Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures.Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level.Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population.Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.Health Surveys: A systematic collection of factual data pertaining to health and disease in a human population within a given geographic area.Health Care Reform: Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care.Mental Health: The state wherein the person is well adjusted.Health: The state of the organism when it functions optimally without evidence of disease.Attitude to Health: Public attitudes toward health, disease, and the medical care system.Health Care Surveys: Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.Occupational Health Physicians: Physicians employed in a company or corporate setting that is generally not in the health care industry.Health Services Accessibility: The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others.Primary Health Care: Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192)Norprogesterones: Progesterones which have undergone ring contraction or which are lacking carbon 18 or 19.Quality of Health Care: The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.Health Services: Services for the diagnosis and treatment of disease and the maintenance of health.Insurance, Health: Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.World Health: The concept pertaining to the health status of inhabitants of the world.Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium.Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease.Health Services Needs and Demand: Health services required by a population or community as well as the health services that the population or community is able and willing to pay for.Nuclear Receptor Subfamily 4, Group A, Member 2: An orphan nuclear receptor that is found at high levels in BRAIN tissue. The protein is believed to play a role in development and maintenance of NEURONS, particularly dopaminergic neurons.Oligomycins: A closely related group of toxic substances elaborated by various strains of Streptomyces. They are 26-membered macrolides with lactone moieties and double bonds and inhibit various ATPases, causing uncoupling of phosphorylation from mitochondrial respiration. Used as tools in cytochemistry. Some specific oligomycins are RUTAMYCIN, peliomycin, and botrycidin (formerly venturicidin X).Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers.Public Health Administration: Management of public health organizations or agencies.Health Knowledge, Attitudes, Practice: Knowledge, attitudes, and associated behaviors which pertain to health-related topics such as PATHOLOGIC PROCESSES or diseases, their prevention, and treatment. This term refers to non-health workers and health workers (HEALTH PERSONNEL).Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health.Health Status Disparities: Variation in rates of disease occurrence and disabilities between population groups defined by socioeconomic characteristics such as age, ethnicity, economic resources, or gender and populations identified geographically or similar measures.Occupational Health: The promotion and maintenance of physical and mental health in the work environment.Patient Acceptance of Health Care: The seeking and acceptance by patients of health service.Health Care Rationing: Planning for the equitable allocation, apportionment, or distribution of available health resources.Public Health Practice: The activities and endeavors of the public health services in a community on any level.Health Priorities: Preferentially rated health-related activities or functions to be used in establishing health planning goals. This may refer specifically to PL93-641.National Health Programs: Components of a national health care system which administer specific services, e.g., national health insurance.Mental Health Services: Organized services to provide mental health care.Delivery of Health Care, Integrated: A health care system which combines physicians, hospitals, and other medical services with a health plan to provide the complete spectrum of medical care for its customers. In a fully integrated system, the three key elements - physicians, hospital, and health plan membership - are in balance in terms of matching medical resources with the needs of purchasers and patients. (Coddington et al., Integrated Health Care: Reorganizing the Physician, Hospital and Health Plan Relationship, 1994, p7)Women's Health: The concept covering the physical and mental conditions of women.Nuclear Pore: An opening through the NUCLEAR ENVELOPE formed by the nuclear pore complex which transports nuclear proteins or RNA into or out of the CELL NUCLEUS and which, under some conditions, acts as an ion channel.Rural Health: The status of health in rural populations.Health Literacy: Degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.Community Health Services: Diagnostic, therapeutic and preventive health services provided for individuals in the community.Urban Health: The status of health in urban populations.Attitude of Health Personnel: Attitudes of personnel toward their patients, other professionals, toward the medical care system, etc.Child Health Services: Organized services to provide health care for children.World Health Organization: A specialized agency of the United Nations designed as a coordinating authority on international health work; its aim is to promote the attainment of the highest possible level of health by all peoples.Outcome Assessment (Health Care): Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).Community Health Planning: Planning that has the goals of improving health, improving accessibility to health services, and promoting efficiency in the provision of services and resources on a comprehensive basis for a whole community. (From Facts on File Dictionary of Health Care Management, 1988, p299)Rural Health Services: Health services, public or private, in rural areas. The services include the promotion of health and the delivery of health care.Nucleobase, Nucleoside, Nucleotide, and Nucleic Acid Transport Proteins: A broad class of proteins involved in the transport of nucleobases, NUCLEOSIDES; NUCLEOTIDES; and NUCLEIC ACIDS; across membranes.Regional Health Planning: Planning for health resources at a regional or multi-state level.Health Manpower: The availability of HEALTH PERSONNEL. It includes the demand and recruitment of both professional and allied health personnel, their present and future supply and distribution, and their assignment and utilization.Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure.Health Resources: Available manpower, facilities, revenue, equipment, and supplies to produce requisite health care and services.Quality Assurance, Health Care: Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.Community Health Centers: Facilities which administer the delivery of health care services to people living in a community or neighborhood.Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time.Preventive Health Services: Services designed for HEALTH PROMOTION and prevention of disease.Public Health Nursing: A nursing specialty concerned with promoting and protecting the health of populations, using knowledge from nursing, social, and public health sciences to develop local, regional, state, and national health policy and research. It is population-focused and community-oriented, aimed at health promotion and disease prevention through educational, diagnostic, and preventive programs.Health Occupations: Professions or other business activities directed to the cure and prevention of disease. For occupations of medical personnel who are not physicians but who are working in the fields of medical technology, physical therapy, etc., ALLIED HEALTH OCCUPATIONS is available.Reproductive Health: The physical condition of human reproductive systems.Cyclosteroids: Steroid derivatives in which one or more bridges is formed between carbon atoms at any locant in any of the rings.Maternal Health Services: Organized services to provide health care to expectant and nursing mothers.Health Benefit Plans, Employee: Health insurance plans for employees, and generally including their dependents, usually on a cost-sharing basis with the employer paying a percentage of the premium.Occupational Health Services: Health services for employees, usually provided by the employer at the place of work.Health Services for the Aged: Services for the diagnosis and treatment of diseases in the aged and the maintenance of health in the elderly.Public Health Informatics: The systematic application of information and computer sciences to public health practice, research, and learning.Health Services Administration: The organization and administration of health services dedicated to the delivery of health care.National Institutes of Health (U.S.): An operating division of the US Department of Health and Human Services. It is concerned with the overall planning, promoting, and administering of programs pertaining to health and medical research. Until 1995, it was an agency of the United States PUBLIC HEALTH SERVICE.State Health Plans: State plans prepared by the State Health Planning and Development Agencies which are made up from plans submitted by the Health Systems Agencies and subject to review and revision by the Statewide Health Coordinating Council.Health Plan Implementation: Those actions designed to carry out recommendations pertaining to health plans or programs.Politics: Activities concerned with governmental policies, functions, etc.Interviews as Topic: Conversations with an individual or individuals held in order to obtain information about their background and other personal biographical data, their attitudes and opinions, etc. It includes school admission or job interviews.Quality Indicators, Health Care: Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of health care.Catchment Area (Health): A geographic area defined and served by a health program or institution.Reproductive Health Services: Health care services related to human REPRODUCTION and diseases of the reproductive system. Services are provided to both sexes and usually by physicians in the medical or the surgical specialties such as REPRODUCTIVE MEDICINE; ANDROLOGY; GYNECOLOGY; OBSTETRICS; and PERINATOLOGY.Women's Health Services: Organized services to provide health care to women. It excludes maternal care services for which MATERNAL HEALTH SERVICES is available.Health Care Coalitions: Voluntary groups of people representing diverse interests in the community such as hospitals, businesses, physicians, and insurers, with the principal objective to improve health care cost effectiveness.Health Services, Indigenous: Health care provided to specific cultural or tribal peoples which incorporates local customs, beliefs, and taboos.Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.Odontogenic Tumor, Squamous: A well-differentiated, benign, hamartomatous proliferation of odontogenic epithelium, probably arising from the rests of Malassez.Men's Health: The concept covering the physical and mental conditions of men.Ochlerotatus: A genus of mosquitoes in the family CULICIDAE. A large number of the species are found in the neotropical part of the Americas.Family Health: The health status of the family as a unit including the impact of the health of one member of the family on the family as a unit and on individual family members; also, the impact of family organization or disorganization on the health status of its members.Outcome and Process Assessment (Health Care): Evaluation procedures that focus on both the outcome or status (OUTCOMES ASSESSMENT) of the patient at the end of an episode of care - presence of symptoms, level of activity, and mortality; and the process (ASSESSMENT, PROCESS) - what is done for the patient diagnostically and therapeutically.Health Maintenance Organizations: Organized systems for providing comprehensive prepaid health care that have five basic attributes: (1) provide care in a defined geographic area; (2) provide or ensure delivery of an agreed-upon set of basic and supplemental health maintenance and treatment services; (3) provide care to a voluntarily enrolled group of persons; (4) require their enrollees to use the services of designated providers; and (5) receive reimbursement through a predetermined, fixed, periodic prepayment made by the enrollee without regard to the degree of services provided. (From Facts on File Dictionary of Health Care Management, 1988)Urban Health Services: Health services, public or private, in urban areas. The services include the promotion of health and the delivery of health care.Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function.Health Planning Support: Financial resources provided for activities related to health planning and development.Poverty: A situation in which the level of living of an individual, family, or group is below the standard of the community. It is often related to a specific income level.Adolescent Health Services: Organized services to provide health care to adolescents, ages ranging from 13 through 18 years.Schools, Public Health: Educational institutions for individuals specializing in the field of public health.Program Evaluation: Studies designed to assess the efficacy of programs. They may include the evaluation of cost-effectiveness, the extent to which objectives are met, or impact.Social Justice: An interactive process whereby members of a community are concerned for the equality and rights of all.Allied Health Personnel: Health care workers specially trained and licensed to assist and support the work of health professionals. Often used synonymously with paramedical personnel, the term generally refers to all health care workers who perform tasks which must otherwise be performed by a physician or other health professional.Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment; the overall condition of a human life.Community Mental Health Services: Diagnostic, therapeutic and preventive mental health services provided for individuals in the community.Population Surveillance: Ongoing scrutiny of a population (general population, study population, target population, etc.), generally using methods distinguished by their practicability, uniformity, and frequently their rapidity, rather than by complete accuracy.School Health Services: Preventive health services provided for students. It excludes college or university students.Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.Oncorhynchus mykiss: A large stout-bodied, sometimes anadromous, TROUT found in still and flowing waters of the Pacific coast from southern California to Alaska. It has a greenish back, a whitish belly, and pink, red, or lavender stripes on the sides, with usually a sprinkling of black dots. It is highly regarded as a sport and food fish. Its former name was Salmo gairdneri. The sea-run rainbow trouts are often called steelheads. Redband trouts refer to interior populations of rainbows.Great BritainPolicy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.Consumer Participation: Community or individual involvement in the decision-making process.Comprehensive Health Care: Providing for the full range of personal health services for diagnosis, treatment, follow-up and rehabilitation of patients.United States Dept. of Health and Human Services: A cabinet department in the Executive Branch of the United States Government concerned with administering those agencies and offices having programs pertaining to health and human services.Questionnaires: Predetermined sets of questions used to collect data - clinical data, social status, occupational group, etc. The term is often applied to a self-completed survey instrument.Health Fairs: Community health education events focused on prevention of disease and promotion of health through audiovisual exhibits.Rural Population: The inhabitants of rural areas or of small towns classified as rural.Health Food: A non-medical term defined by the lay public as a food that has little or no preservatives, which has not undergone major processing, enrichment or refinement and which may be grown without pesticides. (from Segen, The Dictionary of Modern Medicine, 1992)Age Factors: Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.Qualitative Research: Any type of research that employs nonnumeric information to explore individual or group characteristics, producing findings not arrived at by statistical procedures or other quantitative means. (Qualitative Inquiry: A Dictionary of Terms Thousand Oaks, CA: Sage Publications, 1997)Health Communication: The transfer of information from experts in the medical and public health fields to patients and the public. The study and use of communication strategies to inform and influence individual and community decisions that enhance health.Marketing of Health Services: Application of marketing principles and techniques to maximize the use of health care resources.Needs Assessment: Systematic identification of a population's needs or the assessment of individuals to determine the proper level of services needed.Sex Factors: Maleness or femaleness as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or effect of a circumstance. It is used with human or animal concepts but should be differentiated from SEX CHARACTERISTICS, anatomical or physiological manifestations of sex, and from SEX DISTRIBUTION, the number of males and females in given circumstances.Financing, Government: Federal, state, or local government organized methods of financial assistance.Corneal Diseases: Diseases of the cornea.Social Class: A stratum of people with similar position and prestige; includes social stratification. Social class is measured by criteria such as education, occupation, and income.United States Public Health Service: A constituent organization of the DEPARTMENT OF HEALTH AND HUMAN SERVICES concerned with protecting and improving the health of the nation.Dental Health Services: Services designed to promote, maintain, or restore dental health.Somatotypes: Particular categories of body build, determined on the basis of certain physical characteristics. The three basic body types are ectomorph (thin physique), endomorph (rounded physique), and mesomorph (athletic physique).Suprofen: An IBUPROFEN-type anti-inflammatory analgesic and antipyretic. It inhibits prostaglandin synthesis and has been proposed as an anti-arthritic.Chronic Disease: Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care. (Dictionary of Health Services Management, 2d ed)Prepaid Health Plans: Contracts between an insurer and a subscriber or a group of subscribers whereby a specified set of health benefits is provided in return for a periodic premium.Private Sector: That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests.Health Planning Councils: Organized groups serving in advisory capacities related to health planning activities.International Cooperation: The interaction of persons or groups of persons representing various nations in the pursuit of a common goal or interest.Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time.Program Development: The process of formulating, improving, and expanding educational, managerial, or service-oriented work plans (excluding computer program development).Health Transition: Demographic and epidemiologic changes that have occurred in the last five decades in many developing countries and that are characterized by major growth in the number and proportion of middle-aged and elderly persons and in the frequency of the diseases that occur in these age groups. The health transition is the result of efforts to improve maternal and child health via primary care and outreach services and such efforts have been responsible for a decrease in the birth rate; reduced maternal mortality; improved preventive services; reduced infant mortality, and the increased life expectancy that defines the transition. (From Ann Intern Med 1992 Mar 15;116(6):499-504)Occupational Health Nursing: The practice of nursing in the work environment.Cooperative Behavior: The interaction of two or more persons or organizations directed toward a common goal which is mutually beneficial. An act or instance of working or acting together for a common purpose or benefit, i.e., joint action. (From Random House Dictionary Unabridged, 2d ed)Organizational Objectives: The purposes, missions, and goals of an individual organization or its units, established through administrative processes. It includes an organization's long-range plans and administrative philosophy.Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions.Education, Public Health Professional: Education and training in PUBLIC HEALTH for the practice of the profession.Residence Characteristics: Elements of residence that characterize a population. They are applicable in determining need for and utilization of health services.Suriname: A republic in the north of South America, bordered on the west by GUYANA (British Guiana) and on the east by FRENCH GUIANA. Its capital is Paramaribo. It was formerly called Netherlands Guiana or Dutch Guiana or Surinam. Suriname was first settled by the English in 1651 but was ceded to the Dutch by treaty in 1667. It became an autonomous territory under the Dutch crown in 1954 and gained independence in 1975. The country was named for the Surinam River but the meaning of that name is uncertain. (From Webster's New Geographical Dictionary, 1988, p1167 & Room, Brewer's Dictionary of Names, 1992, p526)Universal Coverage: Health insurance coverage for all persons in a state or country, rather than for some subset of the population. It may extend to the unemployed as well as to the employed; to aliens as well as to citizens; for pre-existing conditions as well as for current illnesses; for mental as well as for physical conditions.Interinstitutional Relations: The interactions between representatives of institutions, agencies, or organizations.Government Agencies: Administrative units of government responsible for policy making and management of governmental activities.Social Determinants of Health: The circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics ( Health Centers: Facilities which administer the delivery of health care services to mothers and children.Urban Population: The inhabitants of a city or town, including metropolitan areas and suburban areas.Pregnancy: The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.Holistic Health: Health as viewed from the perspective that humans and other organisms function as complete, integrated units rather than as aggregates of separate parts.Organizational Case Studies: Descriptions and evaluations of specific health care organizations.Cost-Benefit Analysis: A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. Cost effectiveness compares alternative ways to achieve a specific set of results.History, 20th Century: Time period from 1901 through 2000 of the common era.Australia: The smallest continent and an independent country, comprising six states and two territories. Its capital is Canberra.Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures.National Health Insurance, United StatesEmployment: The state of being engaged in an activity or service for wages or salary.Stress, Psychological: Stress wherein emotional factors predominate.Public Sector: The area of a nation's economy that is tax-supported and under government control.Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc.State Medicine: A system of medical care regulated, controlled and financed by the government, in which the government assumes responsibility for the health needs of the population.Heart Diseases: Pathological conditions involving the HEART including its structural and functional abnormalities.Medically Uninsured: Individuals or groups with no or inadequate health insurance coverage. Those falling into this category usually comprise three primary groups: the medically indigent (MEDICAL INDIGENCY); those whose clinical condition makes them medically uninsurable; and the working uninsured.Factor VII: Heat- and storage-stable plasma protein that is activated by tissue thromboplastin to form factor VIIa in the extrinsic pathway of blood coagulation. The activated form then catalyzes the activation of factor X to factor Xa.Nutritional Sciences: The study of NUTRITION PROCESSES as well as the components of food, their actions, interaction, and balance in relation to health and disease.EnglandHealth Education, Dental: Education which increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of dental health on a personal or community basis.Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.Personal Health Services: Health care provided to individuals.Smoking: Inhaling and exhaling the smoke of burning TOBACCO.Health Facility Administration: Management of the organization of HEALTH FACILITIES.Decision Making, Organizational: The process by which decisions are made in an institution or other organization.Social Responsibility: The obligations and accountability assumed in carrying out actions or ideas on behalf of others.BrazilMedical Informatics: The field of information science concerned with the analysis and dissemination of medical data through the application of computers to various aspects of health care and medicine.Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see LINEAR MODELS) the relationship is constrained to be a straight line and LEAST-SQUARES ANALYSIS is used to determine the best fit. In logistic regression (see LOGISTIC MODELS) the dependent variable is qualitative rather than continuously variable and LIKELIHOOD FUNCTIONS are used to find the best relationship. In multiple regression, the dependent variable is considered to depend on more than a single independent variable.Public Health Dentistry: A dental specialty concerned with the prevention of disease and the maintenance of oral health through promoting organized dental health programs at a community, state, or federal level.Managed Care Programs: Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.Time Factors: Elements of limited time intervals, contributing to particular results or situations.Local Government: Smallest political subdivisions within a country at which general governmental functions are carried-out.Life Style: Typical way of life or manner of living characteristic of an individual or group. (From APA, Thesaurus of Psychological Index Terms, 8th ed)Demography: Statistical interpretation and description of a population with reference to distribution, composition, or structure.Minority Health: The concept covering the physical and mental conditions of members of minority groups.State Government: The level of governmental organization and function below that of the national or country-wide government.Information Services: Organized services to provide information on any questions an individual might have using databases and other sources. (From Random House Unabridged Dictionary, 2d ed)Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals.Vulnerable Populations: Groups of persons whose range of options is severely limited, who are frequently subjected to COERCION in their DECISION MAKING, or who may be compromised in their ability to give INFORMED CONSENT.Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial.Information Dissemination: The circulation or wide dispersal of information.Consumer Satisfaction: Customer satisfaction or dissatisfaction with a benefit or service received.Research: Critical and exhaustive investigation or experimentation, having for its aim the discovery of new facts and their correct interpretation, the revision of accepted conclusions, theories, or laws in the light of newly discovered facts, or the practical application of such new or revised conclusions, theories, or laws. (Webster, 3d ed)Community-Institutional Relations: The interactions between members of a community and representatives of the institutions within that community.Mass Screening: Organized periodic procedures performed on large groups of people for the purpose of detecting disease.African Americans: Persons living in the United States having origins in any of the black groups of Africa.Heart Function Tests: Examinations used to diagnose and treat heart conditions.Pilot Projects: Small-scale tests of methods and procedures to be used on a larger scale if the pilot study demonstrates that these methods and procedures can work.Federal Government: The level of governmental organization and function at the national or country-wide level.Follow-Up Studies: Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.Cost of Illness: The personal cost of acute or chronic disease. The cost to the patient may be an economic, social, or psychological cost or personal loss to self, family, or immediate community. The cost of illness may be reflected in absenteeism, productivity, response to treatment, peace of mind, or QUALITY OF LIFE. It differs from HEALTH CARE COSTS, meaning the societal cost of providing services related to the delivery of health care, rather than personal impact on individuals.Employer Health Costs: That portion of total HEALTH CARE COSTS borne by an individual's or group's employing organization.Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly.IndiaMaternal Welfare: Organized efforts by communities or organizations to improve the health and well-being of the mother.Leadership: The function of directing or controlling the actions or attitudes of an individual or group with more or less willing acquiescence of the followers.

