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Northern Territory euthanasia Act has uncertain start
THE LANCET
POLICY AND PEOPLE
Northern Territory euthanasia Act has uncertain start
T
he Northern Territory’s Rights of the Terminally Ill Act came into operation this week despite a challenge to its validity by the Northern Territory (NT) branch of the Australian Medical Association (AMA) (see Lancet, June 29, p 1777). The Full Court of the NT Supreme Court has reserved its judgment, hoping to deliver in about 2 weeks. The AMA’s Chris Wake did not obtain the injunctive relief that he had hoped would prevent the Act coming into effect while the Court made up its mind. On a national level, the issue has led to a constitutional debate about the powers of states and territories to make laws. A bill drafted by a Federal government backbencher, which seeks a constitutional veto on
the NT legislation, is expected to be debated in Federal parliament in September. Both the Prime Minister and the leader of the Federal opposition have recently supported the overturning of the euthanasia legislation. But the Victorian Premier spoke out against the Federal government challenge, arguing that the rights of states and territories were at stake. In the meantime, the legislation has come into force. The doctor of 65-year-old Max Bell is searching for the required second doctor whose declaration, together with that of a psychiatrist, will enable Bell to be assisted to die. The Act became more difficult to use after tabling of recent regulations required that the second medical practitioner—who must confirm the first doctor’s diagnosis and
prognosis of the terminal illness— must have expertise in that illness. Bell’s doctor has written to ten specialists who have declined to assist for fear of prosecution should the legal challenge to the Act succeed. This is despite the fact that the Territory’s Chief Minister says that it is extremely unlikely that the director of public prosecutions would charge a person who acted under what was believed to be valid legislation. Both parties to the Supreme Court action have foreshadowed that they will appeal to the High Court if they are unsuccessful in the current action; thus ensuring the matter remains unsettled for months to come. Stephen Cordner, Kathy Ettershank
New York legislature to levy tax to pay for medical education
N
ew York is set to become the first US state to explicitly tax health insurers for graduate medical education. The proposal is tucked in a major piece of legislation moving through the state legislature that would extinguish New York’s unique hospital rate-setting system. The bill, which the governor is expected to sign when legislators wrap up their work on the budget, would force all of New York’s hospitals to negotiate fees with payers like their counterparts elsewhere in the USA. HMOs and health plans would have to contribute an 8·7% surcharge into a graduate medical education
pool; the bill also would levy a tax on health plans to help hospitals shoulder the cost of caring for the state’s nearly 3 million uninsured. A graduate medical education tax is a major win for New York. Its 69 teaching hospitals and academic medical centres train 15% of the nation’s medical residents. Half of the state’s academic medical centres are in New York City. Under the bill, the pool would be allocated among teaching hospitals across the state based on need. The tax is expected to raise nearly US$1·4 billion a year. That is $500 million less than what hospitals now get but it is signifi-
cantly better than the $700 million budget for graduate medical education Governor George Pataki initially proposed. The tax for uncompensated care is expected to raise another $1 billion. Health maintenance organisations in the state support funding graduate medical education but they think the funding level the legislature has agreed to is higher than it should be given the oversupply of doctors and hospital beds in the state, says Leslie Moran, of the New York state HMO Conference in Albany. Janet Firshein
Germany’s insurance targets disabled and elderly
O
n July 1, the second stage of Germany’s nursing-care insurance (Pflegeversicherung) was launched. It aims to provide financial support for about 400 000 disabled people living in nursing homes, most of whom are more than 60 years old. The care insurance is the responsibility of the health-insurance companies, which have set up teams of medical experts to classify applicants, according to the severity of their disability, into three categories. Depending on the category, applicants, or rather the nursing homes, receive financial support of DM 2000–3000 per month. However, the maximum sum must not exceed 75% of the nursing home’s cost. The
120
insurance covers only medical, nursing, and social services, not rent and food. But it relieves the local community’s social-insurance burden— many disabled people and their families are not able to pay the total costs, which run to DM 5000 per month or more. Currently, there are about 8500 nursing homes with 680 000 places. The care insurance is financed by monthly contributions from pensioners and employees, half paid by employer and employee. The firms were partly compensated for their financial loss by abolishing one public holiday. The first stage of the care insurance was introduced in April, 1995, to provide financial support to dis-
abled people living at home. About 1·2 million applications were accepted by the health insurances. The support from the insurance covers the costs of nursing services at home, either by a relative or a professional. It ranges from DM 400 to 1300 per month for care by a relative, or DM2800 to 3750 per month for professional services. However, the new insurance has not generally been welcomed as a remedy for an ageing population. Employers are complaining about having yet another payment. And some critics argue that the categories are not always appropriately applied. Annette Tuffs
