RESUMO
We review the history, current status, and potential future of state infertility mandates and focus on the business implications of mandates and on the inadequacies and reproductive injustice resulting from gaps between legislative intent and practical implementation. Nineteen states have passed laws that require insurers to either cover or offer coverage for infertility diagnoses and treatment. The qualifications for coverage, extent of coverage, and exemptions vary drastically from one state to another, resulting in deficiencies in access to care even within mandated states for certain groups, such as single individuals, patients in same-sex relationships, and patients pursuing fertility preservation. Although insurance coverage of fertility services in the United States has expanded as an increasing number of states have enacted infertility mandates, significant gaps in implementation and access remain even among states with existing mandates. Provider, patient, and legislative advocacy is warranted in the name of reproductive justice to expand insurance coverage and, in turn, maximize reproductive outcomes, which have been shown to improve as financial barriers are lifted.
Assuntos
Fertilidade/fisiologia , Acessibilidade aos Serviços de Saúde , Cobertura do Seguro/legislação & jurisprudência , Direitos Sexuais e Reprodutivos , Feminino , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/história , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/tendências , História do Século XXI , Humanos , Infertilidade/economia , Infertilidade/terapia , Cobertura do Seguro/economia , Cobertura do Seguro/história , Cobertura do Seguro/tendências , Seguro Saúde/economia , Seguro Saúde/história , Seguro Saúde/legislação & jurisprudência , Seguro Saúde/tendências , Masculino , Programas Obrigatórios/economia , Programas Obrigatórios/história , Programas Obrigatórios/legislação & jurisprudência , Programas Obrigatórios/tendências , Gravidez , Direitos Sexuais e Reprodutivos/legislação & jurisprudência , Direitos Sexuais e Reprodutivos/tendências , Minorias Sexuais e de Gênero/história , Minorias Sexuais e de Gênero/legislação & jurisprudência , Estados UnidosAssuntos
Movimento contra Vacinação/história , Programas Obrigatórios/história , Recusa de Vacinação/história , Vacinação/história , Movimento contra Vacinação/legislação & jurisprudência , Liberdade , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Programas de Imunização/história , Programas de Imunização/legislação & jurisprudência , Programas Obrigatórios/legislação & jurisprudência , Sarampo/história , Sarampo/prevenção & controle , Poliomielite/história , Poliomielite/prevenção & controle , Varíola/história , Varíola/prevenção & controle , Estados Unidos , Recusa de Vacinação/legislação & jurisprudênciaRESUMO
In 2019, the United States saw the single largest outbreak of measles in recent history. The measles crisis has prompted state legislative bodies to face a seemingly impossible dilemma: eliminate both religious and philosophical exemptions to mandatory school vaccination statutes or sit by idly and allow measles to continue to run its course. As of June 2019, five states have neither religious nor philosophical exemptions to their mandatory vaccination statutes. This Note argues that states should remove all religious and philosophical exemptions to compulsory vaccination statutes. The 2019 measles outbreak demonstrates that the anti-vaccination movement poses a legitimate risk to the health of the masses, especially to the most vulnerable members of our communities. If individuals continue to opt out of compulsory vaccination requirements, diseases that were eradicated decades ago will undoubtably return to the absolute detriment of those unable to protect themselves.
Assuntos
Surtos de Doenças/prevenção & controle , Programas Obrigatórios/legislação & jurisprudência , Sarampo/prevenção & controle , Recusa de Vacinação , Vacinação/legislação & jurisprudência , Regulamentação Governamental , História do Século XX , Humanos , Jurisprudência , Programas Obrigatórios/história , Saúde Pública , Religião , Governo Estadual , Estados Unidos , Vacinação/históriaAssuntos
Política de Saúde/história , Programas Obrigatórios/história , Vigilância da População , Trabalho Sexual/história , Infecções Sexualmente Transmissíveis/história , França , História do Século XX , Humanos , Líbano/epidemiologia , Império Otomano , Trabalho Sexual/legislação & jurisprudência , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/tratamento farmacológico , Infecções Sexualmente Transmissíveis/epidemiologiaRESUMO
School-based compulsory vaccination laws have provoked debates over the legitimacy of government coercion versus the scope of parental rights. A key point of contention in these school vaccination laws are provisions known as exemption clauses that allow some parents to enroll their children in school unimmunized for reasons other than medical conditions. For more than three decades Mississippi and West Virginia stood apart as the only two US states that did not offer nonmedical exemptions to school vaccination laws. But other states seem to be moving in this direction, such as California, which in 2015 eliminated nonmedical exemptions following the Disneyland measles outbreak. The apparent shift creates an opportune moment to look at the experiences of Mississippi and West Virginia. Through a review of legislative histories, legal rulings, media accounts, and interviews with health officials in the two states, we consider the reasons for and consequences of their allowing only medical exemptions and the prospects their approach holds out for other states that may wish to emulate it. The experiences of these two states suggest that contrary to conventional wisdom, it may be politically tenable to limit exemptions to only medical reasons without damaging either the stature of public health or the immunization system.
