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PubMed2002

The systems of care for frail elderly persons: the case of Sweden.

Sweden has a well-developed welfare system following the Nordic model and it maintains - even though there have been some reductions in the last decade - good economic security and comprehensive services for the elderly. The national policy for the elderly aims at enabling older persons to live independently with a high quality of life. A great majority of the elderly in Sweden live in ordinary homes - very few live with their grown-up children. The municipalities are responsible for providing long-term social services and care for the frail elderly in the form of home help services for those that live in ordinary housing, and special housing accommodation for those with extensive needs. The county councils are responsible for health care and provide home nursing care and rehabilitation. Sweden used to have the oldest population in the world. The proportion of 80+ years old in the population increased from 3% to over 5% between 1980 and 2000. Due to financial restrictions as a result of the economic recession in the last decade, the health and social services for the elderly have not been able to keep up with the population development. The previous generous allocation of care has been replaced by a more restrictive approach. This has mainly affected persons with lesser needs for help, younger elderly, and married persons. The number of elderly persons is expected to increase rapidly in the coming decades. However, due to improved health among the elderly, this will lead to a relatively limited increase of needs. Depending on assumptions concerning the health development, the required increase in volume of health and social services is expected to fall somewhere between 10-30% during the coming 30-year period.

Aged↗
PubMed1998

Patterns of psychiatric hospital service use in Finland: a national register study of hospital discharges in the early 1990s.

We were interested in studying the possible concurrent changes in the psychiatric inpatient population during a rapid phase of deinstitutionalisation, and severe economic recession with a record level unemployment rate, and after the amendment of the mental health legislation. Although there were 4540 fewer beds in the psychiatric hospitals in 1993 compared to 1990, the rate of patient admissions remained the same. There was a significant increase in readmissions (P < 0.001) to the psychiatric hospitals, and particularly in multiple (three or more) readmissions among new inpatients (P < 0.001). The prevalence of inpatients with major depression increased by 0.2/1000 in the whole cohort and by 0.12/1000 among first-timers from 1990 to 1993 (P < 0.001). In addition, the rate of involuntary admissions decreased significantly (P < 0.001).

Adolescent↗
PubMed2003

Pain: psychiatric aspects of impairment and disability.

Patients with chronic pain frequently experience a complex and convoluted journey through the health care system that often is unrewarding for all involved. As job satisfaction and financial security diminish during our economic recession, the impact of the disability epidemic becomes more profound. There often is no direct correlation between objective impairment and a patient's request for disability status. Injured workers maintained on workers' compensation may have an increased risk for developing chronic pain syndromes unresponsive to conventional treatments. These patients may have significant financial, psychosocial, and environmental reinforcement for maintenance of their disability and little incentive to return to work. Excessive pain behavior may lead to unnecessary diagnostic testing or invasive procedures and result in iatrogenic complications and prolonged disability. Patients with chronic pain syndrome who have not had psychosocial treatment may not be at maximum medical improvement. The purpose of this paper is to help the readership identify types of psychiatric, psychologic, and psychosocial issues that can coexist in patients with chronic pain who are applying for disability, and to help treating physicians avoid contributing to iatrogenic pain and disability by performing needless and potentially harmful procedures on patients who may be better served with an emphasis on psychiatric or psychologic care.

Disability Evaluation↗
PubMedDate not supplied

Chile's health sector reform: lessons from four reform periods.

This paper applies an interdisciplinary approach to analyze the process of health reform in four significant periods in Chilean history: (1) the consolidation of state responsibility for public health in the 1920s, (2) the creation of the state-run National Health Service in the 1950s, (3) the decentralization of primary care and privatization of health insurance in the 1980s, and (4) the strengthening of the mixed public-private market in the 1990s. Building on the authors' separate disciplines, the paper examines the epidemiological, political and economic contexts of these reforms to test simple hypotheses about how these factors shape reform adoption and implementation. The analysis underlines: (1) the importance of epidemiological data as an impetus to public policy; (2) the inhibiting role of economic recession in adoption and implementation of reforms: and (3) the importance of the congruence of reforms with underlying political ideology in civil society. The paper also tests several hypotheses about the reform processes themselves, exploring the role of antecedents, interest groups, and consensus-building in the policy process. It found that incremental processes building on antecedent trends characterize most reform efforts. However, interest group politics and consensus building were found to be complex processes that are not easily captured by the simple hypotheses that were tested. The interdisciplinary approach is found to be a promising form of analysis and suggests further theoretical and empirical issues to be explored.

