Biomedical subjects
Publications and source records attributed to M Terris.
The differing concepts of health promotion are reviewed in their historical context and development, and a unified concept is proposed which encompasses general as well as specific causative factors in the social environment. The implications for health promotion strategies are discussed.
The worldwide drive for budget cutting and privatization, led by the WorldBank and the International Monetary Fund, has led to serious deterioration of health services as well as education, housing, nutrition and other social services in many countries. The model for this policy is the United States, which represents the pinnacle of private enterprise in the health field. The U.S. experience with this model--its effects on preventive and treatment services and health status--is reviewed. The example of the current drive toward privatization in Spain is discussed, and alternative recommendations are made to protect and improve the health of the Spanish public.
The epidemiologic basis for emphasis on healthy lifestyles as an important aspect of prevention is presented. Experience in changing lifestyles in the United States is reviewed in terms of health education, regulation, taxation, and resources. The need to shift priorities from planning for medical care to epidemiologically oriented health planning is discussed in terms of the relative impact of preventive versus treatment services in improving the health of the population.
This paper considers the elements that determine the health situation in any country: the specific hazards to health, the health services, and the general determinants which influence both the hazards and the services. The expectation of life--the best single measure of the health situation--is presented for each country of the Americas as representing the resultant of these determinants. The changing pattern of disease in the Americas--the emergence of noninfectious diseases as the major problems--is documented, and the need for epidemiologically oriented health planning is stressed. Data are presented to indicate that medical care is the least significant of the basic triad of public health, and that primary attention must be paid to both disease prevention and living standards.
This paper attempts to answer the question: Would global budgeting control hospital costs in the United States? It reviews the development of health insurance and the growth of specialization in the United States, as well as the experience of Canada in attempting to control costs in a fee-for-service national medical care program. It concludes that the main causes of cost escalation in the U.S. are fee-for-service and overspecialization, and urges adoption of the NAPHP proposal for payment of physicians in a national program, i.e. global budgeting for the entire package of ambulatory and institutional services. It also presents a nine-point program for immediate State action to lower costs.
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The Canadian health program is described and analyzed. Positive features include financing through progressive taxation; complete coverage of physician and hospital services; complete absence of deductibles, copayments, and extra charges by physicians and hospitals; lower administrative costs because private insurance companies are excluded from the program; and avoidance of the straitjacket of a single federal program by decentralization to the provinces. Negative features include ever-rising costs due to the almost complete dominance of fee-for-service payment to physicians; failure to monitor the quality of care; and neglect of serious support for preventive services and improved living standards--the two most important determinants of health status. Recommendations are made for a U.S. national health program that would incorporate the positive features of the Canadian program and avoid its deficiencies.
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The health status of Cuba is described in comparison with Costa Rica and, in some instances, the United States. Recommendations are made for epidemiologic studies and for specific health policies to lower death rates from diarrhea and enteritis, cardiovascular disease, cancer, and injuries. Rapid expansion of training and research in epidemiology and biostatistics is emphasized, and specific goals for health outcomes for the year 2000 are suggested.
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The writer contends that incorporating all the components of health, not only medical care, should be our goal as we strive for a comprehensive national system. In discussing the prospects for a national health program, Terris draws on the ideas and observations of Henry Sigerist, the noted medical historian who brilliantly analyzed the political preconditions for the establishment of national health insurance. Finally, he argues that the lessons of Canada offer progressives here a valuable point of departure.
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