Paternalism, Public Health, and Behavioral Economics: A Problematic Combination

Some critiques of public health regulations assume that measures directed at industry should be considered paternalistic whenever they limit any consumer choices. Given the presumption against paternalistic measures, this conception of paternalism puts government proposals to regulate industry to the same stringent proof as clearly paternalist proposals to directly regulate individuals for their own benefit. The result is to discourage regulating industry in ways that protect the public from harm and instead to encourage regulating individuals for their own good -- quite the opposite of what one would expect from a rejection of paternalism. Arguments favoring soft paternalism to justify some regulatory measures may exacerbate this trend. They can muddy the debate, narrow the range of reasons for regulating industry, and instead encourage harder paternalistic regulation of personal behavior

The Merger Between Public Health and Health Law – The US Situation

Law is an essential tool for protecting the public’s health. It is often the law that turns public health science into public health action. Sanitation, clean air and water, universal vaccination, injury prevention, tobacco control, drug policy, and a vast array of other interventions are achieved through a complex web of local, provincial and national statutes, regulations and judicial cases. The Institute of Medicine in the United States defines public health as “what we, as a society, do collectively to ensure the conditions in which people can be healthy.” And society acts collectively most often through law. Thus, the merging of law and public health is not a future goal. It has already happened. This merger has been with us since kings quarantined ships arriving in port to prevent the spread of contagious disease from abroad. Perhaps because law has been a part of public health for so long, we take it for granted and often fail to recognize how it can and should be used. But the expanding domain of public health invites a fresh look at the relationship between law and public health. Two perspectives are the focus of this paper. The first is the need for training health professionals in law in order to achieve public health goals. The second is an important caveat about the role of law in preventing health risks that arise from personal behaviors. This is because many new threats to public health in the northern hemisphere come from personal behaviors, which means that public health solutions often require infringing on individual rights. This can create conflicts between the goals of law and the goals of public health

Legal Issues in HIV/AIDS Prevention and Treatment in the Russian Federation – Summary and Conclusions of the Boston University HIV/AIDS Project

The Russia Federation faces an urgent need to control the spread of HIV. Although infection has been concentrated primarily among high risk groups so far, the risk that it will spread rapidly throughout the general population is growing daily. Controlling the HIV epidemic requires leadership and strategies that are somewhat different from traditional infectious disease control models because there is no vaccine yet available to prevent disease and people spread infection by engaging in activities that are hidden from public view and not susceptible to simple prohibitions. Boston University conducted several studies as part of USAID’s HIV/AIDS Strategy to assist the Russian Federation in developing effective responses to the epidemic. The Boston University HIV/AIDS Project investigated Russian Federation law governing HIV/AIDS prevention and treatment programs, identified and analyzed criminal laws that may impede prevention and treatment efforts, and solicited ideas from physicians as to problems and opportunities for investigation and change. Conclusions drawn from the Boston University HIV/AIDS Project’s activities are summarized below in two categories. The first category includes findings and suggestions for improving civil law programs, while the second focuses on criminal and administrative law. More detailed information on each subject can be found in the subject-specific reports submitted earlier by Boston University

Law and Public Health: Beyond Emergency Preparedness

This Article examines three questions: What is public health? What is public health law? What roles can lawyers play in public health? It first describes the breadth of public health, highlighting six trends shaping its future: social determinants of health; synergy between medicine and public health; shifts in focus from external (e.g., environmental and social) to internal (behavioral) risks to health; federalization of public health law; globalization of health risks and responses; and bioterrorism. Because the domains of law that apply to public health are equally broad, the Article next offers a conceptual framework for identifying the types of laws most suitable to different public health problems. Finally, the role of lawyers in the applied field of public health law is examined, first to encourage attention to law\u27s effect on health, even laws having little apparent relationship to health; and second, to recognize that laws intended to achieve specific health outcomes may affect broader legal principles. Lawyers have a unique role to play in ensuring that the legal principles used to promote health also preserve justice

A distribuição da responsabilidade por decisões em saúde ao abrigo do Affordable Care Act americano

ABSTRACT - This article summarizes the major elements of the ACA’s insurance reforms and how they affect responsibility for making decisions about the health care that people receive. A key example of the difficulty of allocating decision making responsibility is the effort to define a minimum benefit package for insurance plans, called essential health benefits. While the ACA should achieve its goal of near-universal access to care, it leaves in place a multiplicity of processes and decision-makers for determining individual treatment. As a result, decisions about what care is provided are likely to remain, much as they are today, divided among government agencies, private insurers, private employers, and the courts.RESUMO - Este artigo resume os elementos principais das reformas no sistema de seguros de saúde introduzidas pelo Affordable Care Act (ACA) nos EUA e discute como estas afetam a distribuição de responsabilidade pelas decisões ao nível da prestação de cuidados de saúde. Em particular, o esforço de definição de um pacote de benefícios mínimos nos planos de seguros de saúde, denominado Essential Health Benefits, constitui um exemplo fundamental da dificuldade de atribuição e delimitação de responsabilidade pela tomada de decisão a este nível. Desta forma, enquanto o ACA procura atingir o seu objectivo de proporcionar um acesso o mais universal possível aos cuidados de saúde por parte da população americana, deixa no terreno uma multiplicidade de processos e decisores para a determinação de cada tratamento individual. Em consequência, as decisões acerca dos cuidados de saúde prestados em cada situação permanecerão, provavelmente, a ser divididas pelas entidades que já hoje as tomam na prática – agências governamentais, seguradoras privadas, empregadores privados e tribunais.info:eu-repo/semantics/publishedVersio

Independent External Review of Health Maintenance Organizations\u27 Medical-Necessity Decisions

States may have more freedom to regulate the practices of managed-care organizations than many observers previously believed. In the absence of congressional action on the federal Bipartisan Patient Protection Act, the primary source of patient-protection legislation remains at the state level. Nevertheless, the federal Employee Retirement Income Security Act (ERISA) of 19742restricts state regulation of health maintenance organizations (HMOs) that serve private employee group health plans. On June 20, 2002, the U.S. Supreme Court, in Rush Prudential HMO, Inc. v. Moran, upheld an Illinois state law that requires binding independent external review when an HMO disagrees with the decision of a patient\u27s physician that a treatment is medically necessary. The Moran decision clarifies the states\u27 authority, and may allow physicians a larger say in decisions about managed-care coverage