Tag: incentives

Bioethics News

A Start-Up Suggests a Fix to the Health Care Morass

August 16, 2017

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In Congress, a doomed plan to repeal the Affordable Care Act, President Obama’s health care law, has turned into a precarious effort to rescue it. Meanwhile, President Trump is still threatening to mortally wound the law — which he insists, falsely, is collapsing anyway — while his administration is undermining its being carried out.

So it is surprising that across the continent from Washington, investors and technology entrepreneurs in Silicon Valley see the American health care system as the next great market for reform.

Some of their interest is because of advances in technology like smartphones, wearable health devices (like smart watches), artificial intelligence, and genetic testing and sequencing. There is a regulatory angle: The Affordable Care Act added tens of millions of people to the health care market, and the law created several incentives for start-ups to change how health care is provided. The most prominent of these is Oscar, a start-up co-founded by Joshua Kushner (the younger brother of Mr. Trump’s son-in-law, Jared Kushner), which has found ways to mine health care data to create a better health insurance service.

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The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Whatever Happened to Long-Term Care Reform?

From the Trenches: A Prescription for Change

I have enjoyed looking at the pictures of protestors being arrested in our nation’s capital. I concur with many commentators who credit the civil disobedience of the protestors – many of whom are members of the disability rights activist group ADAPT – with the defeat of the Senate bill to abolish the Affordable Care Act. It’s also been fun because I know so many people in the photos.

The Affordable Care Act was a massive piece of legislation. The complexities and moving parts are best understood by people who have very closely followed or implemented the law. I generally think of the ACA as three things:

1. Reform of the private insurance market with the goal of providing greater access to insurance coverage;

2. Changes to Medicare, such as closing the prescription drug donut hole; and

3. Changes to Medicaid. 

Mike Oxford, Executive Director for Policy at the Topeka Independent Living Resource Center and a member of the national chapter of ADAPT, was one of many who protested against the Senate bill to repeal the Affordable Care Act.

Community Services Optional?

The Medicaid issue that has drawn the most attention is the matter of expanding access, appropriately called “Medicaid expansion.” But the law contains other Medicaid provisions as well. It provides incentives for states to continue to “re-balance” their systems of providing long-term care. “Re-balance” is often mentioned in quotation marks because states were never in balance. Nonetheless, through the ACA, states were provided additional federal matching funds if they would transfer more long-term care to community services and away from institutions, such as nursing homes.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Whatever Happened to Long-Term Care Reform?

From the Trenches: A Prescription for Change

I have enjoyed looking at the pictures of protestors being arrested in our nation’s capital. I concur with many commentators who credit the civil disobedience of the protestors – many of whom are members of the disability rights activist group ADAPT – with the defeat of the Senate bill to abolish the Affordable Care Act. It’s also been fun because I know so many people in the photos.

The Affordable Care Act was a massive piece of legislation. The complexities and moving parts are best understood by people who have very closely followed or implemented the law. I generally think of the ACA as three things:

1. Reform of the private insurance market with the goal of providing greater access to insurance coverage;

2. Changes to Medicare, such as closing the prescription drug donut hole; and

3. Changes to Medicaid. 

Mike Oxford, Executive Director for Policy at the Topeka Independent Living Resource Center and a member of the national chapter of ADAPT, was one of many who protested against the Senate bill to repeal the Affordable Care Act.

Community Services Optional?

The Medicaid issue that has drawn the most attention is the matter of expanding access, appropriately called “Medicaid expansion.” But the law contains other Medicaid provisions as well. It provides incentives for states to continue to “re-balance” their systems of providing long-term care. “Re-balance” is often mentioned in quotation marks because states were never in balance. Nonetheless, through the ACA, states were provided additional federal matching funds if they would transfer more long-term care to community services and away from institutions, such as nursing homes.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Disability Rights Advocates Sue Uber for Wheelchair Inaccessible Cars

Nonprofit organization Disability Rights Advocates has filed a class-action lawsuit against Uber, claiming that the ride service discriminates against riders with disabilities in New York City. Filed in New York State Supreme Court in Manhattan on Tuesday, July 18th, the suit is founded on the accusation that Uber does not supply enough available wheelchair-accessible cars through its app.

