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Full-Text Articles in Health Law and Policy

Health Care's Market Bureaucracy, Allison K. Hoffman May 2019

Health Care's Market Bureaucracy, Allison K. Hoffman

Faculty Scholarship at Penn Law

The last several decades of health law and policy have been built on a foundation of economic theory. This theory supported the proliferation of market-based policies that promised maximum efficiency and minimal bureaucracy. Neither of these promises has been realized. A mounting body of empirical research discussed in this Article makes clear that leading market-based policies are not efficient — they fail to capture what people want. Even more, this Article describes how the struggle to bolster these policies — through constant regulatory, technocratic tinkering that aims to improve the market and the decision-making of consumers in it — has produced a massive ...


Unlocking Access To Health Care: A Federalist Approach To Reforming Occupational Licensing, Gabriel Scheffler Jan 2019

Unlocking Access To Health Care: A Federalist Approach To Reforming Occupational Licensing, Gabriel Scheffler

Faculty Scholarship at Penn Law

Several features of the existing occupational licensing system impede access to health care without providing appreciable protections for patients. Licensing restrictions prevent health care providers from offering services to the full extent of their competency, obstruct the adoption of telehealth, and deter foreign-trained providers from practicing in the United States. Scholars and policymakers have proposed a number of reforms to this system over the years, but these proposals have had a limited impact for political and institutional reasons.

Still, there are grounds for optimism. In recent years, the federal government has taken a range of initial steps to reform licensing ...


Informed Consent And The Role Of The Treating Physician, Eric Feldman, Holly Fernandez Lynch, Steven Joffe Jun 2018

Informed Consent And The Role Of The Treating Physician, Eric Feldman, Holly Fernandez Lynch, Steven Joffe

Faculty Scholarship at Penn Law

In the century since Justice Benjamin N. Cardozo famously declared that “[e]very human being of adult years and sound mind has a right to determine what shall be done with his own body,” informed consent has become a central feature of American medical practice. In an increasingly team-based and technology-driven system, however, who is — or ought to be — responsible for obtaining a patient’s consent? Must the treating physician personally provide all the necessary disclosures, or can the consent process, like other aspects of modern medicine, take advantage of specialization and division of labor? Analysis of Shinal v. Toms ...


Baby M Turns 30: The Law And Policy Of Surrogate Motherhood, Eric A. Feldman Jan 2018

Baby M Turns 30: The Law And Policy Of Surrogate Motherhood, Eric A. Feldman

Faculty Scholarship at Penn Law

This article marks the 30th anniversary of the Supreme Court of New Jersey’s Baby M decision by offering a critical analysis of surrogacy policy in the United States. Despite fundamental changes in both science and society since the case was decided, state courts and legislatures remain bitterly divided on the legality of surrogacy. In arguing for a more uniform, permissive legal posture toward surrogacy, the article addresses five central debates in the surrogacy literature.

First, should the legal system accommodate those seeking conception through surrogacy, or should it prohibit such arrangements? Second, if surrogacy is permitted, what steps can ...


From The Technical To The Personal: Teaching And Learning Health Insurance Regulation And Reform, Allison K. Hoffman, Whitney A. Brown, Lindsay Cutler Jan 2017

From The Technical To The Personal: Teaching And Learning Health Insurance Regulation And Reform, Allison K. Hoffman, Whitney A. Brown, Lindsay Cutler

Faculty Scholarship at Penn Law

In the Fall of 2016, I taught Health Law and Policy for the fourth consecutive semester. Over time, one thing has become increasingly clear: the aspect of this course that I work with most closely as a scholar—the regulation of health care financing and insurance, including the Patient Protection and Affordable Care Act (ACA)—is also the material that I find the most challenging to teach. Every time I reflect on teaching this material, and hear from students about how they learn this material, the thing that stands out is how critical it is that my students understand the ...


