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PubMed2006

[Comparison of two national food surveys (INCA 1 1998-99 and Health Nutrition Barometer 2002) with regard to five food recommendations of the National Nutrition and Health Program].

BACKGROUND: Monitoring the dietary intake of the French population requires the implementation and regular renewal of representative national survey. As these surveys can use different methodologies (food frequency questionnaire, 24 hour recall, 3 or 7-day dietary record...), it seems useful to check whether they supply similar results. The aim of this study is to determine whether two representative national surveys with different methodologies can be used alternately to monitor changes in food consumption of the French population. METHOD: Percentages of consumers aged 15-75 were compared between two national food surveys (Health Nutrition Barometer 2002 and INCA 1 1998-99) with respect to five food frequency recommendations of the French National Nutrition and Health Program. RESULTS: The same public health priorities were found in both surveys: the food groups were graded according to the same hierarchy of adequate food intake prevalences (ascending: fruits and vegetables, dairy products, fish, starchy foods and meat-fish-egg products). On the other hand, significant statistical different elements were pointed out in a few food groups which may be explained by methodological patterns. Definitions of portions and food groups, survey duration and seasons are indeed important parameters to be considered when comparing surveys. CONCLUSION: The results show the need to elaborate standardized methods for comparison of food consumption surveys, which can be useful for the evaluation of the national nutritional recommendations. The methodological limitations described in this study also indicate that the quantitative description of food intake trends should improve when established by the results of the same regularly repeated survey.

Adolescent↗
PubMed2000

[Health management in private health insurance].

German private health insurance faces new challenges. The classical tools of cost containment are no longer sufficient to keep up with ever increasing expenses for health care, and international competitors with managed care experience from their home markets are on the point of entering business in Germany. Although the American example of managed care is not fully compatible with customer demands and state regulations, some elements of this approach will gradually be introduced. First agreements were signed with networks or individual preferred providers in outpatient care and rehabilitation medicine. Insurance companies become more and more interested in supporting evidence based guidelines and programmes for disease and case management. The pros and cons of various other health management tools are discussed against the specific background of the quite unique German health care system.

Cost Control↗
PubMed1999

Is there room for managed care in Canada? A preliminary inquiry of physicians.

Managed care, which is becoming increasingly prevalent in the United States, is virtually absent in Canada. Yet managed care, if implemented judiciously, has the potential to provide comprehensive, high quality care while containing spiraling healthcare expenditures. Managed care is also the foundation of integrated health systems, which have been widely discussed during the past few years. Then why has Canada been so slow to accept managed care? Since physicians have a great deal of influence on how healthcare is ultimately delivered, a group of Ontario physicians was surveyed to determine their perceptions of managed care. It was found that physicians were knowledgeable about the cost-containment capabilities of managed care but had misperceptions about managed care with respect to quality of patient care, preventive services and necessary medical care. Education and further research are recommended so that any debate about managed care, integrated systems or alternative physician payment can be meaningful, objective, beneficial and accurate.

Attitude of Health Personnel↗
PubMedDate not supplied

Identifying dimensions of performance in local public health systems: results from the National Public Health Performance Standards Program.

This article uses data from the National Public Health Performance Standards Program to explore how the performance of essential public health services varies across communities and to identify underlying domains of activity that appear to drive variation in performance. Cross-sectional data were used from 315 local public health jurisdictions located within seven states that participated in the Performance Standards Program pilot tests between 1999 and 2001. Results demonstrate that local public health systems vary considerably in the extent to which they perform essential services and meet established performance standards. Factor analysis results indicate that four underlying domains of activity explain much of the variation observed in the individual performance measures, and that achieving performance standards for a single essential public health service often involves more than one underlying domain of activity. The findings suggest that composite measures constructed from the Performance Standards Program can assist public health decision makers in monitoring the performance of public health systems and identifying promising pathways for improving performance.

Analysis of Variance↗
PubMed1998

[Managed care--a model also for ambulatory medical care in Germany?].

Rising expenditure of health care has caused industrialized nations to change the structure of their health care systems. The goal is to achieve high quality of care at low cost. Managed care (MC)--most prevalent in the United States--plays an important role in the current discussion in Europe. This concept which provides different ways of financing and organization aims to improve the direction and control of health care delivery. Usually, a family physician takes the role of a gatekeeper by offering access to all parts of medical care. This kind of health care system seems to be associated with lower expenditure and a better state of health. Some negative developments in the USA--partly dissatisfaction of patients and physicians as well as refusal or delay of medical care--must not necessarily take place in other countries. With a critical approach to managed care, Germany may take the opportunity of adapting positive elements of MC to its health care system and avoid problems of the US system. Although the basis for testing MC-models has been created by the health care reform act in 1997, these opportunities have not been adequately taken up.

