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PubMedDate not supplied

The role of commercial non-related living kidney transplants.

The motivation for dialysis patients to seek early, even pre-emptive, kidney transplantation from living donors is discussed. In most countries both the waiting time and the numbers of patients awaiting kidney transplantation are increasing. Local geopolitics in Jerusalem have produced a unique window to observe present transplant practices which include widespread international marketing of kidneys from paid living donors. These have been subject of media admonitions and total rejection by professional organizations. In a modern world, traditional medical paternalism to both donors and patients should be balanced by rights for individual autonomy. Since patients, donors and medical professionals are already participating in illicit organ trading, is it not time for us to seriously consider the ethical and logistic implications of legalizing financial remuneration for kidney donation?

Aged↗
PubMed2003

[How do medical facilities cope with a new medical fee system? A case study of the Kumamoto medical area].

In April 2000, a new medical fee system for hospitals designated for specific functions was introduced into the remuneration of medical services. A basic concept of this system is to pay a supplementary fee for hospital treatment during the acute treatment. In this study, in order to clarify the effect of this new system on hospital management, we performed the case study of three hospitals (Kumamoto National Hospital, Saiseikai Kumamoto Hospital and Kumamoto Chuo Hospital) located in Kumamoto medical area. As a result, in this area, the basic qualitative aspects of medical care environment, such as the number of hospital beds and long-term facilities, was found to be well equipped. In addition, three hospitals differ in following points: 1) characteristics of clinical department, 2) management strategy. In conclusion, the case of the Kumamoto medical area was considered to provide an important model of collaboration and co-operation between medical facilities toward the new medical fee system.

Economics, Hospital↗
PubMed2003

A retrospective study of prevalence of antibody to HIV in blood donors at Ile-Ife, Nigeria.

Records of voluntary and remunerative blood donors bled at the OAUTHC, Ile-Ife, Nigeria between January 1993 and December 2000 were reviewed for HIV sero-positivity. With a structured questionnaire, and over a period of 2 months, the attitudes and awareness of some of the donors of HIV/AIDS epidemic in the country were also assessed. Of the 16,080 units of blood collected in the period under review, only 1073(6.7%) were obtained from voluntary donors. The cumulative HIV seroprevalence rate was 2.1% in the paid donors as against 0.3% in the voluntary donors (c2 = 16.3, df = 1, p = 0.00003). Sixty-five (805) of the donors interviewed confirmed previous knowledge of HIV/AIDS before the interview. All the respondents appreciated the roles of blood transfusion in the transmission of AIDS viruses. The majority (74%) of the respondents were unemployed. Poverty was the reason given by 61(75%) of the commercial donors for selling their blood. We conclude that there is a greater risk of transmitting AIDS viruses (and possibly other blood transmissible diseases) through remunerated blood donors.

Adult↗
PubMed2004

Knowledge, attitudes and practices regarding blood donation among the Saudi population.

OBJECTIVE: To assess the knowledge, attitude and practice regarding blood donation among the Saudi population. Based on this study, an effective strategy can be made regarding motivation and recruitment of voluntary non-remunerated blood donors in future. METHODS: This cross sectional study was carried out at the Armed Forces Hospital, Sharourah, Kingdom of Saudi Arabia, during January 2003. A total of 500 adult males were interviewed. Each individual completed a questionnaire in Arabic language containing epidemiological data and knowledge regarding blood donation and reasons of blood donation or non donation. RESULTS: Out of 500 individuals, 291 (58.2%) were donors and 209 (41.8%) were non donors. Four hundred and seventy-one (94.2%) replied that a person more than 45-years of age could not donate blood. Fifty-one point two percent (107 out of 209) of the non-donors answered that one can donate blood once a year. Out of 291 donors, 186 (63.9%) donated blood for their family members or friends and 105 (36.1%) were volunteer blood donors. Eighty-nine non donors (42.6%) replied that they were 'not approached by anybody' for blood donation and 80 (38.3%) considered themselves unfit for donation due to weakness. CONCLUSION: There are misconceptions regarding blood donation among the Saudi population. This needs education and motivation through dissemination of information regarding blood donation particularly on electronic media.

