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PubMed1984

Health in the workplace.

General good health and the prevention of specific "non-occupational" disease, in addition to protection against occupational disease and injury, are already part of the aim and function of occupational health services. They are justified, if at all, mostly on the grounds of intangible benefits the virtue of which is not questioned. Concern over health costs and financial constraints are forcing industry to justify health expenditure. Yet, the health programmes can be justified, and industry has some obligation to adopt them.

Australia↗
PubMed1999

Health sector reform in the Republic of Macedonia.

AIM: To evaluate the results of current reforms in Macedonian health sector. METHOD: Description and situation analysis, covering the period 1991-1997, are focused on demographic and vital indicators, morbidity and mortality data, elements of health care system, legislation, health insurance, health care financing, and elements of health care reforms. RESULTS: The Republic of Macedonia experienced changes in the social and economic situation, similar to those in other countries in transition. The growing number of dependents (young and old persons) impact high health expenditures. High priority health problems were infant and premature adult mortality. As an inheritance of the former political system, the development of different parts of health care services was unbalanced and insurance and local network of health facilities were highly decentralized. The reforms addressed health financing and reimbursement, organization and management of health services, and pharmaceutical policies and supply. The legislation was revised, but new revision is needed. CONCLUSIONS: Health care reforms were needed in Republic of Macedonia in order to overcome the problems associated with early phase of transition. The disadvantages of the current reforms are: lack of proper political will for the implementation of activities according to the planned schedule, initial over-utilization of hospital care, and no significant changes in financing of the public sector facilities. The advantages are that the health system did not disintegrate, universal access to health services was maintained, free choice of physician was promoted, and public/private mix of services was established and financed by the Health Insurance Fund.

Delivery of Health Care↗
PubMedDate not supplied

The new system of health care funding: ethical and social instances.

Ethical instances emerging from the funding system introduced in Italy in 1995 and confirmed in 1999, aiming at the rationalization of National Health Service, are considered. Based on the observation that economic ethics in health care is mainly confronted by the topic of service organization, the causes of the increment in health expenditure, equity in health economy and relative theories are dealt with. The system of payment according to service provided, based on Diagnosis Related Groups is analyzed from the ethical viewpoint and its potentialities and limits are evidenced with respect to the sick person. Possible economy-oriented deviations, the health care service as enterprise can induced in health operators, are discussed.

Diagnosis-Related Groups↗
PubMedDate not supplied

Economic costs of neoplasms, arteriosclerosis, and diabetes in the United States.

Substantial economic resources are used for treatment of neoplasms, arteriosclerotic diseases, and diabetes (direct costs), and substantial productivity is lost due to morbidity and mortality (indirect costs). Costs of these disease groups in the U.S. in 1993 are estimated from national health expenditures from the Health Care Financing Administration and survey data from the National Center for Health Statistics. Based on primary diagnosis, direct costs are $37 billion for neoplasms, $126 billion for arteriosclerosis, and $15 billion for diabetes, and indirect costs are $70, $83, and $5 billion respectively. Costs would be higher, particularly for diabetes ($92-138 billion), if based on primary and secondary diagnosis.

Arteriosclerosis↗
PubMedDate not supplied

Mid-1990s review of Medicaid and Medicaid dentistry.

In light of a federal report on the extremely limited availability of preventive dental services for children under the Medicaid program, a review is provided of the evolving comparative share of general health expenditures and Medicaid funds that are spent on dental services. The findings indicate that during the 1990s, dentistry in general and within the Medicaid program occupies a continuing decreasing share of expenditures.

Adult↗
PubMed1998

CATCH/IT: a data warehouse to support comprehensive assessment for tracking community health.

A systematic methodology, Comprehensive Assessment for Tracking Community Health (CATCH), for analyzing the health status of communities has been under development at the University of South Florida since the early 1990s. CATCH draws 226 health status indicators from multiple data sources and uses an innovative comparative framework and weighted evaluation criteria to produce a rank-ordered list of community health problems. CATCH has been applied successfully in many Florida counties; focusing attention on high priority health issues and measuring the impact of health expenditures on community health status outcomes. Previously performed manually, we are using information technology (IT) to automate the CATCH methodology with a full-scale data warehouse, user-friendly forms and reports, and extended analysis and data mining capabilities. The automated system, CATCH/IT, will reduce the time to prepare community health status reports from months to days. In this paper, we present the current status of the project, along with the principal research and development issues and future directions of the project.

Community Health Planning↗
PubMed1982

Economic issues in health policy.

This paper is a brief review of the economic implications of recent health policy decisions in Australia. Health expenditure as an aspect of social policy is considered, and the relationship between health expenditure and other public sector expenditure is examined with particular reference to social security and education. Economic considerations in achieving policy objectives, and the resource implications of alternative methods of financing are reviewed. Finally, some economic issues relating to possible future options for Australia are discussed.

Australia↗
PubMed1995

PAs/NPs: forging effective partnerships in managed care systems.

