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PubMedDate not supplied

Health care delivery system in France: effects on surgical education.

Surgical education in France has changed in recent years. It had to conform to the transformation of surgery into a more scientific discipline, to European Community regulations, and to increasing costs of health care. It is now organized on a national scale and is based on anonymous selection. The main objective is to train general surgeons who only afterward become specialized in various surgical specialties. The aim is to make them able to adapt to the changes that will transform surgery in the near future. In France the obligatory social insurance system, called Social Security, reimburses most medical expenses for 99% of the population. Patients can be reimbursed in a similar way whether they seek treatment in a private or a public institution. However, the system has to face major and presently unsolved problems due to the rapidly increasing cost of health care.

Delivery of Health Care↗
PubMed1990

Medicare program; update of ambulatory surgical center payment rates effective July 1, 1990--HCFA. Notice with comment period.

This notice implements section 1833(i)(2(A) of the Social Security Act, which requires that the payment rates for ambulatory surgical center services be reviewed and updated annually, and responds to public comments we received concerning the ambulatory surgical center payment rate update notice published on February 8, 1990 (55 FR 4577).

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

[Damage through surgical risk. A persistent challenge].

No surgical act is innocuous and a complication is not inevitably the result of a mistake. Improved definition of the risk involved should allow a new approach to compensation for damages to be envisaged. Publicly or privately sponsored mutual insurance is worth considering for application of the single European act. Without questioning the concept of professional responsibility, a response should be prepared adapted for damages due to medicosurgical accidents for which a fault cannot be demonstrated. By stimulating enlightened reflection, the present study should allow acceptance of this persistent challenge.

France↗
PubMed1982

How good are the data? Reliability of one health care data bank.

This study investigates the reliability of the Manitoba Health Services Commission data bank from a variety of perspectives. Emphasizing diagnostic and surgical procedures, the research focuses on those areas in which problems exist and in which the data can be relied upon. Computerized comparisons are stressed, since they can provide cost-effective checks on data quality. One key to performing reliability studies inexpensively is finding information recorded independently: by separate individuals or organizations, at two different times, or in two or more data files. When a particular event has certain logical implications vis-à-vis another, inconsistencies can be located. Face sheet information and data on the performance of major surgical procedures were found to be reliably recorded in the Manitoba data bank. Collapsing ICD-8 diagnosis from medical claims into several categories proved much better than relying upon individual diagnoses. Problems in working with the data included difficulty in distinguishing between closely related surgical procedures and the underreporting of inhospital consultations and nonsurgical procedures.

Computers↗
PubMed1975

Comparison of provincial surgical rates in 1968.

Studies have been made of age- and sex-adjusted 1968 provincial rates for individual surgical procedures. For elective and discretionary operations, such as tonsillectomy and adenoidectomy, hysterectomy, vein stripping and lens extraction, provincial rates varied by approximately 100 percent. Newfoundland, with few surgeons and hospital beds, had the lowest discretionary rates, and Alberta, which ranked hgih both for surgeons and hospital beds, the highest. Interprovincial differences were of smaller magnitude for non-discretionary surgery (radical mastectomy, cesarean section, colectomy., lobectomy, etc.). Ther were statistically significant correlations between numbers of surgeons and elective and discretionary surgical rates and between numbers of hospital beds and bed use in the provinces. The effect of disease prevalence on discretionary surgical rates was minimized because the rates were age- and sex-adjusted. Provincial organization of, and payment for, medical services has been similar. Hence, the ratio of surgical personnel to population in each province is postulated as a major determinant of the differing interprovincial rates.

Age Factors↗
PubMed2006

An overview of current techniques for tonsillectomy.

