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Policy analysis for prenatal genetic diagnosis.

Consideration of the analytic difficulties faced in estimating the benefits and costs of prenatal genetic diagnosis, coupled with a brief review of existing benefit-cost studies, leads to the conclusion that public subsidy of prenatal testing can yield benefits substantially in excess of costs. The practical obstacles to such programs include the attitudes of prospective parents, a lack of knowledge, monetary barriers, inadequately organized medical resources, and the political issue of abortion. Policy analysis can now nevertheless formulate principles and guide immediate actions to improve present utilization of prenatal testing and to facilitate possible future expansion of these diagnostic techniques.

Abortion, Induced↗

Medicare program; solicitation of hospitals and medical centers to participate in a study of heart transplants: Health Care Financing Administration. Notice.

This notice invites hospitals and medical centers to participate in a study of heart transplants to be conducted by HCFA. The purpose of the study is to examine, in general, all aspects of heart transplants, including the scientific, social, economic, and ethical issues, and, in particular, the impact of a possible Medicare decision to pay for heart transplants on the Medicare program, Medicare beneficiaries, and providers of health care. The study will be done in two related parts--the selection and participation of hospitals and medical centers, to which this notice is addressed, and an analysis of pertinent data and issues, to be conducted by an independent contractor. Hospitals and medical centers selected to participate in this study, under this notice, may be reimbursed for a limited number of heart transplants performed for Medicare beneficiaries during the course of the study. In addition, these institutions will furnish data about heart transplants performed at their facilities and will be reimbursed for the costs of furnishing this information. This notice contains information about the study, the availability of funds, and the procedures by which interested institutions can communicate their willingness to participate in the study. This notice also contains the criteria for the selection of hospitals and medical centers for heart transplant funding.

Cardiac Care Facilities↗

The use and costs of Medicare services in the last 2 years of life.

This study reports on the use of services by Medicare enrollees who died in 1978. Decedents comprised 5.9 percent of the study group but accounted for 28 percent of Medicare expenditures. The use of services became more intense as death approached. Despite the idea that heroic efforts to prolong life are common, only 6 percent of persons who died had more than $15,000 in Medicare expenses in their last year of life. As shown here, the unique patterns of health care use by decedents and survivors should be fully understood and considered when contemplating changes in the Medicare program.

Aged↗

Drug testing in Canadian jails: to what end?

Since 1995, Corrections Services Canada (CSC) has conducted randomized urinalysis screening of a minimum of 5% of the federal inmate population on a monthly basis. Urine samples are screened for a broad range of psychoactive substances. The stated purpose of such screening is to reduce substance use in federal jails. Analysis of data provided by CSC for testing between 1994 and 1998 reveals small but statistically significant increases in the percentage of all urine samples that tested positive over that time. Analysis of the results of screening for opiates, cocaine and THC from data provided by CSC for the same time period, shows steady rates of opiate and cocaine detection at maximum and medium levels of security, decreases in opiate and cocaine detection in minimum security, and statistically significant increases in THC detection at all levels of security. The implications of these findings are discussed.

Canada↗

Genes and the law.

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Black or African American↗