Regulating E-Cigarettes: Why Policies Diverge, Eric A. Feldman Apr 2016

Regulating E-Cigarettes: Why Policies Diverge, Eric A. Feldman

Faculty Scholarship at Penn Law

This paper, part of a festschrift in honor of Professor Malcolm Feeley, explores the landscape of e-cigarette policy globally by looking at three jurisdictions that have taken starkly different approaches to regulating e-cigarettes—the US, Japan, and China. Each of those countries has a robust tobacco industry, government agencies entrusted with protecting public health, an active and sophisticated scientific and medical community, and a regulatory structure for managing new pharmaceutical, tobacco, and consumer products. All three are signatories of the World Health Organization’s Framework Convention on Tobacco Control, all are signatories of the Agreement on Trade-Related Aspects of Intellectual ...


Reimagining The Risk Of Long-Term Care, Allison K. Hoffman Jan 2016

Reimagining The Risk Of Long-Term Care, Allison K. Hoffman

Faculty Scholarship at Penn Law

U.S. law and policy on long-term care fail to address the insecurity American families face due to prolonged illness and disability — a problem that grows more serious as the population ages and rates of disability rise. This Article argues that, even worse, we have focused on only part of the problem. It illuminates two ways that prolonged disability or illness can create insecurity. The first arises from the risk of becoming disabled or sick and needing long-term care, which could be called “care-recipient” risk. The second arises out of the risk of becoming responsible for someone else’s care ...


E-Cigarette Regulation In China: The Road Ahead, Eric A. Feldman, Chai Yue Jan 2016

E-Cigarette Regulation In China: The Road Ahead, Eric A. Feldman, Chai Yue

Faculty Scholarship at Penn Law

The global electronic cigarette industry has exploded in the past decade—from $20 million in sales in 2008 to an estimated $7 billion in 2014—and China has been an essential part of that growth. As the world's largest consumer of combustible tobacco products, accounting for about one-third of the global market. China is also a prime contender to become the largest consumer of electronic cigarettes. These simple facts raise a critical question—what should the Chinese government do about regulating electronic cigarettes?

So far, the regulation of electronic cigarettes in China has attracted scant attention. This paper begins ...


Health Care Spending And Financial Security After The Affordable Care Act, Allison K. Hoffman Jan 2015

Health Care Spending And Financial Security After The Affordable Care Act, Allison K. Hoffman

Faculty Scholarship at Penn Law

Health insurance has fallen notoriously short of protecting Americans from financial insecurity caused by health care spending. The Patient Protection and Affordable Care Act (“ACA”) attempted to ameliorate this shortcoming by regulating health insurance. The ACA offers a new policy vision of how health insurance will (and perhaps should) serve to promote financial security in the face of health care spending. Yet, the ACA’s policy vision applies differently among insured, based on the type of insurance they have, resulting in inconsistent types and levels of financial protection among Americans.

To examine this picture of inconsistent financial protection, this Article ...


The Reverberating Risk Of Long-Term Care, Allison K. Hoffman Jan 2015

The Reverberating Risk Of Long-Term Care, Allison K. Hoffman

Faculty Scholarship at Penn Law

The Fiftieth Anniversary of Medicare and Medicaid offers an opportunity to reflect on how American social policy has conceived of the problem of long-term care. In this essay, based on a longer forthcoming article, I argue that current policies adopt too narrow a conception of long-term care risk, by focusing on the effect of serious illness and disability on people who need care and not on the friends and family who often provide it. I propose a more complete view of long-term care risk that acknowledges how illness and disability reverberates through communities, posing insecurity for people beyond those in ...


Layers Of Law: The Case Of E-Cigarettes, Eric A. Feldman Jan 2014

Layers Of Law: The Case Of E-Cigarettes, Eric A. Feldman

Faculty Scholarship at Penn Law

This paper, written for a symposium on "Layers of Law and Social Order," connects the current debate over the regulation of electronic cigarettes with socio-legal scholarship on law, norms, and social control. Although almost every aspect of modern life that is subject to regulation can be seen through the framework ‘layers of law,’ e-cigarettes are distinguished by the rapid emergence of an unusually dense legal and regulatory web. In part, the dense fabric of e-cigarette law and regulation, both within and beyond the US, results from the lack of robust scientific and epidemiological data on the behavioral and health consequences ...


