Effective health care最新文献

{"title":"Regional health budgeting in Western Europe.","authors":"G Schrijvers","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This article distinguishes in the first section three characteristics of regional budgeting in health care systems: geographical division of budgets, regional financial limits, and policy freedom for regional authorities. Following these and more general elements of regional budgeting systems sections 2 to 5 describe the situation in the U.K., Sweden, The Netherlands, and some other European countries. The first two countries have a developed regional budgeting system for health services paid by taxation. Other European countries are developing regional budgeting models which are to be combined with a social insurance system. Of these countries, the Netherlands are discussed in some detail. Based on the experiences with regional budgeting in different countries three hypotheses are generated which require further empirical research. They are: (1) One management tier on a regional level--or municipal or provincial level--is a condition for a regional budgeting system which contributes more to an integration of health services than a two-tier system. (2) Countries with a regional budgeting system with a regional financial limit superimposed by the state seem to spend a smaller percentage of their gross national product than other countries. (3) Countries with policy freedom on a local level show a faster growth rate for primary care than for hospital care.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 2","pages":"57-64"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21138952","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":"Algorithms in medicine.","authors":"H N Greeo,&nbsp;P A van Gelder","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The ever rising costs of health care in Western countries necessitate some form of cost control. Restrictions can be and will be imposed externally by, for instance, the government. These measures will probably lead to a decrease in quality of health care and the profession should therefore seek ways to prevent outside interference by developing an internal means of cost control. On short terms a form of internal control with preservation of the quality of care would be the introduction and widespread use of algorithms, restricting the use of useless and unnecessary tests and therapies. For long term results education must take on new tasks leading to a better understanding of costs an benefits of medical activities. The development of algorithms is hindered by the lack of common consensus of optimal care, the lack of relevant data and the inefficient way data are managed. When introduced the algorithm, especially when compulsory, will engender much resistance and unhappily, ways must be found to overcome them by sanctions. The profession must realise that if they do not do anything it will be done for them.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 2","pages":"83-7"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21169104","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 smoking.","authors":"R E Leu,&nbsp;T Schaub","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Smoking has become a major issue for public health policy in recent years. This paper deals with the economic aspects of smoking. First, we outline the basic concepts of welfare economics which subsequently are used as the normative framework of the analysis. In particular, we stress the role of efficiency as a criterion for economic policy evaluation. Second, we demonstrate that smoking is associated with several market failures, notably externalities and dependency/addiction (non-rational behavior). Third, costs and benefits of smoking are considered. We argue that the benefits of smoking are the satisfaction (utility) which the consumers derive from it rather than the employment effect of producing tobacco products or the revenues of the excise tax on these products. A general model for estimating the costs of smoking is developed and various cost concepts are discussed. Empirical cost estimates are presented for Switzerland. In 1976, estimated social (economic) costs of smoking were between 560 and 800 million Swiss francs while the external costs were between 140 and 260 million francs. Contrary to a widely held belief, smoking hardly influenced health care costs because the higher medical care costs of smokers during their lifetime are offset by their reduced life expectancy. The last section deals with intervention strategies to reduce smoking: anti-smoking publicity, advertising restrictions, and taxation. We discuss these three instruments on a conceptual level and summarize previous empirical studies. The main results are: (1) Both publicity and taxation offer a considerable potential as deterrents of cigarette demand. (2) The results for Switzerland imply that publicity campaigns are likely to be efficient in the sense that expected campaign benefits outweigh its costs.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 3","pages":"111-22"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21138957","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":"Diet and primary prevention of cancer.","authors":"J Kevany","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Various assessments have been made of the contribution of diet to the risk of developing cancer in industrialized societies. The evidence available for a causal relationship between diet factors and cancer of specific sites is still incomplete and further research is needed to fill gaps in knowledge. Nevertheless given the limited effectiveness of available therapy in the treatment of established disease, preventive measures based on available evidence should receive active consideration, particularly as they are unlikely to be hazardous in other respects and as they approximate to changes in food supply and diet recommended for general health maintenance. Prevention must address itself to the nature of the food supply, to the choice of the foods that constitute the normal diet and the way in which these are stored and prepared both domestically and industrially. The objectives of a primary prevention programme would be to develop dietary intake patterns that would meet established requirements for health maintenance, would minimize the intake of carcinogens and optimize the intake of inhibitors. The feasibility of public health measures in respect of these objectives is examined and the cost effectiveness assessed. Potential problems arising from the implementations are considered. Measures include the modification of agricultural practices and of food processing techniques as well as various approaches to nutrition education, and modification of food intake patterns. It is concluded that considerable experience exists in other areas of nutrition intervention to suggest that primary prevention of cancer in respect of dietary factors is feasible and would complement other public health activities in this area.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 3","pages":"105-10"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21138954","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":"Budgeting in health care.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 2","pages":"39-40"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21139136","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":"Accidental injuries in the young: from epidemiology to prevention.","authors":"M Manciaux","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Reducing children's injuries is an urgent task, if one is to decrease the toll of young human lives taken by accidents and the burden of handicaps resulting from them. Yet it is not an easy task, if one judges by the stability and resistance of this tremendous cause of death, disease and disability. This paper first reviews some conceptual difficulties in the definition of accidental injuries, their scaling and their recording; the assessment of risk and of the amount of exposure is also a trying process. Then some concrete problems are considered that deal with registration and surveys, and retrieval and use of information. Finally, some preventive outcomes are discussed, some models presented and a preventive strategy outlined. A series of WHO reports addressing these various issues are referred to.