Tonsillectomy remains a commonly performed surgical procedure. Although common, it has complications and associated morbidity. In an era of cost containment, indications for surgery have been promulgated by the American Academy of Otolaryngology-Head and Neck Surgery (2000) to aid the healthcare practitioner in appropriate referral to the surgeon, as well as clinical indicators to help insure that surgical intervention is in the best interest of the patient. Surgical techniques are constantly evolving, with the goal of reducing complications and improving postoperative recovery and healing. Review of the literature suggests that new technologies may or may not be better than the tried-and-true surgical techniques combined with good post-operative nursing care.

Adult↗
PubMed1998

Intraoperative monitoring and postoperative imaging of hepatic cryosurgery.

Because intraoperative sonography displays segmental anatomy, allows discovery of more lesions than previously suspected from preoperative imaging, surgical inspection, or palpation, and permits more certain diagnosis of problematic masses, it facilitates surgical decision-making when liver resection or cryoablation is anticipated. Intraoperative sonography provides a guidance modality to accurately place cryosurgery probes in liver masses. More precise treatment of metastatic and primary tumors of the liver is possible with cryoablation because intraoperative sonography provides a means of monitoring the growth of the enlarging freeze zone to insure adequate surgical margins. Postoperative detection of acute complications after cryosurgery is best done with computed tomography. Normally cryosurgery defects shrink with time and lose the peripheral contrast opacification seen after surgery. Gas collections, seen as a result of tissue necrosis, must be discriminated from infection. Tumor recurrence can be detected well with computed tomography or magnetic resonance imaging following hepatic cryosurgery.

Carcinoma, Hepatocellular↗
PubMed2002

Has the increase in private health insurance uptake affected the Victorian public hospital surgical waiting list?

It was anticipated that increase uptake of Private Health Insurance (PHI) would reduce demand on public sector surgical waiting lists. The best measure of changed demand is the comparison of the actual cases added to that projected given previous trends in PHI uptake. Detailed Victorian data is available up to 2000-1. The total waiting list has varied little, reflecting significant decreases in both in patients added to and removed. There was a marked increase in private sector elective surgery cases coinciding with the fall in additions to the public sector waiting list and in public sector elective surgical cases. The June 2001 Victorian surgical waiting list would have been 69,599 not 41,838 if the PHI uptake rate had continued to fall in line with pre-1999 trends, and that of June 2002 about 100,000 compared to 40,458 in March 2002. Limited data from other states suggests the Victorian trends are representative of all Australia.

Elective Surgical Procedures↗
PubMed1980

Evaluating a voluntary second surgical opinion program.

Numerous problem areas were encountered in the evaluation of a voluntary second surgical opinion program. Some problems could be handled only on a conceptual level, while others require for their solution the integration of existing with new data sets. (1) Reliance on program participants to provide medical data was sensitivity tested and found to have minimal impact. (2) Program impact on hospital bed reduction was considered in the context of the total market and political environment in the region, and the anticipated duration of the program. A reasonable judgment was that almost the entire fixed component in the per diem cost of anticipated patient days foregone could be written off as part of the cost savings of the program. (3) As hospital reporting systems identify only average per diem costs, a methodology was developed to separate surgical from nonsurgical case costs. (4) Quality of care evaluation will incorporate a substratum of cases for which there exists a control group within the program user population. Outcome measures obtainable through survey interviews were identified.

Evaluation Studies as Topic↗
PubMed1985

Physician DRGs.

DRG-based reimbursement for inpatient services is an option currently being considered by federal policy makers, but little is known about how physician DRGs might work. We performed simulations of potential impacts, using Medicare claims from four states. Although physician-related inpatient costs associated with surgical DRGs were quite homogeneous, those associated with medical admissions varied dramatically. This suggests that DRG payment could be a lottery, with inequitable losses for some physicians and windfall gains for others. Potential gains and losses were also found to be systematically related to the specialty of the attending physician. General practitioners and ophthalmologists would gain financially on average, whereas medical specialists and some surgical specialists would incur net losses. These differences may be due to the triaging of more seriously ill patients within a given DRG to certain specialists.

Costs and Cost Analysis↗