Assisted reproductive technology in the USA: is more regulation needed?

The regulation of assisted reproductive technologies is a contested area. Some jurisdictions, such as the UK and a number of Australian states, have comprehensive regulation of most aspects of assisted reproductive technologies; others, such as the USA, have taken a more piecemeal approach and rely on professional guidelines and the general regulation of medical practice to govern this area. It will be argued that such a laissez-faire approach is inadequate for regulating the complex area of assisted reproductive technologies. Two key examples, reducing multiple births and registers of donors and offspring, will be considered to illustrate the effects of the regulatory structure of assisted reproductive technologies in the USA on practice. It will be concluded that the regulatory structure in the USA fails to provide an adequate mechanism for ensuring the ethical and safe conduct of ART services, and that more comprehensive regulation is required

Impact of state mandatory insurance coverage on the use of diabetes preventive care

<p>Abstract</p> <p>Background</p> <p>46 U.S. states and the District of Columbia have passed laws and regulations mandating that health insurance plans cover diabetes treatment and preventive care. Previous research on state mandates suggested that these policies had little impact, since many health plans already covered the benefits. Here, we analyze the contents of and model the effect of state mandates. We examined how state mandates impacted the likelihood of using three types of diabetes preventive care: annual eye exams, annual foot exams, and performing daily self-monitoring of blood glucose (SMBG).</p> <p>Methods</p> <p>We collected information on diabetes benefits specified in state mandates and time the mandates were enacted. To assess impact, we used data that the Behavioral Risk Factor Surveillance System gathered between 1996 and 2000. 4,797 individuals with self-reported diabetes and covered by private insurance were included; 3,195 of these resided in the 16 states that passed state mandates between 1997 and 1999; 1,602 resided in the 8 states or the District of Columbia without state mandates by 2000. Multivariate logistic regression models (with state fixed effect, controlling for patient demographic characteristics and socio-economic status, state characteristics, and time trend) were used to model the association between passing state mandates and the usage of the forms of diabetes preventive care, both individually and collectively.</p> <p>Results</p> <p>All 16 states that passed mandates between 1997 and 1999 required coverage of diabetic monitors and strips, while 15 states required coverage of diabetes self management education. Only 1 state required coverage of periodic eye and foot exams. State mandates were positively associated with a 6.3 (P = 0.04) and a 5.8 (P = 0.03) percentage point increase in the probability of privately insured diabetic patient's performing SMBG and simultaneous receiving all three preventive care, respectively; state mandates were not significantly associated with receiving annual diabetic eye (0.05 percentage points decrease, P = 0.92) or foot exams (2.3 percentage points increase, P = 0.45).</p> <p>Conclusions</p> <p>Effects of state mandates varied by preventive care type, with state mandates being associated with a small increase in SMBG. We found no evidence that state mandates were effective in increasing receipt of annual eye or foot exams. The small or non-significant effects might be attributed to small numbers of insured people not having the benefits prior to the mandates' passage. If state mandates' purpose is to provide improved benefits to many persons, policy makers should consider determining the number of people who might benefit prior to passing the mandate.</p

Comparing and learning from English and American higher education access and completion policies

England and the United States provide a very interesting pairing as countries with many similarities, but also instructive dissimilarities, with respect to their policies for higher education access and success. We focus on five key policy strands: student information provision; outreach from higher education institutions; student financial aid; affirmative action or contextualisation in higher education admissions; and programmes to improve higher education retention and completion. At the end, we draw conclusions on what England and the US can learn from each other. The US would benefit from following England in using Access and Participation Plans to govern university outreach efforts, making more use of income-contingent loans, and expanding the range of information provided to prospective higher education students. Meanwhile, England would benefit from following the US in making greater use of grant aid to students, devoting more policy attention to educational decisions students are making in early secondary school, and expanding its use of contextualised admissions. While we focus on England and the US, we think that the policy recommendations we make carry wider applicability. Many other countries with somewhat similar educational structures, experiences, and challenges could learn useful lessons from the policy experiences of these two countries

State and Local Government Finances: Was There a Structural Break in the Reagan Years?

The Reagan administration\u27s New Federalism and tax reform proposals were expected to have chilling effects on growth of state and local government revenues and expenditures. This paper examines the hypothesis that there was a structural break in state and local government fiscal behavior in the 1980s. Although the evidence is far from conclusive, it does suggest some different fiscal patterns in this decade. However, the real structural break ap­pears to have occurred in the late 1970s and these trends have continued during the Reagan years