Child↗
PubMed1989

Employment of individuals with haemophilia in The Netherlands.

A study was performed to determine whether improvements in the treatment of haemophilia over the past 20 years have influenced the prospects of these patients in the labour market. Surveys on the medical and social situation of haemophiliacs in The Netherlands were carried out in 1972, 1978 and 1985. Most of the patients participated in these surveys. Trends in employment do not show either an increase in the number of employed haemophiliacs or a decrease in the number administratively defined as disabled. However, considering the influence of the economic recession on the position of the chronically sick on the labour market and the rise in the number administratively defined as disabled in the Dutch population, haemophiliacs perform well. Sick leave has decreased considerably. Although the employment rate for the group of haemophiliacs is lower than that for the general male population, the level of employment in relation to educational achievements is high and most of the employed do not feel limited in their daily job activities by the haemophilia. Physical mobility is a main factor influencing the employment status but other factors, such as the type of occupation or former occupation and prejudice against people with haemophilia, have to be considered.

Absenteeism↗
PubMed2005

A survey of teenager unnatural deaths in northern Sweden 1981-2000.

OBJECTIVE: To survey unnatural deaths among teenagers in northern Sweden and to suggest preventive measures. SETTING: The four northernmost counties (908,000 inhabitants, 1991), forming 55% of the area of Sweden. MATERIAL AND METHODS: All unnatural teenager deaths from 1981 through 2000 were identified in the databases of the Department of Forensic Medicine in Umea, National Board of Forensic Medicine. Police reports and autopsy findings were always studied, social and hospital records if present. RESULTS: Three hundred and fifty-five deaths were found, of which 267 (75%) were males and 88 (25%) females. Ninety out of 327 (28%) tested positive for alcohol. Two hundred and forty-eight (70%) were unintentional and 102 (30%) were intentional deaths, and five (1%) were categorized as undetermined manner of death. Unintentional deaths decreased while the incidence of intentional deaths remained unaffected by time. CONCLUSIONS: Injury-reducing measures have been effective concerning unintentional deaths and the fall in young licensed drivers due to the economical recess have probably also contributed to the decrease. However, there were no signs of decreasing numbers of suicides during the study period, which calls for resources to be allocated to suicide prevention.

Adolescent↗
PubMed2005

Labour supply in the home care industry: A case study in a Dutch region.

Health organizations have started to become more market-driven. Therefore, it is important for health organizations to analyse the competitive dynamics of their industrial structure. However, relevant theories and models have mainly been developed for organizations acting in the profit sector. In this paper, we adapt Porter's 'five forces model' to the home care industry. In particular, we modify the (determinants of the) bargaining power of labour suppliers. We then apply the modified Porter-model to the home care industry in the Netherlands for the period of 1987-1997 with special attention for labour supply. The new instrument clarifies the complexity of the supply chains and value systems of the home care industry. As can be illustrated by developments in the home care industry in the province of North Brabant during the 1990s, competition between home care providers has influenced labour market relations, but so do other factors as well. Between 1987 and 1997, the bargaining power of labour suppliers was relatively limited. After 1997, however, the demand for home care personnel has increased strongly. In spite of the present economic recession, scarcity on this labour market seems to prevail in the longer term due to a growing demand for home care services.

Health Workforce↗
PubMed2006

The incidence of schizophrenia in European immigrants to Canada.