Cost Control↗
PubMedDate not supplied

[Do we really want managed care?].

In spite of the mounting criticism levelled at Managed Care, it is still being discussed in Germany as a promising concept expected to improve both the quality as well as the cost effectiveness of health care. However, this discussion focuses largely on the theoretical advantages of Managed Care in comparison with the German health care system. To examine whether these advantages of Managed Care are actually realised once the concept is broadly implemented, we analysed the contemporary effects of managed care on patients and physicians in the US. This revealed that while Managed Care has for the time being slowed the rise in health services expenditures, major shortcomings of the concept are evident: Patients express a loss of trust in the health care system and complain about decreased choice, poor continuity of care, and persistent high personal health care cost. Physicians complain about increasing financial risks imposed on them, about curtailed therapeutic freedom, and generally the way they must now conduct their medical practice. Law-makers, in turn, react to the defects of the Managed Care industry by imposing increasing external controls and regulations. All in all, Managed Care as implemented by many of the US systems does not appear to fulfill the positive expectations of the two principal stakeholders--patients and physicians. Instead, a large number of side effects are in evidence that appear to make a transfer of the American concept to the German health care system far from desirable.

Cost-Benefit Analysis↗
PubMed1996

[Managed health care: scope, concept and strategic management potentials from the viewpoint of the Swiss Accident Insurance Fund].

The following item presents briefly the cost relevant factors in health care in Switzerland. The principal key issues and reasons for managed health care programs are dealt with by recognizing the new health care law. In order to present the central strategies for improvement in managed care from an integral point of view, managed health care is being treated in the context of a widely founded conceptional framework. A very detailed and medically complete as well as performance oriented case statistic of medical treatments is a strategic success and key factor. The author represents the thesis that the given opportunities and micro-management tools could be much more widely used, that they should be extended and that, therefore, the strength of our independent and liberal health care system could be much better integrated in the context of a necessary social acceptance. This shall not only be reached by maximising the individual revenues, but by optimizing structures and increasing organizational effectiveness in medical health care. The existing readiness of the health care suppliers, especially the physicians, to take over responsibility in improving health care outcome is the core to this strategy.

Artificial Intelligence↗
PubMed1987

They did it in Massachusetts. A report on the first national health referendum.

"Shall the Commonwealth of Massachusetts urge the United States Congress to enact a national health program which: provides high quality comprehensive personal health care including preventive, curative and occupational health services; is universal in coverage, community controlled, rationally organized, equitable financed, with no out-of-pocket charges, is sensitive to the articular health needs of all, and is efficient in containing its cost; and whose yearly expenditure does not exceed the proportion of the Gross National Product spent on health care in the immediately preceding fiscal year?"

Government↗
PubMed1998

[Total quality management in laboratory medicine].

The German Public Health will be continuously challenged in the future. It has to be assumed that modified managed care will not only take place sporadically. Thus, quality aspects of services gain more and more significance. Only suppliers will be successful who can offer services of highest quality at lowest prices. Quality in a comprehensive sense has to be substantiated in the near future. It is recommended to apply industry proven models also in public health service. Medical laboratories can be pioneers in this field as they have been already in the past. All previously proposed procedures can not describe quality of results comprehensively. They are based to a high degree on external control. Total quality management, however, represents a comprehensive approach. Principles are zero-defect approach, customer orientation and system management. Quality is given in the sense of TQM if the customer is permanently satisfied with the service of the supplier. In such a way, the customer defines quality of service. A customer is everyone who receives products or services. TQM overcomes the drawbacks of quality management systems, which are strongly formal and oriented by external control, as accreditation (EN 45,000) or certification (ISO 9000). Competition between hospitals is a declared goal of German health politics because usually quality is increased and cost decreased as a consequence. Competition means also comparison of services. TQM emphasizes benchmarking especially among the best suppliers.

Forecasting↗
PubMed1997

[Prerequisites to successful conversion to the Swiss model managed care-gatekeeper systems in Germany].

In Switzerland different gatekeeper-systems to improve the capacity and economic efficiency were successfully tried and tested. The systems show clear advantages of the gatekeeper-system concerning the costs and quality of health care over the customary Swiss health insurances. The German as well as the Swiss health care system are facing similar problems. The introduction of the Swiss gatekeeper-system in Germany would offer a promising opportunity to achieve economic efficiency and quality in German Statutory Health Insurance. Thus, greater flexibility is imperative in the subjects of legal conditions, especially the contract, incentive and information systems.

Cost-Benefit Analysis↗
PubMed2003

Cancer epidemiology in Hungary and the Béla Johan National Program for the decade of health.

