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At least 1,297 records · Page 72Linked to original sources
PubMed1994

Outcome and cost of open- and closed-chest cardiopulmonary resuscitation in pediatric cardiac arrests.

OBJECTIVE: The dismal survival rates of cardiac arrest in children managed with conventional closed-chest cardiopulmonary resuscitation (CC-CPR) have renewed interest in the use of open-chest CPR (OC-CPR). We determined the efficacy of the early use of OC-CPR in children after cardiac arrest. METHODS: A retrospective review of emergency medical services (EMS) and hospital records revealed 27 children who were brought to the emergency department under CPR after blunt trauma. RESULTS: Twelve children had CC-CPR and 15 children underwent OC-CPR. Prehospital resuscitation and transport of both groups of children was excellent by current standards, and OC-CPR was performed within 5 minutes of arrival in the emergency department. CPR was successful with restoration of spontaneous circulation in 17% of children after CC-CPR, whereas 20% of children had restoration of spontaneous circulation after OC-CPR. This difference was not statistically significant. None of the children regained consciousness or survived to discharge. The hospital charges for patients who underwent OC-CPR were significantly higher (P = .005). Less than 30% of the hospital charges were reimbursed in both groups. CONCLUSIONS: OC-CPR does not improve survival in children who sustain cardiac arrest and receive CPR for more than 20 minutes in the field. Under these circumstances OC-CPR is an expensive and futile procedure to undertake.

California↗
PubMed1999

Cost containment mechanisms in Canada.

AIM: Describe the mechanisms currently being used by federal and provincial/territorial governments, medical associations, and private insurers to control the cost of health care in our country. METHODS: Descriptive method used. Statistics on percentage GDP spent on health, and health status of the population, were compared with other OECD countries. Questions discussed: importance of cost control, why difficult to control, and what is needed to control costs. RESULTS: System-wide mechanisms used to control health care costs include: single payer financing, universal coverage for hospital/physician services, global budgets, preventive health services, evidence-based information systems, and regionalization. Sector specific mechanisms used to control costs of physicians, hospitals, drugs, and technology. Cost control within the health care sector allows spending on other sectors (e.g., employment) that have a proven impact on one's health. Future health care cost containment policies must focus on restraining private sector costs and encouraging movement towards the determinants of health approach. CONCLUSIONS: Canada's relative success in containing costs is the result of public financing of the health insurance system. Our single payer, publicly financed health care system, allows for cost containment and universal access based on need for services rather than ability to pay. The shift of costs from the public to private sector must be curtailed. The determinants of health approach is instrumental in containing and channeling future spending on health.

Canada↗
PubMed2006

Characteristics of motorcycle-related hospitalizations: comparing states with different helmet laws.

This study compares U.S. motorcycle-related hospitalizations across states with differing helmet laws. Cross-sectional analyses of hospital discharge data from 33 states participating in the Healthcare Cost and Utilization Project in 2001 were conducted. Results revealed that motorcyclists hospitalized from states without universal helmet laws are more likely to die during the hospitalization, sustain severe traumatic brain injury, be discharged to long-term care facilities, and lack private health insurance. This study further illustrates and substantiates the increased burden of hospitalization and long-term care seen in states that lack universal motorcycle helmet use laws.

Accidents, Traffic↗
PubMed1994

Japanese healthcare system: in vitro diagnostic tests and reimbursements.

In 1961, a new and mandatory National Health Insurance plan was enacted in Japan. This healthcare system has succeeded in providing universal coverage while also containing the growth of national medical expenditures (NME) to the rate of growth of the gross national product (GNP), namely, approximately 4-5% annually, for several decades. All Japanese medical procedures, including dental procedures, prescription drugs, and diagnostic tests, are reimbursed by a fee schedule set by the Ministry of Health and Welfare. The combination of strict fee control and low administration costs has kept the Japanese NME growth below that of the GNP. In 1990, NME was 20.6 trillion yen ($187 billion), total diagnostic testing expenditures (DTE) were 2.3 trillion yen, representing 11.2% of national medical expenditures (NME). Of this amount, in vitro diagnostic testing accounted for 1.4 trillion yen, representing 61% of DTE and 6.8% of NME. Annually, 1.8 billion in vitro diagnostic tests are performed.

