bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolution of NMDA receptor cytoplasmic interaction domains: implications for organisation of synaptic signalling complexes
Authors: Ryan Tomás J , Emes Richard D , Grant Seth GN , Komiyama Noboru H
Published: January 2008

Background

Glutamate gated postsynaptic receptors in the central nervous system (CNS) are essential for environmentally stimulated behaviours including learning and memory in both invertebrates and vertebrates. Though their genetics, biochemistry, physiology, and role in behaviour have been intensely studiedin vitroandin vivo, their molecular evolution and structural aspects remain poorly understood. To understand how these receptors have evolved different physiological requirements we have investigated the molecular evolution of glutamate gated receptors and ion channels, in particular theN-methyl-D-aspartate (NMDA) receptor, which is essential for higher cognitive function. Studies of rodent NMDA receptors show that the C-terminal intracellular domain forms a signalling complex with enzymes and scaffold proteins, which is important for neuronal and behavioural plasticity

Results

The vertebrate NMDA receptor was found to have subunits with C-terminal domains up to 500 amino acids longer than invertebrates. This extension was specific to the NR2 subunit and occurred before the duplication and subsequent divergence of NR2 in the vertebrate lineage. The shorter invertebrate C-terminus lacked vertebrate protein interaction motifs involved with forming a signaling complex although the terminal PDZ interaction domain was conserved. The vertebrate NR2 C-terminal domain was predicted to be intrinsically disordered but with a conserved secondary structure.

Conclusion

We highlight an evolutionary adaptation specific to vertebrate NMDA receptor NR2 subunits. Usingin silicomethods we find that evolution has shaped the NMDA receptor C-terminus into an unstructured but modular intracellular domain that parallels the expansion in complexity of an NMDA receptor signalling complex in the vertebrate lineage. We propose the NR2 C-terminus has evolved to be a natively unstructured yet flexible hub organising postsynaptic signalling. The evolution of the NR2 C-terminus and its associated signalling complex may contribute to species differences in behaviour and in particular cognitive function.
Coexpression of VEGF-C and COX-2 and its association with lymphangiogenesis in human breast cancer
Authors: Zhang Xiao-Hua , Huang Du-Ping , Guo Gui-Long , Chen Guo-Rong , Zhang Hu-Xiang , Wan Li , Chen Sheng-Ying
Published: January 2008

Background

Lymphangiogenesis has become a new research frontier in tumor metastasis since the discovery of reliable lymphatic markers that have allowed observation and isolation of lymphatic endothelium. Cyclooxygenase-2 (COX-2) has been reported to be involved in the critical steps in carcinogenesis. However, possible role of COX-2 in lymphangiogenesis and lymphatic metastasis is still poorly understood. In present study, we aimed to investigate the relationship between vascular endothelial growth factor-C (VEGF-C) and COX-2 in human breast cancer, and correlations with lymphangiogenesis and prognosis.

Methods

Tissue samples of primary tumors from 70 patients undergoing intentionally curative surgical resections for breast cancer were immunohistochemically examined for VEGF-C, COX-2, and D2-40 expressions. The association between COX-2 and VEGF-C expressions and clinicopathological parameters as well as prognosis were analysised. To demonstrate the presence of proliferating lymphatic endothelial cells, 10 random cases with high LVD counts were selected for D2-40/Ki-67 double immunostaining.

Results

A significant correlation was found between the expression of VEGF-C and COX-2 (r = 0.529, P < 0.001), and both elevated VEGF-C expression and elevated COX-2 expression were associated with higher lymph vessel density (LVD), lymph node metastasis and D2-40 positive lymphatic invasion (LVI) as well as worse disease free survival (DFS) and overall survival (OS) in a univariate analysis. In the double immunostain for the lymph vessel marker D2-40 and the proliferation marker Ki-67, the results confirmed Ki-67-positive nuclei in a proportion of lymph vessel endothelial cells.

Conclusion

There is indeed lymphangiogenesis in breast cancer, the most compelling evidence being the presence of proliferating lymphatic endothelial cells. VEGF-C and COX-2 are coexpressed and significantly associated with lymphangiogenesis and prognosis in invasive breast cancer. Suggesting COX-2 may up-regulate VEGF-C expression and thus promote lymph node metastasis via lymphangiogenesis pathway in human breast cancer.
Cost-effectiveness of a workplace intervention for sick-listed employees with common mental disorders: design of a randomized controlled trial
Authors: van Oostrom Sandra H , Anema Johannes R , Terluin Berend , de Vet Henrica CW , Knol Dirk L , van Mechelen Willem
Published: January 2008

Background

Considering the high costs of sick leave and the consequences of sick leave for employees, an early return-to-work of employees with mental disorders is very important. Therefore, a workplace intervention is developed based on a successful return-to-work intervention for employees with low back pain. The objective of this paper is to present the design of a randomized controlled trial evaluating the cost-effectiveness of the workplace intervention compared with usual care for sick-listed employees with common mental disorders.

