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For many hospitals, billing and receivables management are inefficient and costly. Economic recession, increasing costs for patient and provider alike, and cost-containment strategies will only compound difficulties. The author describes the foundations of an automated billing system that would save hospitals time, error, and, most importantly, money.
This time-trend study was conducted during and after the severe economic recession and the period of high unemployment in Finland in the 1990s. The changes in the behavioral and emotional problems of children and adolescents placed in children's homes were studied in the same area using the Child Behavior Checklist questionnaire at three different time points (1993, 1996 and 1999), and the Children's Global Assessment Scale in 1996 and 1999. Internalizing symptoms of the children increased significantly. The level of psychosocial problems among boys was already high at the first rating in 1993, and it remained high during the whole study period. Behavioral and emotional problems of the girls placed in children's homes increased significantly, being at the same level as the boys' by the end of the study period.
This paper analyses the potential socio-economic impact of HIV disease in the Philippines, with focus on the situation of two vulnerable populations: overseas contract workers and sex workers. The potential impact of HIV disease is examined in the context of recent developments in the Philippines, including the economic recession, widespread poverty and income inequality. The contributions of overseas workers and sex workers are then reviewed, both at the macro- (national) and micro- (household) levels. The impact is examined in terms of lost income, costs of medical care and sociopolitical disruption.
BACKGROUND: The aim of the study was to investigate changes in psychosomatic complaints (PSC) and long-term illness (LTI) and the association between parents' socioeconomic conditions and children's complaints in the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden). METHODS: The cross-sectional study covered a representative sample of children, aged 2-17 years in each country, altogether 10,219 in 1984 and 10,317 in 1996. The data were collected by mailed questionnaires. The relationship between LTI, PSC and parents' education, income, satisfaction with economy and family situation was analysed using descriptive statistics and logistics regression. RESULTS: LTI and PSC in children have increased in all age groups between 1984 and 1996. The prevalence of LTI was higher among boys than girls, whereas the prevalence of PSC was higher among girls. In both years, the prevalence was higher in low-income, low-educated, one-parent families. The general tendency is the same in all countries, although there are some minor differences. The differences in 1984 remained unchanged in 1996 except for LTI that increased in low-educated families for Nordic children as a whole. CONCLUSION: Socially and economically vulnerable families seem to run the greatest risk of having children with LTI and PSC, although the data do not permit a strict causal relationship to be drawn. Also, families with high formal education, solid economy and general satisfaction with their situation seem to be able to offer their children sheltered and stimulating conditions for growth and development, even in times of economic recession.
Individuals with chronic pain frequently experience a complex and convoluted journey through the health care system that is often unrewarding for all involved. Excessive pain behavior may lead to unnecessary diagnostic testing or invasive procedures and result in iatrogenic complications and prolonged disability. Injured workers maintained on Worker's Compensation may be at increased risk for developing chronic pain syndromes unresponsive to conventional treatments. These individuals may have significant financial, psychosocial, and environmental reinforcement for maintenance of their disability and little incentive to return to work. Often there is no direct correlation between objective impairment and an individual's request for disability status. As job satisfaction and financial security diminish during our economic recession, the impact of the disability epidemic becomes more profound.
Many children in the United States do not have access to health insurance. Providing health insurance for children has been particularly challenging in rural America. This article describes and evaluates a local plan to provide access to health care for school children in a rural Alabama county. A triangulated methodology (personal interviews, ad hoc survey focus groups, US census and health fair data) was used in the evaluation. Gains were made in enrolling children despite some limitations, especially in rural outreach. The most successful aspect of the program was a partnership between local leaders, health providers, and educators to provide impetus for a coordinated plan. The stability of the program is uncertain because of diminishing resources and the negative effects of economic recession.
Of 1,332 unemployed individuals in the Detroit area interviewed in late 1983, 51% did not have health insurance. Lack of insurance was directly related to length of unemployment. Of those unemployed 3 months or less, 31% had no insurance, as compared with 56% of those unemployed more than 3 years. For the most part, these were not the chronically uninsured: 78% of them were insured when they were employed. Three fourths of those without insurance were not covered by Medicaid either. These findings suggest that during the latest economic recession, the problem of health insurance loss due to losing one's job was more severe than had been assumed by most policymakers.
A brief insight into the issues affecting German health care is given. Namely, upward pressure on costs leads to increasing expenditure within health care and downward pressure from economic recession and political unwillingness to increase taxes and budget spending. In the case of competing key stakeholder perspectives, a quality management framework is seen as a potential approach for addressing these issues. The framework is the European Foundation for Quality Management (EFQM) Excellence Model. The article briefly explains the pilot phase for utilising the EFQM Excellence Model within German health care organisations and the various implementation approaches recommended by EFQM. Specific details of an approach used by a health care organisation within Germany (providing social medicine, geriatric and elderly services) are described in detail. The benefits achieved from using the Model are a clear picture of where the gaps are in the organisation and a clear vision for concentrating future efforts towards total quality management.