According to the New York Times, the lawsuit alleges that though Uber provides wheelchair-accessible cars through its related service UberWAV, the specially equipped vehicles “account for a tiny fraction of the 58,000 for-hire cars dispatched by Uber in New York City’s five boroughs” and that “this already limited pool of cars can be used for other riders, and… may be unavailable when needed by those with disabilities.”

Filed on behalf of numerous advocacy organizations and individual New Yorkers, the lawsuit comes after two discrimination lawsuits against the Metropolitan Transportation Authority regarding the subway system’s dearth of elevators and lifts. The suit requests that the court order Uber to “develop and implement a remedial plan to ensure full and equal access to its services for riders who require accessible transportation.”

For its part, Uber has in the past offered monetary incentives to drivers of wheelchair-accessible cars. It has also suggested that New York City law implement an “accessibility fee” on certain types of rides across companies to raise funds for further monetary incentives. The case raises notable questions regarding civil and corporate duties to persons with disabilities.

The post Disability Rights Advocates Sue Uber for Wheelchair Inaccessible Cars appeared first on Global Bioethics Initiative (GBI).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Pushing Hospitals To Reduce Readmissions Hasn’t Increased Deaths

July 18, 2017

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Historically, U.S. hospitals have had little incentive to keep patients healthy following discharge. Hospital discharge indicated success, and we paid little mind to what happened on the other side. Meanwhile, 1 in 5 patients returned to the hospital within 30 days of discharge, and the health system largely felt it had no responsibility for that. Hospitals were paid each time a patient was readmitted.

Over time, it became clear that the risk for readmission could be reduced with improved quality of care. For this to happen, hospitals would have to institute programs that would take into account the challenges of managing the recovery period. They would also have to be sure people were strong enough to leave the hospital – and had the support they needed after discharge. And mistakes that were all too common, like sending people home with the wrong medication list, would need to be addressed.

The Affordable Care Act sought to make all of that happen by changing hospital incentives. Hospitals with higher than average readmission rates would be penalized financially. These penalties began in 2012 and have increased over time.

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Image: By Royak77 – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=33077912

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NPR Shots

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The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Inherent Problems with Commercial Surrogacy in India

The degree to which financial incentives can muddle ethical deliberation and practice is evident in the commercial surrogacy trade in Indian. For years, “rent-a-womb” services to foreigners has been “big business” indeed, generating nearly $1 billion annually. Would-be Western parents, many from the U.K. and Scandinavia, argue that commercial surrogacy arrangements are a win-win situation for everyone. They get the baby they’ve longed for and… // Read More »

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

The Specialists’ Stranglehold on Medicine

Though they would vigorously deny it, entrepreneurial doctors often treat each patient as an opportunity to make money. Research shows that physicians quickly adapt their treatment choices if the fees they get paid change. But the current payment incentives do more than drive up costs — they can kill people

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Gender Bias in the Sciences: A Neuroethical Priority

By Lindsey Grubbs
Lindsey Grubbs is a doctoral candidate in English at Emory University, where she is also pursuing a certificate in bioethics. Her work has been published in Literature & Medicine and the American Journal of Bioethics Neuroscience, and she has a chapter co-authored with Karen Rommelfanger forthcoming in the Routledge Handbook of Neuroethics.   
In a March 29, 2017 lecture at Emory University, Dr. Bita Moghaddam, Chair of the Department of Behavioral Neuroscience at Oregon Health & Science University, began her talk, “Women’s Reality in Academic Science,” by asking the room of around fifty undergraduate and graduate students, “Who’s not here today?”
The answer? Men. (Mostly. To be fair, there were two.) Women in the audience offered a few hypotheses: maybe men felt like they would be judged for coming to a “women’s” event; maybe they wanted the women in their community to enjoy a female-majority space; maybe they don’t think that gender impacts their education and career.
Moghaddam seemed inclined to favor this third view: anecdotally, she has noticed a marked lack of interest from younger men when it comes to discussing gender bias in the sciences. More interested, she suggested, are older men who run laboratories or departments and watch wave after wave of talented women leave the profession, and those who have seen their partners or children impacted by sexism in science.
Dr. Moghaddam was invited to speak in Atlanta for her work against the systemic bias facing women in the sciences. She co-authored a short piece in Neuropsychopharmacology titled “Women at the Podium: ACNP Strives to Reach Speaker Gender Equality at the Annual Meeting.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Are Incentives Corrupting? The Case of Paying People to be Healthy.