Methods

The study is designed as a randomized controlled trial with a follow-up of one year. Employees eligible for this study are on sick leave for 2 to 8 weeks with common mental disorders. The workplace intervention will be compared with usual care. The workplace intervention is a stepwise approach that aims to reach consensus about a return-to-work plan by active participation and strong commitment of both the sick-listed employee and the supervisor. Outcomes will be assessed at baseline, 3, 6, 9 and 12 months. The primary outcome of this study is lasting return-to-work, which will be acquired from continuous registration systems of the companies after the follow-up. Secondary outcomes are total number of days of sick leave during the follow-up, severity of common mental disorders, coping style, job content, and attitude, social influence, and self-efficacy determinants. Cost-effectiveness will be evaluated from the societal perspective. A process evaluation will also be conducted.

Discussion

Return-to-work is difficult to discuss in the workplace for sick-listed employees with mental disorders and their supervisors. Therefore, this intervention offers a unique opportunity for the sick-listed employee and the supervisor to discuss barriers for return-to-work. Results of this study will possibly contribute to improvement of disability management for sick-listed employees with common mental disorders. Results will become available in 2009.

Trial registration

ISRCTN92307123
Optimization of an E. coli L-rhamnose-inducible expression vector: test of various genetic module combinations
Authors: Wegerer Angelika , Sun Tianqi , Altenbuchner Josef
Published: January 2008

Background

A capable expression vector is mainly characterized by its production efficiency, stability and induction response. These features can be influenced by a variation of modifications and versatile genetic modules.

Results

We examined miscellaneous variations of a rhaP

BAD
expression vector. The introduction of a stem loop into the translation initiation region of the rhaP

BAD
promoter resulted in the most significant improvement of eGFP expression. Starting from this plasmid, we constructed a set of expression vectors bearing different genetic modules like rop, ccdAB, cer and combinations thereof, and tested the efficiency of expression and plasmid stability. The plasmid pWA21, containing the stem loop, one cer site and rop, attained high expression levels accompanied by a good stability, and on that score seems to be a well-balanced choice.

Conclusion

We report the generation of variations of the rhaP

BAD
expression vector and characterization hereof. The genetic modules showed a complex interplay, therefore two positive effects combined sometimes resulted in a disadvantage.
Can teaching agenda-setting skills to physicians improve clinical interaction quality? A controlled intervention
Authors: Rodriguez Hector P , Anastario Michael P , Frankel Richard M , Odigie Esosa G , Rogers William H , von Glahn Ted , Safran Dana G
Published: January 2008

Background

Physicians and medical educators have repeatedly acknowledged the inadequacy of communication skills training in the medical school curriculum and opportunities to improve these skills in practice. This study of a controlled intervention evaluates the effect of teaching practicing physicians the skill of "agenda-setting" on patients' experiences with care. The agenda-setting intervention aimed to engage clinicians in the practice of initiating patient encounters by eliciting the full set of concerns from the patient's perspective and using that information to prioritize and negotiate which clinical issues should most appropriately be dealt with and which (if any) should be deferred to a subsequent visit.

Methods

Ten physicians from a large physician organization in California with baseline patient survey scores below the statewide 25th percentile participated in the agenda-setting intervention. Eleven physicians matched on baseline scores, geography, specialty, and practice size were selected as controls. Changes in survey summary scores from pre- and post-intervention surveys were compared between the two groups. Multilevel regression models that accounted for the clustering of patients within physicians and controlled for respondent characteristics were used to examine the effect of the intervention on survey scale scores.

Results

There was statistically significant improvement in intervention physicians' ability to "explain things in a way that was easy to understand" (p = 0.02) and marginally significant improvement in the overall quality of physician-patient interactions (p = 0.08) compared to control group physicians. Changes in patients' experiences with organizational access, care coordination, and office staff interactions did not differ by experimental group.

Conclusion

A simple and modest behavioral training for practicing physicians has potential to positively affect physician-patient relationship interaction quality. It will be important to evaluate the effect of more extensive trainings, including those that work with physicians on a broader set of communication techniques.
Gendered dimensions of obesity in childhood and adolescence
Authors: Sweeting Helen N
Published: January 2008

Background

The literature on childhood and adolescent obesity is vast. In addition to producing a general overview, this paper aims to highlight gender differences or similarities, an area which has tended not to be the principal focus of this literature.

Methods

Databases were searched using the terms 'obesity' and 'child', 'adolescent', 'teenager', 'youth', 'young people', 'sex', 'gender', 'masculine', 'feminine', 'male', 'female', 'boy' and 'girl' (or variations on these terms). In order to limit the potential literature, the main focus is on other reviews, both general and relating to specific aspects of obesity.