*  EDITORIAL: Rationing health care

... The Washington Times ^ , April 21, 2009 , EDITORIAL Posted on 04/21/2009 10:15:06 AM PDT by ... 700 billion a year out of our health care system.' Let's be clear - Mr. Summers is talking about rationing. . . .. ... KEYWORDS: healthcare; hillarycare; obama; rationing; rinoromney; romney; romneycare; washingtontimes Navigation: use the links ... Socialized Medicine aka Universal Health Care PING LIST. FReepmail me if you want to be added to or removed from this ping list ...

*  Health Care, Insurance, Rationing [Mackinac Center]

Although it is true that government would ration health care under universal coverage, it is also true that rationing would ... The best health care system will alleviate these shortages quickly and distribute the remaining scarce health care services to ... Present in several health care debates is a fear that universal coverage will result in the rationing of services. ... Health care is scarce, and therefore it is absolutely necessary that rationing take place. There is, however, a distinct ...

*  Desperately Seeking Solutions: Rationing Health Care | The BMJ

Healthcare rationing, according to Professor Hunter's summary of the rationing debate, is inevitable and, since the case of " ... Desperately Seeking Solutions: Rationing Health Care. BMJ 1999; 318 doi: (Published 02 ... However, rationing is difficult to justify, he says, because society is not yet ready for clear rules about when to deny ... South Staffordshire and Shropshire Healthcare NHS Foundation Trust: Consultant Psychiatrist Derby Teaching Hospitals NHS ...

*  Another Obama Advisor Favors Health Care Rationing

Rationing Hospital Care. Six years later, the team wrote Rationing Health Care: The Choice Before Us. In 2005, Aaron teamed ... Can We Say No? argues that sensible health care rationing not only can save money, but can improve public health and general ... "The simplest way to slow the growth of health care spending is to cap resources available to health care providers." He noted ... Far from a passing interest, it would be fair to say advocacy for health care rationing has been the defining goal of Aaron's ...

*  Moonbattery: Healthcare Rationing Primer

The effect is rationed care:. At least there's good news for those with AIDS; as a reward for their typical lifestyle, the ... Healthcare Rationing Primer. Posted by Dave Blount at August 13, 2009 6:45 PM ... Government involvement in healthcare means political priorities will determine which diseases receive resources. ...

*  Putting effectiveness into the health care equation: Rational or rationing?

ACP: Putting effectiveness into the health care equation: Rational or rationing?. Kevin , Policy , July 30, 2009 ... ACP: Putting effectiveness into the health care equation: Rational or rationing? 17 comments ... A health care solution to rival single payer. Matthew Hahn, MD , Policy * 9 reasons the "golden age of medicine" was golden. ... favoring the use of treatment A or limiting the use of treatment B is rational use of healthcare, not rationing. Rationing, on ...

