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Biomedical subjects

A Maynard

Publications and source records attributed to A Maynard.

At least 19 recordsLinked to original sources
PubMed1992

Reforming the Department of Health's research and development policy: from the devil to the deep blue sea?

Research into health and social services in Britain is largely funded by the Department of Health. Regional NHS research and development has recently been reformed and a new report now proposes replacement of the 13 research units funded by the department with three or four large multidisciplinary centres. Evidence to support such a step is lacking, and many criticisms of the existing units arise from poor departmental planning rather than deficiencies of the units themselves. Large units may make research less responsive to the department's needs, and it is essential that the proposed new structure is thoroughly evaluated before it is introduced.

Academies and Institutes↗
PubMed1992

The economics of drug use and abuse.

The markets for drugs such as cocaine are characterized by much ignorance about the nature of trading relationships, in particular the volumes and prices exhibited by overlapping national and international networks of buyers and sellers (i.e. markets), and by severe regulation by the State. The regulation of illegal markets is expensive; for example, in 1988 in the UK, over 5000 Customs officers and 1800 CID and uniformed policemen were involved in enforcing the law at a cost of about 140 million pounds. The size of the markets can be only 'guesstimated': in 1989 just over 520 kg of cocaine was seized. If this is assumed to be 10% of the market, the total size of the cocaine market was somewhere in excess of 5000 kg. The 'cost-effectiveness' of both Customs and the police in enforcing the law may have declined in the late 1980s. What economic arguments are there for sustaining illegality and an expensive enforcement effort? Some arguments for State regulation are explored; for example, the drug user harms 'innocent' third parties, the drug user is less productive and reduces national income, the drug user will impose costs on the National Health Service, the drug user's behaviour is offensive, and the drug user should be protected from his own stupidity. Where do these arguments leave the case for maintaining public policy towards illicit drugs? Would it be cost effective to move towards the liberalization of these markets?

Cocaine↗
PubMed1990

The design of future cost-benefit studies.

An economic evaluation is designed to prioritize expenditure, aid decision making, and inform medical audit. A good economic evaluation is explicit and clearly describes the alternative therapies to be evaluated. The evaluation takes into consideration the cost of each component and measures outcome in economic benefit and physical, social, and psychologic well-being. A variety of approaches can be used to assess quality of life, and a good economic evaluation will use a range of measures. Costs and outcomes of health care interventions typically accrue across time periods, and the analysis must allow for this. Similarly, data must answer the question; how much does it cost to identify one additional unit of benefit? Because all evaluations are imprecise both in cost and outcome, sensitivity analysis is needed to determine the effect that different assumptions have on the results.

Coronary Disease↗
PubMed1990

Morbidity variation and RAWP.

STUDY OBJECTIVE: Resource allocations from the central government to the English health regions are determined by population levels adjusted by relative standardised mortality ratios (SMRs). The White Paper Working for Patients proposes that allocations should in future be based on capitation adjusted by some other measures of health. The aim of this paper was to investigate the effect of using morbidity data in the weighting algorithm instead of relative SMRs. DESIGN: Morbidity data were obtained from the Health and Lifestyle Survey, 1986. Three different measures of self reported morbidity were used (Long Standing Illness, Any Declared Condition, Any Handicap). Population weightings were calculated by national average bed use for these conditions and again for SMRs. SETTING: This was a national survey using data from all the English health regions. MAIN RESULTS: All three measures of morbidity showed a wider variation between regions than SMRs, and the weighted populations showed a correspondingly wide variation (approximately double that obtained when using SMRs). CONCLUSION: The weighting of populations will be crucial in determining resource allocations to budget holders, whether in the hospital or primary care sector. However without a prior agreement on what counts as "need", the choice of these alternative measures will be arbitrary.

Health Care Rationing↗
PubMed1989

Can general practitioners counsel?

It has been suggested that general practitioners are in a prime position to counsel patients presenting with psychosocial problems. While many doctors use counselling skills in their consultations few have received training in counselling and the difference between the use of counselling skills and the process of counselling is not always understood. This paper examines the differences between counselling and counselling skills and compares the role of doctors and counsellors. It is concluded that there is a need for trained counsellors to work alongside general practitioners and that this is of benefit to patients and all members of the primary care team.

Counseling↗
PubMed1988

Economic aspects of tobacco use and taxation policy.

Tax levels have important effects on cigarette prices and tax revenues. Over 70p of every pound spent on tobacco goes to the Chancellor of the Exchequer, yielding over 5 billion pounds. But the value of tobacco tax revenues have generally fallen--by 1986 they were 10% lower than at their peak in 1965, and tobacco revenue is becoming a smaller proportion of total tax receipts. The impact of a consistent increase in tobacco taxation is important in terms of reduced consumption (and harm to health) as well as in terms of reduced employment. Revenue may, however, increase in the short term. Finally, if the findings of Townsend and Atkinson et al (see above) still apply then the distributive effects of increased taxation on the poor might be less than is sometimes feared.

Employment↗