Results

The findings of genetic studies are similar for males and females, and differences in obesity rates as defined by body mass index are generally small and inconsistent. However, differences between males and females due to biology are evident in the patterning of body fat, the fat levels at which health risks become apparent, levels of resting energy expenditure and energy requirements, ability to engage in certain physical activities and the consequences of obesity for the female reproductive system. Differences due to society or culture include food choices and dietary concerns, overall physical activity levels, body satisfaction and the long-term psychosocial consequences of childhood and adolescent obesity.

Conclusion

This review suggests differences between males and females in exposure and vulnerability to obesogenic environments, the consequences of child and adolescent obesity, and responses to interventions for the condition. A clearer focus on gender differences is required among both researchers and policy makers within this field.
Pvt1-encoded microRNAs in oncogenesis
Authors: Beck-Engeser Gabriele B , Lum Amy M , Huppi Konrad , Caplen Natasha J , Wang Bruce B , Wabl Matthias
Published: January 2008

Background

The functional significance of the Pvt1 locus in the oncogenesis of Burkitt's lymphoma and plasmacytomas has remained a puzzle. In these tumors, Pvt1 is the site of reciprocal translocations to immunoglobulin loci. Although the locus encodes a number of alternative transcripts, no protein or regulatory RNA products were found. The recent identification of non-coding microRNAs encoded within the PVT1 region has suggested a regulatory role for this locus.

Results

The mouse Pvt1 locus encodes several microRNAs. In mouse T cell lymphomas induced by retroviral insertions into the locus, the Pvt1 transcripts, and at least one of their microRNA products, mmu-miR-1204 are overexpressed. Whereas up to seven co-mutations can be found in a single tumor, in over 2,000 tumors none had insertions into both the Myc and Pvt1 loci.

Conclusion

Judging from the large number of integrations into the Pvt1 locus – more than in the nearby Myc locus – Pvt1 and the microRNAs encoded by it are as important as Myc in T lymphomagenesis, and, presumably, in T cell activation. An analysis of the co-mutations in the lymphomas likely place Pvt1 and Myc into the same pathway.
The Effect of Deletion of the Orphan G – Protein Coupled Receptor (GPCR) Gene MrgE on Pain-Like Behaviours in Mice
Authors: Cox Peter J , Pitcher Tom , Trim Steven A , Bell Christine H , Qin Wenning , Kinloch Ross A
Published: January 2008

Background:

The orphan GPCR MrgE is one of an extended family of GPCRs that are expressed in dorsal root ganglia (DRG). Based on these expression patterns it has been suggested that GPCRs like MrgE may play a role in nociception however, to date, no direct supporting evidence has emerged. We generated mutant mice lacking MrgE and examined the effects of deletion of this gene in three pain behavioural models. The effect of MrgE gene deletion on expression of Mrgs and genes involved in sensory neurone function was also investigated.

Results:

The absence of MrgE had no effect on the development of pain responses to a noxious chemical stimulus or an acute thermal stimulus. However, in contrast, the development but not the maintenance of neuropathic pain was affected by deletion of MrgE. The expression of Mrg genes was not significantly affected in the MrgE knockout (KO) mice with the sole exception of MrgF. In addition, the expression of 77 of 84 genes involved in sensory neuron development and function was also unaffected by deletion of MrgE. Of the 7 genes affected by MrgE deletion, 4 have previously been implicated in nociception.

Conclusion:

The data suggests that MrgE may play a role in selective pain behavioural responses in mice.
Maternal undernutrition and the ovine acute phase response to vaccination
Authors: Eckersall Peter D , Lawson Fraser P , Kyle Carol E , Waterston Mary , Bence Laura , Stear Michael J , Rhind Stewart M
Published: January 2008

Background

The acute phase response is the immediate host response to infection, inflammation and trauma and can be monitored by measuring the acute phase proteins (APP) such as haptoglobin (Hp) or serum amyloid A (SAA). The plane of nutrition during pregnancy is known to affect many mechanisms including the neuroendocrine and neuroimmune systems in neonatal animals but effects on the APP are unknown. To investigate this phenomenon the serum concentration of Hp and SAA was initially determined in non-stimulated lambs from 3 groups (n = 10/group). The dams of the lambs of the respective groups were fed 100% of requirements throughout gestation (High/High; HH); 100% of requirements for the first 65 d of gestation followed by 70% of requirements until 125 d from when they were fed 100% of requirements (High/Low; HL); 65% of liveweight maintenance requirements for the first 65 d gestation followed by 100% of requirements for the remainder of pregnancy (Low/High; LH). The dynamic APP response in the lambs was estimated by measuring the concentration of Hp and SAA following routine vaccination with a multivalent clostridial vaccine with a Pasteurella component, Heptavac P™ following primary and secondary vaccination.

