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PubMed2004

Spreading it around: money for researcher and research participants.

There is a consensus that inducements for participants in research studies are ethically permitted as long as they are not "undue." The subject of inducements for investigators has not been ethically analyzed. This essay outlines the three models for compensation suggested by Dickert and Grady--market model, reimbursement model and wage-payment model--and argues that this analysis can be fruitfully applied to remuneration for investigators. Currently, investigators are compensated according to the market model, resulting in undue inducement. Investigators should be compensated according to the wage-payment model, as skilled workers, at the rate an internist earns per hour. The wage-payment model avoids undue inducement, but compensates investigators, particularly non-academic investigators who are not salaried, for their time and effort. However, additional safeguards must be erected: investigators must demonstrate research competency for the studies they are to manage; they must understand research ethics; all investigators must be routinely audited; and subjects must be informed of all remuneration that investigators receive.

Compensation and Redress↗
PubMed2004

Rural GPs' ratings of initiatives designed to improve rural medical workforce recruitment and retention.

INTRODUCTION: Since the early 1990s, Australian governments have recognised the problems of rural medical workforce recruitment and retention and have implemented a range of programs and incentives designed to improve the supply of, and access to, doctors in rural and remote areas. Some incentives involve differential payments according to degree of rurality or remoteness. Since these programs involve considerable costs to governments, some assessment of their impact on recruitment or retention is warranted. The objective of this study is to examine the effectiveness of different recruitment and retention incentives from the perspective of the rural GP. Doctors practising in rural and remote communities were, therefore, asked to rank the relative importance of different interventions in terms of their impact on recruitment to and retention of GPs in their communities. METHODS: Six possible interventions were selected to cover the major objectives underpinning rural workforce programs most relevant to doctors currently in rural practice. Respondents assigned a rank to indicate the relative importance of each item with respect to each of the two questions: "What would help most to attract more GPs to this community?" and "What would help most to retain GPs in this community?" The data were collected as part of a national study into the viability of rural general practice undertaken jointly by the Rural Doctors Association of Australia and Monash University School of Rural Health Bendigo. The Rural, Remote and Metropolitan Areas (RRMA) classification was used as the rurality indicator. Analysis involved the calculation of mean ranks for each item. Item means were then ranked to indicate most to least important items in total, and within each RRMA category. RESULTS: Thirty-five percent of all GPs practising in rural and remote Australia responded to the national survey, representing 53% of all practices in those areas. Of these, 1050 doctors who nominated themselves as a principal, partner or associate in their practice were eligible for inclusion in this analysis. The results showed a high degree of agreement in the responses to both questions, with the possible interventions being ranked in the same overall order. 'Better remuneration for Medicare consultations' and 'Improved after-hours and on-call arrangements' were ranked as the most important interventions for both attracting and retaining GPs, whereas 'Better education and professional support activity' and 'Improved availability of allied health professional services' were ranked as least important of the options presented. 'Better locum availability' and 'Capital funding to improve practice infrastructure/enable GPs to set up practice' ranked in between. Results within each RRMA category were very similar to the overall rankings, confirming the significance of the improved remuneration and workload arrangements, regardless of geographical location. CONCLUSIONS: Ensuring professional support, workforce supply, income and infrastructure support are all relevant to the recruitment and retention of GPs in rural and remote areas. However, from the perspective of GPs practising in such areas, specific initiatives that increase the core income of rural practices, and which address those medical workforce supply issues which impact most on workload, are considered those which are most likely to assist in the recruitment and retention of GPs to Australia's rural and remote communities.

Journal Article↗
PubMed2003

Newborn screening in Korea.

The Ministry of Health and Social Affairs adopted a newborn screening program in 1991 to cover low-income families. The system was extended in 1997 to cover all newborns. The number of screened conditions was reduced from 6 (CH, PKU, Gal, MSUD, HU, HIS) to 2 (CH, PKU) in 1995. The national newborn screening program was in need of an in-depth review for further improvement. Thus, a background survey was conducted at 241 health centers in June 2000 to assess the current status of the screening system and to identify characteristics of detected patients. Expert opinions on the effect and efficiency of the screening program were also gathered. The number of identified cases was 481--CH (378 cases), PKU (73), MSUD (11), PA (7), UCD (9) and Gal (3). Most cases were identified after 1997. Of all cases, 83.5% were identified within 2 months after birth; discovery rate within 2 months after birth increased rapidly from 23.5% in 1994 to 90% in 1997; 17.7% of PKU and 4.2% of CH cases had associated family histories. Among the problems the present study revealed are: absence of an organization responsible for coordination and control of national newborn screening services, too many screening laboratories (76 laboratories as of 2000), inadequate follow-up treatments and services, complicated remuneration system. Further services; reduce the number of screening laboratories from the current 76 to 3-4 laboratories; mplement Tandem Mass Screening; and simplify the remuneration system.