Written by Dr Rebecca Brown

Financial incentives are commonplace in everyday life. As tools of states, corporations and individuals, they enable the ‘tweaking’ of motivations in ways more desirable to the incentiviser. A parent may pay her child £1 to practice the piano for an hour; a café offers a free coffee for every nine the customer buys; governments offer tax breaks for homeowners who make their houses more energy efficient. Most people, most of the time, would probably find the use of financial incentives unobjectionable.

More recently, incentives have been proposed as a means of promoting health. The thinking goes: many diseases people currently suffer from, and are likely to suffer from in the future, are largely the result of behavioural factors (i.e. ‘lifestyles’). Certain behaviours, such as eating energy dense diets, taking little exercise, smoking and drinking large amounts of alcohol, increase the risk that someone will suffer from diseases like cancer, heart disease, lung disease and type II diabetes. These diseases are very unpleasant – sometimes fatal – for those who suffer from them, their friends and family. They also create economic harms, requiring healthcare resources to be directed towards caring for those who are sick and result in reduced productivity through lost working hours. For instance,the annual cost to the economy of obesity-related disease is variously estimated as £2.47 billion£5.1 billion and a whopping $73 billion (around £56.5 billion), depending on what factors are taken into account and how these are calculated. Since incentives are generally seen as useful tools for influencing people’s behaviour, why not use them to change health-related behaviours?

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

40th Annual Health Law Professors Conference

If you teach health law, come to the 40th Annual Health Law Professors Conference, June 8-10, 2017, at Georgia State University College of Law in Atlanta.  Here is the schedule:


Thursday, June 8, 2017
8:00-12:00 AM Tour of the Centers for Disease Control and Prevention (Separate registration is required. Participants meet in the lobby of Georgia State Law to take a shuttle to the CDC.)


9:45 – 11:15 AM Tour of Grady Health System (Separate registration is required. Participants meet in the lobby of Georgia State Law and will walk over to Grady as a group.)


2:00 – 5:00 PM Conference Registration – Henson Atrium, Georgia State Law


3:00 – 5:00 PM Jay Healey Teaching Session – Knowles Conference Center, Georgia State Law
Experiential Teaching and Learning in Health Law
The format for this session is World Café roundtables, with plenty of opportunity for the collegial exchange of teaching ideas and insights among your colleagues. Come prepared for a lively, interactive workshop.
World Café Hosts:
Dayna Matthew, University of Colorado Law School
Charity Scott, Georgia State University College of Law
Sidney Watson, Saint Louis University School of Law
Invited Discussants and Participants:
Rodney Adams, Virginia Commonwealth University School of Health Administration
Christina Juris Bennett, University of Oklahoma College of Law
Amy Campbell, University of Memphis Cecil C. Humphreys School of Law
Michael Campbell, Villanova University Charles Widger School of Law
Erin Fuse Brown, Georgia State University College of Law
Cynthia Ho, Loyola University of Chicago School of Law
Danielle Pelfrey Duryea, University of Buffalo School of Law, State University of New York
Jennifer Mantel, University of Houston Law Center
Elizabeth McCuskey, University of Toledo College of Law
Laura McNally-Levine, Case Western Reserve University School of Law
Jennifer Oliva, West Virginia University College of Law and School of Public Health
Thaddeus Pope, Mitchell Hamline School of Law
Lauren Roth, St.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.