To examine the relationship between society stress and peptic ulcer perforation, time-trend analysis was performed on the annual incidence of perforated peptic ulcer per 100,000 population in Hong Kong during the years 1962-85, when Hong Kong, as a developing city, went through significant socio-economic and political changes, and the trend was correlated with specially designed and validated society stress scores estimated annually during the same period. The society stress scores were derived independently by two expert panels blinded to the purpose of the study, one selecting and categorizing negative news events for Hong Kong during this period, and the other weighing the categories and scoring the impact of the news on Hong Kong. The incidence of perforation increased significantly during the years and manifested three distinct peaks, which coincided with the worst economic recession in Hong Kong, the influx of mainlander Chinese and Vietnamese boat people, and the Sino-British negotiation on the sovereignty of Hong Kong after 1997. Both linear and autoregression analysis, the latter taking into consideration point fluctuations in rates, showed that perforation rates correlated significantly with the society stress scores (r = 0.57, P < 0.002). The peak effects and the significant correlations indicate that an association exists between society stress and peptic ulcer perforation, and suggest that chronic society stress plays an important role in the aetiology of this condition, although the relatively low r value also suggests the presence of other aetiological factors.
With the sustained economic recession, suicide has been increasing in Japan (more than 300000 victims annually since 1998), particularly among middle-aged employees. Development of preventive measures is needed; however, employees have limited knowledge of the basic information about depression and suicide. One office in Saitama Prefecture, Japan, has been provided with a mental health support program. An initial questionnaire survey was conducted in December 1999. It contained demographic data and information about working styles and daily habits, including alcohol and tobacco use, quality of sleep, social support, the general well-being schedule, and knowledge/attitude toward depression and suicide. Of 225 eligible people, 216 men and women participated. Most of them had stressful schedules and demanding jobs. Their subjective well-being was generally poorer relative to the reference. The mean score of knowledge was 10.5 (SD = 2.02) for 14 items. The accuracy rates ranged from 97.6% incorrect (false) for such items as 'Most suicide victims consult psychiatrists before their deaths' to 42.1% correct (true) for 'A suicidal individual tends to be accident-prone for traffic accidents and injuries.' One-fourth of them had unfavorable attitudes toward depressive colleagues. Neither age nor gender was related to knowledge level and attitude. Variations were observed in the knowledge that employees had toward depression and suicide. A program that provides employees with appropriate information related to mental health is needed.
During the period 1987-1994 there has been a threefold increase in disability pensions granted to individuals with affective disorders in Finland. Possible reasons for this development include a deep economic recession, changes in the diagnostic system, and better recognition of affective disorders. Against this background, it seems relevant to ask why, over the same period, the functional capacity of depressive patients has markedly deteriorated, causing an increase in disability pensions, despite the fact that many new drugs and other treatments have become available.
In the next 20 years every country in Western Europe will see a rise in its total numbers of people aged over 60, and since old people are now living longer the proportion aged over 75 will also rise. Both physical and mental disorders become much more common between 60 and 75, so that if these old people are to be provided with accommodation and medical services at contemporary standards many more places will be needed in sheltered flats, nursing homes, and geriatric hospitals. Yet in the current economic recession most European countries are trying to cut back on public expenditure. How do politicians and administrators reconcile the conflict between the demands created by demographic change and the freeze on public spending? How will the care of the elderly change in response to this conflict? Tony Smith is examining the ways in which old people are looked after in several European countries and their plans for the future. This first article deals with Denmark.
In Switzerland the age-standardised death rate for 'all diseases of the circulatory system' decreased by 22% in males and by 43% in females between 1951 and 1976, which represented a third and nearly a half respectively of the decrease in all deaths. Mortality was reduced by 13% in males and by 40% in females for non-rheumatic heart disease and hypertension, and by 36% and 47% respectively for cerebrovascular disease. These reductions were on the whole greater than those observed in the 13 other developed countries studied. From 1951 to 1976 consumption of animal fats per caput increased by 20% in Switzerland, in spite of a 46% reduction in milk intake. Throughout the same period, smoking increased among women while it remained steady or possibly declined in men. During the last decade a threefold rise in the sales of antihypertensive drugs was observed. Oral contraceptives seem to have been widely used by Swiss women since the 1960s. There were also increases in the proportion of women in professional occupations, and in urbanisation. The advent of the economic recession was associated with a sudden rise in mortality from non-rheumatic heart disease and hypertension in 1974-76.
