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At least 487 records · Page 27Linked to original sources
PubMed1984

The uninsured and the financing of uncompensated care: scope, costs, and policy options.

Access to health care services for the poor and uninsured and financing hospital bad debt and charity care costs encompass two separate and different sets of public policy concerns. However, the two are increasingly considered together by policy makers concerned that future marketplace pressures will challenge hospitals' willingness and ability to provide free care to the poor. This paper explores this presumption, looking at the characteristics and the magnitude of the uninsured population, the cost of bad debt and charity care, and the distribution of those costs among hospitals and among third-party payers. Four broad policy approaches directed at assuring access to care are raised, and the strengths and weaknesses of each approach are discussed.

Adult↗
PubMed1983

Influenza vaccination.

Cost-effectiveness analysis was used to evaluate influenza vaccination. From 1971-1972 through 1977-1978, vaccination of an elderly person 65 years of age or older saved net medical care costs while improving health. Vaccination of younger high-risk adults aged 15 through 64 years also improved health for a low net cost per year of healthy life gained. By covering influenza vaccination during those years, the Medicare program would have incurred a net cost for each vaccination of $13 per year of healthy life gained for medical costs connected with influenza and $791 per year gained including costs of treating other illnesses in later life. The analysis indicates the need for epidemiologic research on the extent of influenza and the mechanism of its spread. The results also raise the issue of public policy to promote influenza vaccination among high-risk persons as a low-cost, preventive technology.

Adolescent↗
PubMedDate not supplied

[Economic aspects of health care for the elderly].

Group-specific analysis of health care in the Federal Republic of Germany is in its infancy. Health care of the elderly is discussed in regard to health status, utilization, expenditures and financing. The empirical approach offers results that are of importance in a policy context, in particular if they are further developed by an interdisciplinary effort in health services research. The results, if published regularly, provide answers to the question whether supply and utilization of health services correspond with the need of the elderly.

Aged↗
PubMed1993

The angels of Bataan.

Fifty years ago, the strategic Battle of Bataan marked the end of American dominance in the Philippine Islands. Historians record the combat on that peninsula, during the winter and spring of 1942, as among the most brutal the United States Army and Navy ever fought. Eighty-eight women, including the first group of American military nurses to be sent into the field in World War II and 25 Filipina nurses endured the entire battle. The purpose of this article is to examine their experiences during the four months these nurses lived and worked through combat, starvation and illness on Bataan. Analysis of primary archival material from federal, private and military sources and nine oral history interviews indicate the women successfully adjusted from peacetime to war roles. They learned that individual and group self-reliance could help them survive the worse in war. From their earliest memoirs to recent interviews, the nurses displayed both a pride in their service and a sense of grief at the losses suffered on Bataan.

History, 20th Century↗
PubMed1993

[Radiologic findings in the kidney of children with severe reflux. Five-year comparative study of conservative and surgical treatment].

The renal findings revealed by intravenous urography (IVU) in 306 children (73 boys, 233 girls) are reported. The children were seen at eight European centres and enrolled in an international study comparing medical and surgical management of children with urinary tract infection and severe vesico-ureteric reflux who were followed for 5 years. In all, 155 children were randomly allocated to medical and 151 to surgical treatment. The protocol and the investigative techniques were standardized, and randomization, data collection and analysis were performed centrally in Essen, Federal Republic of Germany. At entry 149 (49%) had established renal scarring (79 medical, 70 surgical). Presence of normal kidneys (105), areas of thinned parenchyma (52) and grade of reflux were also evenly distributed. IVU was repeated at 6, 18 and 54 months, and serial urine culture, 99mtechnetium-dimer-captosuccinic acid scans and plasma creatinine estimations were performed. Follow-up was complete in 272 children (89%). In 174 children (57%: 90 medical, 84 surgical) there was renal growth without morphological change. New renal scars developed in 19 children treated medically and 20 treated surgically; 12 (5 medical, 7 surgical) developed in previously normal kidneys. Six followed postoperative obstruction. No significant difference in outcome was found between medical and surgical management in terms of the development of new renal lesions or the progression of established renal scars.

Anti-Bacterial Agents↗
PubMed1993

Ethics and the Human Genome Project.

