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Biomedical subjects

J M Morgall

Publications and source records attributed to J M Morgall.

10 recordsLinked to original sources
PubMed2000

Cost containment of pharmaceutical use in Iceland: the impact of liberalization and user charges.

OBJECTIVES: Iceland was the first Nordic country to liberalise its drug distribution system, in March 1996. Subsequent regulation in January 1997 increased patients' share of drug costs. The objectives of this study were to test the assumptions that liberalizing community pharmacy ownership would lower reimbursement costs for the state's Social Security Institute and that increasing patient charges would reduce use and, therefore, lower the cost to the Institute. METHODS: Based on the assumptions, we built and tested two models using interrupted time series designs that contrast the monthly reimbursement costs before and after the legislation and regulation took effect. A control variable (the number of office visits to general practitioners) was tested to assess other events in the health care arena. Monthly data on these variables were provided by the Icelandic State Social Security Institute for January 1993 to August 1998 for reimbursement costs and to December 1998 for office visits to general practitioners. RESULTS: Reimbursement costs have risen steadily throughout the period under study. The interrupted time series analysis did not show a substantial effect from the legislative change in March 1996 or from the regulatory intervention in January 1997. CONCLUSIONS: The main argument used for liberalizing community pharmacy ownership in Iceland was built on false assumptions regarding the effect on drug reimbursement costs to the state. It will be necessary to find more promising interventions to halt the rapidly increasing cost of drugs.

Cost Control↗
PubMed1999

No struggle, no strength: how pharmacists lost their monopoly.

Research accounts of the struggle of professions to attain and maintain a monopoly, strategies of exclusion and usurpation, make for interesting and often exciting reading. The purpose of this article is to present a less frequently reported phenomenon--the study of a profession that had a monopoly, and then lost it. The authors attempt to answer the question: under what circumstances will a profession support the state in breaking their own monopoly? The study looked at the pharmacy profession in Iceland in the light of the recent change in drug legislation. Interviews with key actors in the pharmacy profession were conducted to gain an understanding of how they interpreted and experienced this change. Three factors contributed to the break in the professional monopoly: (1) political desire to take advantage of new competition and deregulation policy, (2) desire to cut the health budget and (3) internal divisions within the profession. The results of the study revealed at least four internal divisions within the pharmacy profession: (1) urban/rural, (2) employer/employee, (3) lower/higher education and (4) young/old. The article illustrates how a profession weakened by internal strife became prey to the government's cost cutting activities. This study is an example of how internal conflicts not only weakened the profession, but created a climate conducive to losing its monopoly. Our findings raise fundamental questions about the future of professions in society today.

Cost Control↗
PubMed1999

Technicians or patient advocates?--still a valid question (results of focus group discussions with pharmacists).

New legislation went into effect in Iceland in March 1996 making it the first Nordic country to liberate their drug distribution system. The term liberalization implies the abolishment of the professional monopoly in that ownership was not tied to the pharmacy profession anymore. Focus group discussions with community pharmacists in the capital area Reykjavík and rural areas were employed to answer the research question: How has the pharmacists' societal role evolved after the legislation and what are the implications for pharmacy practice? The results showed firstly that the public image and the self-image of the pharmacist has changed in the short time since the legislative change. The pharmacists generally said that their patient contact is deteriorating due to the discount wars, the rural pharmacists being more optimistic, and believing in a future competition based on quality. Secondly, the results showed that the pharmacists have difficulties reconciling their technical paradigm with a legislative and professional will specifying customer and patient focus. This study describes the challenges of a new legislation with a market focus for community pharmacists whose education emphasized technical skills. This account of the changes in the drug distribution system in Iceland highlights some of the implications for pharmacists internationally.

Denmark↗
PubMed1997

Multiple induced abortions: Danish experience.

