but an analysis of the causes of failure shows that operational adjustments are mandatory, particularly a strong commitment from medical experts, in order to promote access to new and useful products for patients while at the same time assessing their social impact.

[Fairness in Germany's long-term care insurance: the relationship between social insurance and private mandatory insurance]. / Gerechtigkeit im Verhältnis von Sozialer Pflegeversicherung und Privater Pflegepflichtversicherung.

The long-term care insurance act of 1994 introduced two branches of long-term care insurance (LTCI), namely the social LTCI and a mandatory private LTCI. Both branches together cover almost the whole population. Insurees of the social LTCI, however, have a higher age-specific dependency ratio. Furthermore, social LTCI covers a higher share of elderly people. Therefore, per capita expenses are twice as high as in private LTCI - even if benefits for civil servants directly financed out of the public purse are taken into consideration. Moreover, on average members of private LTCI have higher incomes. If organised according to the principles of social LTCI, private LTCI could therefore operate with a contribution rate that is only one third of the rate necessary in social LTCI. Being assigned to social LTC thus creates a considerable disadvantage for the insurees that cannot be justified. Fairness considerations therefore demand reform. The most simple, but politically most difficult, reform option is to abolish the dualism of social and private LTCI and create an integrated system for the whole population instead. If this is not possible at least a risk equalization scheme should be introduced that equalizes the risk structure concerning the expenses and - if possible - also the income side.

Not-for-profit versus for-profit health care providers-Part I: comparing and contrasting their records.

The debate over which health care providers are most capably meeting their responsibilities in serving the public's interest continues unabated, and the comparisons of not-for-profit (NFP) versus for-profit (FP) hospitals remain at the epicenter of the discussion. From the perspective of available factual information, which of the two sides to this debate is correct? This article is part I of a 2-part series on comparing and contrasting the performance records of NFP health care providers with their FP counterparts. Although it is demonstrated that both NFP and FP providers perform virtuous and selfless feats on behalf of America's public, it is also shown that both camps are involved in potentially willful clinical and administrative missteps. Part I contains the background information (eg, legal differences, perspectives on social responsibility, and types of questionable and fraudulent behavior) that is necessary to adequately understand the scope of the comparison issue. Part II offers actual comparisons of the 2 organizational structures using several disparate factors such as specific organizational behaviors, approach to the health care priorities of cost and quality, and business-focused goals of profits, efficiency, and community benefit.

Predictors of lawsuit activity against nursing homes in Hillsborough County, Florida.

The objective of this study is to examine the litigation experience of twenty-eight nursing homes in Hillsborough County, Florida. Primary data were collected from Hillsborough County Circuit Court's Clerk's Recording Computer System about lawsuit activity from 1996 to 2000 and linked to the Centers for Medicare and Medicaid Services Online Survey, Certification, and Reporting system. We found that registered nurse levels, size, and being part of a chain or system impacted litigation in Hillsborough County.