Effective health care最新文献

{"title":"Measuring the impact of health interventions: a review of available instruments.","authors":"E Scrivens,&nbsp;D Cunningham,&nbsp;J Charlton,&nbsp;W W Holland","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Interest in the measurement of the impact of health services has been increasing for three main reasons. Policy makers and service providers wish to be reassured that they are: (i) benefitting the public for whom the service is provided; (ii) in times of economic recession and limited resources, achieving the 'best value for money'; and (iii) given the need to make economies in health expenditures, maintaining standards of the health care. Recent developments in information for the evaluation of health services have tended to emphasis the control and monitoring of expenditure in preference to the control and monitoring of quality. There is concern that this might lead to adverse consequences for patients and for the health service as a whole in that the quality of services provided might deteriorate. Health interventions are considered to be successful if they result in a beneficial change in the health of the population for whom they are provided. If the health of the population is not improved, or maintained, questions are raised about either the appropriateness of the intervention in relation to health policies which have been selected, or about the quality of the care which has been provided. Because of this, it is necessary to monitor both the outcome of a heath intervention in terms of the change in the level of health of the population, and also to measure the quality and the effectiveness of the care provided. Health services research has, over the years, developed a number of different types of measures which can be applied to health services and has suggested a number of applications for such measures in terms of the impact on the health of patients and the general population and the quality and effectiveness of health services. The first section of this paper reviews a selection of measures for both health and the effects of health interventions and discusses their applicability as management tools. The use to which such measures are put obviously depends upon the type of decisions which they are to inform, which in turn are dependent upon the organisational level at which the decision is to be made, and the policy objectives of the service to which they relate. The second part of the paper discusses factors which must be taken into account when choosing measures to monitor the impact of the health services. In examining the suitability of a management tool, a measure must be proven to provide information which is universally acceptable and which conforms to a number of scientific standards.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 6","pages":"247-61"},"PeriodicalIF":0.0,"publicationDate":"1985-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21141138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic aspects of care of the elderly.","authors":"S Hakansson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The health care costs in the industrialized countries have increased continuously parallel to the aging of the population. There is however only a minor part of the cost increase that can be attributed to the changing age structure. Sweden, which at least till the year 2000 will have the world's oldest population, spends 30 billion Swedish Crowns (approx. 4 billion US $) on medical care and social services for the aged (65 years or older), which amounts to 5% of the GNP. Long-term estimates (year 2000) of the future age-standardized costs show that in Sweden health care and social services resources for the aged must increase at an average annual rate of 1.3% in order to maintain the same standard as in the beginning of the 1980s. The experience from studies in the municipalities of Sundsvall and Vetlanda in Sweden have demonstrated that many transfers to institutions have been 'unnecessary' i.e. could have been avoided through increased medical care and support efforts in the homes of the elderly. Results from the above municipalities show the potential savings which might be realized in the long run if care of the elderly will be more concentrated on home care rather than on institutional care. If Sundsvall and Vetlanda were representative of Sweden as a whole, the annual costs of care for the elderly could be decreased by between 1 and 2 billion Skr, which corresponds to 5-10% of the total costs.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 6","pages":"239-46"},"PeriodicalIF":0.0,"publicationDate":"1985-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21180836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out-patient letters: requirement and contents.","authors":"D W Young,&nbsp;J Parkes,&nbsp;W A Davis,&nbsp;D Harman,&nbsp;R S Williams","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Twenty-five general practitioners were interviewed about the contents of out-patient letters. There was universal agreement on the need for the following information: diagnosis, abnormal physical findings, abnormal routine and non-routine test results, changes in treatment, comments on the patient's physical condition and disposal. The contents of 215 out-patient letters were analysed and the results compared with the GPs' views. There was little difference in the letters from medical and surgical clinics. Both were deficient to a limited extent in the reporting of abnormal test results, the reasons for, and significance of investigations, and in detailing the information given to patients.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 6","pages":"225-9"},"PeriodicalIF":0.0,"publicationDate":"1985-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21141351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social inequalities and perceived health.","authors":"S M Hunt,&nbsp;J McEwen,&nbsp;S P McKenna","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The association between morbidity and mortality indicators and low socio-economic status has been observed for many centuries. In 1980 the publication of the Black Report in Britain drew attention to the failure of the National Health Service to close the gap between rich and poor in relation to health status. The gradients of morbidity and mortality which are linked to social class have been observed throughout Europe, in the U.S.A. and Australia. However, information on how people feel, as opposed to how they become ill, and the cause of their death, is scarce. Measures of perceived need can provide important additions to routinely collected data because they give access to the experiential status of respondents and thus provide vital data on which to base planning, provision and evaluation of health services. A standard reliable and valid measure of perceived health, the Nottingham Health Profile, was used to conduct