*  House Republicans Try to Stop IPAB From Rationing Health Care |

House Republicans Try to Stop IPAB From Rationing Health Care. National Jennifer Popik, J.D. Jan 14, 2013 , 6:23PM Washington, ... The health care law then empowers the federal Department of Health and Human Services to implement these recommendations by ... one at the core of rationing in the Obama health care law. (See ... The health care law instructs the IPAB to make recommendations to limit what all Americans are legally allowed to spend for ...

*  In Reply: Health Care Rationing | Science

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*  Rationing Health Care « Healthcare Economist

Rationing Health Care. Written By: Jason Shafrin - Jul• 20•09. The N.Y. Times Magazine has a nice piece on rationing health ... health care is a scarce good an must be rationed. Unlike most goods, healthy people generally do not demand zero medical care, ... "Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most ... In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high ...

*  House votes on ObamaCare anniversary to repeal health care 'rationing board' | Human Events

Healthcare. House votes on ObamaCare anniversary to repeal health care 'rationing board'. Audrey Hudson Follow @AudreyHudson , ... access to care. IPAB does just the opposite - it threatens seniors' access to health care - and that is why it must be repealed ... "We need to reform health care, but this reform made things worse," McConnell said. "The evidence and broken promises are all- ... Thursday's vote marked the 26th time the House has voted to repeal, defund, or dismantle significant portions of the health care ...

*  Reform Other Aspects Of Health Care System Before Addressing Rationing - tribunedigital-sunsentinel

Rationing is one of the most sensitive issues in the health-care debate.The word has been used variously, but I will use it to ... If reform does not solve the economic problems of health care, we will have to reduce benefits, i.e, ration health care or ask ... Rationing is one of the most sensitive issues in the health-care debate. ... The Clinton health planners say rationing will not be needed in the new, more efficient system they are proposing. But some ...

*  Progressive Healthcare Rationing Archives - Better Health - Better Health

... health policy, healthcare reform, true stories, disease management and expert interviews. ... Better Health is a network of healthcare professional blogs, offering commentary on news, research, ... Better Health Audio. Featured Audio. Healthy VisionTM with Dr. Val: Safe Contact Lens Wear and Care. ... Progressive Healthcare Rationing: What Will It Look Like?. Tweet November 1st, 2010 by DrRich in Better Health Network, Health ...

*  Sarah Palin Warns: Vote Out Obama Democrats or Face More Rationed Health Care

"Government health care will not reduce the cost; it will simply refuse to pay the cost." Friends, that's rationed care. That's ... Sarah Palin Warns: Vote Out Obama Democrats or Face More Rationed Health Care. May 21, 2014 by Jim Hoft *Total: 77 ... Sarah Palin warned Americans on Facebook Wednesday to vote out Obama Democrats or face more rationed health care.. Via Sarah ... America's health care system will go the way of the VA. That's why Obama's Democrat party must be defeated in the ballot box in ...

*  I would like to thank the pro-health care rationing folks for their help.

... DIARY / Moe Lane // Posted at 2:00 pm on September 3 ... 49% "have a favorable opinion of those opposing the health care reforms at town hall meetings" (41% last month). ... "say that it's more important for Congressmen to hear the view of their constituents rather than explain the proposed health care ...

*  Healthcare Rationing: When Is It OK? - Better Health - Better Health

... health policy, healthcare reform, true stories, disease management and expert interviews. ... Better Health is a network of healthcare professional blogs, offering commentary on news, research, ... Better Health Audio. Featured Audio. Healthy VisionTM with Dr. Val: Safe Contact Lens Wear and Care. ... Better Health Channels. Better Health , Health Policy , Video , Audio , Interviews , News , Health Tips , Opinion , Book ...

*  Rationing comes to Massachusetts « Healthcare Economist

Posted in Current Events, Health Insurance , Accountable Care Organizations, ACO, Cost control, Massachusetts, Rationing , 4 ... For five years after that, any rise in health care costs would need to be half a percentage point lower than the increase in ... Massachusetts legislature passed a first-in-the-nation bill limits the growth of health care costs in the state. ... "The bill would not allow spending on health care to grow any faster than the state's economy through 2017. ...

*  Why bioethicists have nothing useful to say about health care rationing. | Journal of Medical Ethics

Bioethicists who want to make a practical difference should either approach health care resource allocation as if the matter ... Bioethicists are increasingly commenting on health care resource allocation, and sometimes suggest ways to solve various ... and examine the health system from the outside. ... Why bioethicists have nothing useful to say about health care ... rationing dilemmas ethically. I argue that both because of the assumptions bioethicists make about social reality, and because ...

*  Uganda's minimum health package for health care: rationing within the minimum? - GOV.UK

Health Policy and Development Journal (2004) 2 (1). Links. Uganda's minimum health package for health care: rationing within ... Essential/minimum health care packages (MHCP) have appeared on the primary health care scene as a means of setting priorities ... for national health budgets. A technical approach of cost-effectiveness was sought to guide the political and group bargaining ... of the MCHP are traced at the infrastructure-based planning and in explicit and implicit re-prioritization and rationing within ...

*  Health Care Lie #493: Rationing - 2parse by Joe Campbell

Rationing Health Care. This entry was posted on Monday, August 31st, 2009 at 9:15 am and is filed under Health care, Politics, ... Health Care Lie #493: Rationing. By Joe Campbell August 31st, 2009 Ezra Klein does a pretty good job taking down the rhetorical ... 2 Responses to "Health Care Lie #493: Rationing". * shawn. Says: September 1st, 2009 at 8:57 am that image is seriously creepy. ... "government takeover of health care" that critics are directing their fire at. It isn't about "rationing." In fact, what it ...

*  Simple Facts: The Truth About Obamacare, Dying And Health Care Rationing - Judie Brown Commentary - News | American Life League

Finally, many ask whether or not health care "reform" could lead to rationing of health care. This is not a crazy question. To ... I am not an expert on health care rationing and end-of-life questions. But I know how to find experts, and the leadership of ... Simple Facts: The Truth About Obamacare, Dying And Health Care Rationing August 12, 2009 09:00 AM ... Home.News.Simple Facts: The Truth About Obamacare, Dying And Health Care Rationing ...

* | Medicare Counseling Reg Not a Death Panel: But Health Care Rationing a Clear and Present Danger

Obama administration has sights set on government rationing of health care. ... Have you ever met a physician who is interested in rationing health care? After all, rationing health care is in no way ... Yet those who continue to object point out that this provides physicians to push a government agenda designed to ration health care ... Has Ungar never heard of capitation? Hospitals could benefit financially from health care rationing because Medicare pays them ...

*  U.S. GAO - VA Health Care: Variabilities in Outpatient Care Eligibility and Rationing Decisions

VA Health Care:. Variabilities in Outpatient Care Eligibility and Rationing Decisions. HRD-93-106: Published: Jul 16, 1993. ... discretionary outpatient care in 1991 to varying degrees; and (4) the VA medical centers that ration care make their rationing ... outpatient care, focusing on how VA: (1) determines veterans' eligibility for outpatient care; and (2) rations care when ... VA Health Care Quality: VA Should Improve the Information It Publicly Reports on the Quality of Care at Its Medical Facilities ...

*  Notwithstanding Paul Krugman's Assurances, the United Kingdom Announces More Healthcare Rationing | International Liberty

Under Obama care everyone will have healthcare. It will become substandard, difficult to access health care within a few short ... Health Care, Health Reform, Third party payer, United Kingdom , Tagged England, Entitlements, Government-run healthcare, ... In every country with government-only health care - a public option monopoly - medicine and treatment are rationed on a ... Bad enough when YOU have to budget healthcare YOU can't pay for, WORSE when the government rations healthcare you DID pay for ...

*  The New American | Healthcare

The decision is not whether or now we will ration care…. The decision is whether we will ration with our eyes open. And right ... community organizations around the country are finding innovative solutions to improve our health care system and the Health Care ... Obama Nominee for Social Security Board Favors Healthcare Rationing Written by Brian Koenig ... Charitable Healthcare: Taking Healthcare Backward to Move It Forward Written by Fr. James Thornton ...

