PubMed · 15303695
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Pamela Thompson. 2004. Guiding principles.. https://pubmed.ncbi.nlm.nih.gov/15303695/
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BACKGROUND: There is no doubt that mental health care should be geared toward evidence, cost-effectiveness, and need. Health care data that allow comparisons of demand and real needs are scarce. This is especially true for outpatient care. METHOD: The aim of this study was to assess and analyze data from health insurance plans and social welfare. RESULTS: The costs of mental health care in Germany amount to 13 mio per year and 100,000 population. Health insurance schemes account for two thirds of total costs and social welfare for one third. The distribution of expenses seems not to be based on need analyses. Especially the chronically mentally ill are disadvantaged. CONCLUSIONS: The redistribution of expenses from inpatient to outpatient care including integrated health care approaches would result in more cost-effective mental health care.
Effective methods to diminish the burden of hepatitis C virus (HCV) infection among injection drug users (IDUs) require consideration of the epidemiology and natural history of both hepatitis C and drug use. Most HCV infections are due to injection drug use, and most IDUs have HCV infection. In addition, HCV infection often occurs with other medical problems, such as human immunodeficiency virus infection and depression, which may complicate its recognition and management. Infection with HCV can be fatal, but usually not until years later, and persons may be unaware of the infection, allowing an individual to infect many others. Effective treatment is available for HCV infection; however, the therapy is prolonged, involving both weekly injections and daily oral medication, and is typically associated with significant adverse effects, such as fatigue, depression, and, rarely, life-threatening complications. Although clearly some IDUs want their HCV infection to be treated, many are unwilling or unable to initiate or sustain treatment with currently available therapies, and IDUs who are treated require considerable, multidimensional support. Solutions to the problem of HCV infection among IDUs must account for these facts.
An estimated 15%-40% of incarcerated persons in the United States are infected with hepatitis C virus (HCV). Approximately 1.4 million HCV-infected persons pass through the corrections system annually, accounting for one-third of the total number of HCV-infected persons in the United States. This high prevalence of HCV infection is due to the substantial increase in drug-related arrests over the past 2 decades. Although the hepatitis C epidemic in the corrections system may be viewed as a burden on correctional health systems, it is an important public health opportunity and an obligation. Research on the implementation of cost-effective HCV screening, prevention, and treatment programs among incarcerated persons is essential. Testing, education, and, when appropriate, treatment of prisoners should be a cornerstone of the public health response to the hepatitis C epidemic in the United States.