Assuntos
Programas Obrigatórios/legislação & jurisprudência , Instituições Acadêmicas/legislação & jurisprudência , Governo Estadual , Vacinação/legislação & jurisprudência , Criança , História do Século XIX , História do Século XX , Humanos , Programas Obrigatórios/história , Mississippi , Pais , Saúde Pública , Religião e Medicina , Vacinação/história , West VirginiaAssuntos
Alcoolismo/terapia , Internação Compulsória de Doente Mental/legislação & jurisprudência , Transtornos Relacionados ao Uso de Substâncias/terapia , Internação Compulsória de Doente Mental/história , História do Século XX , História do Século XXI , Humanos , Programas Obrigatórios/história , Programas Obrigatórios/legislação & jurisprudência , New South WalesRESUMO
After 1945 the common medical training infrastructure was broken up into two different political systems. While in the Federal Republic of Germany the structure was based on physicians' self-governance, in the German Democratic Republic medical professional structures were organised by the government. After the unification of the two German states, which took place on October 3, 1990, the centralistic structure was replaced by the system of physician self-governance. Before January 1, 2004, continuing medical education (CME) in West Germany relied on a system of voluntary obligations. In East Germany, though, professional CMEs were compulsory; they were called "obligatorische periphere Fortbildung." Based on 15 expert interviews on the topic of "CME in Germany", the different circumstances and conditions were analysed taking account of the historical background. Only selected professionals with experience in both German states (one with a federal, the other with a centralistic system), were chosen for the survey.
Assuntos
Serviços Contratados/história , Serviços Contratados/legislação & jurisprudência , Educação Médica Continuada/história , Educação Médica Continuada/legislação & jurisprudência , Programas Obrigatórios/história , Programas Obrigatórios/legislação & jurisprudência , Programas Nacionais de Saúde/história , Programas Nacionais de Saúde/legislação & jurisprudência , Mudança Social/história , Programas Voluntários/história , Programas Voluntários/legislação & jurisprudência , Competência Clínica/legislação & jurisprudência , Currículo , Alemanha Oriental , Alemanha Ocidental , História do Século XIX , História do Século XX , História do Século XXI , Humanos , PolíticaRESUMO
In the German Reich, smallpox vaccinations were organized by the state. A mandatory vaccination throughout the empire was introduced in 1874, which was continued in the Federal Republic of Germany (FRG) and the German Democratic Republic (GDR) until 1982/1983. From 1935, health departments were responsible for vaccinations. In the GDR, immunization was tightly organized: The state made great efforts to achieve high vaccination rates. Responsibilities were clearly defined at all levels and for all ages. While vaccination was initially mandatory only at the regional level, the legally mandated immunization schedule later contained compulsory vaccinations, e.g., against measles. In the beginning there were mandatory vaccinations in the FRG at the Länder level. Since 1961, the Federal Epidemics Act has impeded obligatory vaccinations. Instead, voluntary vaccinations based on recommendations were stressed. Since the 1980s, vaccinations have been shifted from the public health service sector to office-based physicians. Today, public health authorities offer mainly supplementary vaccinations. In 2007, protective immunizations were introduced as compulsory benefits of the statutory health insurance (SHI). Recently, the German federal states developed a National Vaccination Plan to support immunization strategies.
Assuntos
Programas de Imunização/história , Programas Obrigatórios/história , Programas Nacionais de Saúde/história , Saúde Pública/história , Vacina Antivariólica/história , Varíola/história , Alemanha , História do Século XIX , História do Século XX , História do Século XXI , HumanosRESUMO
The 1853 Vaccination Act, adopted in England during XIX century, was the first law about compulsory vaccination in Europe. The Act caused a violent movement of opposition with the birth of Victorian anti-vaccination. The modern anti-vaccination movement was born in 1998 following a paper of Andrew Wakefield published in the Lancet. In this paper Wakefield illustrated a study of twenty patients and concluded that the administration of the MMR vaccine caused autism and some forms of colitis. The publication was later disowned by almost all authors. However the study of Wakefield caused a reduction of compliance to the anti-MMR vaccination in the United Kingdom, resulting in lower coverage and new outbreaks. The theorethical principles of anti-vaccinationists of 19th and 20th century were: the hypothesis that vaccines cause illnesses; the presence of toxic substances in the vaccine; the violation of freedom Personal and People's; the ineffectiveness of vaccinations. Moreover, anti-vaccinationists always refused the scientific methods and the peer-review of their scientific studies.
Assuntos
Medicina Baseada em Evidências , Vacinação em Massa/história , Vacinação/história , Transtorno Autístico/etiologia , Transtorno Autístico/história , Negação em Psicologia , Europa (Continente) , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Programas Obrigatórios/história , Meios de Comunicação de Massa/história , Vacinação em Massa/legislação & jurisprudência , Vacina contra Sarampo-Caxumba-Rubéola/história , Autonomia Pessoal , Conservantes Farmacêuticos/história , Saúde Pública/história , Reino Unido , Vacinação/efeitos adversos , Vacinação/legislação & jurisprudênciaAssuntos
Programas Obrigatórios/legislação & jurisprudência , Vacinação/legislação & jurisprudência , Direitos Civis , Educação em Saúde , História do Século XIX , História do Século XX , Humanos , Programas de Imunização/legislação & jurisprudência , Programas Obrigatórios/história , Cooperação do Paciente/estatística & dados numéricos , Reino Unido , Estados Unidos , Vacinação/históriaRESUMO
Vaccines are among the most effective prevention tools available to clinicians. However, the success of an immunization program depends on high rates of acceptance and coverage. There is evidence of an increase in vaccine refusal in the United States and of geographic clustering of refusals that results in outbreaks. Children with exemptions from school immunization requirements (a measure of vaccine refusal) are at increased risk for measles and pertussis and can infect others who are too young to be vaccinated, cannot be vaccinated for medical reasons, or were vaccinated but did not have a sufficient immunologic response. Clinicians can play a crucial role in parental decision making. Health care providers are cited as the most frequent source of immunization information by parents, including parents of unvaccinated children. Although some clinicians have discontinued or have considered discontinuing their provider relationship with patients who refuse vaccines, the American Academy of Pediatrics Committee on Bioethics advises against this and recommends that clinicians address vaccine refusal by respectfully listening to parental concerns and discussing the risks of nonvaccination.