Evaluating cost-effectiveness of diagnostic equipment: the brain scanner case.
An approach to evaluating the cost-effectiveness of high-technology diagnostic equipment has been devised, using the introduction of computerised axial tomography (CAT) as a model. With the advent of CAT scanning, angiography and air encephalography have a reduced, though important, role in investigating intracranial disease, and the efficient use of conventional equipment requires the centralisation of neuroradiological services, which would result in major cash savings. In contrast, the pattern of demand for CAT scanning, in addition to the acknowledged clinical efficiency of the scanner and its unique role in the head-injured patient, ephasies the need for improved access to scanners. In the interest of the patients the pattern of service must change. (+info)
The expiry date of man: a synthesis of evolutionary biology and public health.
In industrialised countries, mortality and morbidity are dominated by age related chronic degenerative diseases. The health and health care needs of future populations will be heavily determined by these conditions of old age. Two opposite scenarios of future morbidity exist: morbidity might decrease ("compress"), because life span is limited, and the incidence of disease is postponed. Or morbidity might increase ("expand"), because death is delayed more than disease incidence. Optimality theory in evolutionary biology explains senescence as a by product of an optimised life history. The theory clarifies how senescence is timed by the competing needs for reproduction and survival, and why this leads to a generalised deterioration of many functions at many levels. As death and disease are not independent, future morbidity will depend on duration and severity of the process of senescence, partly determined by health care, palliating the disease severity but increasing the disease duration by postponing death. Even if morbidity might be compressed, health care needs will surely expand. (+info)
Good health care: patient and professional perspectives.
Many health needs assessment exercises are professionally led, employing complex epidemiological methods. An alternative method that gives valuable information about patient preferences is a forced-choice questionnaire, which this study used in five practices in the West of Scotland. In each practice, patient-centred care was the most highly valued attribute of service provision. (+info)
Excess capacity: markets regulation, and values.
OBJECTIVE: To examine the conceptual bases for the conflicting views of excess capacity in healthcare markets and their application in the context of today's turbulent environment. STUDY SETTING: The policy and research literature of the past three decades. STUDY DESIGN: The theoretical perspectives of alternative economic schools of thought are used to support different policy positions with regard to excess capacity. Changes in these policy positions over time are linked to changes in the economic and political environment of the period. The social values implied by this history are articulated. DATA COLLECTION: Standard library search procedures are used to identify relevant literature. PRINCIPAL FINDINGS: Alternative policy views of excess capacity in healthcare markets rely on differing theoretical foundations. Changes in the context in which policy decisions are made over time affect the dominant theoretical framework and, therefore, the dominant policy view of excess capacity. CONCLUSIONS: In the 1990s, multiple perspectives of optimal capacity still exist. However, our evolving history suggests a set of persistent values that should guide future policy in this area. (+info)
Record linkage as a research tool for office-based medical care.
OBJECTIVE: To explore the feasibility of linking records to study health services and health outcomes for primary care patients. DESIGN: A cohort of patients from the Family Medicine Centre at Mount Sinai Hospital was assembled from the clinic's billing records. Their health numbers were linked to the Ontario Hospital Discharge Database. The pattern of hospital admission rates was investigated using International Classification of Diseases (ICD) codes for primary discharge diagnosis. A pilot case-control study of risk factor management for stroke was nested in the cohort. SETTING: Family medicine clinic based in a teaching hospital. PARTICIPANTS: A cohort of 19,654 Family Medicine Centre patients seen at least once since 1991. MAIN OUTCOME MEASURES: Admission rates by age, sex, and diagnosis. Numbers of admissions for individual patients, time to readmission, and length of stay. Odds ratios for admission for cerebrovascular disease. RESULTS: The 19,654 patients in the cohort had 14,299 discharges from Ontario hospitals in the 4 years from 1992 to 1995, including 3832 discharges following childbirth. Some patients had many discharges: 4816 people accounted for the 10,467 admissions excluding childbirth. Excluding transfers between institutions, there were 4975 readmissions to hospital during the 4 years, 1392 (28%) of them within 28 days of previous discharge. Admissions for mental disorders accounted for the greatest number of days in hospital. The pilot study of risk factor management suggested that acetylsalicylic acid therapy might not be effective for elderly primary care patients with atrial fibrillation and that calcium channel blocker therapy might be less effective than other therapies for preventing cerebrovascular disease in hypertensive primary care patients. CONCLUSIONS: Record linkage combined with data collection by chart review or interview is a useful method for studying the effectiveness of medical care in Canada and might suggest interesting hypotheses for further investigation. (+info)
Needs assessment following hurricane Georges--Dominican Republic, 1998.
Hurricane Georges struck the Carribean Islands in September 1998, causing numerous deaths and extensive damage throughout the region. The Dominican Republic was hardest hit, with approximately 300 deaths; extensive infrastructure damage; and severe agricultural losses, including staple crops of rice, plantain, and cassava. Two months after the hurricane, the American Red Cross (ARC) was asked to provide food to an estimated 170,000 families affected by the storm throughout the country. To assist in directing relief efforts, CDC performed a needs assessment to estimate the food and water availability, sanitation, and medical needs of the hurricane-affected population. This report summarizes the results of that assessment, which indicate that, 2 months after the disaster, 40% of selected families had insufficient food > or =5 days per and 28% of families reported someone in need of medical attention. (+info)
The changing elderly population and future health care needs.
The impending growth of the elderly population requires both fiscal and substantive changes in Medicare and Medicaid that are responsive to cost issues and to changing patterns of need. More emphasis is required on chronic disease management, on meaningful integration between acute and long-term care services, and on improved coordination between Medicare and Medicaid initiatives. This paper reviews various trends, including the growth in managed-care approaches, experience with social health maintenance organizations and Program of All-Inclusive Care for the Elderly demonstrations, and the need for a coherent long-term care policy. Such policies, however, transcend health care and require a broad range of community initiatives. (+info)
The future of managed care organization.
This paper analyzes the transformation of the central organization in the managed care system: the multiproduct, multimarket health plan. It examines vertical disintegration, the shift from ownership to contractual linkages between plans and provider organizations, and horizontal integration--the consolidation of erstwhile indemnity carriers, Blue Cross plans, health maintenance organizations (HMOs), and specialty networks. Health care consumers differ widely in their preferences and willingness to pay for particular products and network characteristics, while providers differ widely in their willingness to adopt particular organization and financing structures. This heterogeneity creates an enduring role for health plans that are diversified into multiple networks, benefit products, distribution channels, and geographic regions. Diversification now is driving health plans toward being national, full-service corporations and away from being local, single-product organizations linked to particular providers and selling to particular consumer niches. (+info)