OBJECTIVE: The risk for schizophrenia in immigrants to Europe is approximately three times that of native-born populations. Discrimination and marginalization may influence the risk for schizophrenia within migrant populations. The primary objective of the present study was to determine whether the risk associated with migration was also evident 100 years ago. A second objective was to determine whether changing social stresses are associated with changes to the incidence of schizophrenia. METHOD: During the first two decades of the twentieth century, the Provincial Mental Hospital was the sole provider of psychiatric services in British Columbia, Canada. Detailed clinical records have been preserved for 99.5% of 2477 patients who had a psychiatric admission between 1902 and 1913. Diagnoses were made after a detailed file review and 807 patients met DSM-IV criteria for first-episode schizophrenia, schizophreniform disorder, schizoaffective disorder, or psychosis not otherwise specified. Diagnoses had high inter-rater reliability. The incidence of schizophrenia in migrants from Britain or Continental Europe was compared with that in the Canadian-born population using indirect standardization and Poisson models. RESULTS: Migration from Britain or Continental Europe to Canada in the early twentieth century was associated with an increased rate of schizophrenia; IRR=1.54, (95% CI=1.33-1.78). Incidence increased over time in immigrants but not in the native-born population and this increase occurred during a period of economic recession. CONCLUSIONS: Migration was a risk factor for schizophrenia a century ago as it is today. This risk occurred in white migrants from Europe and increased during a period of increased social stress.

Adolescent↗
PubMed1995

Total healthcare budget: assigning priority and level of asset allocation to the diagnosis and management of urologic diseases.

During the past decade increasing concern has developed as to how money should best be allocated in the healthcare sector and to the different disciplines within health care. In the Western world, healthcare budgets increase dramatically each year, even during periods of economic recession. There are many reasons explaining this evolution, but publicly funded healthcare systems, as in the United Kingdom, appear to control their growth more effectively than the private systems as, for instance, in the United States. The bulk of the increase in healthcare expenditure happens to be attributed to elderly people who are becoming high consumers of healthcare facilities. There are, however, two important ways to tackle the problem: one is based on free market regulation systems, introducing diagnosis related groups and resource based relative value scales, as in the United States. The other starts from evaluating the needs and the demands of the population and, based on these results, tries to build up an appropriate healthcare system, as in The Netherlands. In the realm of urology where most of the workload is concentrated around older patients, one can foresee difficulties concerning budget allocation. New medical treatments are introduced, demanding new management skills of the urologist. This should involve new ways of evaluating the benefits of the interventions. Quality of life measurements seem to be crucial for the future where, for cost-effectiveness reasons, more care than cure could be the new function of the urologist.

Budgets↗
PubMed1986

Considerations of hospital viability in rural Texas.

The rural hospitals in Texas face the same situation as rural hospitals throughout the country. Unfortunately, little data are available to define the scope or possible duration of the problem. However, rural hospital administrators currently believe that their facilities are being hurt by increased government regulation and that today's figures on average daily census indicate that the problem could threaten their hospital's long-term viability. Initial investigations have shown that the problem of casualty is a complex one; multiple factors interact to exacerbate the situation, such as more stringent enforcement of Medicare certification standards, review of claims and quality of care by PROs, and the use of PPS. Other factors cited include the economic recession, the exodus of young people from rural areas to urban areas, the high cost of technology, and the preadmission review by insurance companies. A study that will both sample and survey rural hospital viability using financial ratio analysis and service utilization data is presently being undertaken to provide some responses to these concerns. Further, it will later examine how rural hospital administrators are responding to the problem of decreased hospital viability. It is possible that new coping strategies may be developed from the study results that will change present modes of health care delivery and result in regional networks and more diversified health care services.

Cost Control↗
PubMed2003

Inpatient treatment of mood disorders in the era of de-institutionalisation, depression awareness campaigns and development of new antidepressants.