Vol 348 • July 13, 1996
POLICY AND PEOPLE
Northern Territory euthanasia Act has uncertain start
T
he Northern Territory’s Rights of the Terminally Ill Act came into operation this week despite a challenge to its validity by the Northern Territory (NT) branch of the Australian Medical Association (AMA) (see Lancet, June 29, p 1777). The Full Court of the NT Supreme Court has reserved its judgment, hoping to deliver in about 2 weeks. The AMA’s Chris Wake did not obtain the injunctive relief that he had hoped would prevent the Act coming into effect while the Court made up its mind. On a national level, the issue has led to a constitutional debate about the powers of states and territories to make laws. A bill drafted by a Federal government backbencher, which seeks a constitutional veto on
the NT legislation, is expected to be debated in Federal parliament in September. Both the Prime Minister and the leader of the Federal opposition have recently supported the overturning of the euthanasia legislation. But the Victorian Premier spoke out against the Federal government challenge, arguing that the rights of states and territories were at stake. In the meantime, the legislation has come into force. The doctor of 65-year-old Max Bell is searching for the required second doctor whose declaration, together with that of a psychiatrist, will enable Bell to be assisted to die. The Act became more difficult to use after tabling of recent regulations required that the second medical practitioner—who must confirm the first doctor’s diagnosis and
prognosis of the terminal illness— must have expertise in that illness. Bell’s doctor has written to ten specialists who have declined to assist for fear of prosecution should the legal challenge to the Act succeed. This is despite the fact that the Territory’s Chief Minister says that it is extremely unlikely that the director of public prosecutions would charge a person who acted under what was believed to be valid legislation. Both parties to the Supreme Court action have foreshadowed that they will appeal to the High Court if they are unsuccessful in the current action; thus ensuring the matter remains unsettled for months to come. Stephen Cordner, Kathy Ettershank
New York legislature to levy tax to pay for medical education
N
ew York is set to become the first US state to explicitly tax health insurers for graduate medical education. The proposal is tucked in a major piece of legislation moving through the state legislature that would extinguish New York’s unique hospital rate-setting system. The bill, which the governor is expected to sign when legislators wrap up their work on the budget, would force all of New York’s hospitals to negotiate fees with payers like their counterparts elsewhere in the USA. HMOs and health plans would have to contribute an 8·7% surcharge into a graduate medical education
pool; the bill also would levy a tax on health plans to help hospitals shoulder the cost of caring for the state’s nearly 3 million uninsured. A graduate medical education tax is a major win for New York. Its 69 teaching hospitals and academic medical centres train 15% of the nation’s medical residents. Half of the state’s academic medical centres are in New York City. Under the bill, the pool would be allocated among teaching hospitals across the state based on need. The tax is expected to raise nearly US$1·4 billion a year. That is $500 million less than what hospitals now get but it is signifi-
cantly better than the $700 million budget for graduate medical education Governor George Pataki initially proposed. The tax for uncompensated care is expected to raise another $1 billion. Health maintenance organisations in the state support funding graduate medical education but they think the funding level the legislature has agreed to is higher than it should be given the oversupply of doctors and hospital beds in the state, says Leslie Moran, of the New York state HMO Conference in Albany. Janet Firshein
Germany’s insurance targets disabled and elderly
O
n July 1, the second stage of Germany’s nursing-care insurance (Pflegeversicherung) was launched. It aims to provide financial support for about 400 000 disabled people living in nursing homes, most of whom are more than 60 years old. The care insurance is the responsibility of the health-insurance companies, which have set up teams of medical experts to classify applicants, according to the severity of their disability, into three categories. Depending on the category, applicants, or rather the nursing homes, receive financial support of DM 2000–3000 per month. However, the maximum sum must not exceed 75% of the nursing home’s cost. The
120
insurance covers only medical, nursing, and social services, not rent and food. But it relieves the local community’s social-insurance burden— many disabled people and their families are not able to pay the total costs, which run to DM 5000 per month or more. Currently, there are about 8500 nursing homes with 680 000 places. The care insurance is financed by monthly contributions from pensioners and employees, half paid by employer and employee. The firms were partly compensated for their financial loss by abolishing one public holiday. The first stage of the care insurance was introduced in April, 1995, to provide financial support to dis-
abled people living at home. About 1·2 million applications were accepted by the health insurances. The support from the insurance covers the costs of nursing services at home, either by a relative or a professional. It ranges from DM 400 to 1300 per month for care by a relative, or DM2800 to 3750 per month for professional services. However, the new insurance has not generally been welcomed as a remedy for an ageing population. Employers are complaining about having yet another payment. And some critics argue that the categories are not always appropriately applied. Annette Tuffs
Vol 348 • July 13, 1996