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PubMed1991

The team physician.

The term "team physician" may refer to the activity of a sports physician in providing medical surveillance and care to a team of athletes, or to activities in coordinating a team of medical and paramedical professionals (the "sports medicine team") in the care of one or more athletes. Frequently, it denotes both activities undertaken by the same physician simultaneously. To be effective, the team physician must have medical knowledge and skill in breadth, as opposed to depth, such as derives from primary care experience. Furthermore, he or she must understand, appreciate, and function comfortably with athletics, athletes, the athlete's milieu, and the other individuals important to athletes' successful pursuit of their chosen sport. Although such service rarely provides significant financial remuneration, the rewards in terms of personal satisfaction, the opportunity for unique interpersonal relationships, and the ability to make a meaningful community contribution are significant and apparently sufficient to encourage a rapidly growing number of physicians to undertake the role.

Humans↗

PubMed1991

Immunoassay external quality assessment in the Federal Republic of Germany.

The state of the art in practical external quality assessment (EQA) in the Federal Republic of Germany is described. Two organizations, INSTAND (Institute for Standardization and Documentation in Medical Laboratories) and the German Society for Clinical Chemistry (DGKCh) have been appointed by the central government to organize and run EQA schemes. Although legislation rules that participation for seven analytes (five steroids, thyroxine and theophyllin) is mandatory, using gas chromatography-isotope dilution-mass spectrometry as the reference method, this has been suspended. For remuneration from the local health insurance organizations, the laboratory must provide evidence of having participated in one of the two national EQA schemes. The schemes are run between 3 and 6 times yearly and cover the whole field of endocrinology and related substances.

Academies and Institutes↗

PubMed1991

Primary care services. In search of alternative ways of providing services that are affordable, accessible and appropriate. A review of recent literature.

Services where the G.P. is the central health professional or "team leader" may satisfactorily provide first-contact medical services. Major problems reported in literature are related to inequity in distribution, and the fee-for-service practice that limits access for those on lower incomes and encourages high throughput. There is a heavy reliance on pharmaceuticals as the main treatment, with health promotion and educative services, and counselling, being generally low. While alternative or complementary therapies may address problems of "failed medicine", these don't answer issues of accessibility, or self-responsibility. Studies on nurse practitioners as the first contact in primary level care demonstrate that technically they can function competently and safely amongst a similar clientele, and that the clients find nurses both satisfactory and acceptable as health care providers. While the quality of care is comparable to that offered by a G.P., the cost is less, both directly to user, or more generally to society. This is related to lower costs of education and remuneration, and that lower costs of pharmaceuticals and diagnostic tests are generated. In addition, the health promotion and educative functions of nurses are overall more prominent, and effective in enhancing peoples self-responsibility in health through improving competence and awareness. User-participation and involvement in health services, and empowerment and self responsibility in health, are therefore more likely to be an outcome of a service in which health promotion and educational activities are central, rather than when medical interventions are the focus. In conclusion, this review of recent literature has raised questions about services currently provided by general practitioners, and as presently funded.(ABSTRACT TRUNCATED AT 250 WORDS)

Family Practice↗

PubMedDate not supplied

[Psychiatric family care--alternative management for long-term psychiatric patients].

It is unfortunate that mental patients with long-term hospitalisation patterns are still necessarily scheduled for long-term stay in mental hospitals and institutions designed for the care and treatment of psychiatric cases, since such institutions are characterised by a rather sterile, low-stimulation atmosphere underlining rather than relieving the severity of the disease. This article presents a possible alternative, namely, care of mental patients within the framework of a foster family; these patients had been hospitalised for a long time and are now living in families who are remunerated for their efforts and are given medical assistance in performing their task as hosts. The design of an empirical study is explained.

Activities of Daily Living↗

PubMed1991

[Income of family physicians in Western Europe].