*  On the Edge: It's Health Care Rationing

A deductible is the amount consumers owe for covered health-care services before their insurance plan begins to pay. The report ... Almost one out of three of these adults said they went without needed medical care because the out-of-pocket cost was too high. ... "The key culprit as to why people have been unable to afford medical care despite having year-round coverage is high deductibles ... People who don't have health insurance through their employers find they can't afford the monthly premiums.. People who can ...

Self-rated health: Self-rated health (also called Self-reported health, Self-assessed health, or perceived health) refers to both a single question such as “in general, would you say that you health is excellent, very good, good, fair, or poor?” and a survey questionnaire in which participants assess different dimensions of their own health.Public Health Act: Public Health Act is a stock short title used in the United Kingdom for legislation relating to public health.Global Health Delivery ProjectHealth policy: Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific health care goals within a society."World Health Organization.Rock 'n' Roll (Status Quo song)Lifestyle management programme: A lifestyle management programme (also referred to as a health promotion programme, health behaviour change programme, lifestyle improvement programme or wellness programme) is an intervention designed to promote positive lifestyle and behaviour change and is widely used in the field of health promotion.American Association of Public Health Physicians: The American Association of Public Health Physicians (AAPHP), is a professional association of public health physicians. Its motto is "the voice of Public Health Physicians / Guardians of the Public's Health".Halfdan T. MahlerContraceptive mandate (United States): A contraceptive mandate is a state or federal regulation or law that requires health insurers, or employers that provide their employees with health insurance, to cover some contraceptive costs in their health insurance plans. In 1978, the U.Outline of obstetrics: The following outline is provided as an overview of and topical guide to obstetrics:Nuclear receptor related-1 protein: The Nuclear receptor related 1 protein (NURR1) also known as NR4A2 (nuclear receptor subfamily 4, group A, member 2) is a protein that in humans is encoded by the NR4A2 gene. NURR1 is a member of the nuclear receptor family of intracellular transcription factors.Behavior change (public health): Behavior change is a central objective in public health interventions,WHO 2002: World Health Report 2002 - Reducing Risks, Promoting Healthy Life Accessed Feb 2015 http://www.who.Great Lakes Environmental Research Laboratory: right|300px|thumb|Great Lakes Environmental Research Laboratory logo.WHO collaborating centres in occupational health: The WHO collaborating centres in occupational health constitute a network of institutions put in place by the World Health Organization to extend availability of occupational health coverage in both developed and undeveloped countries.Network of WHO Collaborating Centres in occupational health.Aging (scheduling): In Operating systems, Aging is a scheduling technique used to avoid starvation. Fixed priority scheduling is a scheduling discipline, in which tasks queued for utilizing a system resource are assigned a priority each.National Collaborating Centre for Mental Health: The National Collaborating Centre for Mental Health (NCCMH) is one of several centres of the National Institute for Health and Care Excellence (NICE) tasked with developing guidance on the appropriate treatment and care of people with specific conditions within the National Health Service (NHS) in England and Wales. It was established in 2001.Women's Health Initiative: The Women's Health Initiative (WHI) was initiated by the U.S.Comprehensive Rural Health Project: The Comprehensive Rural Health Project (CRHP) is a non profit, non-governmental organization located in Jamkhed, Ahmednagar District in the state of Maharashtra, India. The organization works with rural communities to provide community-based primary healthcare and improve the general standard of living through a variety of community-led development programs, including Women's Self-Help Groups, Farmers' Clubs, Adolescent Programs and Sanitation and Watershed Development Programs.European Immunization Week: European Immunization Week (EIW) is an annual regional initiative, coordinated by the World Health Organization Regional Office for Europe (WHO/Europe), to promote immunization against vaccine-preventable diseases. EIW activities are carried out by participating WHO/Europe member states.Healthy community design: Healthy community design is planning and designing communities that make it easier for people to live healthy lives. Healthy community design offers important benefits:Society for Education Action and Research in Community Health: Searching}}Sharon Regional Health System: Sharon Regional Health System is a profit health care service provider based in Sharon, Pennsylvania. Its main hospital is located in Sharon; additionally, the health system operates schools of nursing and radiography; a comprehensive pain management center across the street from its main hospital; clinics in nearby Mercer, Greenville, Hermitage, and Brookfield, Ohio; and Sharon Regional Medical Park in Hermitage.Minati SenResource leak: In computer science, a resource leak is a particular type of resource consumption by a computer program where the program does not release resources it has acquired. This condition is normally the result of a bug in a program.Northeast Community Health CentreMaternal Health Task ForceDenplanBasic Occupational Health Services: The Basic Occupational Health Services are an application of the primary health care principles in the sector of occupational health. Primary health care definition can be found in the World Health Organization Alma Ata declaration from the year 1978 as the “essential health care based on practical scientifically sound and socially accepted methods, (…) it is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work (…)”.Essence (Electronic Surveillance System for the Early Notification of Community-based Epidemics): Essence is the United States Department of Defense's Electronic Surveillance System for the Early Notification of Community-based Epidemics. Essence's goal is to monitor health data as it becomes available and discover epidemics and similar health concerns before they move out of control.Implementation research: Implementation research is the scientific study of methods to promote the uptake of research findings. Often research projects focus on small scale pilot studies or laboratory based experiments, and assume that findings can be generalised to roll out into a practice based domain with few changes.Opinion polling in the Philippine presidential election, 2010: Opinion polling (popularly known as surveys in the Philippines) for the 2010 Philippine presidential election is managed by two major polling firms: Social Weather Stations and Pulse Asia, and several minor polling firms. The polling firms conducted surveys both prior and after the deadline for filing of certificates of candidacies on December 1, 2009.Psychiatric interview: The psychiatric interview refers to the set of tools that a mental health worker (most times a psychiatrist or a psychologist but at times social workers or nurses) uses to complete a psychiatric assessment.Integrated catchment management: Integrated catchment management is a subset of environmental planning which approaches sustainable resource management from a catchment perspective, in contrast to a piecemeal approach that artificially separates land management from water management.Open Fuel Standard Coalition: The Open Fuel Standard Coalition is a bipartisan group in the United States actively working for passage of H.R.Squamous odontogenic tumor: The squamous odontogenic tumor is a rare odontogenic tumor found in any area of the alveolar bone. Usually, there is a painless swelling with adjacent teeth becoming mobile.Gay Men's Health Crisis: The GMHC (formerly Gay Men's Health Crisis) is a New York City–based non-profit, volunteer-supported and community-based AIDS service organization whose mission statement is "end the AIDS epidemic and uplift the lives of all affected."Ochlerotatus triseriatus: Ochlerotatus triseriatus is also known by the synonym Aedes triseriatus and is a member of the true fly family. This species is a tree hole breeding mosquito in eastern North America.Mental disorderPoverty trap: A poverty trap is "any self-reinforcing mechanism which causes poverty to persist."Costas Azariadis and John Stachurski, "Poverty Traps," Handbook of Economic Growth, 2005, 326.Jiann-Ping Hsu College of Public Health: The Jiann-Ping Hsu College of Public Health is one of the eight colleges of Georgia Southern University, located in Statesboro, Georgia, in the United States.Standard evaluation frameworkInjustice SocietyTime-trade-off: Time-Trade-Off (TTO) is a tool used in health economics to help determine the quality of life of a patient or group. The individual will be presented with a set of directions such as:Community mental health service: Community mental health services (CMHS), also known as Community Mental Health Teams (CMHT) in the United Kingdom, support or treat people with mental disorders (mental illness or mental health difficulties) in a domiciliary setting, instead of a psychiatric hospital (asylum). The array of community mental health services vary depending on the country in which the services are provided.Proportional reporting ratio: The proportional reporting ratio (PRR) is a statistic that is used to summarize the extent to which a particular adverse event is reported for individuals taking a specific drug, compared to the frequency at which the same adverse event is reported for patients taking some other drug (or who are taking any drug in a specified class of drugs). The PRR will typically be calculated using a surveillance database in which reports of adverse events from a variety of drugs are recorded.