A Vision Of An Emerging Right To Health Care In The U.S.: Expanding Health Care Equity Through Legislative Reform, Allison K. Hoffman Jan 2014

A Vision Of An Emerging Right To Health Care In The U.S.: Expanding Health Care Equity Through Legislative Reform, Allison K. Hoffman

Faculty Scholarship at Penn Law

When asked to write a chapter on how litigation has advanced a right to health in the U.S., I responded skeptically, both because evidence of the existence of any such right is weak and the role of litigation in promoting its development is small at best. A snapshot of the U.S. health care system evinces the absence of even a more narrow right to health care – a guarantee of equitable access to basic medical care. Instead, it reveals a fragmented picture of public and private financing that leaves many people lacking meaningful access to care. More so, the ...


Can Consumers Make Affordable Care Affordable? The Value Of Choice Architecture, Eric J. Johnson, Ran Hassin, Tom Baker, Allison T. Bajger, Galen Treuer Jul 2013

Can Consumers Make Affordable Care Affordable? The Value Of Choice Architecture, Eric J. Johnson, Ran Hassin, Tom Baker, Allison T. Bajger, Galen Treuer

Faculty Scholarship at Penn Law

Starting this October, tens of millions will be choosing health coverage on a state or federal health insurance exchange as part of the Patient Protection and Affordable Care Act. We examine how well people make these choices, how well they think they do, and what can be done to improve these choices. We conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. Our results suggest there is significant room for improvement. Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do ...


Shots For Tots?, Eric A. Feldman May 2013

Shots For Tots?, Eric A. Feldman

Faculty Scholarship at Penn Law

By endorsing the use of a vaccine that makes the experience of puffing on a cigarette deeply distasteful, Lieber and Millum have taken the first few tentative steps into a future filled with medical interventions that manipulate individual preferences. It is tempting to embrace the careful arguments of “Preventing Sin” and celebrate the possibility that the profound individual and social costs of smoking will finally be tamed. Yet there is something unsettling about the possibility that parental discretion may be on the cusp of a radical expansion, one that involves a new and unexplored approach to behavior modification.


Conditional Spending And The (General) Conditional Offer Puzzle, Mitchell N. Berman Jan 2013

Conditional Spending And The (General) Conditional Offer Puzzle, Mitchell N. Berman

Faculty Scholarship at Penn Law

No abstract provided.


Coercion, Compulsion, And The Medicaid Expansion: A Study In The Doctrine Of Unconstitutional Conditions, Mitchell N. Berman Jan 2013

Coercion, Compulsion, And The Medicaid Expansion: A Study In The Doctrine Of Unconstitutional Conditions, Mitchell N. Berman

Faculty Scholarship at Penn Law

No abstract provided.


Retiree Out-Of-Pocket Healthcare Spending: A Study Of Consumer Expectations And Policy Implications, Allison K. Hoffman, Howell E. Jackson Jan 2013

Retiree Out-Of-Pocket Healthcare Spending: A Study Of Consumer Expectations And Policy Implications, Allison K. Hoffman, Howell E. Jackson

Faculty Scholarship at Penn Law

Even though most American retirees benefit from Medicare coverage, a mounting body of research predicts that many will face large and increasing out-of-pocket expenditures for healthcare costs in retirement and that many already struggle to finance these costs. It is unclear, however, whether the general population understands the likely magnitude of these out-of-pocket expenditures well enough to plan for them effectively. This study is the first comprehensive examination of Americans’ expectations regarding their out-of-pocket spending on healthcare in retirement. We surveyed over 1700 near retirees and retirees to assess their expectations regarding their own spending and then compared their responses ...


