Approaches to Covering the Uninsured: A Guide

Explains the main options for expanding heath insurance coverage -- strengthening the current system, making it more affordable or more accessible, and changing how it is financed -- and their potential impact. Compares current reform proposals

The Effects Of Oil-Contaminated Prey On The Feeding, Growth, And Related Energetics On Pink Salmon, Oncorhynchus Gorbuscha Walbaum, Fry

Thesis (Ph.D.) University of Alaska Fairbanks, 1984Pink salmon, Oncorhynchus gorbuscha Walbaum, fry were exposed to oil-contaminated prey (OCP) in a series of experiments to determine the effects of oil exposure via the diet on the ability of pink fry to survive. Brine shrimp, Artemia salina, nauplii were contaminated with petroleum hydrocarbons by exposure to the water-soluble fraction (WSF) of Cook Inlet crude oil and fed to the fish. Feeding rates were measured for 10 days using OCP and for 5 days using uncontaminated prey (post-exposure period). In a separate experiment, fry growth was measured over a 50 day period. In another experiment, fry oxygen consumption, food absorption and utilization, and ammonia excretion was measured to determine the effects of OCP on fry metabolic activity. Fry feeding rates were reduced by exposure to OCP, and remained suppressed during the post-exposure period. Chronic exposure to OCP for 50 days reduced fry growth. OCP were not lethal to the fry. There was no change in fry oxygen consumption or ammonia excretion from exposure to OCP, but the fish exposed to OCP absorbed less food than controls and continued to absorb less food for 7 days after exposure. Results indicate that exposure to OCP can reduce fry growth primarily by reducing food intake, but additional nutrition is lost from the non-absorption of ingested food. Reductions in growth could decrease fry survival, and thereby reduce the number of returning adult pink salmon

Stopping Deceptive Health Claims: The Need for a Private Right of Action Under Federal Law

This is the accepted version of the article. The final published version is available at https://journals.sagepub.com/doi/abs/10.1177/009885881664471

True Risk Management: Physicians\u27 Liability Risk and the Practice of Patient-Centered Medicine

While most physicians understand that a serious deficiency in technical care increases their risk of liability, too often their risk management behavior indicates that they do not fully appreciate the impact that poor interpersonal skills have on patients\u27 motivations to sue. Ironically, many of these physicians have taken risk management steps that have increased, rather than reduced, their exposure to lawsuits. In this paper, we argue that a strong legal and factual claim does not invariably explain patients\u27 decisions to sue. Dissatisfaction with the physician\u27s interpersonal care as well as with the clinical outcome is often a factor. Conversely, patients with a potentially meritorious claim may forego legal action due to the strength of the relationship with the physician. In view of patients\u27 motivations to sue, we advocate a more broadly conceived approach to reducing liability risk, one that honors the ethical aspirations of medicine instead of the secretive counsels of misguided risk management. To be sure, strategies to reduce technical error are necessary, but they are not sufficient. Errors causing harm will inevitably occur. The first step in the liability path is the patient\u27s decision to transform the fact of harm into a legal claim. Whether this crucial first step is taken, as research has shown, can be strongly influenced by the physician\u27s interpersonal competence: the more open and honest physicians are towards their patients, the less likely these patients will pursue litigation. Thus, we argue that physicians should seek to establish strong relationships with their patients and avoid questionable defensive medicine practices that can harm these relationships