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Uncertainty about Italy's health service
POLICY AND PEOPLE
POLICY AND PEOPLE
US House passes patients’ bill of rights
A
fter a flurry of last-minute dealmaking with the White House, the Republican-led US House of Representatives narrowly passed a patients’ bill of rights on Aug 2, before adjourning for the August Congressional recess. The now Democratic-controlled Senate passed its own, broader version of a patients’ rights bill in June (see Lancet 2001; 358: 46). In September an attempt will be made to reconcile the two bills in a House-Senate conference committee, where legislation died in the last Congress. The House bill includes a controversial amendment limiting patients’ rights to sue their health maintenance organisations (HMOs). The amendment arose from a deal struck between President George Bush and one of the bill’s Republican cosponsors, Republican representative Charles Norwood, of Georgia. The President promised to sign the revised bill into law, which then passed the House by a vote of
226 to 203, split mainly along party lines. Like the Senate bill, the House version offers people in managedcare organisations: the right to appeal to an independent review committee if a patient has been denied care; allowances for women to visit obstetricians and gynaecologists without referral or authorisation; emergency care at the nearest hospital regardless of its plan affiliation; prompt access to specialist care; the right of doctors to prescribe drugs whether or not they are on the plan’s preferred list; and access to clinical trials when no effective standard treatment exists. The two bills differ with respect to enforcement of these rights. The House version is more restrictive than the Senate’s and limits patients’ ability to sue their HMOs in several ways. Class-action lawsuits are eliminated. Suits against employers who administer their own health plans must be filed in federal
Canadian researchers awarded record damages hat began in 1996 as a media insult to two Canadian cardiologists that could have been settled out of court for $35 000, was just decided by the Ontario Court of Appeal in a joint judgment levied against the national television Canadian Broadcasting Corporation, equal to over $2·8 million—one of the highest libel damages in Canadian history. Specifically, the three appeal court justices ruled against the CBC’s the fifth estate, for an episode entitled “the heart of the matter”, aired in 1996 to an estimated one million viewers across Canada. The Court upheld two 1999 lower court trial decisions, ordering the award-winning investigative news programme to pay even greater damages and the full legal costs of the two doctors. Frans Leenen, a medical researcher and director of the Hypertension Unit in Ottawa’s Heart Institute, and Martin Myers, a cardiologist at Toronto’s Sunnybrook and Women’s College Health Sciences Centre, were described as placing personal gain from pharmaceutical industry interests over the protection of public safety, falsely accusing them of callously endangering the lives of thousands of heart patients
W
480
by supporting Bayer’s heart drug nifedipine. The voice-over promotion for the show stated that, “people are dying, people who don’t need to die are dying”. The appeals court further ruled that the CBC had a preconceived notion, revealed in its behind-thescenes records and “privileged information” which, although not intended for public disclosure, was indeed admissible evidence. The trial judges had ruled that although the investigative team had interviewed scores of medical professionals over 14 weeks and understood the debate about the hazards and benefits of drug treatment, they decided to “dramatically simplify a complex medical debate” and had “seriously mischaracterised” the physicians’ positions. The full impact of this suit is yet to be determined, but the costs of the lost suit against this crown corporation will be borne by the Canadian taxpayer. “The story is not yet ended, and will not be until the CBC decides if it will try an appeal to the Supreme Court of Canada”, to which it must apply for before Sept 10, Myers told The Lancet. Rachelle HB Fishman
court, where damages are capped and usually lower than in state court. Patients may sue their HMOs over a medical decision in a state court, but only after review by an appeals board (if the board rules against them, they have a higher burden of proof); and state courts would operate under a newly created federal law setting uniform standards for HMOs, which will override existing state protections. Further, the House bill caps damages to US$3 million; half of this amount is for punitive damages, which may be awarded only if the outside appeals board had ruled against the HMO. Senate Democrats vowed to defeat the House bill, which is also opposed by the American Medical Association and consumer groups. But the Congress will be under intense pressure to pass legislation on the issue, which polls show is of vital importance to most Americans. Faith McLellan
Uncertainty about Italy’s health service lthough Italy’s recently appointed health minister, Girolamo Sirchia, a transplant physician, in the newly elected government, reassured the nation that public-health services would continue to be inspired by the “founding principles of universality and solidarity”, declarations by Antonio Fazio, the governor of the Bank of Italy, caused widespread concern among doctors last week. Fazio announced “structural changes” in the public-health sector, because “we cannot keep granting everything to all”. On July 26 Giuseppe del Barone, President of Italy’s Medical Council, noted that Italy’s national health service does not “grant everything to everybody”. “Otherwise”, he added, “Italians would not spend US$22 billion annually in the private health-care sector”. Del Barone warned that cuts in public spending must spare the publichealth sector, which is one of the least funded in the European Union, he added. Del Barone demanded cuts in the growing administrative costs and concluded his declarations to the press by reminding everyone that Italy’s Constitution guarantees “the right to health care for all”.
A
Bruno Simini
THE LANCET • Vol 358 • August 11, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.