Adult↗
PubMed2004

Attitudes of physical therapist students toward physical therapist assistants before and after full-time clinical internships.

Development of attitudes of physical therapists (PTs) toward physical therapist assistants (PTAs) begins during their professional education, and attitudes are influenced further by clinical experiences. The purpose of this study was to understand attitudes of student PTs toward PTAs. We surveyed 66 clinical intern students enrolled in an entry-level master of physical therapy program. PT students received the same survey before and after their full-time clinical internship. Eleven Likert scale items were used to assess students' attitudes toward PTAs in the areas of competence, financial remuneration, and job security. One item was designed to determine whether PT students' level of contact with PTAs influenced attitudes. A random sample of 13 (20.9%) students who returned surveys were asked to participate in a telephone interview designed to enrich the quantitative data. After item analysis, five of the scale items were eliminated from the analyses due to poor internal consistency. Cronbach's alpha of the remaining six scale items was 0.75. Survey results reveal that PT students maintain an overall positive attitude toward PTAs before and after full-time clinical internship. Qualitative interview data support this finding. Students' attitudes in specific areas of PTA competence were negative and positive, however. The negative attitude may have been based on the students' beliefs that PTAs are not competent to perform physical therapy in situations that are changing or unpredictable. Positive attitudes may have been reflective of the students' beliefs that PTAs are competent to implement established plans of care. Student ranking of four professional issues showed a significant difference before and after full-time clinical internships.

Adult↗
PubMed1992

Toxicology consultation fees to health care facilities: a successful revenue generating program for poison centers.

Poison information center funding is a continuous problem and is growing more critical as cost containment effects the health care industry. Although a limited number of poison centers are partially funded by governmental agencies, general poison center operational support is derived from a variety of sources, and there is significant pressure upon centers to identify alternative funding sources. Affiliated members of our member hospital treatment network have provided one revenue source, but not all hospitals within our service region have subscribed. Furthermore, hospitals outside of our service region have utilized the service without any financial responsibility despite recommendations to use their local center. Therefore, to provide an incentive for local hospitals to subscribe to the service and to dissuade hospitals from outside of the region from using the service, we implemented a toxicology consultative fee for service on all calls emanating from non-member hospitals. In just 19 mo, recruitment of 16 new member hospitals has generated $65,150 additional revenue. Non-member hospitals electing not to affiliate but to remunerate for toxicology consultations (226 cases) have generated $20,400 (98% collection rate). A startling 95% reduction in calls from hospital outside of region has resulted since this fiduciary initiative began. New revenue totaling $85,550 has been generated by establishment of a toxicology consultation fee, and our staff is now able to dedicate priceless time and resources to the poison information needs of the residents of our region.

Fees and Charges↗
PubMed2004

Markers for transfusion-associated hepatitis in north Indian blood donors: prevalence and trends.

Transfusion-associated hepatitis is a great problem in developing countries including India due to endemic hepatitis infections and a lack of voluntary donors, trained personnel, and funds. The prevalence of post-transfusion hepatitis B and C in India is about 1-5% and 1%, respectively. A total of 128,589 blood donors were screened for hepatitis B surface antigen (HBsAg) and 76,089 donors were screened for anti-hepatitis C virus (HCV) from 1997 - 2002. Data were tabulated annually. Out of the total 83.6% were replacement donors. Our study concluded that the prevalence of HBsAg and antibodies for HCV ranged between 1.7 - 2.2% and 0.25 - 0.9%, respectively among all of the donors. Seropositivity was definitely higher in replacement donors than in voluntary donors. Based on these results, we recognize an urgent need to establish a non-remunerated voluntary donor base in India. A stringent deferral system should be developed. The use of sensitive laboratory tests and the addition of core antigen (anti-HBc) to the mandatory screening test list would further reduce the incidence of post-transfusion hepatitis.