Although doctors tend to belong to the best paid categories of professionals, considerable differences between countries in average remuneration can be found. This study is focused on incomes (1985) of general practitioners (GP) in II Western European countries (Austria, Belgium, Denmark, Finland, France, West Germany, Italy, United Kingdom, the Netherlands, Norway and Sweden). Beside a description of the incomes (before taxation) as such, an attempt is made to correlate the income figures with some characteristics of the general practitioner's position in each country. The average GP income per country (before taxes) was ECU 43,600. The German (ECU 67,000), Austrian (ECU 56,000) and Danish (ECU 55,000) form the top, the Italian (ECU 14,000), Belgian (ECU 31,000) and Swedish (ECU 34,500) doctors the bottom-three. Correcting for OECD purchasing power parities does not change the rank order of the GP income in the different countries essentially. The more doctors per inhabitant, the lower the income, and the more different tasks the GP has to perform, the higher the income. Direct access of specialist care has no relationship with GP incomes.

Europe↗

PubMedDate not supplied

Phantom stock dividend plan.

The Phantom Stock Dividend Plan is a method of sharing net profits with staff in the same way a stock holder in a company receives periodic dividends. The purposes of the plan are to reward the staff for creative talents and recommendations for improvements; to involve the staff in the concept of being partially responsible for increased profitability of the practice; to encourage long-term employment; and to base increases in staff remuneration on profits rather than simply on seniority. An example of the plan is presented which can be modified to fit different practice situations.

Dental Staff↗

PubMed1990

[Legal contract of workshops for handicapped people--a wish or reality?].

In August 1990, the "Werkstättenverordnung" (the Workshops for the disabled ordinance) has been in force for ten years. Concluding a lengthy historical development, it describes an utopia seeking to implement the opportunity for personal growth and for economically viable productive activity, even-handedly and concurrently, for all disabled people covered (excepting those with very severe disablement). In everyday practice, such notions are confronted with major obstacles: growing demand; poor transition into other employment, terminal workshop employment instead; problems with performance requirements, with the dependence from customers, and with remuneration issues; insufficient promotional services for learning disabled clients whose labour performance is essential to the workshops; adjustment problems of clients with mental illness within the workshop; counting of alternative service attendants toward the staffing plan; unsolved civil and labour law issues relative to contracts involving mentally retarded persons; protection against dismissal, clients' right to freely choose the workshop, their co-determination and the rights of their relatives; the need for special educational qualification of workshop and group senior staff who have to face up to the expectations and difficulties in the day-to-day running of the workshops.

Persons with Disabilities↗

PubMed1990

[The end of a myth? The topic of charity care of indigent patients in deontologic texts especially in the 17th century].

Deontological writings of the 17th and early 18th century frequently stress an obligation of physicians to provide free medical care to the poor. This obligation can be traced to medical writings of antiquity and to medieval civil and canon law. Medical authors of early modern times restricted this duty in many respects: they emphasized that a physician was obliged to treat without remuneration only if the patient was in mortal danger, if nobody else could be found to pay for the treatment, if no other physicians were available, or if the patient himself had called on him for help. In this context, a debate on the definition of poverty played a decisive role. Physicians employed by towns or by the state were obliged to provide free treatment to a well defined group of poor inhabitants. Still, the general right of physicians to their fees was strongly emphasized too. On the basis of the deontological sources of the 17th and 18th century it is not possible to determine to what degree physicians of the time did in fact offer free medical care to the poor. A moral obligation to offer treatment to all persons who could not afford the physicians' fees, did not exist.

Charities↗

PubMed1977

[The legal status of medical students during practical training in hospitals (author's transl)].

The most important change in the qualification regulations in force at the present time is the provision for the practical training of medical students, which occurs not only in university hospitals but also in "teaching hospitals" outside the university. The realization of the practical year is problematic according to the actual conditions because of the difficulties and financial investment necessarily associated with it. Furthermore, the legal status of the students during the practical activities differes from that of earlier medical assistants, because according to the present law the legal provisions for employment and social insurance such as the determination of division of labour, working hours and remuneration and also for third party and accident insurance do not apply.