(1/684) The cost of obesity in Canada.

BACKGROUND: Almost one-third of adult Canadians are at increased risk of disability, disease and premature death because of being obese. In order to allocate limited health care resources rationally, it is necessary to elucidate the economic burden of obesity. OBJECTIVE: To estimate the direct costs related to the treatment of and research into obesity in Canada in 1997. METHODS: The prevalence of obesity (body mass index of 27 or greater) in Canada was determined using data from the National Population Health Survey, 1994-1995. Ten comorbidities of obesity were identified from the medical literature. A population attributable fraction (PAF) was calculated for each comorbidity with data from large cohort studies to determine the extent to which each comorbidity and its management costs were attributable to obesity. The direct cost of each comorbidity was determined using data from the Canadian Institute of Health Information (for direct expenditure categories) and from Health Canada (for the proportion of expenditure category attributable to the comorbidity). This prevalence-based approach identified the direct costs of hospital care, physician services, services of other health professionals, drugs, other health care and health research. For each comorbidity, the cost attributable to obesity was determined by multiplying the PAF by the total direct cost of the comorbidity. The overall impact of obesity was estimated as the sum of the PAF-weighted costs of treating the comorbidities. A sensitivity analysis was completed on both the estimated costs and the PAFs. RESULTS: The total direct cost of obesity in Canada in 1997 was estimated to be over $1.8 billion. This corresponded to 2.4% of the total health care expenditures for all diseases in Canada in 1997. The sensitivity analysis revealed that the total cost could be as high as $3.5 billion or as low as $829.4 million; this corresponded to 4.6% and 1.1% respectively of the total health care expenditures in 1997. When the contributions of the comorbidities to the total cost were considered, the 3 largest contributors were hypertension ($656.6 million), type 2 diabetes mellitus ($423.2 million) and coronary artery disease ($346.0 million). INTERPRETATION: A considerable proportion of health care dollars is devoted to the treatment and management of obesity-related comorbidities in Canada. Further research into the therapeutic benefits and cost-effectiveness of management strategies for obesity is required. It is anticipated that the prevention and treatment of obesity will have major positive effects on the overall cost of health care.  (+info)

(2/684) Selection for oesophagectomy and postoperative outcome in a defined population.

OBJECTIVE: To measure the extent of use of, and perioperative mortality from, oesophagectomy for carcinoma of the oesophagus, and to examine the association between oesophagectomy and long term survival. DESIGN: Retrospective cohort study of cases of oesophageal carcinoma notified to the Thames Cancer Registry. SETTING: South East Thames and South West Thames health regions. PATIENTS: 3273 patients first registered with carcinoma of the oesophagus during 1985-9, 789 of whom were excluded because of incomplete data, leaving 2484 (75.9%) for further analysis. MAIN MEASURES: Treatment of oesophagectomy, mortality within 30 days of oesophagectomy, and duration of survival from date of diagnosis to death, according to patient and tumour characteristics. RESULTS: Oesophagectomy was performed in 571(23.0%) patients. Its use decreased with increasing age (odds ratio (95% confidence interval) 0.935(0.925 to 0.944) per year) and was less common for tumours of the middle or upper third of the oesophagus than the lower third (0.56(0.42 to 0.75)). The proportion of patients undergoing oesophagectomy varied threefold among the 28 districts of residence. The perioperative mortality rate was 15.1(86/571) (12% to 18%); it increased with age (odds ratio 1.05(1.02 to 1.08) per year) and for tumours of the middle or upper third of the oesophagus compared with the lower third (2.52(1.31 to 4.84)). Long term survival was slightly higher for patients undergoing oesophagectomy (0.5% v 0.2%). CONCLUSIONS: Despite a high perioperative mortality rate patients selected for oesophagectomy showed better long term survival than those who were not, suggesting that clinical judgements used in selection were independent markers of a better prognosis. The nature of this selection needs to be more completely characterised to permit a valid evaluation of outcome of oesophagectomy.  (+info)

(3/684) Resource allocation for public hospitals in Andhra Pradesh, India.

The composition of the hospital sector has important implications for cost effectiveness accessibility and coverage. The classification of acute general hospitals is reviewed here with particular reference to India and Andhra Pradesh. Approaches to arrive at a norm for allocation of hospital expenditure among secondary and tertiary hospitals are discussed. The actual allocation of public sector hospital expenditures is analyzed with data from Andhra Pradesh. The shift in allocative emphasis away from hospitals and in favour of primary health care during the 1980s was found to have been equally shared by secondary and tertiary hospitals. The shares of recurrent (non-plan) expenditure to secondary and tertiary hospitals were 51% and 49% respectively. This can be compared to a derived norm of 66% and 33%. The opportunity that new investment funds (plan schemes) could have provided to rectify the expenditure bias against secondary level hospitals was missed as two-thirds of plan expenditure were also spent on tertiary level hospitals. The share of secondary hospital bed capacity was 45.5% against India's Planning Commission norm of 70%. Public spending strategies should explicitly consider what mix of hospital services is being financed as well as the balance between hospital and primary health care expenditures.  (+info)

(4/684) Ability to pay for health care: concepts and evidence.

In many developing countries people are expected to contribute to the cost of health care from their own pockets. As a result, people's ability to pay (ATP) for health care, or the affordability of health care, has become a critical policy issue in developing countries, and a particularly urgent issue where households face combined user fee burdens from various essential service sectors such as health, education and water. Research and policy debates have focused on willingness to pay (WTP) for essential services, and have tended to assume that WTP is synonymous with ATP. This paper questions this assumption, and suggests that WTP may not reflect ATP. Households may persist in paying for care, but to mobilize resources they may sacrifice other basic needs such as food and education, with serious consequences for the household or individuals within it. The opportunity costs of payment make the payment 'unaffordable' because other basic needs are sacrificed. An approach to ATP founded on basic needs and the opportunity costs of payment strategies (including non-utilization) is therefore proposed. From the few studies available, common household responses to payment difficulties are identified, ranging from borrowing to more serious 'distress sales' of productive assets (e.g. land), delays to treatment and, ultimately, abandonment of treatment. Although these strategies may have a devastating impact on livelihoods and health, few studies have investigated them in any detail. In-depth longitudinal household studies are proposed to develop understanding of ATP and to inform policy initiative which might contribute to more affordable health care.  (+info)

(5/684) Choice and accountability in health promotion: the role of health economics.

Choices need to be made between competing uses of health care resources. There is debate about how these choices should be made, who should make them and the criteria upon which they should be made. Evaluation of health care is an important part of this debate. It has been suggested that the contribution of health economics to the evaluation of health promotion is limited, both because the methods and principles underlying economic evaluation are unsuited to health promotion, and because the political and cultural processes governing the health care system are more appropriate mechanisms for allocating health care resources than systematic economic analysis of the costs and benefits of different health care choices. This view misrepresents and misunderstands the contribution of health economics to the evaluation of health promotion. It overstates the undoubted methodological difficulties of evaluating health promotion. It also argues, mistakenly, that economists see economic evaluation as a substitute for the political and cultural processes governing health care, rather than an input to them. This paper argues for an economics input on grounds of efficiency, accountability and ethics, and challenges the critics of the economic approach to judge alternative mechanisms for allocating resources by the same criteria.  (+info)

(6/684) Audit in the therapy professions: some constraints on progress.