OBJECTIVE: To analyse changes in inpatient treatment for mood disorders during the period of de-institutionalisation, de-centralisation of service planning, economic recession, attempts to increase depression awareness and increasing biological treatment possibilities. A special interest is paid to whether de-institutionalisation at specialist level psychiatric care results in transfer of inpatient care into non-specialised institutions. METHOD: A register study of all inpatient treatment due to psychiatric disorders from four health care districts in Northern Finland, with a population of more than 600,000. Treatment undertaken by psychiatric hospitals and wards, primary care wards and medical and surgical wards in general hospitals are distinguished. RESULTS: Inpatient treatment for mood disorders increased vastly in all kinds of health care institutions. The increase was due to growing inpatient treatment of depression. LIMITATIONS: The National Discharge Register does not include treatment episodes in private nursing homes or details about the contents of the treatment. CONCLUSION: Even during explicit active de-institutionalisation, other policies may have a greater impact on hospital use, resulting in unexpected changes in patient populations and service utilisation. In Finland, de-institutionalisation failed concerning mood disorders. The depression awareness policies during the 1990s increased inpatient use of depression across institutions.

Antidepressive Agents↗
PubMed2000

Appraising the financial reform in Bulgarian public health care sector: the Health Insurance Act of 1998.

The public health care services in Bulgaria were deteriorating, especially during the decade of transitional process. The method of health care finance was a major reason for the poor performance of the Bulgarian public health care sector. Bulgarian policy-makers decided that an insurance-based financial mechanism could help to rescue the failing public health care services. This paper explores the social benefits and the feasibility of the insurance-based finance in the Bulgarian public health care sector. The discussion in the paper implies that, in the current conditions of economic recession, the insurance-based health care finance can not be socially beneficial for Bulgaria. Moreover, the insurance implementation seams to be unfeasible due to a lack of sufficient financial resources.

Bulgaria↗
PubMed1997

Decentralisation from acute to home care settings in Sweden.

Sweden has a regionally based, publicly operated and financed, national health care system. Implementation of policy and the provision of health care has been the responsibility of the county council. In 1992, the major responsibility and resources for care of the elderly was transferred to the municipalities. The start of this reform, unintentionally, coincided with an economic recession which caused additional difficulties for the financing of the present level of public services generally. This development, in combination with innovations in health care technology, resulted in a rapid decentralisation of certain elderly care services from acute care settings.

Aged↗
PubMed2003

Equalisation of socioeconomic differences in injury risks at school age? A study of three age cohorts of Swedish children and adolescents.

The objective of the study was to investigate whether there is equalisation of socioeconomic differences in injury risks among Swedish children and adolescents. Equalisation was defined as a reduction in relative differences in risks between socioeconomic groups. All Swedish children and adolescents aged 5-19 in 1990 were grouped into three age cohorts and allocated to four household socioeconomic statuses, considering boys and girls separately. Each cohort was then followed up over a 5-year period (1990-1994) with regard to three injury diagnosis groups (as registered in the national Hospital Discharge and Causes of Death registers) with documented socioeconomic differences: injuries due to traffic, interpersonal violence, and self-infliction. The Relative Index of Inequality was used to measure the magnitude of relative socioeconomic differences, for each year of observation. Where applicable, relative risks were computed in order to see whether equalisation benefited all socioeconomic groups. Tendencies of equalisation were found among girls for two of the diagnosis groups: in traffic injuries for the youngest cohort (aged 5-9 in 1990) and in the case of self-inflicted injuries within the two older cohorts (10-14 and 15-19, in 1990). In conclusion, this study provides limited evidence of equalisation in injury risks between socioeconomic groups among Swedish adolescents. Equalisation appears to be a gender-specific phenomenon, that is, among girls, and manifests itself around the age of 5-13 in traffic-related injuries, when girls are in first and second levels of compulsory school, and later on in self-inflicted injuries. Given the economic recession in Sweden at the time of the study period, whether the equalisation processes are attributable to school, peer group and youth culture effects-as hypothesised by West-is debatable, particularly in the case of self-inflicted injuries.

Accidents, Traffic↗
PubMed1992

Critically examining intensive care.