Experience with 50 first time aborters, 50 second time aborters, and 50 third time aborters residing in an urban area of Copenhagen suggests that women having a repeat abortion are more similar than dissimilar to women having a first induced abortion. There were no differences in socioeconomic status, educational level, or stated reasons for choosing abortion (usually socioeconomic and family considerations). Though similar to first and second time aborters in their life situations and greater contraceptive risk-taking, third timers seemed to become pregnant more readily. They were also less willing to be interviewed. Related studies and suggestions for postabortion counseling are discussed.

Abortion, Induced↗
PubMed1992

Repeat abortion in Denmark.

A study of 50 women undergoing first-time induced abortion and 50 women undergoing second-time induced abortion is reported. Although repeat aborters can not be characterised as a special group of women, it is important that initiatives be taken to reduce the incidence of repeat induced abortion. A suggestion for possible intervention is a thorough post-abortion contraceptive counselling and follow up of women who undergo initial induced abortion. Further general improvement in sex education and use of contraceptive methods is necessary. In this area, avoidance of risk-taking is very important as well as caution during periods of change from one contraceptive method to another. Generally, use of contraceptive methods with a very high effectiveness must be recommended, i.e. oral contraceptives, IUDs, and sterilisation.

Abortion, Habitual↗
PubMed1990

Family planning for the mentally disordered and retarded.

Increasing perception of healthy reproductive functioning and conception prevention has been accompanied by greater recognition of the needs for emotional and sexual fulfillment of individuals with mental disorder or retardation. Although family planning services have burgeoned in the United States and many other countries and the special concerns of mentally disordered and retarded persons have been well documented, organized efforts to include counseling on fertility regulation in mental health and in training programs have, with few exceptions, been sparse. Recent trends are discussed in terms of reported experience from the United States and Denmark. It is recommended that women of childbearing age in psychiatric facilities be given an opportunity to participate in programs offering screening for and treatment of gynecological conditions, as well as family planning counseling, before going on home leave or discharge. Such counseling should be adapted to a woman's emotional functioning, consider possible contraindications of specific contraceptive methods, and, to the extent possible, involve the partner. Ethical aspects need to be considered to avoid even the appearance of coercion. Similar opportunities should be provided for retarded persons seeking to achieve a satisfying sexual life. Surgical contraception and abortion are discussed within the context of patient rights, competence, and the desirability of avoiding unintended conceptions and reducing unwanted births that may engender further stress and psychosocial difficulties for the woman, the child, and society. The experience of former patients might well be useful in restructuring current service programs and priorities.

Family Planning Services↗
PubMedDate not supplied

A question of emphasis: efficiency or equality in the provision of pharmaceuticals.

The reported results are part of the overall evaluation of the new drug distribution legislation that went into effect in March 1996, liberalising ownership of community pharmacies in Iceland. We addressed the following question: What impact did the legislation have on users' access to and costs of pharmaceuticals? Seven focus group discussions were conducted with pharmacy customers in different locations in May, August and October 1997. Widespread ignorance about the legislation was observed. Pharmacy customers preferred to discuss the role of physicians in 'irrational drug use' to discussing community pharmacies. A definite split was observed between urban and rural pharmacy customers; whereas definite changes were reported in the urban setting (lower prices and increased access), the rural population's perception is that it is being left out. Although the study design is not generalisable, it is clear that the equilibrium between equality and efficiency in pharmaceutical distribution in Iceland has shifted. The introduction of the free market system has increased inequality between rural and urban residents in exchange for increased efficiency.

Adult↗
PubMedDate not supplied

United States and Denmark: different approaches to health care and family planning.

The findings of this study suggest that, compared to the United States, Danish health care policies and family planning services delivery systems are, in the aggregate, more conducive to the promotion of effective contraceptive practice, more instrumental in conveying information to high-risk groups, and more successful in reducing the incidence of unintended pregnancies and induced abortions. One of the major reasons for this difference may stem from the positive and nonambivalent climate of public opinion about sexuality in Denmark and the manner in which health care and family planning services are delivered to all segments of the population regardless of age, income, or location of residence. Research in reproductive behavior is greatly facilitated by the existence of automated population registers.

Abortion, Legal↗