Three issues have dominated national health policy discussions over the past three decades--how to control health expenditures, how to improve access to care, and how to ensure delivery of high-quality health services. Cost remains the principal societal concern today. An important new dimension in this debate, however, is a critical examination of the impact of the structure of the nation's health workforce on health expenditures. Within this examination, policy makers are giving specific attention to the supply of health professionals, the role of primary care, and the identification of the most appropriate professionals to deliver primary care. In particular, a renewed interest is being shown in the potential of physician assistants (PAs) and nurse practitioners (NPs) to address all three issues. This article will examine the factors that prompted this focus on health workforce issues and the implications of the use of PAs and NPs for the structure and management of the health workforce in the future.

Cost Control↗
PubMed2004

Adult mental health needs and expenditure in Australia.

BACKGROUND: Relatively little international work has examined whether mental health resource allocation matches need. This study aimed to determine whether adult mental health resources in Australia are being distributed equitably. METHOD: Individual measures of need were extrapolated to Australian Areas, and Area-based proxies of need were considered. Particular attention was paid to the prevalence of mental health problems, since this is arguably the most objective measure of need. The extent to which these measures predicted public sector, private sector and total adult mental health expenditure at an Area level was examined. RESULTS: In the public sector, 41.6% of expenditure variation was explained by the prevalence of affective disorders, personality disorders, cognitive impairment and psychosis, as well as the Area's level of economic resources and State/Territory effects. In the private sector, 72.4% of expenditure variation was explained by service use and State/Territory effects (with an alternative model incorporating service use and State/Territory supply of private psychiatrists explaining 69.4% of expenditure variation). A relatively high proportion (58.7%) of total expenditure variation could be explained by service utilisation and State/Territory effects. CONCLUSIONS: For services to be delivered equitably, the majority of variation in expenditure would have to be accounted for by appropriate measures of need. The best model for public sector expenditure included an appropriate measure of need but had relatively poor explanatory power. The models for private sector and total expenditure had greater explanatory power, but relied on less appropriate measures of need. It is concluded that mental health services in Australia are not yet being delivered equitably.

Adolescent↗
PubMed1993

Japan's experience in long-term home health care of the elderly.

Due to increasing national health expenditure and an aging society, Japan in the 1980s started to reinforce home health care, going beyond her long-time investment in institutional care. Since 1983, a sequence of policies was issued focused mainly on frail elderly care. In support of this governmental approach, a variety of enterprises and charity activities have flourished. Now, however, in the midst of a worldwide recession, rationing as health policy is under reconsideration and has an influence on health care for minorities, including the elderly. In Japan, home health care is under review and a new service system was initiated in April 1992. In this article, the newly inaugurated community-based home visiting nursing scheme is introduced together with a short history of elderly care and related business activities in Japan. Feasibility of the new scheme is discussed and compared with the previous version of home visiting nursing, which had its base in hospitals.

Aged↗
PubMed2003

[Solidarity and financing in the statutory health insurance system sin West Germany during the 1960s and 1970s].

Until the early seventies escalating costs in the health care sector were accepted as being a necessary consequence of social progress. However, this view has since begun to shift. Due to the recession in the mid-seventies, mounting health expenditures now loomed as a threat to the economy. Rather than social progress, the issue now was measures to curb the rising costs and increase-insurance revenues. Rising health care contributions initiated by the government coalition of Social Democrats and the Liberal Party marked this change of perspective in health policy that led to restraints in the principle of solidarity within the statutory health insurance system and, as a result, to a renewed privatisation of health expenditures. Since then patients who had health insurance were obliged to pay a larger share of their health expenses.

Germany, West↗
PubMed1990

Relationship between cross-cultural health attitudes and community health indicators.

Improving health standards both nationally and cross-culturally is a goal for all community health nurses. Previous research has supported links between health attitudes and behavior. The purpose of the present study was to investigate the relationship between attitudes toward health and indexes of community health using a cross-cultural data set. Concepts selected from the data set were I (myself), body, sickness, disease, life, doctor, health, medicine, hospital, nurse, death, and insane. Community health indicators were male and female life expectancy, infant mortality, economic and public health expenditures, and net social progress. The original sample included 1200 high school males within each of 30 language and cultural communities. Data were derived from students' ratings of the dimensions of evaluation, potency, and activity for each concept. The results supported the association between attitudes and objective community health indicators. Unexpected negative correlations were found between attitudes toward medicine and nurse attitudes toward body and life, perhaps indicating that extended contact with health care providers may result in negative attitudes toward them. Positive relationships were found between public health expenditures and nurses, indicating that in countries with more expenditures for community and public health, attitudes toward nurses were more positive.

Adolescent↗
PubMed1991

[Global cost analysis of radiological procedures].

In the Federal Republic of Germany, the amount spent on investments in electromedical equipment and systems has remained constant at 0.7% of total health expenditure over the last 15 years. One-fifth of this sum is used for large medico-technical systems such as CT scanners, cardioangiography systems or shock-wave lithotriptors. Expenditure on this category of equipment, including investments and total application costs, amounts to 2 billion DM. This sum also amounts to 0.7% of total health expenditure, or 1.5% of the volume of the statutory health insurance schemes. This paper contains evaluation from various countries showing that the correct implementation of such high-performance units in diagnosis and therapy results in considerable savings. The cost-reducing effects can nevertheless be over-compensated by additional applications carried out due to the specific advantages of these technologies. However, the growing utilisation indicates improved and more economic medical care of the population.

Costs and Cost Analysis↗