Clinical Laboratory Techniques↗
PubMed1988

Needs, interests, and attitudes of university faculty for a wellness program.

During the 1986-1987 academic year, 484 full-time faculty members at Oklahoma State University responded to a health habits questionnaire. The purpose of this study was to assess the needs, interests, and attitudes of faculty for a wellness program. Behaviors were assessed in the following categories: cigarette smoking, alcohol/drugs, eating habits, exercise/fitness, stress management, and safety. Only 100 (20.6%) of the total indicated that they were currently smokers. Neither the alcohol/drugs nor the safety categories appeared to be problem areas, with no significance noted. Categories indicating a need for improvement were exercise/fitness, eating habits, and stress management. Faculty members were interested in and willing to participate in a wellness program. Preferred areas of interest in rank order were (1) exercise/fitness, (2) stress management, and (3) nutrition. Results of this study indicate that faculty in a major university are interested in wellness and will participate in a wellness program. Need and interest suggest that an exercise/fitness program should be instituted first, with stress management and nutrition components added as funds become available. A successful wellness program in a university setting has implications for happier, more productive employees, reduced absenteeism, and lower health insurance premiums.

Adult↗
PubMedDate not supplied

The Canadian health care system: development, reform, and opportunities for nurses.

The Canadian health care system is a public insurance model built on the four fundamental principles of comprehensiveness, universality, portability, and public administration. Canadians are infinitely proud of the system and value it highly. Widespread fiscal concerns have placed all publicly financed programs under scrutiny, including health care. The challenge for health care planners and providers will be to improve the health status of Canadians, keep costs under control, and maintain the four principles on which the Canadian health care system was built. Nurses have many of the skills required to make a significant contribution to a reformed system. Working together and with other members of the health care team, nurses can play a pivotal role in shaping the future of health care and ensuring the health of Canadians.

Canada↗
PubMedDate not supplied

Obstacles predicting lack of a regular provider and delays in seeking care for patients at an urban public hospital.

OBJECTIVE: To determine the correlation among obstacles to medical care, lack of a regular source of care, and delays in seeking care. DESIGN: Cross-sectional survey of patients presenting for ambulatory care during a 7-day period. Multiple logistic regression models were used to identify obstacles independently associated with outcome variables. SETTING: Urban public hospital. PATIENTS: A total of 3897 disadvantaged and predominantly minority patients. MAIN OUTCOME MEASURES: Lack of a regular source of medical care and delay in seeking medical care for a new problem. RESULTS: The majority (61.6%) of patients reported no regular source of care. Of 2341 patients reporting a new medical problem, 48.4% waited more than 2 days before seeking medical care. No health insurance (adjusted odds ratio [OR], 2.2; 95% confidence interval [CI], 1.89 to 2.61), no transportation (OR, 1.44; 95% CI, 1.23 to 1.70), exposure to violence (OR, 1.21; 95% CI, 1.08 to 1.45), and living in a supervised setting (OR, 1.50; 95% CI, 1.00 to 2.25) were independent predictors of lack of a regular source of care. No insurance (OR, 1.24; 95% CI, 1.02 to 1.51), no transportation (OR, 1.45; 95% CI, 1.19 to 1.77), and less than a high school education (OR, 1.22; 95% CI, 1.08 to 1.49) were independent predictors of delaying care for a new medical problem. CONCLUSIONS: Obstacles in addition to lack of insurance impede provision of medical care to disadvantaged patients. The adoption of universal health care coverage alone will not guarantee access to appropriate medical care.

Adolescent↗
PubMed2006

Health services research as a source of legislative analysis and input: the role of the California Health Benefits Review Program.

