Rearranging the compartments: the financing and delivery of care for Australia's elderly.
(65/1951)
Aged care policy in Australia underwent rapid change following the 1996 change of federal government, although continuing to emphasize changing the balance of aged care away from residential care toward community-based care and improving quality of care. This paper examines these policy directions with reference to two specific areas: the differentiation of funding arrangements for the care and accommodation components of residential care, and the targeting of services in community care. In both cases, funding arrangements have been used as a prime mechanism for redrawing the boundaries between different components and levels of care. This process of compartmentalization appears likely to increase the diversity of the Australian aged care system in the future. (+info)
The Nepal National Vitamin A Program: prototype to emulate or donor enclave?
(66/1951)
More than 250 million of the world's children suffer from vitamin A deficiency. Nepal is one of 60 countries in which this deficiency constitutes a significant public health problem. Each year in Nepal, vitamin A deficiency is responsible for the deaths of 9000 children and for 2500 children becoming permanently blind. The Nepal National Vitamin A Program (NVAP) was begun in 1993 in eight of the country's 75 districts. By the end of 1997, the programme covered 32 districts, and by 2003 its coverage will be nationwide. The Nepal NVAP is considered by many to be a highly successful, model programme. It consists primarily of distributing high-dose vitamin A capsules to all children 6 to 60 months of age during twice-yearly campaigns. The capsule distribution is carried out by a previously existing network of Female Community Health Volunteers (FCHVs) that has been reinvigorated by the highly visible and universally acclaimed success of the NVAP. An important strategy of the programme has been the empowerment of the FCHVs, which has been accomplished by organizing, training and motivating community workers and other representatives from education, agriculture and other sectors, as well as political representatives, to support the FCHVs. The annual cost of the NVAP is US$1.7 million. It costs $1.25 to deliver two vitamin A capsules to each participant. The cost per averted death is $327. The NVAP reduces the incidence and severity of diarrhoeal disease and measles, which in turn reduces the need for Ministry of Health services, thereby annually saving the Government of Nepal $1.5 million. Factoring in these cost savings, the net annual cost of the current NVAP is $167,000, and the net annual cost of the permanent, nationwide programme is estimated at $1.1 million. The NVAP is a highly cost-effective programme. The article concludes with a discussion of the sustainability and replicability of the programme. (+info)
False-negative results in screening programmes: systematic review of impact and implications.
(67/1951)
BACKGROUND: When assessing whether a screening programme is appropriate, there is a particular obligation to ensure that the harms as well as the benefits are considered. Among these harms is the likelihood that false-negative results will occur. In some cases, the consequences of these can be difficult to assess, although false reassurance leading to diagnostic delay and subsequent treatment has been suggested. However, no test is totally accurate (with 100% sensitivity and specificity), and false-negative results are inherent in any screening programme that does not have 100% sensitivity. This review was carried out to assess the medical, psychological, economic and legal consequences of false-negative results that occur in national screening programmes. OBJECTIVES: (1) to determine the consequences of false-negative findings; (2) to investigate how their adverse effects can be minimised; to assess their implications for the NHS, including the impact of false-negatives on public confidence in screening programmes; to identify relevant theoretical perspectives that may be potentially useful when considering the implications of false-negative results. METHODS: A systematic literature review was carried out. This included a search of 18 electronic databases, various bibliographies and contact with experts to identify relevant literature and perspectives. Outcomes included in the review fell into four categories: medical outcomes (morbidity and mortality); psychological outcomes (distress, false reassurance, loss of confidence in services); economic outcomes (such as costs to the NHS); legal outcomes (such as litigation). Other outcomes, such as the impact of false-negatives on public confidence in screening programmes, were also included. The participants included individuals taking part in screening programmes, healthcare professionals and organisations responsible for screening programmes. Methodological details of the review are provided in the full report. RESULTS: A total of 6660 abstracts were screened, and 420 potentially relevant papers were identified. Most of the studies that were identified presented only anecdotal evidence. (1) Medical outcomes: In all, 13 papers presented quantitative information relevant to the medical consequences of false-negative results; seven of these were primary studies, and the remaining studies were literature reviews or models examining the likely impact of false-negative results. (2) Psychological outcomes: A total of eight published studies presented information on the psychological consequences of negative results in general; only one study, on antenatal screening, provided direct evidence of the psychological consequences of false-negative results, where they were associated with lower parental acceptance of the affected child and with blaming others for this outcome. (3) Economic outcomes: Only two studies presented information on the economic consequences. The strength of evidence from most of the primary studies was low. There is some evidence that false-negative results may have a large legal impact. For example, in cervical screening they have led to legal action and its associated costs, including payment of compensation; this is based on reports of events in both the UK and US health systems. There also seems to be a consensus in the literature that false-negatives may have a negative impact on public confidence in screening; evidence is again limited however. CONCLUSIONS: False-negatives are evident in all screening programmes, even when the quality of the service provided is high. They may have the potential to delay the detection of breast and cervical cancer, but there is little evidence to help assess their psychological consequences in these or other screening programmes. False-negatives are likely to lead to legal action being taken by those individuals affected, and potentially may reduce public confidence in screening. (ABSTRACT TRUNCATED) (+info)
Feasibility study of multicentre comparison of NHS hospital pharmacy computer data.