Blood Donors↗
PubMed2004

Impact of decentralization on health services in Uganda: a look at facility utilization, prescribing and availability of essential drugs.

INTRODUCTION: Uganda began implementation of a structural adjustment programme (SAP) in July 1994 in order to improve social services. The decentralization of health services administration to district level was intended to improve the quality of health services and pharmaceutical supplies in the hospitals, with resultant increase in the level of utilization of health facilities. OBJECTIVE: This study evaluated the impact of the decentralization policy on health facility utilization; availability of essential drugs, and prescribing patterns for acute respiratory infections (ARI), diarrhoea, and malaria in two district hospitals in Uganda. DESIGN: Mixed method evaluation design, involving both quantitative and qualitative methods. Time series analyses of data from utilization, pharmacy stock, and prescription records before and after the policy change. Key informant interviews and focus group discussions to obtain information on perceptions and attitude of stakeholders on the process of the policy implementation. STUDY SETTING AND POPULATION: The study was conducted in two district hospitals in northern Uganda. A total of seven years of utilization and pharmacy stock data including 5040 patient records from the hospitals were analysed retrospectively. In-depth interviews were conducted among 11 politicians from each district; 100 open-ended questionnaires were administered to patients in each hospital; 86 health care workers were interviewed using semi-structured questionnaires; and focus group discussions were conducted with 23 health care providers. MAIN OUTCOME MEASURES: Facility utilization was evaluated by average monthly attendance in the outpatient department and paediatric ward admissions. Availability was assessed as average number of drugs per month. Prescribing indicator outcomes included: for malaria, percent chloroquine tablets and percent chloroquine injection; for ARI, percent receiving antibiotics or injections; for diarrhoea, use of oral rehydration salts (ORS), antidiarrhoeal mixtures, and antibiotics. The average number of drugs prescribed assessed polypharmacy. RESULTS: There was a general increase in patient attendance in both hospitals, although the initial increase later declined in Apac. Drug availability was erratic and not always adequate. The situation was better in Lira where funding for drug procurement was more accessible. Prescribing patterns varied, with improvement in some indicators, while others showed no change or even worsened. CONCLUSIONS: The decentralization policy led to increased utilization of health facilities. The perception was that the policy was good because it "empowered the community in terms of creating a sense of responsibility in the stakeholders, and a sense of ownership that facilitated sustainability" of public institutions. In spite of the views expressed by the stakeholders, the policy failed to improve drug shortages, inefficient utilization of resources, and low morale among hospital staff. Staff should be re-trained and better remunerated in order to cope with the implementation of the policy. Local politicians should clearly understand their roles and responsibility under the new policy. Efficient utilization of funds at all levels of the district administrative structures should be ensured.

Delivery of Health Care↗
PubMed2004

The collaborative method. A strategy for improving Australian general practice.

BACKGROUND: The United Kingdom National Primary Care Collaborative (NPCC) is said to be the largest health service improvement project in the world. The 2000 practices participating serve 11.5 million patients throughout the UK. Improvements such as a 60% reduction in waiting times to see a general practitioner and a four-fold reduction in coronary heart disease mortality have drawn the attention of policy makers in Australia. In 2003, I accompanied a group of Australians to Manchester in the UK to participate in an international training course in collaboratives hosted by the NPCC. The Australian government has recently called for tenders to run the Australian Primary Care Collaborative (APCC) program. OBJECTIVE: To describe the NPCC and discuss how the methodology could be adapted and applied to Australia. DISCUSSION: The Australian primary health care system faces challenges in application of evidence to patient care. Collaborative methodology warrants consideration to address these. Differences including distance, business issues, remuneration mechanisms, infrastructure deficiencies and clinician cynicism present challenges in adaptation and application to Australia. Given adequate support, an APCC could empower general practices to continue to make improvements in many areas of activity.

