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New GP charter.

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Costs and Cost Analysis↗

Financing health care.

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Attitude of Health Personnel↗

Financial burden of childhood cancer.

Fifty-nine of 73 families of children referred for treatment of cancer during 1980 co-operated in a study of the financial consequences of the illness. Except for two social class I families who declined to take part, the sample was representative of the childhood cancer population and families were of similar socioeconomic status to the general population. During the first, inpatient, week week of treatment the sum of income lost plus additional expenditure exceeded 50% of total income in over 45% of families. During a subsequent week of outpatient treatment, loss of income plus additional expenditure amounted to more than 20% of income in over half the families. These problems affected all the groups studied and were not confined to lower paid or those living furthest from the centre. Financial help was available from charitable sources and the DHSS towards travel, extra nourishment, and heating costs but could not be obtained to compensate for loss of earnings. The families of children who died had difficulty in meeting the cost of funerals. Families of children with cancer need more help than is at present available, especially to offset loss of income and the cost of funerals.

Burial↗

Cost of counselling women who undergo mastectomy.

The psychiatric morbidity associated with mastectomy and brest cancer was substantially reduced by a specialist nurse who counselled women before and after surgery and monitored their progress. A controlled study was, therefore, carried out to determine what this cost. National Health Service costs were almost wholly covered by savings made because counselled subjects who developed psychiatric problems were recognised and treated much earlier than control patients. Counselled and control subjects suffered considerable financial losses, but these were offset in the counselled group by their relatives' earlier return to work. Such counselling schemes are necessary and effective and may be implemented at little extra cost.

Community Health Services↗

Extension of family planning service in general practice.

All general practitioners on the list of a single executive council were contacted and 91% were interviewed. They were asked about the type of family planning service currently provided and their willingness to extend the service. Only 3% said that they were not providing any service at the time of interview, but only 4% stated that they provided a complete range of techniques to all patients; almost two thirds of practitioners only provided advice and the "pill". Lack of training in family planning techniques emerged as the most important factor in determining the type of service provided. At the time of interview 64% of doctors stated that they would like further training, and 35% of all doctors asked for a full course of clinical training. Many general practitioners (81%) were willing to extend their family planning services but 65% wanted financial reimbursement and 50% needed additional administrative support as prerequisites.

Comprehensive Health Care↗

Socioeconomic determinants of health. The contribution of nutrition to inequalities in health.

Social class differences in health are seen at all ages, with lower socioeconomic groups having greater incidence of premature and low birthweight babies, heart disease, stroke, and some cancers in adults. Risk factors including lack of breast feeding, smoking, physical inactivity, obesity, hypertension, and poor diet are clustered in the lower socioeconomic groups. The diet of the lower socioeconomic groups provides cheap energy from foods such as meat products, full cream milk, fats, sugars, preserves, potatoes, and cereals but has little intake of vegetables, fruit, and wholewheat bread. This type of diet is lower in essential nutrients such as calcium, iron, magnesium, folate, and vitamin C than that of the higher socioeconomic groups. New nutritional knowledge on the protective role of antioxidants and other dietary factors suggests that there is scope for enormous health gain if a diet rich in vegetables, fruit, unrefined cereal, fish, and small quantities of quality vegetable oils could be more accessible to poor people.

Adult↗