Results

The Hp and SAA concentrations were significantly lower at the time of vaccination (day 8–14) than on the day of birth. Vaccination stimulated the acute phase response in lambs with increases found in both Hp and SAA. Maternal undernutrition led to the SAA response to vaccination being significantly lower in the HL group than in the HH group. The LH group did not differ significantly from either the HH or HL groups. No significant effects of maternal undernutrition were found on the Hp concentrations. A significant reduction was found in all groups in the response of SAA following the second vaccination compared to the response after the primary vaccination but no change occurred in the Hp response.

Conclusion

Decreased SAA concentrations, post-vaccination, in lambs born to ewes on the HL diet shows that maternal undernutrition prior to parturition affects the innate immune system of the offspring. The differences in response of Hp and SAA to primary and secondary vaccinations indicate that the cytokine driven APP response mechanisms vary with individual APP.
Reducing Inpatient Hospital Costs: An Attempt at Medicaid Reform in Illinois
Authors: Salmon J. Warren , Lieber H. Stephen , Ayesse Mary C.
Published: January 2008

While California's Mcdi-Cal program and Arizona's Health Care Cost Containment System have been subject to scholarly analysis, little has been written about a similar attempt at competitive bidding under Medicaid by Illinois. This article describes the process of implementing the Illinois Competitive Access and Reimbursement Equity (ICARE) program signed into law in 1984. The article examines hospital data and access implications for recipients and compares the Illinois program with other Medicaid contracting programs. A more thoughtful process of policy implementation is urged for such reform attempts in Medicaid.
Medicare's Fiscal Problems: An Imperative for Reform
Authors: Holahan John , Palmer John L.
Published: January 2008

Many observers have noted that Medicare expenditures will significantly outstrip projected revenues over the course of the next 25 years. This paper examines the economic and demographic assumptions behind forecasts of Medicare hospital insurance and supplementary medical insurance expenditures and revenues and analyzes various strategies for closing the impending gap. It is argued that the present forecasts already assume considerable success in controlling hospital costs and physician payments, making substantial further savings unlikely. Shifting more of the burden onto the elderly through increased cost sharing or higher premiums also will not solve the program's fiscal problems over the long term. The remaining alternativeimposing higher income or payroll taxes on the under-65 population is also unlikely to be a welcome solution. The authors argue that, eventually, the nation must choose between some form of a two-tier system of benefits or a Canadian-style national health insurance system.
Hospital Care for the “Self-Pay” Patient
Authors: Sloan Frank A. , Morrisey Michael A. , Valvona Joseph
Published: January 2008

The number of hospitalized patients lacking an identifiable source of third-party payment has risen substantially in recent years. This study examines trends in the hospitalization of “self-pay” patients and investigates causal influences on the propensity of hospitals to accept such patients for treatment. Our analysis pays particular attention to the relationship between Medicare's prospective payment system (PPS) and hospitals' self-pay patient share. Our results show an overall increase in both the number and proportion of self-pay patients treated by hospitals between 1980 and 1985. Substantial differences existed among the types of hospitals that accepted such patients, with major teaching hospitals treating an increasingly disproportionate share. The mix of self-pay patients in terms of age, sex, and reason for hospitalization remained stable during the period under study. Our conclusion is that the regression analysis shows no evidence that PPS reduced hospitals' willingness to treat uninsured patients.
Is Medical Care Different? Old Questions, New Answers
Authors: Pauly Mark V.
Published: January 2008

This paper examines whether changes in medical markets may be making them more like other markets. The emergence of HMOs and other managed care systems appears to have increased the consumer's potential ability to make better comparative judgments about the price and quality of medical care, and also seems to have made medical care more like other goods. However, the evidence that medical care is a “reputation good” suggests that it is, in this respect, different from other goods. Finally, the social concerns about medical care use necessarily make medical care different.
Competition among Physicians, Revisited
Authors: Feldman Roger , Sloan Frank
Published: January 2008

Ten years ago we developed a model of demand inducement in the physician services market and explored the properties of that model. We found that predictions concerning physicians' prices, workloads, and income were ambiguous and in many cases were consistent with those derived from a standard monopoly pricing model. Spurred in part by our work, numerous empirical studies of the demand inducement model have been conducted. These studies found little evidence of demand inducement for primary care physician services. Demand inducement may exist in the market for surgical services, but its extent is less than previously estimated. We disagree with those who say that physicians generate demand to avoid price controls and that national health care spending is proportional to the number of physicians; the evidence does not support these arguments. Substantial uncertainty may surround the physician's choice of diagnosis and treatment mode. However, this does not imply a breakdown of the agency relationship. In this paper we extend our earlier model of demand inducement to include variations in the quantity of services (which was previously assumed to be less than socially ideal). Using the model, we conclude that the major objection to government price setting is not that physicians will get around the controls by inducing demand; rather, price controls result in a quantity and quality of physicians' services that is not ideal and may be inferior to those provided in an unregulated monopoly.
Has the Erosion of the Medical Marketplace Ended?
Authors: Newhouse Joseph P.
Published: January 2008