a postal survey of differential status in subjective health between social classes in England. The results showed statistically significant differences between social classes in the age group 20-44 years only. For both men and women these were in their experience of sleep problems, emotional problems and lack of energy. In all cases the lower the social class the greater the amount and severity of perceived distress. After the age of 45 these differences, although still present, were not so marked, perhaps because of the excess mortality rates in lower socio-economic groups and the lowering of expectations with age. It is suggested that younger people from unskilled and semi-skilled occupations and, of course, the unemployed, are more vulnerable than their better off compatriots because of a kind of psychic susceptibility which is a consequence of social circumstances and the inability to cushion the effects of ill health. A type of Marxian \"immiseration' may occur whereby in contemporary society health status is undermined by spiritual and social impoverishment rather than by the gross poverty and grinding labour of the past. The results of this study indicate that changes in the allocation of health care resources may have only a minor influence on inequalities in health. Remedial action would, rather, need to take the more radical form of providing fulfillment for aspirations and enhancing well-being by introducing fundamental social, economic and environmental reforms.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 4","pages":"151-60"},"PeriodicalIF":0.0,"publicationDate":"1985-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21142260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary prevention: screening for breast cancer.","authors":"J Chamberlain","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Screening healthy women in order to detect the earliest signs of breast cancer may offer a possibility of curing many breast cancer patients who would be incurable if left until they developed symptoms. However, the natural history of breast cancer is very variable, probably indicating a wide spectrum of different growth rates of the tumour. Therefore it cannot necessarily be assumed that cancers detected by screening at an apparently early stage will behave in the same way as symptomatic cancers at that stage. To prove that screening enables cancer to be cured one needs to compare the number of deaths in a group of women who have been offered screening with those in a comparable group who have not. Unlike the situation in clinical trials of different treatments, comparison of the survival of screen-detected cancers with symptom-detected cancers is inadequate proof, because of selection bias, lead-time bias and length-bias. One randomized controlled trial of screening for breast cancer has so far been published and this shows that women in the group who were offered screening suffered one third fewer deaths from breast cancer than women in the control group, the difference persisting for up to 14 years from the first screening invitation. Further trials are now under way in Canada and various European countries, hoping to confirm this finding and to explore various other issues. Of the screening test methods currently available mammography seems the most sensitive and specific and its radiation hazard is now of almost negligible proportions provided that regular careful monitoring of the equipment is carried out. However it may have the disadvantage of overdiagnosing cases of borderline non-invasive neoplasia which might not progress to invasive cancer within the woman's lifetime. Clinical examination of the breasts is a less satisfactory test in older women but it may be useful in premenopausal women in whom mammography is less sensitive. The validity of self-examination of the breasts by women themselves is still largely unknown, but it is unlikely that compliance with regular breast self-examination will be as high as women's acceptance of screening. Further research is required into the optimal frequency of screening and into its cost-effectiveness.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 5","pages":"179-88"},"PeriodicalIF":0.0,"publicationDate":"1985-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21138656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A frame-work to co-ordinate research and preventive action.","authors":"L L Abenhaim,&nbsp;W Dab","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We are presenting here an integrated decision-making algorithm for preventive action and research in public health (DAP). We reformulated several of the main stages of the elaboration of a community health programme as sets of questions or decisional nodi which lead to a decisional algorithm. The eight main stages of the DAP are the following: (1) detecting a problem, (2) is the significance of the problem well known?, (3) is our understanding of the problem sufficient for action to be initiated?, (4) defining operational objectives, (5) do we have an action strategy?, (6) are effective means available?, (7) action, (8) evaluation. We have found a place for research in six of the eight stages of the process: stages 1, 2, 3, 5, 6, 8. Some operational consequences of this categorisation and the place of research at each stage are discussed. We conclude that decision-making as to the relevance of research, must be subject to some degree of social input.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 5","pages":"189-96"},"PeriodicalIF":0.0,"publicationDate":"1985-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21140617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On regulating perceived risk.","authors":"F G van Andel","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Modern society increasingly depends on government regulation to manage risks. Until recently, evaluation of risks of technology was primarily considered a technical problem. However, public controversy has politicized the issue of risk, raising questions about the role of experts. This paper briefly explores the nature of technical risks of aircraft, nuclear energy and medicines. It is contended that in the case of aircraft intensive regulation has led to a measurable improvement of its safety record. The constant call for more regulation in the areas of medicines and nuclear energy on the other hand seems more the result of public controversy, since the actual effect of regulatory measures on safety is too difficult to show. This stresses the important role of the media, a theme, which is elaborated by reviewing a number of cases. The general conclusion is concerned with the notion that public pressure is the only rationale which makes regulators step in. Regulatory decision-making about risk, then, is more anecdotal than systematic, because public controversy is unpredictable. As a consequence regulators can no longer seek to minimize harm, but must now move towards the aim of minimizing perceived harm. Finally, in the light of this assumption, some thought is given to costs and benefits of medicines and nuclear energy. It is appropriate to make a strong case for medicines in this context, for, as opposed to nuclear energy, alternatives are usually not available.