The Failure of Mandated Disclosure

This article explores the spectacular prevalence, and failure, of the single most common technique for protecting personal autonomy in modern society: mandated disclosure. The article has four sections: (1) A comprehensive summary of the recurring use of mandated disclosures, in many forms and circumstances, in the areas of consumer and borrower protection, patient informed consent, contract formation, and constitutional rights; (2) A survey of the empirical literature documenting the failure of the mandated disclosure regime in informing people and in improving their decisions; (3) An account of the multitude of reasons mandated disclosures fail, focusing on the political dynamics underlying the enactments of these mandates, the incentives of disclosers to carry them out, and, most importantly, on the ability of disclosees to use them; (4) An argument that mandated disclosure not only fails to achieve its stated goal but also leads to unintended consequences that often harm the very people it intends to serve

The Failure of Mandated Disclosure

Objective to elaborate the conceptual theoreticallegal provisions and scientific recommendations for the substantiating the inefficiency of mandated disclosure. Methods general dialectic method of cognition as well as the general scientific and specific legal methods of research based on it. Results the article explores the spectacular prevalence and failure of the single most common technique for protecting personal autonomy in modern society mandated disclosure. The article has four parts 1 a comprehensive summary of the recurring use of mandated disclosures in many forms and circumstances in the areas of consumer and borrower protection patient informed consent contract formation and constitutional rights 2 a survey of the empirical literature documenting the failure of the mandated disclosure regime in informing people and in improving their decisions 3 an account of the multitude of reasons mandated disclosures fail focusing on the political dynamics underlying the enactments of these mandates the incentives of disclosers to carry them out and most importantly on the ability of disclosees to use them and 4 an argument that mandated disclosure not only fails to achieve its stated goal but also leads to unintended consequences that often harm the very people it intends to serve. Scientific novelty the article elaborates and introduces into academic sphere the substantiation of the efficiency of mandated disclosure proves the failure of the mandated disclosure regime in informing people and in improving their decisions and reveals the unintended consequences that often harm the very people it intends to serve. Practical significance the provisions ad conclusions of the article can be used in scientific lawmaking and lawenforcement activities and in the educational process of institutions of higher education

Disability, utilization, and costs associated with musculoskeletal conditions, United States, 1980

"Health Care Financing Administration, Office of Research and Demonstrations"-- P. 1 of cover.Written by: Hillary A. Murt and others."September 1986."DHHS publication no. 86-20405.Also available via the World Wide Web.Bibliography: p. 27

Determinants of total family charges for health care--United States, 1980

This report addresses a question of importance for policymakers: \ue2\u20ac\u153What are the determinants of the total charges for health care that U.S. families face?\ue2\u20ac? Policymakers\ue2\u20ac\u2122 concerns about this question have two main grounds. First, U.S. health care costs are large and growing rapidly. They now exceed 11 percent of the gross national product, and the answer to the question can shed some light on their troubling growth. Second, total family charges for health care reflect the quantity of health care received by families, and it is important to know whether the determinants of total charges are principally the need for health care, or involve other factors less related to need. In this report, the determinants of total charges and their importance are identified principally through multiple regression analysis. Total charges are defined as the full amount charged for all types of health care for all family members regardless of whether these amounts are paid out of pocket, paid by insurance (or public health care coverage programs), or go unpaid. The data used are from the family data files of the 1980 National Medical Care Utilization and Expenditure Survey (NMCUES). This report presents data on the approximately 5,000 multiple-person families inter-viewed in this year-long longitudinal survey. The report provides a separate analysis for each of three socioeconomic family populations that have consistently been of interest to policymakers. These are (1) older families (defined for this report as all U.S. multiple person families with a member 65 years of age or over); (2) younger, lower income families (all U.S. multiple-person families below 200 percent of the poverty level in 1980 and with all members under 65 years of age); and (3) younger, better off families (all U.S. multiple-person families at 200 percent of the poverty level or higher in 1980 and with all members under 65).[Sunshine, J.H., and Dicker, M.] ; published by Public Health Service, Centers for Disease Control, National Center for Health Statistics."Health Care Financing Administration, Office of Research and Demonstrations"--Cover."November 1990."Includes bibliographical references (p. 31-32)

Evaluation of data collection and coding for medical conditions in the National Medical Care Utilization and Expenditure Survey

