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The National Breast and Cervical Cancer Early Detection Program: a comprehensive public health response to two major health issues for women.

The passage of the Breast and Cervical Cancer Mortality Prevention Act established a nationwide, comprehensive public health program to increase access to breast and cervical cancer screening services for women who are medically underserved. This act created the first opportunity for state health agencies to build a public health infrastructure for cancer control at the state and community levels. The Congress appropriated $30 million in fiscal year 1991 for the first year of this program. In the summer of 1991, the Centers for Disease Control and Prevention (CDC) used a competitive application process to fund the first eight states to establish early detection programs. Since then, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has become a nationwide program with a budget of $100 million. Thirty-five states and nine American Indian Tribes are supported to implement comprehensive screening programs. Fifteen states, three territories, and the District of Columbia receive planning and infrastructure grants as part of the Capacity Building Program. The NBCCEDP surveillance data through January 31, 1995 shows that 556,003 screening tests have been provided to women who are medically underserved. The success of NBCCEDP has contributed to the growing pressure on state health agencies to focus more attention and resources on chronic disease prevention and control.

Adult↗

[Hepatitis A in Poland in 2003].

Epidemiological situation of hepatitis A in Poland since 1997 was evaluated as low endemicity and since 2002 as very low endemicity. High percentage of cases were noted among adult persons, especially in the age 25-29 years. The course of disease was more serious, than before 1997. In 2004 only 95 cases of hepatitis A were noted in Poland (Incidence rate 0.25/100 000). The number and percentage of unimmunized persons, especially among children, adolescents and young adults increases very rapidly. In such situation vaccination against hepatitis A of persons from risk groups is necessary.

Disease Outbreaks↗

Four malaria success stories: how malaria burden was successfully reduced in Brazil, Eritrea, India, and Vietnam.

While many countries struggle to control malaria, four countries, Brazil, Eritrea, India, and Vietnam, have successfully reduced malaria burden. To determine what led these countries to achieve impact, published and unpublished reports were reviewed and selected program and partner staff were interviewed to identify common factors that contributed to these successes. Common success factors included conducive country conditions, a targeted technical approach using a package of effective tools, data-driven decision-making, active leadership at all levels of government, involvement of communities, decentralized implementation and control of finances, skilled technical and managerial capacity at national and sub-national levels, hands-on technical and programmatic support from partner agencies, and sufficient and flexible financing. All these factors were essential in achieving success. If the goals of Roll Back Malaria are to be achieved, governments and their partners must take the lessons learned from these program successes and apply them in other affected countries.

Antimalarials↗

Setting national priorities for quality assessment of health care services in Korea.

OBJECTIVE: To identify target services and determine national priorities among those services identified for a national quality assessment program of the Health Insurance Review Agency (HIRA) in Korea. DESIGN: Target services were identified from published sources addressing quality problems, various quality-monitoring programs in other countries, suggestions from 26 medical specialty associations in Korea, and frequently reported consumer claims. Three steps were involved in the prioritization decision: (i) development of a set of priority criteria; (ii) expert panel survey to evaluate the extent to which individual services satisfy each of the priority criteria and to calculate mean priority ratings for individual services; and (iii) formation of four levels of priority groups-top, high-middle, middle, and low-according to the allocated priority ratings. RESULTS: Five priority criteria were selected: "burden of the condition", "seriousness of the quality problem", "interest and demand of society", "acceptability", and "the feasibility of quality assessment". Among the 57 services identified as targets for the national quality assessment program, 10 were selected as having a top priority for quality assessment because of their high feasibility rating. These are: cardiac surgery; cataract surgery; tonsillectomy; appendectomy; tooth extraction; usage of albumin/globulin products; treatments for hypertension, pneumonia, and acute upper respiratory infection; and services provided by clinical laboratory centers. CONCLUSION: The priority services identified from the studies will assist the HIRA in selecting target services and implementing the national assessment program.

Acute Disease↗

A national program for control of acute respiratory tract infections: the Philippine experience.

Maturing programs on child immunization and diarrheal diseases, a community-based research project, and a rational drug-use program facilitated the launching in 1989 of a nationwide Philippine Control of Acute Respiratory Infections program (Phil-CARI). From 1990 to 1991 the Phil-CARI expanded rapidly, training >80% of its middle managers and frontline health care providers on the case-management protocols of the World Health Organization for acute respiratory infection. Multiple donors and good collaboration with various societies and medical schools assisted the program. However, by 1992, there were difficulties in maintaining training quality, follow-up, and supervision. Donor assistance dwindled and the health care delivery system decentralized. Government procurement systems were unable to meet the logistics demands of the program. The monitoring and evaluation system was inadequate to measure impact. The Phil-CARI provides lessons in searching for more sustainable approaches and systems to meet the various demands of a nationwide ARI control program and to create the desired impact.

Acute Disease↗

Medical necessity in Canadian health policy: four meanings and ... a funeral?

Four meanings of medical necessity have emerged, evolved, and dominated past and current health policy debates about the appropriate level of service coverage under Canada's health insurance program. To explore the shift in definition, provincial government and national health care association position papers responding to federal legislative and policy reviews of Canada's health insurance program from 1957 to 1984 were examined, as were more current reports on medical necessity. Four meanings of medical necessity predominated: "what doctors and hospitals do"; "the maximum we can afford"; "what is scientifically justified"; and "what is consistently funded across all provinces." These meanings changed with time as different stakeholder associations and governments redefined the concept of medical necessity to achieve different policy objectives for health service coverage under Canada's health insurance program.

Attitude to Health↗

Containing cost through competition: the new wave.

The enormous increases in outlays for federal health care program beneficiaries have prompted national policy developers to look for effective means to contain health care expenditures. Past attempts to do so through Federal regulation have not worked because they were not directed at creating incentives to contain cost. In the Reagan Administration, the most talked-about alternative is a comprehensive reform of health care financing and delivery through instituting a competitive model. The plan will be discussed extensively in the 97th Congress; the outcome of that debate can have profound effects on the methods by which Americans receive and pay for health services.

Cost Control↗

Why the Scandinavian countries have not implemented universal vaccination against hepatitis B.

Within the 50 member states of the WHO European region, HBsAg carriage rates vary from a high of approximately 20% to a low of 0.05%. The Scandinavian countries have the lowest carriage rates in the region (0.05%). The situation in Sweden is representative of the situation throughout Scandinavia: although a substantial number of immigrants to Sweden are HBsAg-positive, acute cases of hepatitis B continue to be seen mainly in drug addicts and their contacts and to a certain extent, in male homosexuals with multiple partners. Public health officials and governments in Scandinavia are unwilling to introduce universal vaccination of infants because hepatitis B infection is viewed as a limited public health problem that does not justify the expense and other efforts of universal immunization.

Acute Disease↗

Data mining approach to model the diagnostic service management.

Korea has National Health Insurance Program operated by the government-owned National Health Insurance Corporation, and diagnostic services are provided every two year for the insured and their family members. Developing a customer relationship management (CRM) system using data mining technology would be useful to improve the performance of diagnostic service programs. Under these circumstances, this study developed a model for diagnostic service management taking into account the characteristics of subjects using a data mining approach. This study could be further used to develop an automated CRM system contributing to the increase in the rate of receiving diagnostic services.

Databases, Factual↗