This article provides an overview of ethical issues in genetic testing and screening as they are currently considered in relationship to the Human Genome Project. Previous landmark reports and policy recommendations on genetic testing and screening are briefly described. The goals and research interests of the joint National Institutes of Health/Department of Energy Ethical, Legal, and Social Working Group of the Human Genome Project are outlined. To provide an example of one method by which ethical issues in genetics may be addressed, the ethical framework and practical aspects of a clinical ethics research project at the University of Washington, Seattle, are described. Finally, future directions for the study of ethical and social issues related to genetic testing and screening programs are suggested.

Advisory Committees↗
PubMedDate not supplied

Ethical issues in the handling of bloodborne pathogens: evaluating the Occupational Safety & Health Administration Bloodborne Pathogen Standard.

The Occupational Safety & Health Administration Bloodborne Pathogen Standard is designed to help provide protection from contamination in the workplace. Healthcare professionals must evaluate the standard and the behaviors mandated therein, according to the basic professional ethical principles of professional autonomy, beneficence, and cost-benefit considerations. The patient's wellbeing provides the focus for making such an assessment.

Beneficence↗
PubMed1979

Quality Assurance in diagnostic radiology: an irreverent view of a sacred cow: annual oration in honor of Albert Soiland, M.D.

The problem of federal regulation of radiologic practice is examined via an in-depth analysis of the Proposed Recommendations for Diagnostic Radiology Facility Quality Assurance Programs as published in the Federal Register by the Commissioner of Food and Drugs. It is shown that the need for such recommendations is not established, that the program proposed by the Commissioner is potentially burdensome for the radiologist, that it does not address the most significant causes of unnecessary patient irradiation, and that the benefits expected to derive from it are, in fact, negligible. This is not to denigrate the value of well-conceived quality assurance efforts, and measures are suggested that might more reasonably be expected to reduce the radiation exposure of the public. The radiologist is urged to 1) conduct his practice in as faultless a manner as possible; and 2) exercise his right to respond to proposals of the federal regulatory agencies.

Cost-Benefit Analysis↗
PubMed1995

Medicaid matching formula, federal subsidies, and Medicaid payments.

The federal government uses the Medicaid matching formula to distribute federal funds to states to finance various social welfare programs involving billions of dollars. How does the formula affect the distribution of federal money? How would that distribution change if a revised formula were used? This article presents the results of a regression analysis on Medicaid payments in the states and the federal subsidies for states to finance Medicaid. The findings indicate that under the current Medicaid matching formula, fewer federal subsidy dollars per poor person go to states with lower per capita incomes and to states with a higher percentage of African Americans than to states with the opposite characteristics. Even under the revised formula, states with lower per capita incomes would receive the same amount of federal matching dollars per poor person as would states with higher per capita incomes. The implications for policy are discussed.

Data Collection↗
PubMedDate not supplied

[Clinico-immunologic monitoring of HIV-infected patients: comparative analysis of indicators, characterizing development of the disease].

The paper contains the results of a 15-year monitoring (since 1986 to 2001) of HIV-infected patients followed up at the clinic of the Institute of Immunology, Federal Department "Medbioextrem", Russia's Health Ministry. An analysis of a category of HIV-infected persons, who practiced the intravenous consumption of drugs since 1997 to 2001, revealed not only concomitant multi-virus infections (hepatitis C--68%, hepatitis B--48%, herpes 41%, fungal infections--66% and bacterial infections--46%) but also lesions (up to 70%) in the gastrointestinal tract and in the hepatic-cellular and hepatic-biliary systems. It was established that, when only immunological indices are taken account of in presence of multi-virus infections, it does not ensure an adequate evaluation of an HIV-patient condition. The below biochemical parameters must be necessarily taken into consideration: activity of alanine aminotransferase, aspartate aminotransferase and of alkaline phosphatase. The changes in the biochemical parameters were shown to be essentially higher in HIV patients with hepatitis C virus (HCV) even during the 2 initial follow-up years, when the immunological parameters are in the norm or even insignificantly below it. A comparative analysis of dynamic clinical, immunological and biochemical indices was made within the case study for the purpose of defining the prognostic criteria for HIV progression scenarios.

Disease Progression↗
PubMedDate not supplied

[Laboratory variables and stratification of small-cell lung cancer patients: recommendations for therapeutic trials and for clinical practice guidelines].