This article examines the role of the California Health Benefits Review Program (CHBRP) as a source of information in state health policy making. It explains why the California benefits review process relies heavily on university-based researchers and employs a broad set of criteria for review, which set it apart from similar programs in other states. It then analyzes the politics of health insurance mandates and how independent research and analysis might alter the perceived benefits and costs of health insurance mandates and thus political outcomes. It considers how research and analysis is typically used by policy makers, and illustrates how participants inside and outside of state government have used the reports prepared by CHBRP as both guidance in policy design and as political ammunition. Although there is consensus that the review process has reduced the number of mandate bills that are passed out of the legislature, both supporters and opponents favor the new process and generally believe the reports strengthen their case in legislative debates over health insurance mandates. The role of the CHBRP is narrowly defined by statute at the present time, but the program may well face pressure to evolve from its current academic orientation into a more interactive, advisory role for legislators in the future.

California↗
PubMed1980

Cost containment through risk-sharing by primary care physicians: a history of the development of United Healthcare.

A new type of independent practice association has been organized to encourage primary care physicians in private practice to become coordinators and financial managers for their patients' medical care. Each patient chooses one internist, family or general physician, or pediatrician and must be referred by that physician for all specialized care. The primary care physician authorizes payment from his/her own account for hospital and referral care provided to patients. He or she shares any deficit or surplus remaining at the end of the year. This is a background paper detailing the history of development and specific features contained in this new concept of putting the physician in charge and "at risk" for the costs of medical care to his/her patients. The plan has been operating in northern California, Washington, and Utah and has 40,000 members and 750 participating physicians. This historical background paper is part of a large project--State Employees' Insurance Benefits Utilization Study (SEIBUS) being done by the University of Washington School of Public Health to evaluate use and costs of medical care under this innovative plan.

California↗
PubMed2000

Brief history of the tissue bank, charles university hospital, hradec králové, czech republic.

A brief history of the Tissue Bank (TB) of the University Hospital Hradec Králové, Czech Republic, established by Dr. R. Klen in 1952 is presented. In Dr. Klen's original concept the TB was defined as a department specialised in the harvesting, processing, preservation, storage and distribution of various kinds of tissue for clinical and experimental practice. The first kinds of tissue collected in cadaveric donors were corneas, bone and skin. Xenogeneic cartilage and bone grafts were prepared at the same time. Later, preparation of soft connective tissues and chorion-amnion was introduced. During the first 15 years of activity a total of 11,443 grafts preserved by hypothermy at +4 degrees C or freezing in absence of cryoprotectants (-20 degrees C) were prepared. In the 60's freeze-drying of tissue grafts was introduced and the bank of cryopreserved cell lines was established. In the 80's cryopreservation of haematopoietic progenitor cells for clinical transplantations was started and the spectrum of tissue grafts was enlarged (xenogeneic pericardium and allogeneic specially treated dura mater for neurosurgical operations, pigskin for burn treatment, demineralised bone for parodontology and implantology). In the 90's human keratinocyte culture for treatment of burns and chronic skin defects was started. The human milk bank and organ bank co-operating with the Regional Transplantation Centre are component parts of the TB as well. The TB is an institutional member of the European Association of Tissue Banks and annually delivers approximately 1000 grafts that are used in University and county hospitals as well as in surgeons' private practices. Health insurance companies reimburse all grafts on a non-profit and tax-free basis.

Journal Article↗
PubMed1990

Functional status and financial barriers to medical care among the poor.

We compared the functional status of 94 poor patients with financial barriers to recommended medical care with that of 94 poor control patients without such barriers in a university-affiliated community clinic. Financial barriers existed when an insured patient's health insurance failed to cover recommended care or when an uninsured patient could not afford recommended care. Patients with financial barriers scored significantly lower than control subjects on the psychologic function/mental health component of the functional status questionnaire and tended to score lower on all other functional status measures. The results suggest that poor patients with financial barriers to recommended medical care may be sicker than other poor patients.

Adult↗