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6 - Implementing a Public Subsidy for Vaccines
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- By Frank A. Sloan, Duke University, Charles E. Eesley, Sloan School of Management, MIT
- Edited by Frank A. Sloan, Duke University, North Carolina, Chee-Ruey Hsieh, Academia Sinica, Taipei, Taiwan
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- Book:
- Pharmaceutical Innovation
- Published online:
- 18 December 2009
- Print publication:
- 30 April 2007, pp 107-126
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Summary
Introduction and Overview
Judged in terms of the relationship of benefit to cost, vaccines are among the most socially valuable public health investments (U.S. Centers for Disease Control and Prevention [CDC] 1999; Stratton, Durch, and Lawrence 2000). In spite of some recent successes, such as increases in immunization rates in the United States (CDC 2002a, b, 2003), substantial structural and financial problems remain. In particular, the United States has recently experienced unprecedented shortages in 8 of the 11 routine childhood vaccines (Georges et al. 2003). Flu vaccine shortages were experienced in 2000–2002 and 2004 (Cohen 2002; Enserink 2004; Institute of Medicine 2004).
Although unique causes have been attributed to each shortage, a common pattern remains. In the past three decades, the number of firms producing vaccines for the U.S. market has decreased. Between 1966 and 1980, more than half of all commercial vaccine manufacturers stopped producing vaccines, and the exodus has continued to the present (Cohen 2002). As of early 2004, only five companies produced all vaccines recommended for routine use by children and adults, and only three of these were U.S.-based firms. Eight major vaccine products – including MMR (measles-mumps-rubella), tetanus, and polio – each had only one supplier (Institute of Medicine 2004). A long-term shutdown in capacity by any one of these companies could be a major supply shock, as occurred with the disruption in supply of flu vaccine from a Chiron plant in October 2004, which cut the supply of vaccine to the United States by almost half (Enserink 2004).
15 - Governments as Insurers in Professional and Hospital Liability Insurance Markets
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- By Frank A. Sloan, J. Alexander McMahon Professor of Health Policy and Management and professor of economics, Duke, Charles E. Eesley, J. Alexander McMahon Professor of Health Policy and Management, Health Policy and Management and professor of economics at Duke
- Edited by William M. Sage, Columbia University, New York, Rogan Kersh, Syracuse University, New York
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- Book:
- Medical Malpractice and the U.S. Health Care System
- Published online:
- 10 December 2009
- Print publication:
- 12 June 2006, pp 291-317
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Summary
Insurance issues rarely dominate the front page in public discussions of medical malpractice. Sharply rising premiums and nonavailability of coveragehave been the main precipitating factors in each medical crisis that has occurred in the United States in the past three decades. Whatever long-run trends in claims frequency and amounts paid per claim may be (“claims severity”), the immediate causes of premium increases and lack of supply can be found in the workings of the market for medical malpracticeinsurance.
Beginning with the rationale for public provision, this chapter describes the forms such provision has taken. Some public insurance is designed to mitigate fluctuations in the insurance cycle, which is characterized by periodic sharp increases in premiums and reductions in insurer capacity and availability of insurance to individual health care providers. This objective is accomplished by providing coverage for large claims. Other forms of public insurance focus directly on assuring availability of medical malpractice insurance through public risk-pooling arrangements or on protecting policyholders from insurer bankruptcy. Next, we discuss lessons learned from the states' experiences with public provision of medical malpractice insurance coverage.
Although common themes emerge, some lessons only pertain to a single type of public insurance. One common theme is moral hazard, including reducing the potential deterrent effect of tort liability for health care providers to implement precautions to avoid injuries. Additionally, because combining public provision and patient safety may be efficient, we examine the relationship between public provision and patient safety in the following section.