Journal of Health Politics, Policy and Law current issue

Editor's Note

Sparer, M. S. — 2009-05-18

HIV Testing, Human Rights, and Global AIDS Policy: Exceptionalism and Its Discontents

Bayer, R., Edington, C. — 2009-05-18

Two years ago, in May 2007, UNAIDS and WHO issued new guidelines on HIV testing. Prepared to meet the demands of the AIDS pandemic and the prospects of extending the benefits of antiretroviral therapy to regions where such treatment had been all but out of reach, the new guidance was the product of an extended period of sometimes acrimonious controversy both within the two UN agencies and globally. Those pressing for change had argued that a paradigm of testing that had emerged at a time when little could be done for those infected with HIV was inappropriate to the current moment. Those who viewed with skepticism, if not hostility, the claims that current practice and stringent ethical standards had become an impediment to effectively confronting the challenge of AIDS saw in the proposed changes a threat to the bedrock ethical principles of informed consent. In the end, of course, decisions about HIV testing will be taken by nation - states, with the recommendations of international organizations constituting but one element, however important, that will shape policy. Nevertheless, an examination of the history and the dynamics of the recent controversy and its outcome will provide a unique resource to those faced with policy choices; it will also provide a unique opportunity to lay bare the complex and politically charged relationships evolving between public health and human rights.

Community-Based Dialogue: Engaging Communities of Color in the United States' Genetics Policy Conversation

2009-05-18

Engaging communities of color in the genetics public policy conversation is important for the translation of genetics research into strategies aimed at improving the health of all. Implementing model public participation and consultation processes can be informed by the Communities of Color Genetics Policy Project, which engaged individuals from African American and Latino communities of diverse socioeconomic levels in the process of "rational democratic deliberation" on ethical and policy issues stretching from genome research to privacy and discrimination concerns to public education. The results of the study included the development of a participatory framework based on a combination of the theory of democratic deliberation and the community-based public health model which we describe as "community-based dialogue."

Games Policy Makers and Providers Play: Introducing Case-Mix-Based Payment to Hospital Chronic Care Units in Japan

Ikegami, N. — 2009-05-18

Case-mix-based payment was developed for hospital chronic care units in Japan to replace the flat per diem rate and encourage the admission of patients with higher medical acuity and was part of a policy initiative to make the tariff more evidence based. However, although the criteria for grouping patients were developed from a statistical analysis of resource use, the tariff was subsequently set below costs, particularly for the groups with the lowest medical acuity, both because of the prime minister's decision to decrease total health expenditures and because of the health ministry's decision to target the reductions on chronic care units. Providers quickly adapted to the new payment system mainly by reclassifying their patients to higher medical acuity groups. Some hospitals reported high prevalence rates of urinary tract infections and pressure ulcers. The government responded by issuing directives to providers to calculate the prevalence rates and document the care that has been mandated for the patients at risk. However, in order to monitor compliance and to evaluate whether the patient is being billed for the appropriate case-mix group, the government must invest in developing a comprehensive patient-level database and in training staff for making on-site inspections.

Establishing Public Health Security in a Postwar Iraq: Constitutional Obstacles and Lessons for Other Federalizing States

Wilson, K., Fidler, D. P., McDougall, C. W., Lazar, H. — 2009-05-18

The public health consequences of the conflict in Iraq will likely continue after the violence has subsided. Reestablishing public health security will require large investments in infrastructure and the creation of effective systems of governance. On the question of governance, the allocation of powers in the new constitution of Iraq is critical. Given the ease with which public health threats cross borders, the constitution needs to grant to the federal government the legal authority to manage such threats and simultaneously meet international requirements. Unfortunately, the draft constitution does not accomplish this objective. If politically possible, the constitution should be amended to provide the federal government with this authority. If not possible, the Iraqi federal government would have two options. It could attempt to use alternative constitutional powers, such as national security powers. This option would be contentious and the results uncertain. Alternatively, the federal government could attempt to establish collaborative relationships with regional governments. Residual sectarian tensions create potential problems for this option, however. Reflecting on the Iraqi situation, we conclude that other federalizing countries emerging from conflict should ensure that their constitutions provide the federal government with the necessary authority to manage threats to public health security effectively.

The Landscape in 2009: A Conversation with Bruce C. Vladeck

Birnbaum, M. — 2009-05-18

Michael Birnbaum interviews Bruce C. Vladeck about the landscape for national health reform in 2009. Vladeck, who worked under President Clinton directing Medicare and Medicaid as administrator of the Health Care Financing Administration, discusses some of the challenges and opportunities facing the Obama administration. By comparing the current political and economic environments with those he faced while working in the Clinton administration, Vladeck argues that this time around America might be ready for pragmatic reforms leading toward universal coverage. He explores the future of employer-based coverage; problems and solutions for America's aging workforce; poor customer service in Medicare; the "Medicaid Stigma"; the promise of immigration; and the trade-offs between access, quality, and cost in the American system. Finally, Vladeck offers a silver lining to the current economic catastrophe. As he sees it, common sense and results may be taking the place of ideology in policy making and policy analysis: "The intellectual hegemony of neoclassical economics has been blown out of the water."

Medicaid Politics and Policy: 1965-2007

Rosenbaum, S. — 2009-05-18

Targeting in Social Programs: Avoiding Bad Bets, Removing Bad Apples

Green, J. C. — 2009-05-18

Property in the Body: Feminist Perspectives

Taylor, J. S. — 2009-05-18

Books Received

2009-05-18

Contributors

2009-05-18