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Abstract:
This article offers some ideas about how the international human right to health, established in a variety of sources of international human rights law and general international law, creates a right to health care in the nations of the world. The article addresses the formidable question of the content of the international human right to health. It concludes that the international human right to health requires nation states to take affirmative steps to assure that their residents have access to population-based public health protection measures and also affordable health care services consistent with the nation's economic resources and cultural mores.

This article lays out the sources of international law that establish a human right to health for all people. These include international human rights treaties and customary international law. Second, the article suggests ideas for the implementation of a right to health throughout the world. Third, are offered observations about the potential impact of full recognition of the international human right to health on the people of all nations, including the United States.

The article suggests three approaches to the implementation of the international human right to health: (1) define universal outcome measures that measure compliance with the core state obligations of the human right to health; (2) establish systematic reporting to responsible international bodies to monitor progress on implementation and compliance with international human rights obligations, and (3) highlight civil rights violations, such as discrimination against protected groups, that inhibit access to health care services. These three approaches are realistic given the economic, social and cultural differences among the nations of the world. While these approaches are not comprehensive, they can do much to advance recognition and implementation of the international human right to health throughout the world.

Abstract:
At a time of renewed interest in the international human right to health, it is useful to identify and examine the provisions of the constitutions of the countries of the world regarding health and health care. These provisions indicate a national commitment to progress toward the assurance of access to high quality and affordable health care for national populations. Also, such constitutional provisions might well be important factors in the international campaign to promote the recognition and implementation of the international human right to health domestically throughout the world.

This article reports findings of an empirical analysis of the provisions of the constitutions of the countries of the world that address health and health care. This article also examines other indices of national commitment to health and health care. Specifically, ratification of ICESCR and relevant regional human rights treaties are presented, as well as national performance in allocating budgetary resources towards health and health care. This article concludes that the national commitment to health and health care is not highly related to whether or not a nation's constitution addresses health or health care specifically. Nevertheless, the fact that 67.5 percent of the constitutions of all nations have provisions regarding health and health care is important for efforts to promote recognition and implementation of the international human right to health.

international human right to health, constitutional, health law

Abstract:
This article reviews the history and progress of the realization of the international human right to health in the United States. Realization is defined and described as ratification of international human rights treaties, on which the US performance is poor, and constitutional guarantees and legislative and regulatory programming at the federal and state level. Key to realizing the international human right to health throughout the world is how progress is measured.

Historically, progress has been measured by ratification of treaties, adoption of legal authorities for public health care programs, and comparison of per capita health expenditures as a proxy for resources committed to health care. These measures fall short as accurate indicators of true progress. Health services research has developed indicators, measures, methods and data for measuring and comparing progress in the realization of the international human right to health.

The World Health Organization (WHO), United Nations Development Programme (UNDP), Organization for Economic Co-operation and Development (OECD) and World Bank have promoted development of statistical indicators and assisted nations in developing infrastructure for collecting data and reporting indicators. The four key categories of indicators to date are: (1) population health status and outcomes, (2) population access to health care, (3) health sector performance on quality and efficiency, and (4) government competence and commitment to health care. Comparing national performance on realization of the international human right to health with statistical indicators is more informative than comparing legal institutions or per capita health spending. The case of the US is instructive. The US spends more on health care per capita than other countries but performs less well on measures of population-based health status or health sector performance. Also, inequity in American society contributes to disparate health outcomes.

international health care, human rights, per capita health expenditures

Abstract:
The author investigates the actual and potential contribution of administrative law in public health both historically and today, describing the evolution of public health regulation in the United States; exploring the major administrative law issues in public health regulation; and addressing how administrative law principles can be used to improve the policy and decision-making processes and to set priorities with respect to politically charged and scientifically based issues.

Abstract:
This article presents a taxonomy of the medical standards of care that are involved in health-care delivery today. Next, it traces the historical evolution of medical standards of care since the early 1980s. Included in this discussion are the origins of the standard-setting movement as well as the developments that led to the way standards of care are currently used by large institutional providers and managed care plans to improve the quality of their health-care services. The article concludes with a brief analysis of the key legal issues that affect how standards of care can be used to improve the health care of patients.

Abstract:
Consumer concerns about their health care have attracted intense attention as more Americans get care through prepaid managed care plans. A recent poll sponsored by the Kaiser Family Foundation reported that over half of Americans believe that managed care has decreased the quality of their health care. Journalistic reports and widely publicized court decisions involving coverage denials for gravely ill people have fueled consumer concerns as well. Consumer protection and access to high quality health care is an issue that resonates deeply with the American public, and reforms are in order.

Consumers have been heard in the political system. States have been active in legislating consumer protections into state HMO statutes, including stronger disclosure requirements and more open utilization review. President Clinton made consumer protection a cornerstone of his health policy agenda and convened a presidential commission that proposed recommendations for reform and a consumer bill of rights with respect to health plans. The 105th and 106th Congresses considered but did not pass patient protection legislation.