The Triumph And Tragedy Of Tobacco Control: A Tale Of Nine Nations, Eric A. Feldman, Ronald Bayer Dec 2011

The Triumph And Tragedy Of Tobacco Control: A Tale Of Nine Nations, Eric A. Feldman, Ronald Bayer

Faculty Scholarship at Penn Law

The use of law and policy to limit tobacco consumption illustrates one of the greatest triumphs of public health in the late twentieth and early twenty-first centuries, as well as one of its most fundamental failures. Overall decreases in tobacco consumption throughout the developed world represent millions of saved lives and unquantifiable suffering averted. Yet those benefits have not been equally distributed. The poor and the undereducated have enjoyed fewer of the gains. In this review, we build on existing tobacco control scholarship and expand it both conceptually and comparatively. Our focus is the social gradient of smoking both within ...


Three Models Of Health Insurance: The Conceptual Pluralism Of The Patient Protection And Affordable Care Act, Allison K. Hoffman Jan 2011

Three Models Of Health Insurance: The Conceptual Pluralism Of The Patient Protection And Affordable Care Act, Allison K. Hoffman

Faculty Scholarship at Penn Law

What risks should health insurance mitigate? American health scholars, politicians, and the public at large answer this question ambivalently. This Article defines three dominant conceptions of health insurance that weave throughout popular and academic discourse and that echoed in the 2010 health reform debates. The first conception is that health insurance should primarily serve to mitigate harms to health. This “Health Promotion” theory relies on using health insurance to pay for medical care that most cost-effectively preserves and improves health. Alternately, health insurance might primarily mitigate risks to wealth from high medical care costs. This “Financial Security” theory demands that ...


Oil And Water: Mixing Individual Mandates, Fragmented Markets, And Health Reform, Allison K. Hoffman Jan 2010

Oil And Water: Mixing Individual Mandates, Fragmented Markets, And Health Reform, Allison K. Hoffman

Faculty Scholarship at Penn Law

With momentum toward national health reform, there is wide support for legislation to include an individual mandate that would require all Americans to carry health insurance. Discussion of the individual mandate has relied largely on whether the mandate will generate universal coverage as a gauge for success. This article challenges the notion that an individual mandate is successful if it leads to universal coverage, revealing a critical problem the individual mandate will face even if all Americans were to have health insurance. To uncover this problem, this article sets out a novel framework that disentangles the three different policy objectives ...


Allowing Patients To Waive The Right To Sue For Medical Malpractice: A Response To Thaler And Sunstein, Tom Baker, Timothy D. Lytton Jan 2010

Allowing Patients To Waive The Right To Sue For Medical Malpractice: A Response To Thaler And Sunstein, Tom Baker, Timothy D. Lytton

Faculty Scholarship at Penn Law

This essay critically evaluates Richard Thaler and Cass Sunstein’s proposal to allow patients to prospectively waive their rights to bring a malpractice claim, presented in their recent, much acclaimed book, Nudge: Improving Decisions about Health, Wealth and Happiness. We show that the behavioral insights that undergird Nudge do not support the waiver proposal. In addition, we demonstrate that Thaler and Sunstein have not provided a persuasive cost-benefit justification for the proposal. Finally, we argue that their liberty-based defense of waivers rests on misleading analogies and polemical rhetoric that ignore the liberty and other interests served by patients’ tort law ...


Tontines For The Invincibles: Enticing Low Risks Into The Health-Insurance Pool With An Idea From Insurance History And Behavioral Economics, Tom Baker, Peter Siegelman Jan 2010

Tontines For The Invincibles: Enticing Low Risks Into The Health-Insurance Pool With An Idea From Insurance History And Behavioral Economics, Tom Baker, Peter Siegelman

Faculty Scholarship at Penn Law

Over one third of the uninsured adults in the U.S. below retirement age are between 19 and 29 years old. Young adults, especially men, often go without insurance, even when buying it is mandatory and sometimes even when it is a low cost employment benefit. This paper proposes a new form of health insurance targeted at this group—the “Young Invincibles”—those who (wrongly) believe that they don’t need health insurance because they won’t get sick. Our proposal offers a cash bonus to those who turn out to be right in their belief that they did not ...