Education, Medical, Undergraduate↗

PubMed1990

The economics of dental hygiene work in traditional and nontraditional settings.

The information presented in this paper was obtained as part of an ongoing longitudinal study of 1982 dental hygiene graduates. This portion of the study was contracted by the American Dental Hygienists' Association and provides information about method and amount of remuneration, fringe benefits, pay increases, and amount of money generated from dental hygienists' services. Data presented here were collected at two points in time: September 1985 and September 1986. The September 1985 survey was returned by 850 dental hygienists (83%) and the September 1986 survey was completed by 766 subjects (77%). Data were analyzed for clinical dental hygienists working in traditional and nontraditional settings. Results showed that most dental hygienists were salaried (80% traditional, 100% nontraditional) with a 1985 mean annual income of $19,160 for traditional and $17,197 for nontraditional hygienists. The mean daily wage in 1986 was $106.27 for traditional and $85.12 for nontraditional hygienists. Nontraditional hygienists were more likely to have received a pay increase in the previous six months and to receive fringe benefits than were traditional hygienists. Wages earned and money generated from dental hygiene services varied greatly. On the average, hygienists' wages constituted about one-third of the fees their services generated.

Adult↗

PubMed1990

Drug trials on healthy volunteers in Yugoslavia.

Ninety-seven healthy volunteers who participated in different clinical trials (phases III and IV) in a clinical pharmacology unit were interviewed over the period December 1988-February 1990 using questionnaire method. The aim of the investigation was to analyze the examinees' occupational distribution, the degree of insight in the trials they participated in, their opinion about the remuneration they get and their estimate of the importance or inconveniences of numerous trial elements. Only 39 volunteers (40.2%) were members of medical staff: 17 (17.5%) physicians, 17 (17.5%) medical students and 5 (5.2%) nurses. The volunteers assessed the importance of different elements related to the trial marking them from 1-5. They were more afraid of possible adverse drug reactions (ADR) occurring during the trial (median 3.87) than of those that might occur afterwards (2.94). Significant was their concern about the kind of investigated drug (3.49). "Potential contribution of the trial to the medicine and society" (3.30) and "length of time spent in the laboratory" (3.17) followed. The conduct of clinical trials on healthy volunteers in Yugoslavia and legal regulations are discussed at the end of the paper.

Adult↗

PubMed1990

[Vocational rehabilitation of psychiatrically handicapped people].

The article describes the working concepts of "Lankwitzer Werkstätten", a facility for vocational rehabilitation of persons with (chronic) mental illness. The working concept of this sheltered workshop is crafts- and service-oriented. Some 60 rehabilitees and sheltered workshop employees work in four small "shops". Work structures and everyday organization are somewhat unusual in that they follow general labour market conditions as closely as possible. In their working structures, the sheltered workplaces usually do not differ from workplaces in small crafts enterprises of the general labour market. As far as remuneration is concerned, the workshop is in a position to at least envisage levels of pay that will ensure independence from social assistance supplements if the facility's technical equipment can be kept current and work planning made more efficient. Within the limits of the legal possibilities, and making the most of them, both the diagnostic-prognostic benefits of the entry procedure in the work training process as well as the placement opportunities for rehabilitees in the general labour market are being utilized, with occasionally very successful outcomes.

Chronic Disease↗

PubMed1990

Free enterprise, professional ideology, and self-interest: an analysis of resistance by Canadian physicians to universal health insurance.

Under Canada's universal health care system, physicians are remunerated through government-run health insurance plans; a private market for physicians' services is virtually nonexistent. A proposal to ban the practice of extra-billing, whereby some physicians billed patients for amounts over and above insured rates, met with physicians' opposition. The particular constellation of legislative, social, and political events that followed the proposed ban presented a unique opportunity to explore the nature of the medical profession's resistance to encroachment on professional autonomy. The results of this survey of physicians in four specialties (N = 313) in metropolitan Toronto suggest that resistance to universal health insurance is complex; it involves a prevailing social ideology among physicians, which happens to be antiwelfare and conservative generally, entangled with economic self-interest and a specific set of beliefs about medical practice and physicians' rights and privileges.