According to a recent survey, in 1995 Hungary lead cancer mortality statistics in men in Europe, while was on the second place in the case of women. The figures for cancer morbidity were highly similar. According to cancer types, the Hungarian mortality rates are the worst in the case of lung, oral cavity laryngeal and pancreatic cancers among men and oral cavity colorectal and thyroid cancers in women. Between 1999 and 2001 in Hungary the cancer mortality list is topped by lung and colorectal cancers among men and by breast and colorectal cancers among women. The National Cancer Registry started to provide reliable morbidity data which indicate that in 2001 in Hungary the men's most frequent cancer types are lung, colorectal and lip and mouth cancers while among women breast, colorectal and lung cancers. These shocking cancer mortality and morbidity figures outlined the primary targets of the recently lunched national public health program for this decade.

Female↗
PubMedDate not supplied

Asthma mortality in Cuba during 1972-1993.

UNLABELLED: Morbi-mortality due to asthma has increased in recent years both throughout the world in Cuba. A study of mortality caused by this disease has conducted in order to describe its current trend in the country. METHOD: A time series study was conducted which included all deaths attributed to asthma in Cuba recorded in the vital statistics records of the Ministry of Public Health from 1972 to 1993. Rates, secular trends of general mortality and according to gender were estimated. The proportional mortality for the 1972-1993 period was calculated and the potential years of life lost during the 90-92 trienium were quantified. RESULTS AND DISCUSSION: A drop in these global rates occurred between 1972 and 1975, with values of 3.6; 4.1; 3.0; 2.2; respectively; possibly due to the introduction of disodic chromoglycate among other drugs and the beginning of the Asthmatic Patient Program. An later increase in mortality was observed until 1993 (5.9 x 100,000 inhabitants) which may attributed to a drop of the intensity and regularity of said program and to other internationally knowledge factors which are present in our country. The trend of general mortality rose during this period and was greater in females than in males; which means that the risk to die of this cause has increased. Proportional Mortality since 1980 (0.50%) also increased until 1993 (0.80%). Potential years of life lost due to premature death ranged from 5,646 in 1990 to 7,386 in 1992. The increase in proportional mortality and the potential years of life lost suggest that this disease should been given priority by the National Health Program as a preventable cause of death, especially in women. CONCLUSIONS: There is a rising trend of mortality among asthmatic patients during the period under consideration. Asthma is a cause of premature death in Cuba.

Asthma↗
PubMed1996

The history and politics of US health care policy for American Indians and Alaskan Natives.

This paper traces the development of the US federal government's program to provide personal and public health services to American Indians and Alaska Natives since the 1940s. Minimal services had been provided since the mid 19th century through the Bureau of Indian Affairs of the Department of the Interior. As a result of attempts by western congressmen to weaken and destroy the bureau during the 1940s, responsibility for health services was placed with the US Public Health Service. The transfer thus created the only US national health program for civilians, providing virtually the full range of personal and public health services to a defined population at relatively low cost. Policy changes since the 1970s have led to an emphasis on self-determination that did not exist during the 1950s and 1960s. Programs administered by tribal governments tend to be more expensive than those provided by the Indian Health Service, but appropriations have not risen to meet the rising costs, nor are the appropriated funds distributed equitably among Indian Health Service regions. The result is likely to be an unequal deterioration in accessibility and quality of care.

Alaska↗
PubMed1991

Physicians' plan for health care reform.

Numerous proposals have been made for health care reform during the last decade. Still, the richest health care system in the world offers little or nothing to millions of Americans. The quality of nursing practice is threatened by calls for rationing of health care resources and cost control. The Canadian system for national health care is frequently cited as a model for health care reform in the United States. Physicians for a National Health Program have designed a plan similar to that of Canada. This article presents an overview of the physicians' proposal and suggests its comparison with that of the Pepper Commission.

Delivery of Health Care↗
PubMed1998

Health care system of the United States and its priorities: history and implications for other countries.

The health care system of the United States is examined from the end of the 19th century to the present, using secondary sources on labor and health care. During that period, several actors, each with its own priorities, exercised control over the United States (US) health services: physicians (from the 1900s on), hospitals and not-for-profit insurance (from the 1930s on), governmental regulators (from the 1960s on), and, lastly, for-profit managed care enterprises (from the 1980s on). A class contest between corporations and labor was involved at two critical points. In the 1870s to 1890s (with further steps in the 1920s and, with the Taft-Hartley law, in 1947), it weakened the labor movement that was unable to mount a successful effort for a national health program in 1972 and 1992. In the 1980s and 1990s, as health services developed into a major industry, two contending business groups (health plans and payers) took commanding positions over consumers and employees. Market-oriented, for-profit managed care organizations came to play a dominant role. During that period, access to, and, by some measures, quality of care has declined. The rise in health care costs has been interrupted, but it is not clear how long this will last. European nations that are reforming their health care system, should be wary of such profit-oriented market approaches to bring costs down.

Delivery of Health Care↗