This is one of five reports that evaluates the National Medical Care Utilization and Expenditure Survey. That survey was designed for the collection of data about the U.S. civilian noninstitutionalized population during 1980. During the course of the survey, information was obtained on health, access to and use of medical services, associated charges and sources of payment, and health insurance coverage. This report evaluates procedures used in the National Medical Care Utilization and Expenditure Survey to collect and code medical conditions. Estimates derived from the National Medical Care Utilization and Expenditure Survey are compared with estimates derived from the National Health Interview Survey. Several of the procedures used in the two surveys were identical or similar.Prepared by Janet Gans.Bibliography: p. 20.198

Family use of health care, United States, 1980

Information on families' use of health care in 1980 is presented in this report. The data discussed here were gathered in the national household sample of the National Medical Care Utilization and Expenditure Survey. In this sample, information was collected on health problems, health care received, expenditures for care, health insurance, and related topics throughout calendar year 1980 from approximately 6,800 families in the U.S. civilian noninstitutionalized population. (The report entirely excludes families with military heads, even if they have civilian members.) For this report, a family was initially defined as (1) two or more persons living together who were related by either blood, marriage, adoption, or a formal foster care relationship or (2) a single person living outside such relationships. But because these data were collected across an entire year, the important concept of "Longitudinal family" was developed. This concept was necessary to deaI with the fact that the composition of a family could change over time and that families could come into existence and go out of existence over time. As the data are based on this dynamic concept of families, all measures of the use of health services are calculated in annual rates. Family data are important for understanding the health care system because decisions to seek and use health care are usually family decisions, health care is usually paid for out of family resources, and family distributions for health-related variables differ from the distributions found for individuals. Data on both multi- pie-person families (families that averaged 1.5 persons or more during the year) and one-person families (families that averaged less than 1.5 persons during the year) are presented in this report. Only findings for multiple-person families, however, are addressed in this section. It is multiple-person families that are usually referred to in discussions of families by both the general public and professional social scientists. General Findings: The burden of illness in the U.S. population, as measured by poor or fair health on a scale of perceived health status, is much more widespread among families than among individuals. For example, 25 percent of families with all members under 65 years of age had a member whose health was rated fair or poor, compared with 10 percent of aH persons under 65. The completeness of health care coverage (by a pub_ lic coverage program or by private health insurance) also differed between families and individuals. Again comparing persons and families under 65 years of age, 29 percent of families had members without full-year coverage, compared with 19 percent of per- sons without such coverage.Written by: Marvin Dicker and Jonathan H. Sunshine.Bibliography: p. 28-29.1029688

Total family expenditures for health care, United States, 1980

Information on total family expenditures for health care in 1980 is presented in this report. Total expenditures are the total amounts billed (either actual or imputed) to families whether these amounts are paid out-of-pocket by the family, paid by private health insurance or a public health care coverage program, or remain unpaid. The data discussed here were gathered in the national household sample of the National Medical Care Utilization and Expenditure Survey (NMCUES). In this sample, information was collected on health problems, health care received, expenditures for care, health insurance, and related topics throughout calendar year 1980 from approximately 6,800 families in the civilian noninstitutionalized population of the United States. The survey excluded all individuals who were in institutions or in the military. This report also entirely excludes families with military heads, even if they had some civilian members. For this report, a family was initially defined as (1) two or more persons living together who were related by either blood, marriage, adoption, or a formal foster care relationship or (2) a single person living outside such relationships. Because data on these families were collected across an entire year, the important concept of "longitudinal family" was developed. This concept was necessary to deal with the fact that the composition of a family could change over time and that families could come into existence and go out of existence over time. As the data are based on this dynamic concept of families, all measures of expenditures for care are calculated in annual rates. Family data are important for understanding the health care system because decisions to seek and use health care are usually family decisions, health care is usually paid for out of family resources, and family distributions for health-related variables differ from the distributions found for individuals. This report deals with total expenditures for health care as reported by a sample of consumers of health care. These types of data are limited by the knowledge the respondent has as to the amount of the total bill. For various reasons, which are discussed in detail in the text, the respondent often doesn\u2019t know the amount of the total bill. Therefore, the statistics in this report should be regarded as having more limitations than the statistics in two previous family reports: "Family Use of Health Care: United States, 1980" (Dicker and Sun-shine, 1987) and "Family Out-of-Pocket Expenditures for Health Care: United States, 1980" (Sunshine and Dicker, 1987).By Jonathan H. Sunshine and Marvin Dicker.Bibliography: p. 30-31.1031341