Health Care Surveys↗
PubMed2006

Medicare and state health care programs: fraud and abuse; safe harbors for certain electronic prescribing and electronic health records arrangements under the anti-kickback statute. Final rule.

As required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Public Law 108-173, this final rule establishes a new safe harbor under the Federal anti-kickback statute for certain arrangements involving the provision of electronic prescribing technology. Specifically, the safe harbor would protect certain arrangements involving hospitals, group practices, and prescription drug plan (PDP) sponsors and Medicare Advantage (MA) organizations that provide to specified recipients certain nonmonetary remuneration in the form of hardware, software, or information technology and training services necessary and used solely to receive and transmit electronic prescription information. In addition, in accordance with section 1128B(b)(3)(E) of the Social Security Act (the Act), this final rule creates a separate new safe harbor for certain arrangements involving the provision of nonmonetary remuneration in the form of electronic health records software or information technology and training services necessary and used predominantly to create, maintain, transmit, or receive electronic health records.

Fraud↗
PubMed2006

Medicare program; physicians referrals to health care entities with which they have financial relationships; exceptions for certain electronic prescribing and electronic health records arrangements. Final rule.

As required by section 101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), this final rule creates an exception to the physician self-referral prohibition in section 1877 of the Social Security Act (the Act) for certain arrangements in which a physician receives compensation in the form of items or services (not including cash or cash equivalents) ("nonmonetary remuneration"') that is necessary and used solely to receive and transmit electronic prescription information. In addition, using our separate legal authority under section 1877(b)(4) of the Act, this rule creates a separate regulatory exception for certain arrangements involving the provision of nonmonetary remuneration in the form of electronic health records software or information technology and training services necessary and used predominantly to create, maintain, transmit, or receive electronic health records. These exceptions are consistent with the President's goal of achieving widespread adoption of interoperable electronic health records to improve the quality and efficiency of health care while maintaining the levels of security and privacy that consumers expect.

Humans↗
PubMed2006

The risk of transfusion-acquired hepatitis-C virus infection among blood donors in Port Harcourt: the question of blood safety in Nigeria.

OBJECTIVE: This study was undertaken to establish the sero-epidemology of Hepatitis C Virus (HCV) antibodies among blood donors in Port Harcourt, Nigeria. METHODS: One Thousand Five Hundred consecutive blood donors presenting to the blood transfusion unit of the University of Port Harcourt Teaching Hospital between January and April, 2003 comprising of 1481 males and 19 females were screened for hepatitis C antibodies using the commercially available Clinotech anti-HCV test strips. All initially positive samples were subsequently tested using a second-generation Trinity Biotec enzyme linked immunosorbent assay. RESULTS: HCV antibodies were detected in 7 (0.5%) of donors. Although statistically not significant, the overall sero prevalence of HCV antibodies was higher in males 7 (0.5%) compared to zero prevalence among females. (chi-squared = 1.94, p = 1.000). Commercial remunerated donors had a higher prevalence of anti-HCV anti-bodies 5 (0.8%) compared to family replacement donors (0.2%) (chi-squared = 1.25, p = 0.26). The highest infection rate occurred in the 18 - 27 years age group 7 (0.7%). CONCLUSION: This study shows a 0.5% prevalence of HCV antibodies among blood donors and describes their demographic characteristics. This calls for urgent implementation of a universal donor screening for HCV antibodies and setting up of a national blood transfusion service run on the basis of voluntary, non-remunerated low risk donors.

Adolescent↗
PubMed2006

The clinical interventional radiologist: results of a national survey by the Canadian Interventional Radiology Association.

OBJECTIVE: To determine the level of clinical responsibility interventional radiologists in Canada currently have within their practice and would like to have within their future practices. METHODS: An anonymous online survey was e-mailed to all members of the Canadian Interventional Radiology Association. The survey was open for a period of 2 months. RESULTS: A total of 75 surveys were received, of a possible 247, a response rate of 30.4%. Responses regarding general measures of clinical duties were collected. The current situation in Canada is mixed, in that while most (82%) respondents perform procedures that require an overnight admission, only 11% have a dedicated interventional radiology (IR) ward and 29% have admitting privileges. Most (73%) respondents stated that interventional radiologists in Canada should become more clinical. The most common reason cited for a lack of admitting privileges was a lack of time (44%), followed by a lack of hospital or administrative support (40%), "other" (20%), and inadequate remuneration (14%). CONCLUSIONS: Most respondents believe that interventional radiologists should become more clinically oriented. The most frequently noted obstacles to becoming more clinically oriented are reluctant administration, lack of time, and inadequate remuneration for clinical duties.