This paper updates tests of the validity of three models of medical price inflation: a standard model, in which changes in demand press against inelastic supply; a dynamic version of the standard model, in which high levels of insurance induce high rates of product innovation and development; and a model of increasing inefficiency, in which consumers have weak incentives to search out efficient suppliers. Earlier statistical support for the third model has weakened, which provides some evidence that the regulatory and competitive initiatives of the last decade are having their intended effects. But time series measures of medical prices upon which the statistical evidence relies have important methodological problems, so other types of evidence are useful. Trends in expenditure in other countries and in HMOs suggest that the most important explanation of medical price inflation is the dynamic version of the standard model, although the other models have some validity as well.
Health Insurance without Provider Influence: The Limits of Cost Containment
Authors: Goldberg Lawrence G. , Greenberg Warren
Published: January 2008

In our previous paper, we showed that market forces can play a significant role in controlling health care costs and that a considerable amount of cost containment effort was pursued by third-party insurers in Oregon in the 1930s and 1940s. Although physicians were able to thwart this cost-control effort, a 1986 Supreme Court decision, FTC v. Indiana Federation of Dentists, found that a boycott of insurers by dentists violated Section 5 of the Federal Trade Commission Act. Further investigation of recent developments, including the recent Wickline v. California decision, indicates that the primary barriers to cost containment today are not obstructive tactics by providers or provider-controlled health insurance plans. Rather, the primary barriers are increases in the development and diffusion of new technology and society's apparent preference for paying for new tests and procedures regardless of economic efficiency.
Managed Competition of Alternative Delivery Systems
Authors: Enthoven Alain
Published: January 2008

The markets for health insurance and health care are not naturally competitive: they are susceptible to many forms of market failure. Health plans and consumers may use strategies that lead to inequity and inefficiency. But experience with successful models of competition suggests that tools are available to enable sponsors (active collective agents on the demand side who contract with health plans to structure and manage competition) to use competition to achieve a reasonable degree of efficiency and equity for their sponsored populations. All this implies a more complex, dynamic, and sophisticated view of competition than one usually finds in apologia for free markets. A free market is not possible in health insurance.
Competition in the Market for Nursing Home Care
Authors: Bishop Christine E.
Published: January 2008

The competitive model may fit the nursing home sector better than it fits other health care markets, but Medicaid subsidies and regulation have not allowed the market to work freely, and nursing home insurance may cause further divergence from a competitive ideal. Incentives for both providers and consumers that capitalize on competitive aspects of the market might be used to improve outcomes of the nursing home market, especially under a system of comprehensive long-term care insurance.
The Profits of Not-for-Profit Hospitals
Authors: Chang Cyril F. , Tuckman Howard P.
Published: January 2008

This paper explores the profits of not-for-profit (NFP) hospitals and identifies the factors that determine whether such profits are adequate. A model which relates hospital charges to surpluses is used to derive NFP surplus from gross patient charges and operating costs. This is done to identify the items contributing to surpluses and to explore the dispersion of NFP surpluses. We first discuss why the literature is relatively silent on NFP profitability. We then present the model and use Tennessee hospital data to identify how its components vary by hospital type and through time. The dispersion of surpluses among NFPs is then examined. We next propose three rate of return measures of profitability and use these to relate NFP profits to select characteristics of hospitals and their environments. Several alternative profit levels of NFP are discussed, and the factors that are relevant to the issue of determining the adequate level of profit are identified. The paper ends with a plea for better data on NFP profits.
Hospital Utilization Review: Past Experience, Future Directions
Authors: Ermann Danny
Published: January 2008

Utilization review (UR) programs seek to determine whether specific services are medically necessary and whether they are delivered at an appropriate level of intensity and cost. Although UR programs have been operating for more than 40 years, they have changed dramatically during the past two decades. Today, many health care providers, analysts, and policymakers view UR as a possible solution to hospital inpatient cost and quality problems. This paper addresses how UR has evolved, how UR is used today by different delivery mechanisms (i.e., Medicare, health maintenance organizations, preferred provider organizations, Blue Cross, and commercial insurers), the cost effects of various UR approaches, and how UR will be used in the future.
The Shadow Price of Pluralism: The Use of Tax Expenditures to Subsidize Hospital Care in the United States
Authors: Falcone David , Warren David G.
Published: January 2008

During the 1980s, and particularly during the past year, controversy has arisen over the propriety of the not-for-profit hospital' s tax-exempt status. In addressing the issue, policy analysts and activists have focused attention on the comparative efficiency and effectiveness of not-for-profit and for-profit hospitals' provision of social benefit, variously conceived and quantified. We review the results of current research carried out within that focus and suggest that the findings are inconclusive and the focus misplaced. A more profitable avenue of inquiry would be to explore the extent to which the dominance of tax-subsidized not-for-profit hospitals is a societally preferred means of achieving the provision of a level of access to quality care that otherwise would require a large direct government subsidy.
The Politics of Organ Transplantation: A Parable of Our Time
Authors: Rettig Richard A.
Published: January 2008

