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PubMed1987

Hill-Burton: the unfulfilled promise.

The poor and uninsured encounter numerous barriers to health care access. The Hill-Burton Act of 1946 required many hospitals to make their services available to all persons, yet ineffective enforcement has limited the utility of the act's requirements. Hill-Burton hospital audits have revealed widespread facility noncompliance. In light of these findings, alternative enforcement procedures should be considered.

Community Health Services↗
PubMed1996

Drug use in relation to clinical activities as an instrument for prospective drug budgeting. The Belgian experience.

In an effort to control escalating health expenditures, especially in hospitals, many countries are planning or experimenting with prospective budgeting systems. Belgium is no exception and has recently introduced, with some success, limited fixed charges per hospital admission and/or per hospitalisation day for laboratory tests and radiographic investigations. More recently, the focus has shifted to hospital drug expenditures, which have shown high growth rates over the past few years. Until now, such expenditures have been reimbursed on a fee-for-service system, often with limited out-of-pocket charges for hospitalised patients. In order to curb the growth of drug expenditures, it is appropriate to investigate whether the financing of hospital drugs through a prospective budgeting system could be a feasible solution. Therefore, we constructed a database of over 270 000 admissions from a sample of 23 Belgian general and teaching (university) hospitals for the year 1991. Data were obtained from the official Minimum Basic Data Set or Résumé Clinique Minimum, which contains summarised clinical and administrative information, plus detailed expenditures (including medications) for each hospital stay. This information allowed us to categorize each stay into an appropriate diagnosis-related group (DRG). Our first descriptive analysis identified a number of major variables that influenced patients' drug expenditures: all-patient DRG (APDRG), age, disease severity, length of stay in an intensive care unit, emergency admission, death during hospitalisation, and hospital type (teaching or general). A covariance analysis was then performed on all hospital stays combined, and separately on surgical and medical stays. The results indicated that these variables taken together account for between 56.5 and 76.3% of drug expenditures in medical and surgical stays, respectively, with the major variance explained by differences in APDRG category. However, when the data were disaggregated according to major diagnosis category, a large degree of heterogeneity in the explained variance was observed. In patients with drug use- and alcohol-related disorders, 5.2% of drug billings/expenditures were attributable to the APDRG, and the corresponding figure in patients undergoing circulatory system surgery was 84%. This means that, if DRGs are used to define a global prospective drug budget for a hospital, using the hospital's historical case mix as a weighting factor, we should pay particular attention to the hospital profile because the predictive power of such a system could be relatively low in some hospitals. Consequently, we need to construct larger confidence intervals for hospitals in which historical drug expenditures have low predictive power, or search for additional explanatory variables for expenditures in these hospitals.

Belgium↗
PubMed1980

Estate management: when reality stifles ambition.

Health service buildings and lands make up an estate which must be managed in such a way that the future does not suffer from the neglect of the present. Looking to the NHS as it is likely to be in the 1980s, Gordon Brooke, regional works officer, Mersey RHA, suggests an end to a system in which capital is a 'free good' and districts under financial pressure have little incentive to preserve the value of their estates.

Capital Financing↗
PubMed2005

Demonstration plasma gasification/vitrification system for effective hazardous waste treatment.

Plasma gasification/vitrification is a technologically advanced and environmentally friendly method of disposing of waste, converting it to commercially usable by-products. This process is a drastic non-incineration thermal process, which uses extremely high temperatures in an oxygen-starved environment to completely decompose input waste material into very simple molecules. The intense and versatile heat generation capabilities of plasma technology enable a plasma gasification/vitrification facility to treat a large number of waste streams in a safe and reliable manner. The by-products of the process are a combustible gas and an inert slag. Plasma gasification consistently exhibits much lower environmental levels for both air emissions and slag leachate toxicity than other thermal technologies. In the framework of a LIFE-Environment project, financed by Directorate General Environment and Viotia Prefecture in Greece, a pilot plasma gasification/vitrification system was designed, constructed and installed in Viotia Region in order to examine the efficiency of this innovative technology in treating industrial hazardous waste. The pilot plant, which was designed to treat up to 50kg waste/h, has two main sections: (i) the furnace and its related equipment and (ii) the off-gas treatment system, including the secondary combustion chamber, quench and scrubber.

Equipment Design↗
PubMed1988

Quality of life in chronic diseases: perceptions of elderly patients.

Quality of life is an important consideration in medical decisions involving elderly patients and a clinical outcome measure of health care. Elderly outpatients (N = 126) with five common chronic diseases (arthritis, ischemic heart disease, chronic pulmonary disease, diabetes mellitus, and cancer) and their physicians were interviewed to better characterize patient quality of life. Patients generally perceived their quality of life to be slightly worse than "good, no major complaints" in each chronic disease. Physicians' ratings were generally worse than and only weakly associated with the patients' ratings of quality of life in each chronic disease. Significant independent correlates of patients' ratings of quality of life included the patients' perceptions of their health, interpersonal relationships, and finances. These results suggest that quality of life in elderly outpatients with chronic disease is a multidimensional construct involving health, as well as social and other factors. Physicians may misunderstand patients' perceptions of their quality of life.

Aged↗
PubMedDate not supplied

Work-related exacerbation of asthma.

Adults with asthma who had been enrolled in an HMO for at least a year were requested to complete a questionnaire about their health status. Approximately 25% of the 1,461 participants responded positively to "Does your current work environment make your asthma worse?" and were classified as having workplace exacerbation of asthma. Those with workplace exacerbation were more likely to have never attended college, be current or former smokers, have a history of other respiratory diseases, have missed work or usual activities at least one day in the past for weeks, and report their asthma was moderate, severe, or very severe. Percentages with workplace exacerbation of asthma were highest for mining and construction (36%), wholesale and retail trade (33%), and public administration (33%), and lowest for educational services (22%), finance, insurance, and real estate (22%), and non-medical and non-educational services (18%). Future studies are needed for objective validation of self-reported workplace exacerbation, and to follow subjects prospectively to clarify the temporal sequence of workplace exacerbation and asthma severity, and how other respiratory conditions and smoking might contribute to work-related worsening of asthma.

Adolescent↗