Socioeconomic aspects of peritoneal dialysis in North America: role of non medical factors in the choice of dialysis.
(17/951)
Patients initiating dialysis therapy must make a choice between hemodialysis (HD) and peritoneal dialysis (PD). Controversy persists over the relative merits of each modality in the treatment of end-stage renal disease (ESRD). Issues relating to survival, morbidity, economics, and patient characteristics will all determine the final choice of therapy. Non medical factors are the most important determinant of dialysis modality selection. In the United States, HD has been the more commonly used modality, while PD is underrepresented. This disparity arises from multiple factors including reactions (sometimes incorrect) to the healthcare financing structure, physician biases, and changing demographic patterns in the ESRD population. We discuss these issues and present collected evidence showing that increased use of PD may have substantial overall benefit. (+info)
Family planning funding through four federal-state programs, FY 1997.
(18/951)
CONTEXT: The maternal and child health (MCH) and the social services block grants have long played an important role in the provision of family planning services in the United States. The extent to which states have incorporated family planning services into the newer federally funded, but state-controlled, programs--Temporary Aid to Needy Families (TANF) and the State Children's Health Insurance Program (CHIP)--has yet to be identified. METHODS: The health and social services agencies in all U.S. states, the District of Columbia and five federal jurisdictions were queried regarding their family planning expenditures and activities through the MCH and social services block grants and the TANF program in FY 1997. In addition, the states' CHIP plans were analyzed following their approval by the federal government. Because of differences in methodology, these findings cannot be compared with those of previous attempts to determine public expenditures for contraceptive services and supplies. RESULTS: In FY 1997, 42 states, the District of Columbia and two federal jurisdictions spent $41 million on family planning through the MCH program. Fifteen states reported spending $27 million through the social services block grant. Most of these jurisdictions indicated that they provide direct patient care services, most frequently contraceptive services and supplies. Indirect services--most often population-based efforts such as outreach and public education--were reported to have been provided more often through the MCH program than through the social services program. MCH block grant funds were more likely to go to local health departments, while social services block grant funds were more likely to be channeled through Planned Parenthood affiliates. Four states reported family planning activities funded under TANF in FY 1997, the first year of the program's operation. Virtually all state plans for the implementation of the CHIP program appear to include coverage of family planning services and supplies for the adolescents covered under the program, even when not specifically required to do so by federal law. CONCLUSIONS: Joining two existing--but frequently overlooked--block grants, two new, largely state-controlled programs are poised to become important sources of support for publicly funded family planning services. Now more than ever, supporters of family planning services need to look beyond the traditional sources of support--Title X and Medicaid--as well as beyond the federal level to the states, where important program decisions are increasingly being made. (+info)
Quality of care in mental health: the case of schizophrenia.
(19/951)
Scientific evidence supporting the efficacy of a range of treatments for persons with schizophrenia set the stage for the recent development of evidence-based quality-of-care indicators for this disorder. On the heels of these quality indicators, research has found that treatment services for many persons with schizophrenia are inadequate. Because most of these patients receive their care under public auspices (Medicaid, Medicare, and Veterans Affairs), public health policy can exert considerable influence to address these quality-of-care problems. Publicly funded managed care could promote evidence-based care. It also could coordinate specialty and primary care to improve early detection and general medical care for persons with schizophrenia. (+info)
Office of Research Integrity: a reflection of disputes and misunderstandings.
(20/951)
Each year, the U.S. Public Health Service (PHS) provides billions of dollars to support over 30,000 extramural research grants to more than 2,000 institutions in the U.S. and other countries. The Office of Research Integrity (ORI) is responsible for protecting the integrity of the research supported by the grants awarded for the PHS extramural research program. One of its responsibilities includes monitoring investigations into alleged or suspected scientific misconduct by institutions that receive the PHS funds. However, not all of the alleged or suspected scientific misconduct meet the the PHS definition of scientific misconduct. Among the wide range of allegations that the ORI receives are those that are ultimately determined to be authorship disputes. This article will report on ORI's functions and review some of the commonly reported allegations that do not constitute scientific misconduct according to the PHS definition. (+info)
The Spanish health care system: lessons for newly industrialized countries.
(21/951)
This article summarizes the organization, financing, and delivery of health care services in Spain, and discusses the elements that made it possible to maintain high levels of health among the population, while spending comparatively fewer resources on the health care system than most industrialized countries. The case of Spain is of particular interest for newly industrialized countries, because of the fast evolution that it has undergone in recent years. Considered, by United Nations' economic standards, a developing country until 1964, Spain became in a few years the fastest growing economy in the world after Japan. By the early 1970s the infant mortality rate was already lower than in Britain or the United States. (+info)
Centers needed to study women's environmental health.
(22/951)
The view of women as primarily fecund beings goes back to prehistory, where it is expressed in the well-known series of Venuses--stone figures of women with enlarged breasts, who are often represented as pregnant. Although the Venus figures date from the late Paleolithic era, this view of women did not change much in the next 20,000 years. With the approaching millennium, however, the field of health research has begun to consider women apart from their children or prospective progeny. Reflecting this shift in viewpoint, funds for research on the environmental health of women have now become available. However, no coordinated program has been launched on the scale of the newly established Centers for Children's Environmental Health and Disease Prevention Research (1). Should women, like children, be the focus of a concerted research effort? (+info)
The costs of a Medicare prescription drug benefit.
(23/951)
This paper describes a preliminary cost estimate, prepared by the Congressional Budget Office (CBO), of President Clinton's 1999 prescription drug benefit proposal. The CBO estimated that the new benefit would increase net Medicare outlays by $136 billion between 2002 and 2009, although these estimates are highly uncertain. Because the proposal included an annual cap on the amount of the benefit, it did not require consideration of an important effect of a more comprehensive benefit: higher prices for some drugs. Estimates of future proposals for a Medicare prescription drug benefit may require consideration of that pricing effect. (+info)
Historical analysis of the development of health care facilities in Kerala State, India.
(24/951)
Kerala's development experience has been distinguished by the primacy of the social sectors. Traditionally, education and health accounted for the greatest shares of the state government's expenditure. Health sector spending continued to grow even after 1980 when generally the fiscal deficit in the state budget was growing and government was looking for ways to control expenditure. But growth in the number of beds and institutions in the public sector had slowed down by the mid-1980s. From 1986-1996, growth in the private sector surpassed that in the public sector by a wide margin. Public sector spending reveals that in recent years, expansion has been limited to revenue expenditure rather than capital, and salaries at the cost of supplies. Many developments outside health, such as growing literacy, increasing household incomes and population ageing (leading to increased numbers of people with chronic afflictions), probably fueled the demand for health care already created by the increased access to health facilities. Since the government institutions could not grow in number and quality at a rate that would have satisfied this demand, health sector development in Kerala after the mid-1980s has been dominated by the private sector. Expansion in private facilities in health has been closely linked to developments in the government health sector. Public institutions play by far the dominant role in training personnel. They have also sensitized people to the need for timely health interventions and thus helped to create demand. At this point in time, the government must take the lead in quality maintenance and setting of standards. Current legislation, which has brought government health institutions under local government control, can perhaps facilitate this change by helping to improve standards in public institutions. (+info)