OBJECTIVE: To identify, through a systematic review of the literature, the laboratory variables that, in addition to performance status and to extent of the disease, would allow a more accurate stratification of small-cell lung cancer patients who participate in chemotherapy trials, with or without radiotherapy. Secondary aim: to compare the results of our systematic review with the recommendations made in current clinical practice guidelines. METHODS: Update of two recently published systematic reviews, without meta-analysis, following the recommendations of the International Federation of Clinical Chemistry and Laboratory Medicine, and taking into account the Consolidated Standards of Reporting Trials statement. RESULTS: Of 1143 publications retrieved, exclusion and inclusion criteria allow us to include 13 studies in our review. The three variables which were the most often found significant in multivariate statistical analysis, were: pre-therapeutic levels of laboratory variables (13/13), performance status (12/13), and degree of tumour invasion (10/10). Among the laboratory variables, serum lactate dehydrogenase (LDH) is the only one that was quite consistently found to be of independent prognostic significance, with p values or hazard ratios quite close to those obtained with performance status, or with extent of the disease. The recommendations made in the four clinical practice guidelines that we retrieved, are often vague regarding laboratory variables, and sometimes they even contradict each others. CONCLUSIONS: Available evidence would support the recommendation that pretreatment LDH should be systematically measured in order to stratify patients in therapeutic trials. If other laboratory variables were to be measured in addition to LDH for this purpose, it seems that alkaline phosphatase (ALP), and to a lesser extent, sodium and white blood cell counts, might be the best suited ones. Nevertheless, further studies are necessary to more clearly support this latter recommendation. Available evidence would not support the measurement of any other laboratory variable in this context, before, during, or after treatment. Our recommendations are more in agreement with the recommendations made in the clinical practice guidelines that use evidence-based methods than with the guidelines that do not.

Carcinoma, Small Cell↗
PubMed2001

Epidemiology and factor analysis of obesity, type II diabetes, hypertension, and dyslipidemia (syndrome X) on the Island of Kosrae, Federated States of Micronesia.

OBJECTIVES: Obesity, type II diabetes, hypertension, and dyslipidemia are major causes of morbidity and mortality throughout the world. Though these disorders often cluster in individuals and families and are collectively known as syndrome X, the basis for this aggregation is not well understood. To further understand the pathogenesis of syndrome X, a comprehensive epidemiological study was undertaken on the Pacific Island of Kosrae, Federated States of Micronesia (FSM). METHODS: The entire adult (>20 years of age) population of Kosrae underwent a clinical evaluation that included a questionnaire that noted the participants' sex, family data including listing of biological parents, siblings, and children, smoking status, village of residence, age and health status. The medical evaluation included: anthropometric measures (weight, height, waist, hip), serum chemistries (leptin, fasting blood sugar (FBS), insulin, total cholesterol (TC), triglycerides (TG), and apolipoproteins B and A-I (apo B and apo A-I) and blood pressure (BP) measurements. RESULTS: Obesity (BMI >/=35) was found in 24%, diabetes (FBS >/=126 or 2-hour oral glucose tolerance test >/=200) in 12%, hypertension (SBP >/=140 or DBP >/=90) in 17%, and dyslipidemia (TC >/=240 or TG >/=200 or apo B >/=120 or apo A-I </=88) in 20% of the population. Significant covariate effects after multivariate analysis were as follows: sex affected the frequency of all four disorders, parity affected the frequency of dyslipidemia, smoking affected the frequency of obesity and diabetes, village of residence affected the frequency of obesity, hypertension, and dyslipidemia, and age affected the frequency of all four disorders. Factor analysis identified four independent factors that explained 73% of the total variance of the entire data set: factor 1 (weight, waist, leptin, insulin, and TG), factor 2 (TC, TG, apo B, apo A-I, and insulin), factor 3 (systolic and diastolic BP, FBS, waist and weight), and factor 4 (apo A-I, TG, leptin, and weight). CONCLUSIONS: This population-based study on the Island of Kosrae suggests that syndrome X is a composite of 4 independent factors: obesity with diabetes and hypertriglyceridemia, combined hyperlipidemia with diabetes, hypertension with obesity and diabetes, and increased HDL-low TG with thinness and high leptin. Further studies to identify the genetic components of these factors as well as the individual traits are under way.

Adult↗