Insurance access control

There is a clear impasse arising between society s desire for new and better drugs and the barriers society is erecting to their development and introduction. These barriers, based on a valid desire to improve the standards of safety and efficacy and to insure ethical control in clinical evaluation, increase developmental costs. There is a real danger of bringing the development process and access to clinical resources to a halt."(l)... 

In the United States, the access control and the control of sojourn is very strict with regards to the unemployment insurance. Concerning social assistance benefits, the rule that benefits are paid up to a maximum of 60 months during the whole lifetime is even more rigorous. US activation addresses in a holistic manner all entities concerned, i.e. the job seekers and their families, the employers and, last but not least, the state itself. The high degree of indirect promotion (e.g. by minimum wages, premiums for jobs and tax reduction both for employers and employees) for low paid jobs is remarkable. US labour market policy often comprehends financial incentives as the better way for activation. The practice of sanctions underlines this idea. 

When a therapist is evaluating a patient who demonstrates intermittent loss of impulse control, it is important to look for the sequence of events that kindled the condition. Sometimes, one discovers an obsessional antecedent to the loss of control, and this may respond very well to antiobsessional medication. The woman in the example that follows could have had an intermittent explosive disorder, a personality disorder, or other diagnoses but given her poverty and lack of health care insurance or access, she would probably have received no treatment. Had she been wealthy, she might have received psychotherapy, which may have helped, given time. However, medication management did result in prompt remission of her symptoms, and it may have saved her life and that of her son. In some cases, medication consultation for a patient with one of the impulse control disorders can be a life-saving collaboration between therapist and physician (see case example below). 

These similarities are offset by contrasts in their health insurance arrangements, access of patients to the political process, the authority wielded by physicians, and social insurance systems. For example, health care in the United States is generally seen as a private good associated with individual choice and the availability of menus for insurance, thereby rationing care by price. In Germany, by contrast, health care is seen primarily as a right or entitlement. It serves as an instrument of broader social justice, and rationing, if at all, is controlled by providers on a local and individual level. 

In the United States, on the other hand, treatment in intensive care units helped maintain control over unruly subjects and eliminated some of the uncertainties of insurance reimbursement and potential liability from adverse reactions. Patients had little control over either the treatment regimen or any other aspect of their daily lives while receiving Proleukin. In both countries, clinical trials—before and after Proleukin s market authorization—served as sites for data collection and patient care. Despite their loss of autonomy in the intensive care unit, patients with terminal diseases in the United States played a greater role in debates over access to the experimental treatment than their German counterparts, a contrast that gained additional saliency with the rise of HIV-AIDS. 

In the United States, federal legislation called the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to make patient information more strictly protected than before. Although most pharmaceutical companies have limited access to patient names and other health information, any patient information must be carefully guarded to avoid violation of HIPAA statutes, which address the use and disclosure of individuals medical information by covered entities , and set standards for individuals rights to control the use of their medical information. Violations can result in fines and/ or, in some instances, imprisonment. 

In France, activation is achieved by means of a strict control of access to social security. Here, it has to be distinguished between non-contributoiy systems for the needy and contributory insurance systems, i.e. the insurances branches which attribute social benefits on the basis of former payment of social contributions. But job seekers who are not entitled to such social benefits may have access to activation measures with the objective to get a job, especially by special contracts, i.e. contrats aides. ... 

OTA found only one attempt to bring together industrywide data to determine if product liability inhibits pharmaceutical innovation. In a 1991 study, Viscusi and Moore compiled data for pharmaceuticals and several other manufacturing industries for the lfost half of the 1980s on both product liability insurance experience and innovation (501). They concluded that during the period examined pharmaceuticals were both relatively innovative and subject to a volatile liability burden-that do not lend support to the hypothesis that product liability inhibits innovation. However, their study does not control for other factors that might have affected innovation.18 In addition, their examination of industrywide data may obscure differences in access to various types of pharmaceuticals. 

The motor carrier must ensure that access to this data is limited to those who are involved in the hiring decision or who control access to the data. In addition, the motor carrier s insurer may have access to the data, except the alcohol and controlled substances data. 

If the business owns the building, it may have more control over building access, whereas the landlord or the landlord s insurer may prevent a business in rented premises from gaining access. This also applies to speed of repairs, how insurance payouts are used to repair or upgrade the building, and the disruption this has on access to the building. These decisions are typically in the hands of the owner (with some constraints from emergency services and the insurer), while a renter or lessee may find that they have limited influence over such decisions. 

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