Australia↗
PubMed2004

[Corresponding to an investigation of the Japan Council for Quality Health Care].

The Japan Council for Quality Health Care (JCQHC) was established in 1995, to improve medical facilities in Japan. After 2001, the medical service of a medical facility could be remunerated. When its activity level is authorized of JCQHC, thereafter the medical facilities applying the authorization have been increasing. For the authorization of a medical laboratory section, two functions must be evaluated by JCQHC, i.e., (1) reliable quality control of laboratory data, and (2) effective cooperation with the other sections within the facility. Items included in the latter are participation in hospital operation, teamwork and personnel management within the section, education-training, quality control of materials and equipments, reasonable utilization of out-sourcing, etc. The application documents for the assessment by the JCQHC describe the organization of the medical facility, available guidelines and manuals, and operation records. The operation records should be itemized into programming, inspection-analysis of the procedures, measures of incidents-accidents, etc. It is recommended that self-assessment of these items be established within a facility.

Accreditation↗
PubMed1992

General practice 'going places'.

This paper, which was presented at the Annual General Meeting of the Royal Australian College of General Practitioners in September 1991, outlines possible roles for the general practitioner in the public health system. Four fundamental steps need to be taken: affirmative action by health boards to include GPs in all activities; representation of the RACGP on health boards; adequate remuneration; and part time employment of GPs in all health care delivery service units.

Australia↗
PubMed2004

Mineral wealth and medical opportunity.

With the increase in population and in colonial revenues after the discovery of diamonds and gold in the last quarter of the nineteenth century, public and private hospitals proliferated, particularly in larger centres such as Cape Town. The numbers of practitioners engaged in public health also increased. Perhaps as important, doctors were now accepted as skilled professionals and remunerated accordingly. At the same time there was also a greater demand for doctors in the employment of business and industry, particularly the insurance industry and the railways. These opportunities for salaried employment somewhat reduced doctors' professional autonomy and occasionally encouraged intra-professional squabbles. Yet they also provided a springboard for general professional regulation, growing professional status in specialisms like psychiatry, and a solid base for the economic survival of country doctors.

Colonialism↗
PubMed2004

[Cervix cancer screening in a health district (Burkina Faso) by voluntary biopsies after the application of acetic acid and lugol].

A voluntary screening of uterus cervix cancer took place in Kossodo health district from February 1st 2001 to April 30th 2002. It involved the age-group women of 25 to 59 years. This study included 239 women given a participation rate of 6.8%. We had sampled young women in three categories with average age of 38 years: a) doing a remunerated job (64.9%); b) mostly educated (85.3%); and c) married (86.2%). The visual inspection was the method used after the application of 4% acetic acid followed by that of lugol. In all 74 biopsies have been undertaken. Furthermore, we have noticed a 4.2% prevalence of pre-cancerous injuries. The cancerous lesions represented 2.5% of the sampling and the inflammatory lesions 13.4%. VPH infection was found on 2.5% samples and condylomatous injuries in 5% cases. This experience would deserve to be carried out always and a cervix cancer screening campaign held at national level.

Acetic Acid↗
PubMed2004

Maori responsiveness in health and medical research: key issues for researchers (part 1).

INTRODUCTION: Application for contestable government-research funding and ethical approval requires researchers to outline how their intended research project contributes to Maori development or advancement. METHODS AND RESULTS: When formulating their research proposals, the key issues for researchers are research utility, defining Maori, informed consent, confidentiality, issues with human tissues and genetic material, participant remuneration and recognition (koha), intellectual property, and involvement of local Maori health or social services. CONCLUSIONS: The most common Maori responsiveness issues in research applications can be readily approached by researchers who address straightforward methodological concerns, by working through precedents established by peers and colleagues, as well as by working with end-users of their research.

Advisory Committees↗
PubMed2004

Academic medicine in a southern African country of Malawi.

