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Back Issues and Articles

Table of Contents
Table Of Contents
Foreword: Following the Money
Frances H. Miller - [PDF]

Follow the money is a versatile phrase; the term can be used as an exhortation, designate a pathway, or denote a lifestyle choice. When it comes to health care, following the money is at least part of the sine qua non for anyone seeking to understand how this complex sector of the US economy has arrived at its present sorry state. It's not hard to conclude that a country which allocates 13.7% of its GDP to health care,1 yet ranks down at #37 on the World Health Organization's listing of global health systems,2 has not been spending its money wisely. Things may get a whole lot better - or a whole lot worse - now that Congress has enacted the Patient Protection and Affordable Care Act of 20103, but in any event things will most definitely be different. The essays in this Symposium all contribute to an understanding of how different they could turn out to be.
The Death of Jesse Gelsinger: New Evidence of the Influence of Money and Prestige in Human Research
Robin Fretwell Wilson - [PDF]

I. INTRODUCTION Ten years ago, Jesse Gelsinger died while participating in a human genetherapy trial at the University of Pennsylvania ("Penn"). His death came to signify the corrosive influence of financial interests in human subjects research.1 After Jesse's death, the media reported that one researcher, Dr.
Oversight of Marketing Relationships Between Physicians and the Drug and Device Industry: A Comparative Study
Timothy Stoltzfus Jost - [PDF]

ABSTRACT Throughout the world, complex mutually-dependent relationships exist between physicians and pharmaceutical and medical device companies. This article focuses on one particular aspect of these relationships-payments made by drug and device companies to physicians and their organizations and institutions to market drugs and devices. It is widely believed that drug and device company marketing to physicians creates conflicts of interest that corrupt physician judgment and increase the cost of medical care. This article examines first the economic basis of physician/industry relationships that causes conflicts to arise. It next considers the measures that a number of developed countries have taken to respond to these relationships. Finally, it proposes an approach that would comprehensively address the problems caused by drug and device company marketing to physicians.
Following the Money in Health Care Fraud: Reflections on a Modern-Day Yellow Brick Road
Joan H. Krause - [PDF]

I. INTRODUCTION Health care fraud is all about the money. A small group of offenders may believe the rules simply do not apply to them; a few may be motivated by the thrill of outsmarting a complex regulatory system; and occasionally someone may view fraud as a political act of protest against unwarranted governmental intrusion into health care.3 But in the vast majority of cases, health care fraud
Follow the Money: Money Matters in Health Care, Just Like in Everything Else
David A. Hyman - [PDF]

I. INTRODUCTION In health care, as in everything else, money matters. Of course, money is not the only thing that matters - but it matters a lot - perhaps more than all the other factors combined. What we pay for and how we pay for it profoundly affects the care that is provided (and not provided), the settings in
Health Law 2010: It's Not All About the Money
Peter D. Jacobson and Soniya Keskar Mathur - [PDF]

I. INTRODUCTION It would be naive to argue that money isn't the driving force motivating health care delivery in 2010. At nearly 17% of GDP, health care delivery is a large and growing industrial enterprise that is the largest employer in many communities. Save for free clinics, generating revenue is fundamental to every aspect of the delivery system. From insurance reimbursement rates to the cost of purchasing the latest technology, the surest explanation for understanding changes in the health care system and concomitant development of legal doctrine is, indeed, to "follow the money."
For Profit Enterprise in Health Care: Can it Contribute to Health Reform?
Eleanor D. Kinney - [PDF]

I. INTRODUCTION Since the demise of the last major health reform initiative in 1994,1 health coverage for the American people has deteriorated. Private insurance costs have risen, and coverage under private insurance became less comprehensive, with higher deductibles and copayments.2 Many new treatments for serious diseases and associated provider compensation have become more and more unaffordable, even for those with health insurance coverage.3 Recent reports document the challenges for cancer patients faced with the soaring cost of cancer treatment.4 Public programs, such as Medicare and Medicaid, have
Health Reform: What's Insurance got to do with it? Recognizing Health Insurance as a Separate Species of Insurance
Wendy K. Mariner - [PDF]

I. INTRODUCTION Health reform debates in the United States are typically conducted using the language of insurance.1 President Barack Obama described his hopes for expanding access to care as "health insurance reform."2 Both proponents and opponents of reform debated the merits of reform proposals leading to the Patient Protection and Affordable Care Act of 2010 in insurance terms.3 Yet, disagreements over the structure of reform reveal deep differences in what proponents and opponents of reform mean by insurance and the role it should
Is a Flat-Line a Good Thing? On the Privatization of Israel's Healthcare System
Guy I. Seidman - [PDF]

I. INTRODUCTION: WHY ISRAEL? Israel's population of 7.5 million is equivalent to the 13th most populous U.S. state, and its sovereign territory of 8,500 square miles means it is roughly the same size as the 48th largest state .1 In world rankings, Israel ranks 96th in