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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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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↗
PubMed1992

Administrative ethics in the 1990s: CEOs confront payment, access dilemmas.

The 1990s are presenting new challenges to hospital CEOs. One theme currently emerging is the ethics of resource allocation. As they search for ways to fulfill their community responsibilities under pressures related to reimbursement, technology and community desires, hospitals are finding that they must make some very tough choices in how they allocate resources. Given the opportunity, how would you respond? Compare your response to an ethical scenario with those of three nationally recognized hospital CEOs.

Attitude of Health Personnel↗
PubMed1992

Supply and demand factors in the determination of Medicare expenditures.

This article presents multivariate estimates of the effects of supply-side factors (e.g., provider reimbursement) and demand-side factors (e.g., beneficiary ability to pay) on state-level expenditures per enrollee in Medicare Part A and Part B. The results indicate that a 1 percent increase in elderly income significantly increases the propensity to use Medicare Part B services, resulting in a 0.45 percent increase in Part B expenditures per enrollee. By contrast, patients' ability to pay has a much weaker effect on Part A expenditures. Changes in provider reimbursement also exert a substantial effect on expenditures. A 1 percent rise in the Medicare Prevailing Charge Index raises Medicare Part B expenditures by 0.43 percent. Collectively, the findings of this study suggest that both limits on Medicare reimbursement to providers and increased beneficiary liability have substantial effects on Medicare costs. Whatever the merits of arguments for or against such controls, the responsiveness of Medicare expenditures to equal percentage changes in supply and demand factors appears to be of a similar order of magnitude.

Aged↗
PubMedDate not supplied

Can our society afford mechanical hearts?

Congestive heart failure afflicts 4 million people in the United States, with 400,000 deaths annually. Very little can be done for individuals with this condition, which is increasing in prevalence. The only hope is the promise of intervention with permanent circulatory support systems. Can we as a society afford the $3.1 billion that would be required to support every patient needing such a system? This cost represents an increase of 1/2 of 1% of the $662 billion per year expended for medical care. Fortunately, circulatory support systems do not necessarily represent an expense, but rather an investment that has a reasonable payback period. An investment in an individual of $100,000 for the device and implantation cost, coupled with an ongoing maintenance cost of $4,000 per year, can return to society an income greater in value than the investment. The payback period is strongly dependent on the earning power of the individual, as well as the amount of medical attention or complications experienced. An individual with an annual salary of $40,000 per year becomes a positive financial force in our society and increases the gross national product (GNP) within 5 years. The same individual with extensive medical complications and intermittent loss of salary can extend the payback period by an additional 2 years. Circulatory support systems have the potential of increasing our GNP, leading to a higher standard of living for the populace.

Health Care Costs↗