AIMS: To ascertain views about constraints on the progress of audit experienced by members of four of the therapy professions: physiotherapy, occupational therapy, speech and language therapy, and clinical psychology. METHODS: Interviews in six health service sites with a history of audit in these professions. 62 interviews were held with members of the four professions and 60 with other personnel with relevant involvement. Five main themes emerged as the constraints on progress: resources; expertise; relations between groups; organisational structures; and overall planning of audit activities. RESULTS: Concerns about resources focused on lack of time, insufficient finance, and lack of access to appropriate systems of information technology. Insufficient expertise was identified as a major constraint on progress. Guidance on designing instruments for collection of data was the main concern, but help with writing proposals, specifying and keeping to objectives, analysing data, and writing reports was also required. Although sources of guidance were sometimes available, more commonly this was not the case. Several aspects of relations between groups were reported as constraining the progress of audit. These included support and commitment, choice of audit topics, conflicts between staff, willingness to participate and change practice, and concerns about confidentiality. Organisational structures which constrained audit included weak links between heads of professional services and managers of provider units, the inhibiting effect of change, the weakening of professional coherence when therapists were split across directorates, and the ethos of regarding audit findings as business secrets. Lack of an overall plan for audit meant that while some resources were available, others equally necessary for successful completion of projects were not. CONCLUSION: Members of four of the therapy professions identified a wide range of constraints on the progress of audit. If their commitment to audit is to be maintained these constraints require resolution. It is suggested that such expert advice, but also that these are directed towards the particular needs of the four professions. Moreover, a forum is required within which all those with a stake in therapy audit can acknowledge and resolve the different agendas which they may have in the enterprise.  (+info)

(7/684) Aid instruments and health systems development: an analysis of current practice.

There has been a clear shift in the policy of many donors in the health sector-away from discrete project assistance towards more broad-based sectoral support. This paper, based on interviews with officials in a number of bilateral and multilateral agencies, explores whether this shift in policy has been matched by similar changes in the form or range of aid instruments. The paper develops a framework for examining current practice in relation to the different objectives that donors seek to promote through technical and financial assistance. In particular, it looks in some detail at the advantages and disadvantages of budgetary support compared to more traditional forms of project assistance. It concludes that the debate should not be about whether one form of aid is better than another. Ideally, they should be complementary and the forms, channels and systems used for managing aid need to be assessed in relation to how they help to achieve the mix of development objectives that are most appropriate to the country concerned. The review demonstrates that this is a complex task and that to achieve an effective balance is not easy. The final section summarizes the main themes emerging from the discussion and suggests some preliminary conclusions and proposals for future action.  (+info)

(8/684) Costs and financing of improvements in the quality of maternal health services through the Bamako Initiative in Nigeria.

This paper reports on a study to assess the quality of maternal health care in public health facilities in Nigeria and to identify the resource implications of making the necessary quality improvements. Drawing upon unifying themes from quality assurance, basic microeconomics and the Bamako Initiative, locally defined norms were used to estimate resource requirements for improving the quality of maternal health care. Wide gaps existed between what is required (the norm) and what was available in terms of fixed and variable resources required for the delivery of maternal health services in public facilities implementing the Bamako Initiative in the Local Government Areas studied. Given such constraints, it was highly unlikely that technically acceptable standards of care could be met without additional resource inputs to meet the norm. This is part of the cost of doing business and merits serious policy dialogue. Revenue generation from health services was poor and appeared to be more related to inadequate supply of essential drugs and consumables than to the use of uneconomic fee scales. It is likely that user fees will be necessary to supplement scarce government budgets, especially to fund the most critical variable inputs associated with quality improvements. However, any user fee system, especially one that raises fees to patients, will have to be accompanied by immediate and visible quality improvements. Without such quality improvements, cost recovery will result in even lower utilization and attempts to generate new revenues are unlikely to succeed.  (+info)


  • In prior posts, DrRich introduced his readers to Ezekiel Emanuel, M.D., Ph.D., brother of Rahm, eminent medical ethicist, and one of the White House's chief advisers on healthcare policy. (
  • The reason the ideas (and pronouncements) of Dr. Emanuel are important is that he presumably will be a major "decider" in determining who will serve on the GOD panels , and how those panels will operate to advance his (and Mr. Obama's) program of healthcare reform. (
  • So, before we leave Dr. Emanuel to his important duties, let us take one more pass at the views he has expressed, regarding the direction of American healthcare, which we can expect to see manifested in government guidelines and policies in the coming years. (
  • In particular, and especially relevant to the subject of this blog, let us view how Dr. Emanuel would direct the rationing of our healthcare. (
  • Jupe then continues, quoting Ezekiel Emanuel on setting rules for healthcare rationing. (


  • In 2000, Aaron wrote , "The problem is that in the real world of limited medical resources, denial of beneficial care is inescapable. (


  • Healthcare rationing, according to Professor Hunter's summary of the rationing debate, is inevitable and, since the case of "Child B," which exploded the myth that the NHS would pay for any treatment, we all know that it is inevitable. (
  • Rationing is inevitable. (
  • Once you accept those 2 absolutes, then rationing is inevitable. (


  • IPAB, a little-remarked component of the health care bill, is charged with finding "savings" for the government, although its proponents insist this will fall short of rationing. (
  • The Independent Payment Advisory Board, or IPAB, has remained one of the most controversial provisions of the Obama health care law since its passage. (
  • Integral to the Obama Administration's stated mission to drive down what Americans choose to spend for life-saving and health-preserving health care, the IPAB is charged with a key role in suppressing health care spending by limiting what treatment doctors are allowed to give their patients. (
  • The health care law instructs the IPAB to make recommendations to limit what all Americans are legally allowed to spend for their health care to hold it below the rate of medical inflation. (
  • IPAB does just the opposite - it threatens seniors' access to health care - and that is why it must be repealed. (
  • said, "This rationing board conceived by Democrats' threatens seniors' access to care by requiring seniors and Americans with disabilities to pay for IPAB in order to cut their Medicare benefits," Akin said. (


  • If the objective of health care reform is to increase costs and force future generations to bear the burden of massive debt, then the proposal now before Congress is the best choice. (
  • If the objective of health care reform is to lower costs and increase coverage, it is necessary to eliminate insurance in areas where it is unneeded in order to utilize the efficient rationing mechanism of market prices. (
  • Effectiveness" has become a buzzword these days in discussions about healthcare reform. (
  • We need to reform health care, but this reform made things worse," McConnell said. (
  • If reform does not solve the economic problems of health care, we will have to reduce benefits, i.e, ration health care or ask those who can afford it to pay more out of pocket. (


  • Whether the need for rationing would be obviated cannot be known until the reforms are tried. (
  • 49% "have a favorable opinion of those opposing the health care reforms at town hall meetings" (41% last month). (
  • For the rest of us, the health care reforms being discussed now won't reverse this privileged position for the rich. (


  • estimate that we could take as much as $700 billion a year out of our health care system. (
  • Although it is true that government would ration health care under universal coverage, it is also true that rationing would take place under a purely private system. (
  • There is, however, a distinct difference between the rationing that would take place under a government-controlled system compared to a private one. (
  • Individuals demanding health care under a private system would ration by responding to market prices and limited incomes. (
  • Individuals demanding health care under a government system would have no incentive to ration because everything would be provided for "free. (
  • Regardless of structure of the health care system, temporary shortages will emerge as the desires and health issues of individuals change over time. (
  • The best health care system will alleviate these shortages quickly and distribute the remaining scarce health care services to those who desire them most. (
  • A private system, on the other hand, uses prices to separate those who desire health care services from those who do not. (
  • So why doesn't our current health care system function like the example above? (
  • Although our health care system is among the freest in the world, it still shares several undesirable traits with universal coverage. (
  • For instance, our current system is heavily dominated by employer-paid health insurance, which is the result of price controls placed on wages during WWII. (
  • The choice is most dangerous, since Aaron has a decades-long record as an advocate of denying American patients health care along the lines of the British national health system. (
  • Giving the State control over such fundamental goods as health care encourages sycophancy, corruption, and the formation of a medical spoils system. (
  • Even before we tackle the more nuanced decision process that incorporates dollars and value judgments, we can significantly reduce cost and improve our healthcare system by assuring that we provide care that is effective, not overused or misused. (
  • But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. (
  • We are not prepared to turn our health system over to the government. (
  • The Clinton health planners say rationing will not be needed in the new, more efficient system they are proposing. (
  • A new system based on managed care is likely to change these incentives. (
  • To understand why rationing won't work in the present U.S. system, one needs to appreciate its success in other countries like Canada and the United Kingdom. (
  • Rationing can therefore be applied equitably and effectively across the entire system. (
  • Rationing could not be applied uniformly and even if it were, any cost savings in one area would not prevent continued or even accelerated increases elsewhere in the system. (
  • In short, rationing cannot be fairly or effectively used without first changing to a universal insurance system and a fixed budget. (
  • It's no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. (
  • That's why Congress has got to change because until we elect leaders who'll buck the march to socialized medicine known as Obamacare , America's health care system will go the way of the VA. That's why Obama's Democrat party must be defeated in the ballot box in November. (
  • In his last post , DrRich considered the differences between a system of healthcare rationing in which individual autonomy is honored, and one in which the good of the collective takes precedence. (
  • Bioethicists who want to make a practical difference should either approach health care resource allocation as if the matter hinged upon tribal competition (which is essentially what it does), or they should do political philosophy in the traditional sense, and examine the health system from the outside. (
  • System capacity constraints for effective and equitable delivery of the MCHP are traced at the infrastructure-based planning and in explicit and implicit re-prioritization and rationing within the minimum package. (
  • It's because they get to cut the line and get treated ahead of those with less financial status because our system rations by money. (
  • In fact, what it seeks to do is address the rationing our system already does. (


