Medical technology and inequity in health care: the case of Korea. (1/28)

There has been a rapid influx of high cost medical technologies into the Korean hospital market. This has raised concerns about the changes it will bring for the Korean health care sector. Some have questioned whether this diffusion will necessarily have positive effects on the health of the overall population. Some perverse effects of uncontrolled diffusion of technologies have been hinted in recent literature. For example, there is a problem of increasing inequity with the adoption of expensive technologies. Utilization of most of the expensive high technology services is not covered by national health insurance schemes; examples of such technologies are Ultra Sonic, CT Scanner, MRI, Radiotherapy, EKG, and Lithotripter. As a result, the rich can afford expensive high technology services while the poor cannot. This produces a gradual evolution of classes in health service utilization. This study examines how health service utilization among different income groups is affected by the import of high technologies. It discusses changes made within the health care system, and explains the circumstances under which the rapid and excessive diffusion of medical technologies occurred in the hospital sector.  (+info)

Assessing the use of nuclear medicine technology in sub-Saharan Africa: the essential equipment list. (2/28)

OBJECTIVE: The primary aim of the survey was to determine the core equipment required in a nuclear medicine department in public hospitals in Kenya and South Africa, and evaluate the capital investment requirements. METHODS: Physical site audits of equipment and direct interviews of medical and clinical engineering professionals were performed, as well as examination of tender and purchase documents, maintenance payment receipts, and other relevant documents. Originally, 10 public hospitals were selected: 6 referral and 4 teaching hospitals. The 6 referral hospitals were excluded from the survey due to lack of essential documents and records on equipment. The medical and technical staff from these hospitals were, however, interviewed on equipment usage and technical constraints. Data collection was done on-site and counter-checked against documents provided by the hospital administration. RESULTS: A list of essential equipment for a nuclear medicine department in sub-Saharan Africa was identified. Quotations for equipment were provided by all major equipment suppliers, local and international. CONCLUSION: A nuclear medicine department requires eight essential pieces of equipment to operate in sub-Saharan Africa. Two additional items are desirable but not essential.  (+info)

Quality and cost of healthcare: a cross-national comparison of American and Dutch attitudes. (3/28)

OBJECTIVE: To compare attitudes of consumers in America and Holland toward the quality and cost of healthcare. STUDY DESIGN: Data were derived from one American (n = 466) and two Dutch (n = 260, n = 1629) surveys. PATIENTS AND METHODS: Questionnaires were completed by respondents. Pairwise comparisons requiring respondents to compare statements with one another were used to assess preferences for quality of care. Respondents were asked to "indicate the extent to which each of the factors listed plays a role in placing demands on the American (Dutch) healthcare system." Factors included the public's tendency to consume, high technology, defensive medicine, decrease in informal care, increase in standard diagnostic procedures, and medicalization. RESULTS: Americans reported comparatively greater concern with empathy, whereas the Dutch were more interested in the continuity of care. Effectiveness, knowledge, information, and patient-physician relationships were ranked higher in both nations than waiting time, autonomy, and efficiency. Respondents in both countries attributed the increase in healthcare cost primarily to the high cost of technology. Compared with their Dutch peers, Americans were less likely to attribute increases in the cost of healthcare to the public tendency to consume and to the decrease in informal care and were more likely to implicate defensive medicine and an increase in diagnostic procedures. CONCLUSIONS: As both nations experience pressures to reduce costs while maintaining and augmenting the quality of healthcare, planners and government officials should tailor their approaches to each nation's problems within the context of their public perspectives. Replication of such studies should help assess the impact of changing societal values on healthcare delivery.  (+info)

The Chinese experience of hospital price regulation. (4/28)

This paper analyzes the distortion effects of the hospital pricing policies in China. To help maintain equitable access to hospital services, the Chinese government regulates prices of hospital services, and provides subsidies to public hospitals. Comparing the regulated fees of selected hospital services with their average unit costs indicates that the average cost-recovery rate of the fees is only 50%. The fees for 90% of the services are less than their average unit costs, while the fees for the high-tech services exceed their costs. Moreover, the State Price Commission allowed a drug profit margin of 15-20% over the wholesale price. The distorted fee schedule affects the behaviour of hospitals. Empirical evidence revealed problems of violation of price regulations (charging a fee exceeding the regulated fee), over-provision of profitable high-tech services and over-prescription of drugs. The Chinese experience shows that low regulated fees cannot reduce the economic burden on patients, and that distorted medical fees can result in distorted service provision and low efficiency of medical resources. Strategies to correct for the price distortions are discussed.  (+info)