Academic medicine is usually considered to be a tripartite composition of teaching, research, and health care services delivery or patient care. The meaning of each component varies with interpretation. Developing countries such as Malawi face particular challenges in the field of academic medicine, including research resources, financing, and the brain drain of health human resources. Such constraints contribute to reduced numbers of faculty members, poor remuneration and diminished capabilities for career advancement. Addressing the issues currently plaguing academic medicine will enable this essential and multi-faceted discipline to flourish.

Academic Medical Centers↗
PubMed1992

[What does the higher concentration of general practitioners mean for fee-for-service reimbursement].

The density of general practitioners has increased steadily in Norway. By the end of 1989, there were 1,339 inhabitants per general practitioner. General practitioners are partly remunerated per item of service, i.e., by reimbursement from the National Insurance Fund and partly by patient co-payment. The article analyses the connection between density of general practitioner and level of fee-for-service reimbursement. The average general practitioner received about 60% higher fee-for-service reimbursement in 1989 than in 1985. This increase is markedly higher than the nominal changes in the tariff. The increase was somewhat higher in areas with a relatively low density of general practitioners. Also, in each of the years 1985-1989, the average fee-for-service reimbursement was slightly higher in areas with a low density of general practitioners. The variations have only a slight impact on the gross revenues of general practitioners. Three models explaining the use of general medical services are outlined. The results can be interpreted in the light of changes in health, changes in health-related behaviour, and supplier-induced demand. Since only aggregate data are available, it is difficult to further explore possible explanations.

Fees, Medical↗
PubMed2004

Oral healthcare systems in the extended European union.

UNLABELLED: This article reports a survey of the systems for the provision of oral healthcare in the 28 member and accession states of the EU/EEA in 2003. Descriptions of the systems were collected from the principal dental advisers to governments in the individual states. In many states these were the Chief Dental Officers (CDOs). In states without a CDO, descriptions were gathered from CDO equivalents or senior academics. A template (model description) was used to guide all respondents. Additional statistical information on oral healthcare costs and workforce was collected from the Council of European Chief Dental Officers, WHO and World Bank websites. The study showed that in broad terms there were six patterns (Beveridgian, Bismarkian, The Eastern European (in transition), Nordic, Southern European and Hybrid) for the administration and financing of oral healthcare in the expanding EU. The extent and nature of government involvement in planning and coordinating oral healthcare services and the numbers and pay of the oral healthcare workforce varied between the different models. The biggest recent changes in European oral healthcare were found to have occurred in Eastern Europe, where there has been wide scale privatization of the previously public dental services. However, most of the EU accession (Eastern European) states seemed to be slowly developing insurance systems to cover oral health treatment costs. In the existing EU/EEA, the public dental services such as those in the Nordic countries still have strong political support and some expansion has occurred. In Southern Europe public dental services seemed to have gained some acceptance for the treatment of children and special needs groups. In UK, which has a unique public dental service system, there are plans to make big changes in the delivery, commissioning and remuneration of dental services in the near future. Some EU member states which operate the Bismarkian system with health insurances offering wide population coverage, comprehensive treatment and benefits connected with frequent dental visits, were reported to be experiencing financial problems. The study also indicated that at present, with the exception of Portugal and Spain, where there is dynamic growth in the numbers of dentists, the overall size of the EU/EEA oral health workforce is expanding fairly slowly. Only a minority of member states appeared to collect data on uptake of services and care costs and there were great difficulties in assessing outcomes of care. The data on costs appeared to show wide variations from member state to member state in per capita spending on oral healthcare. In the majority of states, however, costs, especially those in the private sector, could only be estimated. Nevertheless, at a 'macro' level, the study indicated that, in 2000, the 28 member and accession states of the EU/EEA had a total population of 456 million and an oral health workforce of 900,000 (some 300,000 of whom were dentists) and that the cost of oral healthcare was about EUR 54,000,000,000. CONCLUSION: The study showed wide variations in oral healthcare provision systems between EU/EEA member and accession states and no evidence of harmonization in the past.

Adult↗