Canada↗
PubMed2006

Rural mental health units--is there a role for a GP?

INTRODUCTION: Mental illness is a common medical condition which is increasing in frequency. In Australia, almost one in five persons have experienced an anxiety, depressive or substance abuse disorder in the last 12 months, but less than half have sought professional assistance. In rural and remote areas, there is limited access to psychiatrists, and the majority of mental health care resides with the GP. This study aimed to ascertain the opinions of GPs in rural and remote areas of Queensland on the concept of locating a GP within in a mental health unit. METHODS: Participants were all general practitioners listed on the databases of the Rural Divisions of General Practice covering RRMA 5-7 in Queensland, Australia, excluding those who could potentially refer patients to the mental health unit where the principal investigator worked. A specially designed questionnaire was forwarded to eligible GPs in a series of three mailings. RESULTS: In total, 145 GPs returned the questionnaire, giving a 69% response rate. The majority of GP respondents believed that there was a significant number of patients with mental illness who would benefit from the contribution of a GP, and that locating a GP within a mental health unit was a viable option, especially for enhancing continuity of care and consequently overall health. The majority of respondents said they felt confident in treating mental illness, especially those with higher mental health caseloads and those with a professional college fellowship. However, there were varying inclinations towards working in such a unit, with no definite preferred method of remuneration identified. CONCLUSIONS: Rural and remote GPs in Queensland believe there is a case for placing a GP within established mental health units, subject to addressing logistic and remuneration issues, as they believe this would enhance continuity of care and improve overall health for those with mental health problems.

Adult↗
PubMed1990

[Hepatitis C virus (HCV) antibodies in German blood donors--a pilot study].

A new EIA-test to detect Hepatitis C antibody (ORTHO Diagnostic Systems) has been evaluated in four blood transfusion services in FRG (Hamburg, Hannover, Springe, Frankfurt). Among 3,123 specimens, 18 (0.58%) reacted initially positive, 13 (0.42%) remained positive after repeat testing. A detailed analysis revealed remarkable differences: blood donors from the northern part of Germany were less frequently positive than donors from the southern region (0.24% vs. 0.79%), repeat donors had a higher HCV-antibody incidence than first-time donors (0.48% vs. 0.29%). Similar differences were observed between remunerated and non-remunerated donors (0.24% vs. 0.53%), as well as between donors from rural and urban areas (0.34% vs. 0.46%). In contrast to other investigators, only a weak correlation between elevated ALT-levels (greater than 50 IU/ml) and anti-HCV seropositivity rate has been found.

Antigens, Viral↗
PubMedDate not supplied

[A study of job satisfaction of nurses of the RSA (South Africa Nurses' Association)].

The purpose of this study was to determine whether changes had occurred in the work satisfaction of nursing services after the establishment of private initiative in health care due to the deregulation program currently conducted by the government. In a survey conducted in the latter part of 1988 700 questionnaires were sent out of which 213 were returned which gives a response of 30.43 percent. The analysis was based on this data. The attitudes of the members of the nursing services ranged from antipathy to lively enthusiasm. It was, however, clear from the response that there exists a strong negative view amongst the nursing profession regarding remuneration, communication, training and promotion. These are tendencies that can harm the profession as a whole on the long run and should therefore receive special managerial attention. Recommendations include market related remuneration, continued nursing training, and planned career paths, as well as an appeal that only minimum admission requirements should be accepted as preconditions to training in order to cope with the growing Third World demands on health care services.

Attitude of Health Personnel↗
PubMed1989

[A team form of organization and payment for the services of medical personnel providing ambulatory-polyclinical care].

The study is designed to analyze team forms of labour organization and remuneration for work of medical personnel when rendering outpatient care to the population. Owing to this organizational form, it becomes possible to integrate obstetric, therapeutic and specialized services at the territorial and shop levels by means of consolidation of physician's sectors. Five possible variants of the team form of labour organization and remuneration for work of medical personnel providing outpatient care have been proposed according to specific conditions. The experiment carried out during a year confirmed social, medical and economic efficacy of the team form of labour organization.

Ambulatory Care↗
PubMed1989

Paying general practitioners: shedding light on the review of health services.

