6 July 2018
on course website
Health Law & Economics: The Necessity for Efficient Compliance
Why is healthcare compliance necessary or desirable? At a global scale, it may be suggested that it is. Notable examples, like the $1.7 billion Medicare fraud in the Columbia/HCA case, suggest that poor compliance may lead to significant monetary losses. Worldwide, other scandals reached the news, not only pertaining to fraud but also to other issues, like privacy and safety breaches, drug prices, and over-prescription of medication and services. This course gives insight into (the causes of) these problems - including the economic issues of an inefficient health care marketplace - and the preventative function of a good compliance plan.
Health Care is a highly charged topic in the US and the EU. Many diverse, often conflicting views indicate the importance of healthcare as a “right”; where quality and quantity can vary greatly among regions and socioeconomic groups, and where costs have been soaring much faster than in their economic sectors. Compliance - (the duty to) act according to legal rules and accepted standards - affects all healthcare providers, big and small. While some providers perceive it to be an essential part of ensuring quality, safety, availability, and costs, others perceive it to be bureaucratically complicated and often over-reaching. Many healthcare providers and hospitals have been affected by scandals that were caused by inadequate compliance. Internationally, well-known British cases include the Alder Hey Organs scandal, which involved the unauthorized removal, retention, and disposal of human tissue; the Stafford hospital scandal which concerns poor care and high mortality rates amongst patients and the Furness General Hospital scandal which is about the intentionally destroying of medical records alongside the discovery of major wrongdoing on behalf of midwives. In addition, the VUmc faced criminal proceedings after it came to light that this Dutch hospital had allowed a TV-show to film seven patients in emergency care without prior permission. Also, the Dutch Meavita case indicates how inadequate corporate governance of a home-care provider may lead to bankruptcy.
A very recent case with important economic overtones (August 2017) is about two of the USA’s largest cancer-care providers, which are accused of closing an illegal “gentlemen’s agreement” to divide up treatment services in Florida.
Fraud and other threats to the sustainability of the healthcare system and/or the healthcare provided to people cannot be cured by the market. Legal and ethical rules are needed to discipline healthcare providers. The first known rule of Health law is the Hippocratic Oath which dates back to the days of the Ancient Greek around 420 BCE. This oath contains the promise to keep everything the practitioner sees or hears in the lives of his patients secret (actually the first known protection of privacy of the patient), the promise to do no harm to the patient but also to not do an abortion or give a lethal medicine to the patient even when he asks for that (actually a ban on euthanasia). Since then the scope of what is called Health Law has widened enormously.
According to T.K. Hervey and J.V. McHale, European Health law, Cambridge Press 2015, p. 20 the following six core elements of modern Health Law can be identified: “a concern with human rights; professional liability; access to and practising of health care professions and regulating health care institutions; funding and organization of health systems; public health and regulation of human material in health contexts.”
From an economics standpoint, the critical question can be posed asking why a free-market seems to be inadequate in addressing health care provision, and the ethical questions of profit-driven enterprises being entrusted with the provision of what society sees as a critical public good.
Obviously, not all elements of Health can be dealt with in this introductory course of one week. The focus will be (a) on how healthcare institutions are regulated and the way compliance of these rules within a healthcare institution should be organized (day 1 and 2), (b) how health systems are funded an organized (day 3); (c) how the right to privacy of the patient (which is a fundamental human right) is protected in the EU and why patients deserve protection of their privacy (part of day 3); (d) how the compliance of Healthcare rules can be monitored by one (or more) national Healthcare Supervising Authorities (the other part of day 3); (e) how healthcare systems are organized and funded (day 4) and (f) how a fair competition between healthcare providers is (in the Netherlands and the EU) regulated and how problems in a healthcare institution can be detected by, e.g. by facilitating whistle blowers (part of day 5).
An interesting part of this course will be the group presentations of the participants in which they will discuss a topic case of a Health scandal in a country of their choice, and analyse how this could have been or can be prevented (second part of day 5).
Prof. dr. Wilco J. Oostwouder
To equip law & economics students and young professionals with an insight into the background and development of Healthcare Law and Compliance. This course is also recommended for those who study or have studied health sciences or medicine. The assignment will stimulate participants to apply this knowledge to one of the big scandals while also practicing academic writing skills.
Certificate of Attendance
EUR 625: Course + course materials
EUR 200: Housing
on course website