Health care utilization and costs of adult cardiovascular conditions, United States, 1980

Cardiovascular conditions have a major economic as well as health impact on adults in the United States. In the National Medical Care Utilization and Expenditure Survey, conducted during 1980, health service data were obtained from a national sample of 17,123 civilian noninstitutionalized individuals. These data have been analyzed to define the impact and demographic patterns of health care utilization and costs attributable to adult cardiovascular conditions. Approximately 28 million persons in the United States, or 17.3 percent of the total civilian noninstitutionalized population 17 years of age and over, had a cardiovascular condition during 1980. Cardiovascular conditions were reported with increasing frequency in successively older age groups and were reported most frequently by black persons. The prevalence and economic impact differed by specific type of cardiovascular condition and whether the condition was complicated by another disease. To examine these differences, persons reporting cardiovascular conditions were categorized into four mutually exclusive groups: persons with hypertension alone, persons with arteriosclerotic cardiovascular and cerebrovascular disease associated with hypertension, persons with arteriosclerotic cardiovascular disease alone, and persons with cardiovascular disease associated with other conditions that might alter medical care utilization and disability. The disability, service utilization, and health care charges were compared among these groups, and data for each group were compared with those for the overall U.S. population. Survey participants were asked to rate their health relative to that of other people their age. The self-rating of persons reporting hypertension alone was lower than the national average. Only 17 percent of the general population rated their health as "fair" or "poor," but 27 percent of persons with hypertension alone used these descriptions.Written by: William R. Harlan, P. Ellen Parsons, and others.Includes bibliographical references (p. 28-29).19891031347

Determinants of financially burdensome family health expenses: United States, 1980

This report focuses on two questions of current interest to policy makers. First, \ue2\u20ac\u153What percent of U.S. families experience financially burdensome health expenses?\ue2\u20ac? and, second, \ue2\u20ac\u153What are the determinants of financially burdensome health expenses among U.S. families?\ue2\u20ac? The first question is addressed by examining how the distribution in. the United States of families with financially burdensome health expenses is affected by six different possible measures of financial burden. The second question is addressed by using multiple regression techniques on one of the measures selected as a preferred measure. The data used are from the family data files of the 1980 National Medical Care Utilization and Expenditure Survey (NMCUES). This report presents data on approximately 5,000 multiple-person families interviewed in this longitudinal survey. It provides a separate analysis for each of three socioeconomic family populations that have consistently been of interest to policymakers. These are (1) older families (defined for this report as all U.S. multiple-person families with a member 65 years of age or over); (2) younger, lower-income families (defined as all U.S. multiple-person families below 200 percent of the poverty level in 1980 and with all members under 65 years of age); and (3) younger, better-off families (defined as all U.S. multiple-person families at 200 percent of the poverty level or higher in 1980 and with all members under 65 years of age). Two general conceptual approaches have been used in the literature to assess financially burdensome health expenses. The first approach measures financial burden by the size of a family\ue2\u20ac\u2122s health bill in dollars. The second approach focuses on a family\ue2\u20ac\u2122s ability to pay its health bill, and it measures financial burden as a ratio of health expenses to family income. There is no agreement on which of the two approaches is preferable and also no agreement on which of several operational measures in each category is the most appropriate. In order to shed light on this controversy, this report compares six potentially useful operational measures of financial y burdensome health expenses. Three are dollar measures and three are ratio measures, The three dollar measures are (1) total charges for health care (irrespective of who pays the bill or whether or not the bill is paid), (2) out-of-pocket expenses for health care services (family-paid premiums for health insurance are not included), and (3) total out-of-pocket expenses for health (the previous measure plus out-of pocket premiums). The three ratio measures use the three dollar measures to construct measures involving a ratio of expenses to total family income. This gives (1) the ratio of total charges for health care to family income, (2) the ratio of out-of-pocket expenses for health care services to family income, and (3) the ratio of total out-of-pocket expenses for health to family income. Given these measures, the question still remains as to what level of expense, or ratio of expense to income, constitutes a financially burdensome expense. The usual practice in the literature has been to use several different thresholds arbitrarily selected from the upper part of the particular expense distribution under examination, and this practice is followed in this report. The overall finding for the six measures was that different results were found for the different measures even when the same threshold was used.[by Marvin Dicker and Jonathan H. Sunshine]."April 1988."Bibliography: p. 32-33