POLICY AND PEOPLE
US House passes patients’ bill of rights
A
fter a flurry of last-minute dealmaking with the White House, the Republican-led US House of Representatives narrowly passed a patients’ bill of rights on Aug 2, before adjourning for the August Congressional recess. The now Democratic-controlled Senate passed its own, broader version of a patients’ rights bill in June (see Lancet 2001; 358: 46). In September an attempt will be made to reconcile the two bills in a House-Senate conference committee, where legislation died in the last Congress. The House bill includes a controversial amendment limiting patients’ rights to sue their health maintenance organisations (HMOs). The amendment arose from a deal struck between President George Bush and one of the bill’s Republican cosponsors, Republican representative Charles Norwood, of Georgia. The President promised to sign the revised bill into law, which then passed the House by a vote of
226 to 203, split mainly along party lines. Like the Senate bill, the House version offers people in managedcare organisations: the right to appeal to an independent review committee if a patient has been denied care; allowances for women to visit obstetricians and gynaecologists without referral or authorisation; emergency care at the nearest hospital regardless of its plan affiliation; prompt access to specialist care; the right of doctors to prescribe drugs whether or not they are on the plan’s preferred list; and access to clinical trials when no effective standard treatment exists. The two bills differ with respect to enforcement of these rights. The House version is more restrictive than the Senate’s and limits patients’ ability to sue their HMOs in several ways. Class-action lawsuits are eliminated. Suits against employers who administer their own health plans must be filed in federal
Canadian researchers awarded record damages hat began in 1996 as a media insult to two Canadian cardiologists that could have been settled out of court for $35 000, was just decided by the Ontario Court of Appeal in a joint judgment levied against the national television Canadian Broadcasting Corporation, equal to over $2·8 million—one of the highest libel damages in Canadian history. Specifically, the three appeal court justices ruled against the CBC’s the fifth estate, for an episode entitled “the heart of the matter”, aired in 1996 to an estimated one million viewers across Canada. The Court upheld two 1999 lower court trial decisions, ordering the award-winning investigative news programme to pay even greater damages and the full legal costs of the two doctors. Frans Leenen, a medical researcher and director of the Hypertension Unit in Ottawa’s Heart Institute, and Martin Myers, a cardiologist at Toronto’s Sunnybrook and Women’s College Health Sciences Centre, were described as placing personal gain from pharmaceutical industry interests over the protection of public safety, falsely accusing them of callously endangering the lives of thousands of heart patients
W
480
by supporting Bayer’s heart drug nifedipine. The voice-over promotion for the show stated that, “people are dying, people who don’t need to die are dying”. The appeals court further ruled that the CBC had a preconceived notion, revealed in its behind-thescenes records and “privileged information” which, although not intended for public disclosure, was indeed admissible evidence. The trial judges had ruled that although the investigative team had interviewed scores of medical professionals over 14 weeks and understood the debate about the hazards and benefits of drug treatment, they decided to “dramatically simplify a complex medical debate” and had “seriously mischaracterised” the physicians’ positions. The full impact of this suit is yet to be determined, but the costs of the lost suit against this crown corporation will be borne by the Canadian taxpayer. “The story is not yet ended, and will not be until the CBC decides if it will try an appeal to the Supreme Court of Canada”, to which it must apply for before Sept 10, Myers told The Lancet. Rachelle HB Fishman
court, where damages are capped and usually lower than in state court. Patients may sue their HMOs over a medical decision in a state court, but only after review by an appeals board (if the board rules against them, they have a higher burden of proof); and state courts would operate under a newly created federal law setting uniform standards for HMOs, which will override existing state protections. Further, the House bill caps damages to US$3 million; half of this amount is for punitive damages, which may be awarded only if the outside appeals board had ruled against the HMO. Senate Democrats vowed to defeat the House bill, which is also opposed by the American Medical Association and consumer groups. But the Congress will be under intense pressure to pass legislation on the issue, which polls show is of vital importance to most Americans. Faith McLellan
Uncertainty about Italy’s health service lthough Italy’s recently appointed health minister, Girolamo Sirchia, a transplant physician, in the newly elected government, reassured the nation that public-health services would continue to be inspired by the “founding principles of universality and solidarity”, declarations by Antonio Fazio, the governor of the Bank of Italy, caused widespread concern among doctors last week. Fazio announced “structural changes” in the public-health sector, because “we cannot keep granting everything to all”. On July 26 Giuseppe del Barone, President of Italy’s Medical Council, noted that Italy’s national health service does not “grant everything to everybody”. “Otherwise”, he added, “Italians would not spend US$22 billion annually in the private health-care sector”. Del Barone warned that cuts in public spending must spare the publichealth sector, which is one of the least funded in the European Union, he added. Del Barone demanded cuts in the growing administrative costs and concluded his declarations to the press by reminding everyone that Italy’s Constitution guarantees “the right to health care for all”.
A
Bruno Simini
THE LANCET • Vol 358 • August 11, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.