(68/1951)
AIMS: This study aims to determine the feasibility of collecting, collating and analysing drug expenditure data from a sample of acute hospitals in England. METHODS: The hospital pharmacy computer system was used to report on drug expenditure from 16 hospitals throughout England for a 2 year period. These data were analysed as a whole and hospital episode statistics were correlated to hospital drug costs. RESULTS: Hospital outpatient costs were found to be approximately one third of hospital inpatient costs. Cardiovascular drugs accounted for the greatest increase in expenditure for both inpatients and outpatients (25%). The most expensive therapeutic area of drug use across all sites was anti-infectives. The average daily number of occupied beds explained 55% of the variation in inpatient expenditure and the number of outpatient (including Accident and Emergency) attendances explained 60% of the outpatient drug expenditure. CONCLUSIONS: This project has confirmed the feasibility of collecting, collating and analysing hospital drug expenditure and identified some interesting patterns and trends in hospital drug use. Hospital activity is reflected in hospital drug costs. (+info)
The quality of care and influence of double health care coverage in Catalonia (Spain).
(69/1951)
AIMS: To analyse inequalities by social class in children's access to and utilisation of health services in Catalonia (Spain), private health insurance coverage, and certain aspects of the quality of care received. DESIGN: Cross sectional study using data from the 1994 Catalan Health Interview Survey. SETTING: Child population of Catalonia. PARTICIPANTS: A representative sample of non-institutionalised children younger than 15 years (n = 2433). MAIN OUTCOME MEASURES: Health services utilisation, perceived health, type of health insurance (only National Health System (NHS) or both NHS and private health insurance), and social class. RESULTS: No inequalities by social class were found for the utilisation of health care services provided by the NHS among children in most need. Double health care coverage does not influence the social pattern of visits. Nevertheless, social inequalities still remain in the use of those health services provided only partially by the NHS (dentist) and when characteristics of the last consultation are taken into account. That is, subjects who paid for a private service waited an average of 14.8 minutes less than those whose visit was paid for by the NHS only. CONCLUSION: Equitable access and use of medical care services in relation to need, regardless of the type of insurance and social class of their children and families, has been achieved in this region of Spain; differences by social class remain for those services incompletely covered by national health insurance and aspects of the quality of care provided. (+info)
Evaluation of a national eye care programme: re-survey after 10 years.
(70/1951)
AIM: To re-survey the Gambia after an interval of 10 years to assess the impact of a national eye care programme (NECP) on the prevalence of blindness and low vision. METHOD: Comparison of two multistage cluster random sample surveys taking into account the marked increase in population in the Gambia, west Africa. Samples of the whole population in 1986 and 1996 were taken. The definition of blindness is presenting vision less than 3/60 in the better eye, or visual fields constricted to less than 10 degrees from fixation. Low vision is less than 6/18 but 3/60 or better. Causes of blindness were determined clinically by three ophthalmologists. RESULTS: The crude prevalence of blindness fell from 0.70% to 0.42%, a relative reduction of 40%. During the same 10 year period, the population increased by 51% from 775 000 to 1 169 000. When the results were standardised for age, a west to east gradient was found for changes in risk of blindness over the 10 year period. This matched the phased west to east introduction of the NECP interventions. There was a modest but significant increase in the risk of low vision across the whole country. CONCLUSIONS: The overall reduction in risk of blindness, in those areas where the NECP has been active, appears to justify the programme and the support of donor organisations. The low vision cases due to cataract must now be addressed. (+info)
Differences in public and private health services in a rural district of Malaysia.
(71/1951)
A cross-sectional study, comparing the nature of services in 15 private clinics and 6 public health facilities, was undertaken in a rural district of Malaysia. Semi-structured interviews and observations using check-lists were employed. Public health facilities were run by younger doctors (mean age = 31.1 years), supported mostly by trained staff. The private clinics were run by older doctors (mean age = 41.2 years) who had served the district for much longer (8.9 years vs 1.5 years) but were supported by less well trained staff. The curative services were the main strength of the private clinics but their provision of preventive care was less comprehensive and of inferior quality. Private clinics were inclined to provide more expensive diagnostic services than the public facilities. 'Short hours' private clinics had very restricted opening hours and offered limited range of services. (+info)
Halting the obesity epidemic: a public health policy approach.
(72/1951)
Traditional ways of preventing and treating overweight and obesity have almost invariably focused on changing the behavior of individuals, an approach that has proven woefully inadequate, as indicated by the rising rates of both conditions. Considering the many aspects of American culture that promote obesity, from the proliferation of fast-food outlets to almost universal reliance on automobiles, reversing current trends will require a multifaceted public health policy approach as well as considerable funding. National leadership is needed to ensure the participation of health officials and researchers, educators and legislators, transportation experts and urban planners, and businesses and nonprofit groups in formulating a public health campaign with a better chance of success. The authors outline a broad range of policy recommendations and suggest that an obesity prevention campaign might be funded, in part, with revenues from small taxes on selected products that provide "empty" calories-such as soft drinks-or that reduce physical activity-such as automobiles. (+info)