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 6","pages":"231-7"},"PeriodicalIF":0.0,"publicationDate":"1985-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21141353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failures of the hospital financing system of the Federal Republic of Germany and reform proposals.","authors":"G Neubauer,&nbsp;H Unterhuber","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This paper deals with an economic analysis of the present hospital financing system of the Federal Republic of Germany. In the first section normative criteria for the evaluation of hospital systems are established. The most important objectives are: a medically appropriate hospital care, an efficient production of services and adequate hospital care for everyone. The imminent conflicts between individual and social value systems on the one hand and between allocative and distributive objectives on the other hand are pointed out. The second section contains a short description of the most important elements of a hospital financing system: first the method of coordination of supply and demand. Since pure market systems are rejected as the only mechanism for the coordination of hospital care, other coordination systems must be applied. There are in principle two alternative systems at one's disposal: regulation of the hospital care by public authorities or negotiations between hospitals and financiers. Second, it is analysed how the financial burden can be shared amongst the patient and the various third party financing institutions such as statutory health funds, private insurance companies and public budgets. Third, the modes of reimbursement are discussed. It is pointed out, that besides the problem of how the hospital performance should be measured and how the level of prices of the services should be determined, the distribution of the production risks is the central matter in hospital reimbursement. The more hospitals have to undetake financial risks, the greater the incentives are for an efficient production of services. The third section contains a description of the main failures of the German hospital financing system. It is argued that the central public planning of capacities, which is dominated by political interests, causes excess capacities and structural disequilibria in particular sectors of hospital care. The next important failure is the division of the financial burden amongst public households and statutory health funds in spite of exclusive public planning authority. In the area of reimbursement the total cost reimbursement is criticized. The cost based public investment grants and cost based lump sum per-diem rates per patient in the area of operating cost imply incentives for an inefficient (and ineffective) production of services. The last section deals with some reform proposals which at present are being discussed. All proposals claim a regionalization of the hospital planning and a stronger participation of the hospitals and health funds concerned in the planning process.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 4","pages":"161-71"},"PeriodicalIF":0.0,"publicationDate":"1985-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21142264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of alcohol control policies in Europe.","authors":"P Davies","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This paper examines the relationship between alcohol control measures, alcohol consumption and selected indicators of alcohol related harm in fifteen countries of Europe and in Israel. A public health perspective on alcohol problems is developed in which alcohol related consequences, both positive and negative, are seen as emerging from the interaction of alcohol itself, the individuals who consume it and the physical and social environment. Consequently, a range of alcohol control and prevention measures is examined, some aimed at the availability of alcohol, other at those who drink alcohol and yet other at the environments in which drinking takes place and problems emerge. A rudimentary scale of alcohol control policy is presented, from which a classification of European countries in terms of alcohol control status is possible. Per capita alcohol consumption and liver cirrhosis mortality data in these countries are examined cross-sectionally and over time. These indicate that cross-sectionally there is, in general, a clear relationship between the alcohol control status of European countries and both per capita alcohol consumption and liver cirrhosis mortality. However, from a time series view there are some interesting exceptions to this general observation. Nonetheless, there is sufficient evidence to suggest that alcohol control and prevention measures are effective at controlling alcohol consumption and preventing the adverse consequences of drinking. Some considerations about alcohol control policy in Europe other than the control of availability are presented.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 4","pages":"137-49"},"PeriodicalIF":0.0,"publicationDate":"1985-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21142686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The epidemiology of coronary heart disease: a review.","authors":"J L Richard","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The contribution of epidemiology to the understanding of coronary heart disease (CHD) is described. (1) Descriptive epidemiology has shown the main differences between human populations and the strong association existing between the frequency of the disease and the parameters attesting their levels of socio-economic development. (2) Etiological research has identified the risk factors presumably playing a causal role; it also allows a multifactorial evaluation of risk. A pathogenetic hypothesis has been suggested which proposes a sequence of etiological relationships between the saturated fat content of the diet, the level of serum cholesterol and the development of the disease (Diet Heart Hypothesis). (3) Preventive trials have almost confirmed this hypothesis. The decrease of cholesterol level obtained by diet or drug treatment lowers the risk of the disease, the reduction of the cigarette consumption bringing an additional effect. It has not yet been possible to prove the benefit of an antihypertensive treatment towards the risk of CHD.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 5","pages":"197-209"},"PeriodicalIF":0.0,"publicationDate":"1985-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21168778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}