The economic recession of the last decade brought intensive care systems under the light of cost-effectiveness analysis, making use of several instruments available in medical practice, and others adapted from for-profit enterprises. The present concept of intensive care, particularly its functional and organizational interactions with traditional specialties, is at the brink of an important revaluation. Studies of the cost-effectiveness of therapeutic actions may be grossly biased if they do not consider the complete process of care (before, during, and after treatment), analyzing even its smallest elements.

Cost-Benefit Analysis↗
PubMed1994

Hiring and training staff for financial procedures and collecting money from patients.

For the past few years many countries worldwide have been faced with varying degrees of economic recession. This significant decrease in circulating finances and rising unemployment has affected the lifestyle choices of many people. Unfortunately, dental treatment and payment of such has dropped to the bottom of the list for many. Dental receptionists are faced with the responsibility of collecting fees from patients whose financial priorities may not always include dentistry.

Dentist-Patient Relations↗
PubMed1988

[Does unemployment cause illness? A review of the status of knowledge of the correlation between unemployment, physical and psychological health risks].

Unemployment appears to be a complex condition that burdens the individuals affected in multiple ways both at job loss and in long-term unemployment. To a lesser extent unemployment may also relieve the stressors and risks associated with the place of work. The scope and nature of the burden experienced depends on individual factors, such as mental stability and coping resources, on economic, social and cultural factors, such as availability of alternative roles, system of social security and social context. In the industralized countries, especially in the Federal Republic of Germany, financial security and society's attitudes towards unemployment are less unfavourable than during the economic recession between the two world wars. Nevertheless, household income should not be overlooked as an important factor leading to stress beyond a certain threshold. In this respect it is noteworthy that the income of the unemployed households in the Federal Republic of Germany decreased by 8% between 1981 and 1983 (Brinkmann, 1986). Quantitative relationships between unemployment and physical health have frequently been reported. In studies whose designs allow such associations to be explained selection factors, i.e. an overrepresentation of frequently or chronically ill and disabled individuals among those losing their jobs and the long-term unemployed, contribute to the increased morbidity among the unemployed to a considerable extent. Causal relationships between unemployment and physical health risks have not yet been proven directly, which does not mean that there are none. The mediation of health risks by changes in behaviour during unemployment which as such might lead to or reduce morbidity and mortality risks has not yet been studied sufficiently. Unemployment appears to have both an increasing and a reducing effect, but also no effect at all on the use of alcohol and tobacco in different populations. But we do not yet know enough about the mechanisms bringing about these effects. There are more consistent findings indicating that sustained unemployment influences personal well-being. This influence is reflected primarily in unspecific physical complaints and mild or moderately severe depressive changes of mood. The most important finding of increased health risks in the unemployed versus the employed are elevated rates of suicide and attempted suicide. This finding, too, seems to be attributable to selection factors, i.e. predominantly to an overrepresentation of mental disorders and substance abuse associated with an increased suicide risk among job-losers.(ABSTRACT TRUNCATED AT 400 WORDS)

Disease Susceptibility↗
PubMed1999

The perceptions of users about barriers to the use of free systematic oral care among Finnish pre-school children--a qualitative study.

With the economic recession in the early 1990s in mind, and the change in the provision of healthcare services, our aim was to explore qualitatively what barriers families of Finnish pre-school children had perceived related to the use of free systematic oral healthcare. Qualitative interviews were carried out with the parents of 12 pre-school children attending an oral health examination to ascertain what barriers those using oral services had overcome, and what they considered to be the reasons for the non-attendance of other families. Content analysis was used by classifying groups of barriers and their reported importance as well as the reasons for non-attendance. The barriers discovered were related to: difficulties in the (i) change of daily routines or (ii) booking time for care, (iii) poor coordination with other healthcare services, (iv) fear and negative image of oral care, and (v) inconsistent content of oral health information. When parents replied to the externalized question about reasons for the non-attendance of some families, they most often mentioned difficulties in changing daily routines, laziness, lack of interest and fear. Barriers to attending oral healthcare could be lowered by emphasizing the positive image of oral health services, by providing more effective coordination with mother and child health services, and by providing appointment times later in the day.

Appointments and Schedules↗