STUDY OBJECTIVE: To study trends in the health and socioeconomic circumstances of lone mothers in Sweden over the years 1979-1995, and to make comparisons with couple mothers over the same period. DESIGN: Analysis of data from the annual Survey of Living Conditions (ULF), conducted by Statistics Sweden from 1979-1995. Comparison of demographic, socioeconomic and health status of lone and couple mothers and how these have varied over the 17 years of the study. Main outcome measures include prevalence of self perceived general health and limiting longstanding illness. PARTICIPANTS AND SETTING: All lone mothers (n = 2776) and couple mothers (n = 16,935) aged 16 to 64 years in a random sample of the Swedish population in a series of cross sectional surveys carried out each year between 1979 and 1995. MAIN RESULTS: The socioeconomic conditions of lone mothers deteriorated during the period 1979-1995, with increasing unemployment and poverty rates. Lone mothers had worse health status than couple mothers throughout the period. In comparison with the first two periods, the prevalence of less than good health increased among both lone and couple mothers from the late 1980s onwards. For lone and couple mothers who were poor, their rates of less than good health were similar in the early 1980s, but in 1992-95 poor lone mothers were significantly more likely to report less than good health than poor couple mothers. Unemployed lone mothers had particularly high rates of ill health throughout the study period. CONCLUSIONS: As in other European countries, lone mothers are emerging as a vulnerable group in society in Sweden, especially in the economic climate of the 1990's. While they had very low rates of poverty and high employment rates in the 1980s, their situation has deteriorated with the economic recession of the 1990's. The health status of lone mothers, particularly those who are unemployed or poor, appears worse than that of couple mothers and in some circumstances may be deteriorating. Further study is needed to elucidate the mechanisms mediating their health disadvantage compared with couple mothers.
STUDY OBJECTIVE: To determine the extent of the inequalities in self reported health between socioeconomic groups and its changes over time in the Basque Country (Spain). DESIGN: Cross sectional data on the association between occupation, education and income and three health indicators was obtained from the Basque Health Surveys of 1986 and 1992. Representative population samples were analysed. In 1986 the number of respondents was 24 657 and in 1992, 13 277. SETTING: Basque Country, Spain. MAIN OUTCOME MEASURES: The effect of socioeconomic position on health and the magnitude of social inequalities in health were quantified using the odds ratios based on logistic regression analysis, and the Relative Index of Inequality. RESULTS: As was expected, social inequalities in self reported health existed in both surveys, but the social gradient was greater in 1992. Social differences varied according to gender and health indicator. According to education an increase in social inequalities was observed consistently in all the health indicators except long term conditions in women. A consistent increase in inequalities in limiting longstanding illness was also observed according to all socioeconomic indicators. CONCLUSIONS: These results agree to a large extent with those of previous studies in other countries. In this context the unequal distribution of material circumstances and working conditions between socioeconomic groups seem to play a major part in health inequalities. The worsening of the labour market during this period and the onset of a new economic recession may explain the increase in social inequalities over time.
STUDY OBJECTIVE: Reduction of health inequalities is a primary public health target in many countries. A change of proportion of low income families might affect child health inequalities. Yet, the importance of family incomes in high income welfare states is not well established. The aim of this study was to investigate the effect of increased percentage of low income families on child health inequalities during an economic recession in Sweden, 1991-1996. DESIGN: Health inequalities for six health indicators were assessed during the period 1991-1996 and during adjacent periods. Relative inequality indices were estimated according to Pamuk and Mackenback. Appraisal of a child's socioeconomic situation was based on social data for the child's residency area. SETTING: The total population of children and adolescents 0-<19 years old living in Stockholm County, Sweden, was studied. Each one year cohort comprised 20 470-25 420 people. MAIN OUTCOME MEASURES: Mortality; rate of low birth weight; days of hospital care for infections, asthma/allergic disorders, and unintentional injuries; and rate of abortions. MAIN RESULTS: Mortality decreased annually by 6.9%. The average relative inequality index for mortality before the recession was 1.40 and was lower during the recession, 1.14. The remaining five health indicators, and the relative inequality index for these indicators, did not differ significantly between the recession years (1991-1996) and adjacent periods. CONCLUSIONS: Relative health inequalities did not change, or decreased, during the recession years. The findings indicate that the connection was weak between child health inequalities and family incomes, within the frame of time and the range of income changes that occurred during the study period.
Toothache is a subjective oral health indicator that should become uncommon when oral health is improving. The aim of this study was to assess changes in perceived toothache between 1977 and 1997 among Finnish adolescents. In the Adolescent Health and Lifestyle Survey, a self-administered questionnaire was mailed to a representative sample of 12-, 14-, 16-, and 18-year-old Finns every second year. The sample sizes in the surveys varied from 2422 to 11,105, making a total of 35,349 subjects in the entire study. The incidence of toothache during the previous 2 years was requested in 1977, 1985, 1991, 1995, and 1997, and the prevalences were 31%, 25%, 28%, 29%, and 37%, respectively. The increase between 1995 and 1997 was highest among 16- and 18-year-olds. There was no tendency for perceived toothache to decline over the study period, despite the decrease in caries experience. Toothache varied by age, socioeconomic status (SES), place of residence, and toothbrushing frequency. The increase in the incidence of toothache reported after 1995 could be a warning signal that economic recession in Finland has caused changes in the dental care system.
New Zealand nurses are active and dynamic emerging holistic practitioners. Despite an economic recession and dramatic changes in their health care delivery systems, the country's holistic nurses have mobilized to develop and begin a holistic nurses' association. Holistic nurses from both islands have begun independent practices using complementary therapies and modalities. Although New Zealand is distant from North America geographically, there have been increasing numbers of exchange visits and subsequent influence on international holistic nursing practice. New Zealand, being a lush, green, clean, semitropical country in the South Pacific, is a wonderful place for North American nurses to experience cross-cultural nursing while still being in an English-speaking country.