  • Sarah Palin warned Americans on Facebook Wednesday to vote out Obama Democrats or face more rationed health care. (


  • DrRich interprets Jupe's question as follows: Why does it intuitively seem OK to ration healthcare in the manner described in the first instance, but not in manner described in the second? (


  • Health care is scarce, and therefore it is absolutely necessary that rationing take place. (
  • Health care is a scarce resource, and all scarce resources are rationed in one way or another. (
  • As I've said many times before , health care is a scarce good an must be rationed. (


  • The state wants to ration certain low-priority services to its Medicaid population in order to free up money to cover all indigent residents with services of higher priority. (


  • Bioethicists are increasingly commenting on health care resource allocation, and sometimes suggest ways to solve various rationing dilemmas ethically. (


  • The authors explain why serious consideration of health care rationing in the United States is advisable, even inescapable. (
  • Some say that cost effectiveness and comparative effectiveness are just code words for rationing, whereas others say that consideration of these two concepts is a rational approach to patient care and to controlling escalating healthcare costs. (


  • The bill would not allow spending on health care to grow any faster than the state's economy through 2017. (


  • Rep. Tom Rooney (R-Fla.) said he supported the liability language and that "ending this European-style rationing board and cutting down on junk lawsuits are critical steps toward repealing ObamaCare and replacing it with proposals that will actually make health care more affordable. (
  • have predicted would result, and which has resulted under state-run healthcare in U.S. states like Massachusetts and other countries, if Obamacare passed. (


  • argues that sensible health care rationing not only can save money, but can improve public health and general welfare as well…The choices the British have made point up the nature of the options Americans will face if they wish to prevent health care budgets from driving taxes higher and private spending from crowding out increases in other forms of worker compensation and consumption. (
  • They will be disqualified from contracting with any of the health insurance plans that individual Americans, under the Obama Health Care Law, will be mandated to purchase. (
  • The article also mentions Richard Kronick, a UCSD professor and member of my dissertation committee, and his research suggests that "there is little evidence to suggest that extending health insurance to all Americans would have a large effect on the number of deaths in the United States. (
  • With more and more Americans becoming eligible for Medicare each day, no time is more urgent than now to secure the future of beneficiaries' access to care. (
  • finally, for a small number of Americans to start, and then perhaps for a larger portion if the program is successful, it will provide a choice of health insurance plans in a functioning and transparent market for individuals which our current mish-mash of Wall Street-run health insurance companies and hodge-podge of regulations isn't able to provide. (


  • Essential/minimum health care packages (MHCP) have appeared on the primary health care scene as a means of setting priorities for national health budgets. (


  • Government involvement in healthcare means political priorities will determine which diseases receive resources. (


  • While the focus throughout this debate has been on the IPAB's authority to cut Medicare with very limited Congressional authority to override or alter those cuts, National Right to Life has been emphasizing a still graver concern - one at the core of rationing in the Obama health care law. (
  • This unaccountable board has but one objective - to save money by restricting access to health care for Medicare beneficiaries," said Rep. Dave Camp (R-Mich.) chairman of the House Ways and Means Committee. (


  • Its continued existence has been fueled by the federal tax code, which encourages the insurance of routine health services and masks real costs, resulting in high prices. (
  • Will we be forced to ration care in order to control costs? (
  • But it is morally reprehensible since only the poor would be affected and there would be no overall savings in health-care costs. (
  • Massachusetts legislature passed a first-in-the-nation bill limits the growth of health care costs in the state . (
  • For five years after that, any rise in health care costs would need to be half a percentage point lower than the increase in the state's gross domestic product. (
  • The bill sets up "…a new commission would monitor the growth in health costs and enforce the spending targets. (


  • would start with the establishment by the federal government of a ceiling on U.S. health care spending. (
  • That is, in effect, a more than $200 billion government subsidy for health care. (
  • This moderate plan bears little resemblance to the " government takeover of health care " that critics are directing their fire at. (


  • Rationing is one of the most sensitive issues in the health-care debate. (


  • This does not mean that all health insurance is bad. (
  • In other words, there is a definite need for health insurance to cover life's tragedies. (
  • When health insurance extends beyond the realm of life's tragedies, it can be destructive to the economy. (
  • if you have good insurance and/or personal assets, you get good care. (
  • Our goal should be to cover all individuals through private health insurance. (


  • Over time, competition and the resulting innovation should lower prices and make health care services more affordable for everyone. (


  • Again, some react negatively to this concept, saying either that it limits physicians' independence in decision-making, or that it is also a form of rationing of care. (
  • I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. (


  • Unlike most goods, healthy people generally do not demand zero medical care, so some people are under the assumption that medical care is only for the sick and thus should not be rationed. (


  • House Speaker Nancy Pelosi (D-Calif.), who famously said "we have to pass the bill so that you can find out what is in it" before Congress and voted in favor of the president's health care plan, defended the law as an original intention of the founders. (


  • Rather than proclaiming there will be no rationing - he points out that we already do ration. (


  • The rate of growth is too much now - but we don't need to reduce our levels of health care spending to that of Great Britain. (


  • Why shouldn't we apply the same approach to our health, trying to understand whether treatment A is better than treatment B? (


  • Present in several health care debates is a fear that universal coverage will result in the rationing of services. (
  • The health care law then empowers the federal Department of Health and Human Services to implement these recommendations by imposing so-called "quality" and "efficiency" measures on health care providers. (
  • An obvious example is not guaranteeing health services to patients with dementia. (
  • How do we want to allocate our limited health care technology and services? (


  • He noted hopefully, "Confronted with severe limits on equipment and staffing that necessitates denial of beneficial care to patients in Britain, one physician stated that there are always some reasons not to treat particular patients . (
  • hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals. (

growth of health care

  • Aaron wrote explicitly, "The simplest way to slow the growth of health care spending is to cap resources available to health care providers. (


  • Eliminating unnecessary tests that do not directly improve a patient's care is rational, not rationing, and a critical component of helping us get out of the current healthcare quagmire. (



  • Perhaps these emotionally charged and divergent reactions to the terms "cost effectiveness" and "comparative effectiveness" can be avoided by focusing on the word "effectiveness" and the need to minimize care that is overused or misused. (


  • Most feel helpless about improving their work conditions or solving technical problems in patient care. (



  • If treatment A is shown to be better than treatment B, favoring the use of treatment A or limiting the use of treatment B is rational use of healthcare, not rationing. (
  • Rationing, on the other hand, would be limiting the use of treatment A, the favored treatment. (


  • Aaron, a Brookings Institution scholar, has devoted his entire career to creating an intellectual and economic basis for health care rationing. (

choose to spend

  • How much of our national wealth are we going to choose to spend on health care? (


  • I think we can bypass the need to address such unanswerable questions by first focusing on low-hanging fruit, namely whether a particular diagnostic or therapeutic intervention is at all worthwhile for patient care. (