This paper reviews the historical development of federal government policy for kidney, heart, and liver transplantation. It examines several political dimensions of whole organ transplantation: the role of the print and broadcast media; the management of organ procurement; the certification of transplant centers; the evaluation of new surgical procedures; and the issues of financing, distributive justice, and rationing of scarce medical resources. The author finds that the media, though powerful in affecting transplant policy, have not been subjected to critical analysis. Organ procurement modifications, driven by a need orientation toward closing the gap between actual and desired levels of performance, may have adversely affected performance. The case of liver transplantation suggests the need for improved institutions and mechanisms for evaluating new surgical procedures. Finally, states that confront the need to meet a binding budget-balancing requirement may allocate funds away from expensive medical procedures that benefit the few toward basic services that benefit the many; the Oregon and Virginia Medicaid programs exemplify this point.
Health Policy and Erisa: Interest Groups and Semipreemption
Authors: Fox Daniel M. , Schaffer Daniel C.
Published: January 2008

This paper is a history of the health policy results of the Employee Retirement and Income Security Act of 1974, particularly section 514, which preempts state laws “which relate to any employee benefit plan” but permits states to continue to regulate the business of insurance. This history exemplifies how health policy is often made outside conventional arenas. On the basis of published primary sources and interviews with a number of key participants, the paper describes how interest groups which rarely act together coalesced to create and sustain semipreemption and its effects on state and federal health policy. The paper concludes with an asessment of recent state legislative efforts to address the problems created by ERISA semi-preemption. The ironical results of semipreemption occurred because of the absence of a coalition of interest groups that was sufficiently strong to resolve the fundamental questions raised by our commitment to linking health insurance to employment.
American Perceptions of the British National Health Service: Five Myths
Authors: Potter Christopher , Porter Janet
Published: January 2008

This article explores five strong beliefs, or myths, held by Americans about the British National Health Service: (1) the NHS is socialized medicine; (2) widespread rationing occurs; (3) NHS patients have to face long waiting times; (4) the NHS does not offer free choice of provider; and (5) private medicine is taking over. The authors explore how ethnocentricity and American values have shaped these five myths, and argue that these cultural biases limit the ability of Americans to objectively evaluate the NHS and prevent them from learning from the British system.
The Political and Economic Context of Mental Health Care in the United States
Authors: Marmor Theodore R. , Gill Karyn C.
Published: January 2008

Since the mid-1970s, the mental health treatment system in the U.S. has faced budgetary famine. This is in stark contrast to the growing cornucopia of fiscal resources enjoyed by the overall health care system. This paper explores the complex reasons for this disproportionate allocation in health spending. On the one hand, mental health may suffer from the perception that its diagnoses are largely “subjective” and its treatments do not fit the traditional “medical model” that can be defined precisely and paid for by third-party insurers. But more importantly, the dearth of mental health resources can be attributed to the peculiar nature and characteristics inherent in American politics. This paper describes the American political environment, from both a historical and a contemporary perspective, to give some insight into the development of policies affecting the mental health system in the U.S. Given the current climate of fiscal conservatism in this country toward any increases in social spending, it is likely that the profound mismatch in need and spending for mental health programs will continue indefinitely.
Regulatory Policy and Information Deficiencies in the Market for Mental Health Services
Authors: Frank Richard G.
Published: January 2008

This paper addresses issues related to the regulation of the delivery of mental health services. The focus is primarily on regulations that are aimed at dealing with the consequences of imperfect information in the marketplace. The paper reviews and assesses what is known about the impact of regulations on efficiency and equity. One conclusion is that we know a fair amount about impacts of regulation on prices for mental health service and very little about effects on quality of care. A research agenda is proposed based on the knowledge available in 1988.
Do Physicians Induce Demand for Medical Services?
Authors: Rice Thomas H. , Labelle Roberta J.
Published: January 2008

In this paper we provide a critique of an article by Roger Feldman and Frank Sloan that appeared in the Summer 1988 issue of this journal. In that article, the authors contend that there is little evidence to support the notion of supplier-induced demand or the contention that physicians generate demand to avoid the impact on their incomes of government price controls. In this critique, we argue that the evidence on supplier-induced demand and physician responses to price controls does not support the conclusions drawn by Feldman and Sloan. We conclude with a discussion of the implications of the debate for policy formulation and future research.
Can Price Controls Induce Optimal Physician Behavior?
Authors: Wedig Gerard , Mitchell Janet B. , Cromwell Jerry
Published: January 2008