Attitude of Health Personnel↗

PubMedDate not supplied

[Moral specificity of the work of stomatologists].

The ethical problems in the work of the stomatologists are presented by the author in three aspects: has the stomatologist sufficiently good will? has he/she sufficient knowledge and skill? has he/she sufficient possibilities, that is sufficient time to give to the patient, adequate equipment and adequate remuneration. The author believes that the first factor is in the greatest degree dependent on the stomatologist, while the second factor is less dependent, and the third is least (in the national health service system). This means that the responsibility of the stomatologist is greatest in the first case, only half as great in the second case, and least or nearly none in the third case. Attention is called to the shortcomings in the university education of the stomatologists, and lack of continuous postgraduate training. Stress is laid also on inadequate technical equipment and overworking of the dentists. The specific moral problems of various stomatological specialities are mentioned.

Clinical Competence↗

PubMed1989

Cigarette smoking and federal black lung benefits in bituminous coal miners.

The records of 1000 consecutive coal miners applying for benefits under the Federal Coal Mine Health and Safety Act were examined to determine the contribution of age, dust accumulation, and cigarette smoking to the profile of the miner who satisfies the current pulmonary criteria for disability. Using the presence of pneumoconiosis on chest radiograph as the indication of significant coal dust accumulation, the miners were separated into Group A--those without pneumoconiosis (n = 316) and Group B--those with pneumoconiosis (n = 684). The federal spirometric criteria for disability identified 55/316 miners in Group A (14.5%) and 99/684 miners in Group B (17.4%) potentially eligible for an award (P = .27). The mean ages of miners in both groups did not differ significantly, nor was there difference in the mean ages of groups that did or did not meet the federal criteria. In both groups, those miners potentially eligible for a financial award smoked more cigarettes than did their counterparts (Group A, 31.0 v 18.5 pack-years, P less than .001; Group B, 31.3 v 23.6 pack-years, P less than .001). There was no difference in the smoking histories of the miners from either group who met the federal criteria. Our data indicate that, in the case of bituminous coal miners, the present federal legislation intended to identify and remunerate those who suffer lung impairment from chronic occupational exposure to coal dust is biased in favor of those who sustain additional damage to their ventilatory capacity by smoking cigarettes.

Coal↗

PubMed1989

Cost containment and physician payment methods in The Netherlands.

Cost containment in the Netherlands has been partly achieved by negotiated agreements between insurers and physician associations. The negotiating system in the Netherlands involves the determination of capitation and fee-for-service rates, based on negotiated norms for personal remuneration, practice costs, and practice size. Physician practice patterns are monitored in an effort to control volume. Selected aspects of the negotiating structure could be adopted by Medicare and HMOs to clarify issues in negotiations with physicians and to reimburse physicians more equitably. However, establishment of standardized fees and volume monitoring may not be as effective as global expenditure controls.

Cost Control↗

PubMed1989

History of vocational training for general practice: the 1970s and 1980s.

During the 1970s and 1980s, vocational training for general practice developed from experimental beginnings to become established nationwide. Committees were set up nationally and regionally and methods devised for the approval of training practices. Important publications related to the discipline of general practice and to educational methodology appeared. The problems that remain include the absence of a compulsory assessment prior to entering general practice and the low remuneration for course organizers.

England↗

PubMed1989

[100 years of medical practice in the mountain region of Ticino. I. Development of a health policy following the foundation of the canton].

This essay covers the milestones of health care development in the canton Ticino from its foundation in 1803 reviewing the first attempts for legislation in the medical field to the endorsement of a cantonal health-care amendment covering the fields of health insurance (mandatory or private), the financial basis of insurance carriers, the remuneration of medical acts and global strategies for health care delivery (up to the remotest mountain areas).

Delivery of Health Care↗