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PubMed1992

[Options for continued development of medical care].

The German health care system is currently faced with challenges that stem from the changing demographic structure of the population as well as from the increasing implementation of costly technological advances in diagnosis and treatment in the presence of inadequate preventive and rehabilitative structures. Ever-rising expectations and demands on the part of German citizens and the increasing number of doctors are threatening to overburden the increasingly limited financial resources of the health care system. The pressure for allocatory measures has led to intense competition amongst the various specialties and sectors of the health care system. In this paper the author describes the current developments with regard to the evolution of the health care system in the near future. He predicts an increasing demand for long-term care facilities especially for the elderly, for more easily accessible rehabilitative services as well as a continuing increasing demand for high-tech services. The pressure of these qualitative as well as quantitative demands in the face of intersectoral competition and limited financial resources will necessarily lead to a restructuring of the professional as well as non-professional system with new forms of organization for in-patient as well as out-patient services that will address these issues.

Cost Control↗
PubMed1992

Laser technology planning.

Lasers continue to be a highly useful and important surgical tool, and, in today's competitive healthcare environment, they are also an effective marketing tool. The public perceives lasers to be "high-tech" instruments, associating them with excellence of care. And the availability of state-of-the-art equipment such as lasers is often critical to medical staff recruitment. However, lasers are not universal surgical tools, as some proponents suggest. They are costly, and other less expensive technologies are acceptable and sometimes more desirable for certain procedures. Also, marketing reasons alone cannot justify laser acquisition. Faced with new, more restrictive federal regulations for Medicare reimbursement of capital expenses, hospitals need effective technology planning more than ever, particularly when planning for such "high-ticket" items as lasers. They can no longer afford to acquire lasers based on the perceptions of the public or the demands of one or even a few physicians; poor planning in the past has caused many new lasers to collect dust from low utilization. (ECRI's 1991 user survey on general-purpose surgical lasers found that, on average, hospitals use lasers in less than 5% of their total surgical procedures.) Hospitals need to approach the acquisition of laser technology cautiously to ensure that the appropriate equipment is obtained, that it will be well utilized for procedures in which it offers a demonstrable improvement over alternative technologies, and that it will also conform to the overall strategic plan of the institution. The purpose of this article is to provide guidance on the technology acquisition process, whether a hospital is acquiring its first laser or has a well-established laser program.(ABSTRACT TRUNCATED AT 250 WORDS)

Capital Expenditures↗
PubMed1992

[Ethical problems from the caregivers' viewpoint].

In a first part the different perspective of physician and nurse is outlined. Then the ethical principles of the health professionals are outlined. The variant views--descriptive and normative--are described. In a second part the dilemmas emerging in daily practice of health care workers are demonstrated. Questions regarding the importance of well-being and illness are raised. Does CAN mean also that one SHOULD, i.e. for transplantation of organs? What are the guiding criteria for this advanced medicine. Since ethical decisions always touch at least two human beings they touch us over and over--profoundly.

Ethics, Medical↗
PubMed1991

[The use of lasers in the treatment of urolithiasis].

The treatment of calculi in the urinary tract has been subject to major changes over the last few years. Since extracorporeal shockwave lithotripsy (ESWL) is the first choice of treatment, there appears to be little need for endoscopic and surgical techniques. In case ESWL treatment is unsuccessful or inadequate, laser lithotripsy is a good alternative. In most cases, laser lithotripsy causes a good disintegration with use of very thin and flexible instrumentation. Hence, the risk of damage to the urinary tract is much less than with other endoscopic techniques such as ultrasonic and electrohydraulic lithotripsy. Our first results with 21 bladder and 18 ureter calculi in 25 patients were a successful disintegration of 84% of bladder calculi and a 70% success for ureter calculi. Only one complication of the ureteroscopic manipulation was observed. Disadvantages of laser lithotripsy are the high price of the equipment and the fact that not all calculi can be fragmented with one type of laser.

Adult↗