This article describes and analyzes the different systems for tapping and resolving consumer concerns and complaints about their health care. It presents a typology of consumer concerns, including how they are initially manifested and ultimately resolved. This article argues that the current legal systems for identifying and resolving consumer concerns are balkanized and incomprehensible to most consumers and inaccessible to many, particularly for those without health insurance. This article concludes with a suggested agenda for future research, and an outline of a theory for fair procedure to guide genuine reform.

Abstract:
In recent years, states have experimented with innovative approaches to expand coverage for underserved persons. Yet lack of health insurance among low income workers remains a problem. A 1997 survey reported that more than half of adults in low income, working families have been uninsured sometime in the previous two years. This group is likely to increase in the future as states implement time-limited welfare benefits and if employer-sponsored health coverage continues to decrease as in recent years.

This paper describes the bipartisan effort of the Indiana Commission on Health Care for the Working Poor to design coverage expansions for uninsured, low income workers and families in Indiana. Initially, legislators challenged the state's insurance industry to develop a private health insurance plan that the state might subsidize to make it affordable to low income workers and/or their employers. However, based on findings from Indiana focus groups of working poor that the Commission conducted, the Commission recommended strategies to mobilize existing safety net providers into networks to provide comprehensive and coordinated care to low income workers and families in designated service areas. Specifically, the state would pay direct subsidies for primary and preventive care to community health centers that participate in networks with safety net hospitals. Also, the state would establish a state-sponsored stop loss fund to protect network hospitals against expenses incurred in the care of catastrophically ill network clients.

These strategies reflect three realities that face states as they craft health coverage expansions for uninsured low income workers and families in today's health policy environment. First, in a conservative state, policy makers are unwilling to pay the cost of even limited coverage for low income workers and families. Second, the uninsured poor already obtain care from safety net providers that are programmatically constituted and ideologically committed to serve them. Third, this lack of demand for health coverage with minimum benefits threatens voluntary participation in a subsidized private program. The findings of the focus groups confirmed that, unless heavily subsidized, it is unlikely that low income workers are going to purchase even heavily subsidized health insurance to finance their health care.

Given the constraints of the day, addressing the need for health coverage for the remaining uninsured calls for innovative thinking beyond conventional paradigms. Direct subsidies for community health centers and subsidized stop loss protection for safety net hospitals to facilitate the development of networks are promising strategies for extending coverage to uninsured, low income workers and families. While not a substitute for enrollment in a fully-paid health plan, these strategies do promise real improvement in access to high quality health care services for this group of vulnerable Americans.

Abstract:
At century's end, states have assumed a very different role in the design, implementation, and operation of health service programs than they did twenty-five years ago. In the current volatile political atmosphere particularly at the federal level, states have taken up the mantel of healthcare reform in the final years of the 1990s. Yet there remain problems and difficulties with the current federal-state relationship in health reform. The critical question is whether states can successfully accomplish genuine reform given its politically charged, complex and costly nature. This question takes on particular significance for the most important reform--expanding coverage to the uninsured poor. This article explores the contours of a federal-state partnership that will move toward the societal goal of universal health coverage, and especially coverage of the uninsured poor. The article suggests several legislative and regulatory changes. The most practical and immediate steps that Congress could take are to reform the Employment Retirement Income Security Act of 1973 (ERISA) and provide matching funds for state health insurance programs for the uninsured that allow states great flexibility in designing programs that really reach the uninsured within their boundaries.

Abstract:
Journalistic reports and widely publicized court decisions have fueled consumer concerns about the availability of high quality health care in prepaid managed care plans. Most consumer concerns about health care services pertain to coverage of services and quality of care. This article analyzes the private processes for developing coverage and quality policy for public and private health plans in the United States. First, this article explores the nature and importance of coverage and quality policy in health plans today and how such policy relates to the current problems consumers face with health plans generally and prepaid health plans in particular. Second, the article reviews the development of coverage and quality policy since the advent of widespread health insurance coverage in the mid-Twentieth Century. Third, this article explores how sponsors of public and private health plans make decisions about coverage and quality policy. As coverage and quality policy is informed predominantly by standards of care developed by private medical organizations and private accrediting bodies, this article also examines the procedures by which these entities develop standards of care. Finally, this article concludes with recommendations for sound policy making procedures for private coverage and quality policy and the standards of care used to develop this policy. Specifically, policy making procedures can do much to ensure that plan coverage and quality policy exhibits three core values of validity, credibility and democratic legitimacy. Proposed here are three principles of policy making procedures that promote these values, with respect to all types of standards of care. First, designated process, however informal must exist, for adopting any coverage and quality policy or any standard of care used in the formulation of a coverage or quality policy. Second, procedural methods must assure that the relevant scientific and clinical information is marshaled, made available and expertly considered by the decision makers formulating the policy. Third, all policy must be publicized and made available easily to affected parties, especially physicians, health professionals and consumers.