A Marxian interpretation of the growth and development of coronary care technology. (5/28)

Cost containment efforts will fail if they continue to ignore the structural relationships between health care costs and private profit in capitalist society. The recent history of coronary care shows that apparent irrationalities of health policy make sense from the standpoint of capitalist profit structure. Coronary care units (CCUs) gained wide acceptance, despite high costs. Studies of CCU effectiveness, using random controlled trials and epidemiologic techniques, do not show a consistent advantage of CCUs over non-intensive ward care or simple rest at home. From a Marxian perspective, the proliferation of CCUs and similar innovations is a complex historical process that includes initiatives by industrial corporations, cooperation by clinical investigators at academic medical centers, support by private philanthropies linked to corporate interests, intervention by state agencies, and changes in the health care labor force. Cost-effective methodology obscures the profit motive as a basic source of high costs and ineffective practices. Health-policy alternatives curtailing corporate involvement in medicine would reduce costs by restricting profit.  (+info)

Use of simulation technology in dental education. (6/28)

Simulation is becoming very beneficial in the area of health care education. Dentistry has used various types of simulation in preclinical education for some time. This article discusses the impact of the current simulation laboratories on dental education and reviews advanced technology simulation that has recently become available or is in the developmental stage. The abilities of advanced technology simulation, its advantages and disadvantages, and its potential to affect dental education are addressed.  (+info)

HMO penetration, competition, and risk-adjusted hospital mortality. (7/28)

OBJECTIVE: HMOs have been shown to have an effect on the care provided directly to their enrollees. They may also influence the care provided to individuals in fee-for-service plans through a spill-over effect. The objective of this study was to investigate the associations among HMO market penetration, HMO and hospital competition, and the quality of care received by Medicare fee-for-service patients measured by risk-adjusted hospital mortality rates. DATA SOURCES: The 1990 data for 1,927 hospitals in 134 metropolitan statistical areas (with five or more hospitals) included Medicare fee-for-service risk-adjusted mortality rates from the Medicare Hospital Information Reports, hospital characteristics from the American Hospital Association annual survey, and HMO market penetration and competition calculated from InterStudy and Group Health Association of America data. STUDY DESIGN: Statistical regression techniques were used to identify the associations between HMO market penetration, competition, and risk-adjusted mortality, controlling for other hospital characteristics and region. PRINCIPAL FINDINGS: Higher HMO market penetration and to a lesser degree increased HMO competition were associated with better mortality outcomes for fee-for-service Medicare enrollees. Competition between hospitals did not exhibit a significant association. CONCLUSIONS: HMOs may have a spill-over effect on quality of care received by individuals enrolled in fee-for-service plans. These findings may be explained by a positive effect on local practice styles or a preferential selection by HMOs for areas with better hospital care.  (+info)

Competition among hospitals for HMO business: effect of price and nonprice attributes. (8/28)

OBJECTIVE: To investigate patterns of competition among hospitals for the business of health maintenance organizations (HMOs). The study focused on the relative importance of hospital price and nonprice attributes in the competition for HMO business. DATA SOURCES/STUDY SETTING: The study capitalized on hospital cost reports from Florida that are unique in their inclusion of financial data regarding HMO business activity. The time frame was 1992 to 1997. STUDY DESIGN: The study was designed as an observational investigation of acute care hospitals. PRINCIPAL FINDINGS: Results indicated that a hospital's share of HMO business was related to both its price and nonprice attributes. However, the importance of both price and nonprice attributes diminished as the number of HMOs in a market increased. Hospitals that were market share leaders in terms of HMO business (i.e., 30 percent or more market share) were superior, on average, to their competitors on both price and nonprice attributes. CONCLUSIONS: Study results indicate that competition among hospitals for HMO business involves a complex set of price and nonprice attributes. The HMOs do not appear to focus on price alone. Hospitals likely to be the most attractive to HMOs are those that can differentiate themselves on the basis of nonprice attributes while being competitive on price as well.  (+info)