Contingent Valuation Studies And Health Policy, Matthew D. Adler Jan 2010

Contingent Valuation Studies And Health Policy, Matthew D. Adler

Faculty Scholarship at Penn Law

This short comment argues that both cost-benefit analysis (CBA) and cost-effectiveness analysis (CEA) should be seen as imperfect tools for evaluating health policy. This is true, not only for extra-welfarists, but even for welfarists, since both CBA and CEA can deviate from the use of social welfare functions (SWF). A simple model is provided to illustrate the divergence between CBA, CEA, and the SWF approach. With this insight in mind, the comment considers the appropriate role of contingent-valuation studies. For full text, please see: http://www.law.upenn.edu/cf/faculty/madler/workingpapers/578A59B6d01.pdf.


Law, Society, And Medical Malpractice Litigation In Japan, Eric Feldman Jan 2009

Law, Society, And Medical Malpractice Litigation In Japan, Eric Feldman

Faculty Scholarship at Penn Law

No abstract provided.


Reconceptualizing Human Rights To Challenge Tobacco, Rangita De Silva De Alwis, Richard Daynard Jan 2009

Reconceptualizing Human Rights To Challenge Tobacco, Rangita De Silva De Alwis, Richard Daynard

Faculty Scholarship at Penn Law

No abstract provided.


Diabetes Treatments And Moral Hazard, Jonathan Klick, Thomas Stratmann Aug 2007

Diabetes Treatments And Moral Hazard, Jonathan Klick, Thomas Stratmann

Faculty Scholarship at Penn Law

In the face of rising rates of diabetes, many states have passed laws requiring health insurance plans to cover medical treatments for the disease. Although supporters of the mandates expect them to improve the health of diabetics, the mandates have the potential to generate a moral hazard to the extent that medical treatments might displace individual behavioral improvements. Another possibility is that the mandates do little to improve insurance coverage for most individuals, as previous research on benefit mandates has suggested that mandates often duplicate what plans already cover. To examine the effects of these mandates, we employ a triple-differences ...


Medical Malpractice Reform And Physicians In High-Risk Specialties, Jonathan Klick, Thomas Stratmann Jun 2007

Medical Malpractice Reform And Physicians In High-Risk Specialties, Jonathan Klick, Thomas Stratmann

Faculty Scholarship at Penn Law

If medical malpractice reform affects the supply of physicians, the effects will be concentrated in specialties facing high liability exposure. Many doctors are likely to be indifferent regarding reform, because their likelihood of being sued is low. This difference can be exploited to isolate the causal effect of medical malpractice reform on the supply of doctors in high-risk specialties, by using doctors in low-risk specialties as a contemporaneous within-state control group. Using this triple-differences design to control for unobserved effects that correlate with the passage of medical malpractice reform, we show that only caps on noneconomic damages have a statistically ...


Subsidizing Addiction: Do State Health Insurance Mandates Increase Alcohol Consumption?, Jonathan Klick, Thomas Stratmann Jan 2006

Subsidizing Addiction: Do State Health Insurance Mandates Increase Alcohol Consumption?, Jonathan Klick, Thomas Stratmann

Faculty Scholarship at Penn Law

A model of addiction in which individuals are forward looking implies that as the availability of addiction treatment options grows, individuals will consume more of an addictive good. We test this implication using cross-state variation in the adoption of mental health parity mandates that include substance abuse treatments. We examine the effects of these mandates on the consumption of alcohol and find that parity legislation leads to an increase in alcohol consumption. To account for the possible endogeneity of the adoption of mental health parity mandates, we perform an instrumental variables analysis and find that the ordinary least squares estimation ...


Mandatory Waiting Periods For Abortions And Female Mental Health, Jonathan Klick Jan 2006

Mandatory Waiting Periods For Abortions And Female Mental Health, Jonathan Klick

Faculty Scholarship at Penn Law

No abstract provided.


Privatization And Punishment In The New Era Of Reprogenetics, Dorothy E. Roberts Jan 2005

Privatization And Punishment In The New Era Of Reprogenetics, Dorothy E. Roberts

Faculty Scholarship at Penn Law

No abstract provided.