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 1","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21186802","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":"Primary health care: a training experience with the community.","authors":"B Pissarro,&nbsp;A Lazarus,&nbsp;V des Fontaines","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In 1982-83 we organized training schemes for various people involved in primary health care at local authority level. These schemes were part of the pattern of similar activity carried out with trained professional staff of the mother-and-child care and school health services. What was new was the participation of non-professional users (or their representatives) of health services, i.e. local politicians, representatives of associations, etc. The training sessions brought together 20-25 participants for two or three days and there were occasionally follow-up meetings of one or two days. The participants, divided into small groups of five or six, played an active part in the meetings, which were based on known information about the local authority area and the participants' own contributions. The initial task was the identification of health problems. For this to be a relevant exercise, the many political, cultural and personal factors which influence people's lives had to be considered. The fact is that the usual epidemiological data are inadequate if they are based solely on a review of symptoms and their distribution among the population as a whole. The procedure begins with the group concerned, and priority in selecting problems is decided with and within the group itself. The solutions that are required will thus be based on the experience and reasoning of the people themselves. A procedure of this type ought to show the factors which affect the community (working conditions, environment, habitat, cultural background, etc.) and which influence health. If we understand the structures of the community and the resources at its disposal, we can adapt our response accordingly. In assessing our experiment, we found that the training sessions produced a local awareness and a mutual recognition of the various participants, both professional and non-professional. Each person began to understand his limits since his role was constantly being reviewed. At the same time the requirements voiced by health care users became more apparent to the professionals with their preconceived ideas about people's needs and requirements.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21142129","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":"Intramural health care budgeting.","authors":"L M Groot","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the last years endeavours have been made in several health systems to get a firm grip on the explosive cost development in hospitals which amounts to nearly half of all health care expenditures. The fee-for-service system for doctors coupled with the professional autonomy leads to expansion of quality and quantity of services provided. In many systems hospitals are financed on basis of output items as patient days, examinations and therapies. As hospital costs are in the short run preponderantly constant prices fixed at average costs are higher than marginal costs. This situation favours expansion of services as in that case marginal revenue exceeds marginal cost. Inversely the decrease of services provided generates losses for the hospital. In systems, where financing takes place in the way of budgets like the U.K., Denmark and Italy, the authorities have more influence on the cost development in the system. In systems where the hospitals are financed by social security on basis of output, arrangements are now made to bring budgetary elements in the financing of these institutions. In France the \"Budget Global\" will be applied to services financed by the Sécurité sociale. In Belgium arrangements have been made to contain the amount of patient days allowed for reimbursement and in the Netherlands in 1983 budget-financing has been introduced for all general and teaching hospitals. In 1984 this system also applies to all other intramural institutions. If a way has been found to focus the financing mechanism of these institutions on budgeted costs, the way is open for budgeting these institutions. A very important problem in this context is the budget formula, which will be used to determine the budgets. In this respect a distinction can be made between internal and external budgeting. Internal budgeting is understood here as a process whereby the hospital itself puts a limit to the use of resources or adapts its resources to budget constraints coming from the outside. External budgeting can be defined as the budgetary constraint given from the outside by third parties to the hospitals. Of course, both internal and external budgeting are narrowly interrelated. The distinction between these two ways of budgeting should be sought in the character of the budget formula. External budgeting should be based on global indications whilst internal budgeting should be more differentiated than the external budget formula.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 2","pages":"69-81"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21188504","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":"Caring for the infirm: a task for the individual or for a social insurance programme?","authors":"J Wasem","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In West Germany, seventy per cent of all nursing home patients receive only a pocket-money, for social health insurances are responsible only for the care of \"sick\" people, but not of those needing only \"care\". The infirm individual, however, rarely can pay for the costs of nursing homes out of his own revenue. Despite general agreement that guarding against the financial risks of becoming dependent on nursing is insufficient there is little consensus on what a new concept should look like. Some proposals are more concerned with avoiding cost-expansion than with effective health care. On the one hand, the implementation of a new branch in the social insurance system, called \"nursing insurance\", is demanded, which would pay for the stay in nursing homes. On the other hand, it is emphasized that the capacity for voluntary individual provision should be strengthened as well as the families' means to care for their bedridden members. This paper presents the discussion and outlines implications for health care of the various proposals.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 3","pages":"125-30"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21138958","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":"Co-ordinating prevention.","authors":"D R Cohen,&nbsp;J B Henderson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A major reason why the balance between pronouncements on prevention and action is tipped so much towards the former is that, in most countries, responsibility for prevention is fragmented and vaguely defined. If an effective and efficient national prevention policy is to come about, then it is important that overall responsibility be placed in the hands of a single agency, and for that agency to recognise that priorities in prevention must be a function of costs as well as benefits. The first task of such an agency will be to sort out the fundamental objectives of public policy by clarifying what is meant by prevention and specifying the rationale for government intervention and hence the sorts of prevention which should be the responsibility of the public sector. Given this, national expenditure on prevention from any source which contributes to government prevention strategy can be identified and expressed in the form of a programme budget showing the proportions of total prevention expenditure going to each of the defined programme areas (environment, occupational health and safety, screening, health promotion, etc.). This framework gives a broad overview of the existing situation and by forcing consideration of benefit valuation in any decision to alter the balance of expenditure between programmes, ought to lead to a more rational prevention strategy than would result from a focus on individual programmes in isolation. Moreover, through an emphasis on costs and benefits, the overseers of prevention policy will be better placed to consider the relative efficiency of existing policies--since all share the common objective of reducing future morbidity and mortality. Finally, consideration will also need to be given to issues of equity. The approach described, illustrated by the case of the United Kingdom, will, if adopted, increase the likelihood that a rational and sensible national prevention policy will emerge.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 1","pages":"7-13"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21179551","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}