This paper reviews evidence from recent research on the effects of different methods of remunerating general practitioners. Each method is examined in terms of patient use of health services in general, use of services by different groups in society and health outcome. Little is known about the effects of capitation as it currently exists in the UK, salaries or special payments for 'good practice', although evidence from British research is likely to be forthcoming on the last of these. Both health maintenance organizations and charges deter utilization, although little is known about the effect of this reduced demand. Furthermore, these two methods of financing health care appear to discriminate between members of society on lower and higher incomes in terms of both service use and health outcome. Fees for items of service provided tend to lead to unnecessary demands for fee yielding services by patients on the recommendation of their doctors. Although more evidence on different methods of remuneration is required, the importance of what is already known depends on the objectives of health care provision.

Capitation Fee↗
PubMed1986

Course organizers in general practice.

In August/September 1984 a survey of the 267 course organizers in post in England and Wales was carried out. Eighty-two per cent replied to a questionnaire asking for details about their work and personal status. All 16 regions in England and Wales completed a questionnaire about levels of staffing and remuneration of those involved in general practice postgraduate education. The results show that there are considerable variations between regions in the role and responsibilities of course organizers, in their training, and in the facilities that are provided for them. The majority of course organizers reported a workload greater than the number of sessions for which they were remunerated. The effects of these factors on recruitment, tenure of post, and job satisfaction are discussed. Recommendations are made for improving the situation, including the removal of course organizer pay from the scale of trainers' pay, so that there can be flexibility in the number of sessions which can be held, improvement in training and certain facilities, and the implementation of national and local job descriptions.

Adult↗
PubMed1980

The Belgian plasmapheresis programme.

In Belgium 6000 non-remunerated donors regularly give plasma by the double plasmapheresis technique. The donation frequency is once every two weeks. Thus 75 000-80 000 liters of plasma are collected annually. This figure represents 7 500-8 000 liters of plasmapheresis plasma/10(6) inhabitants. Furthermore 5000 liters of plasma/10(6) inhabitants are recovered from whole blood (60% utilization of erythrocytes-concentrates). The 13 000 liters of plasma/10(6) inhabitants allow the country to cover all the national needs of albumin, coagulation factors and immunoglobulins. The programme is fully described and presented as a unique model of national self-sufficiency avoiding red cells wastage, and being entirely based on non-remunerated donors.

Belgium↗
PubMedDate not supplied

Valuing the unseen emotional labour of nursing.

This paper argues that comforting, listening, being reassuring and showing sympathy are important nursing skills that are vital to a patients' well-being and, as such, should be both valued and remunerated. The author also argues that the invisibility of these skills has been compounded by the NHS and Community Care Act 1990. This has meant that long-term care is being transferred into the hands of the private and voluntary sectors and informal carers. As an alternative to residential care, many social services departments now use the home care services of not-for-profit care agencies who employ 'ordinary' people to enable those needing long-term care to remain in their own home. Such workers are often paid in a way that does not remunerate the emotional element of their labour.

Emotions↗
PubMedDate not supplied

Risk management: navigating the legal waters of physician referral.

In its OBRA laws and safe harbors, the Federal government seeks to prohibit direct or indirect remuneration of physicians for patient referrals. Physicians must become familiar with the laws and regulations, and use that knowledge to guide practice structure, referrals, and investments. Practices must comply with the regulations' intent; activities designed to meet safe harbors but which still generate illegal remuneration are not protected. Legal counsel can help physicians determine whether state or licensing agency requirements vary from Federal requirements.

Ethics, Medical↗
PubMed1994

[Epidemiology of predominantly occupationally-induced bronchopulmonary diseases].

During the last years occupational diseases are of increasing interest. This lead to an increased sensibility which results in a continuous increase of the number of announcements of suspicion of an underlying occupational diseases. The rate of cases first remunerated remains nevertheless constant. The number of diseases caused by inorganic and organic dusts and the obstructive airway-diseases increase despite of the continuous decrease of silicosis. Among the diseases first remunerated in 1990, occupational diseases caused by inorganic dusts took up the first place (31.6%). As for the deaths in 1990, 91% are due to diseases caused by inorganic dusts.

Cause of Death↗
PubMed1993

Which methods of donor recruitment give the safest donors?

Thus, it can be seen that there are a number of ways by which donors can be recruited into the blood supply: voluntary non-remunerated random donors, paid random donors, directed donors, replacement donors and unused autologous units from autologous donors. It can be seen from the data and evidence discussed above, as designated by the World Health Organisation, voluntary non-remunerated donation is far and away the safest form of blood donation and strenuous efforts must be developed for a strong programme using a core with a high percentage of regular donors in order to maintain the highest possible quality of blood supply.

Blood Donors↗