Recently, budget-conscious policymakers have shifted their attention to the physician services market and have begun to consider a wide variety of price regulatory schemes for moderating expenditures in this market. In a recent article in this journal, Feldman and Sloan warned that price controls on physician services may cause undesirable declines in service quality, independent of their budgetary ramifications. Our aim in this article is to reconsider the effects of price controls in the broader context of insurance coverage and moral hazard. Our ultimate goal is to assess the benefits of price controls independent of specific assumptions about the controversial issues of demand inducement and income targeting. Using a simple extension of the Feldman/ Sloan model, we find that price controls can be and almost certainly are welfare-improving as long as consumers are sufficiently well insured, regardless of where one stands on the inducement issue. The salutary effects of price controls, on the other hand, can be compromised by income-targeting behavior on the part of physicians. We also introduce evidence from Medicare's recent fee freeze to evaluate the possibility of income-targeting behavior empirically. While formal studies of income targeting suggest that its magnitude is small in cross-section, we warn that its effects may be larger over time; this is what our descriptive evidence suggests. We conclude that more dramatic short-term progress on physician fee inflation will require stronger measures, such as putting physicians at risk for consumer expenditures.
Can No-Fault Compensation of Impaired Infants Alleviate the Malpractice Crisis in Obstetrics?
Authors: Gallup Cynthia L.
Published: January 2008

In 1987, Virginia initiated no-fault compensation for birth-related neurological injuries in an attempt to ensure the availability of malpractice insurance for the state's obstetricians. This paper explores some possible causes for the refusal of Virginia's insurers to write malpractice coverage for obstetricians and analyzes the ability of the act to resolve the medical malpractice crisis in obstetrics. It also examines the effect of this limited no-fault compensation scheme on obstetricians' incentives and on the welfare of neurologically damaged children.
Legal Rights and Communicable Disease: Aids, the Police Power, and Individual Liberty
Authors: Parmet Wendy E.
Published: January 2008

The policy debate over AIDS has focused on how to balance the rights of individuals who have the disease against the rights of the public. This paper examines the nature of both sets of rights by analyzing the development of public health law and its dominant visions today. The article argues that while once public health rights implied a vast reserve of community authority and obligation to prevent illness, today the rights of the public and those of individuals are seen as being in opposition. Public health jurisprudence now presupposes that illness is primarily a matter of individual concern. In this view, the science of medicine mediates the relationship between the individual and the public. This understanding of rights protects some of the interests of infected individuals, but is inadequate for addressing many of the major problems raised by the AIDS epidemic, particularly the spread of infection among the uninfected.
Blood Alcohol in Fatally Injured Drivers and the Minimum Legal Drinking Age
Authors: Robertson Leon S.
Published: January 2008

Although most research on the effect of minimum legal drinking age (LDA) laws on proxies for alcohol-related fatalities find effects of higher LDAs in reducing such fatalities, recent research that supposedly controls for drinking experience claims that higher LDAs have little or no effect. This study examines the actual amount of alcohol in the blood of fatally injured drivers per licensed driver in states where more than 80 percent of such drivers were tested for alcohol and where licensure data were available for the period 1982–1986, The involvement of alcohol in fatal crashes increases with age as the LDA is approached. A higher LDA is associated with fewer alcohol-related crashes among those younger than the LDA. No effect of drinking experience was evident, but this study finds an age-related bias in previously used proxies for alcohol involvement that results in overestimates of alcohol levels in younger drivers.
Differences in Health Care Spending across Countries: Statistical Evidence
Authors: Pfaff Martin
Published: January 2008

The empirical evidence available for OECD countries suggests that economic factors play a major role and that demographic factors play a minor role in explaining differences in health care spending across countries. When countries are grouped on the basis of their health care systems, some significant cross-country differences result: countries with higher transfer rates (a larger share of collective financing) are not generally characterized by higher health care expenditures, and conversely, countries with a larger share of private financing (including higher coinsurance rates) do not have lower expenditures. Rather, the opposite holds true. Similar conclusions apply to the share of public versus private production of health goods. Furthermore, the results do not support the claims of those critics of universal public insurance systems who consider the expansion of the coverage to be a major source of expenditure growth. These findings cast serious doubt on the claim that cost containment can be achieved via market reforms that rely heavily on direct consumer payments and cost sharing as instruments of financing. A comparative analysis of the historic record of the United States, Canada, and the Federal Republic of Germany generally supports these conclusions; it also suggests that a greater degree of public penetration offers a better chance for control of health spending, particularly in periods of austerity. There is a strong presumption that health care systems relying on some overall control of spending generally are more cost-effective than those relying more on decentralized mechanisms of control. Services are more equitably distributed in relation to health and payment for health services is far more progressive in the former type of system.
American Political Culture and the Search for Lessons from Abroad
Authors: Morone James A.
Published: January 2008

The American health care system appears to suffer from higher costs and less access than the health care systems of other industrialized nations. This perception has set social scientists searching for “lessons from abroad.” This paper places the dialogue about health system lessons within the context of American political culture. It sketches out some of the distinctive dynamics in the American policymaking process. Those dynamics help explain the problems we face, the programs we have pursued, and the alternatives we have forgone. The same political process which shaped past policies is likely to frame any lessons we try to import from abroad.
The Labor Impacts of Policy Change in Health Care: How Federal Policy Transformed Home Health Organizations and Their Labor Practices
Authors: Szasz Andrew
Published: January 2008

Health care organizations are highly labor-intensive; policies designed to stimulate organizational change are likely to have labor impacts. This paper examines the labor effects of policy change in home health care. Major federal home care policy trends since 1980 have spurred the evolution of the typical home care provider toward greater organizational and market rationality. Greater managerial sophistication has introduced changes in management/labor relations. Survey data from the 1986 DRG Impact Study are used to show how the pressure of cost-containment policies has pushed agencies to cut labor costs by increasing workloads, managerial supervision, and control of the work process. Research on the effects of recent policy change in health care has to date focused primarily on potential client effects. Labor impacts are rarely examined and are poorly understood at the time that policy is made. Findings in this article suggest that these issues deserve greater, more systematic attention, because unanticipated labor impacts may prove to be significant impediments to the realization of intended policy goals.
Health Care of the Disadvantaged: The Elderly
Authors: Feder Judith
Published: January 2008

This paper explores threats to the maintenance and expansion of public commitment to financing health care for the elderly. Threats come from rising costs that increase financial burdens, especially on low-income elderly; efforts to contain costs that may undermine benefits; and financing initiatives that treat the elderly as the sole revenue source for addressing problems in that age group. A review of these threats provides lessons not only for sustaining and improving health care for the elderly, but also for policy toward equally or more disadvantaged groups.
Health Care and the Homeless: A Political Parable for Our Time
Authors: Vladeck Bruce C.
Published: January 2008

The growth in the number of homeless persons is perhaps the most visible indicator of social disintegration in the 1980s, although health and health care are not the central issues of homelessness. This paper, which draws on the author's experience as chairman of the Committee on Health Care for Homeless People of the Institute of Medicine (IOM), describes what is known about the characteristics of homeless persons and the causes of homelessness, and about the health status of homeless persons, which is often not very good (but not significantly worse, it would appear, than that of other low-income persons). The contemporary history of health services targeted to homeless persons begins with the joint initiative of the Robert Wood Johnson Foundation and the Pew Charitable Trusts in 1985, which became the model for federal support through the Stewart B. McKinney Act of 1987. The McKinney Act, like the IOM report, demonstrates how, in contemporary American politics, there can be widespread political consensus not only about a problem but about solutions, while the resulting policy actions are largely symbolic.
Research, Policy, and the National Health Service
Authors: Klein Rudolf
Published: January 2008

The National Health Service is a system designed to bring about a rational use and distribution of resources yet which largely ignores the contribution of the research community. With a relatively closed health policy arena, there are few customers for policy-oriented research. With responsibility for funding research concentrated at the center and responsibility for delivering services at the periphery, the research community finds itself in limbo. In comparison to both the U.S. and Canada, Britain therefore offers an example of research both underfinanced and undervalued. However, research has made some significant contributions in areas where there has been a perceived use for its findings to support service developments. And the changes now being introduced in Britain's NHS are likely to create a new market for research as the system adopts some North American ideas and becomes less consensual and more pluralistic.
Estimating the Extent of Medicaid Spend-Down in Nursing Homes
Authors: Spence Denise A. , Wiener Joshua M.
Published: January 2008

Although it is commonly thought that a very high proportion of private-pay nursing home patients become eligible for Medicaid during their stay, few national studies have been conducted to determine the extent of Medicaid “spend-down.” The discharged resident survey of the 1985 National Nursing Home Survey was analyzed to determine the extent of spend-down among elderly nursing home patients during a single nursing home episode, the proportion of patients who remained Medicaid or private payers throughout their stay, and how the measures varied by patient characteristics. Overall, during a single nursing home episode only 10 percent of nursing home patients who entered as private payers received Medicaid at discharge. Roughly one-third of nursing home patients remained on Medicaid throughout their stay, and another third remained private payers throughout their stay.
Health Economics: A Report on the Field
Authors: Feldman Roger , Morrisey Michael A.
Published: January 2008

This study documents who health economists are, what they do, and what they think about professional and policy issues. Using primary data obtained through a mail survey of 518 health economists, we found that health economists are well trained by the standards of their profession. Most are employed in noneconomics departments in universities, where they spend their time very differently from their cousins in economics departments. There is a clear dichotomy in policy views among health economists. The characterization of the field as composed of “narrow” neo-classicists and “broad” eclecticists is supported by our data.