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PubMed1995

Health department administration of the Canadian Health Care Program.

Public administration of the Canadian health care program has been very successful in preserving a single-tiered system, ensuring accessibility and accountability, reducing administrative costs and the need for regulation, and fairly successful in achieving orderly planning and cost control. Although the provincial programs are administered by health departments, failure to link personal to public health services has robbed them of a population perspective, resulting in insufficient emphasis on prevention and on the effectiveness of interventions, and has hampered the development of comprehensive primary care. The program supports insufficient research and innovation, and has failed to link payments to performance. Four lessons for a national health care program are drawn from the Canadian experience: (1) keep it public; (2) use a single payer; (3) link personal health services to public health; and (4) provide health departments with policy expertise. Despite its overall success, the Canadian program can no longer be afforded. Many of the proposals for its reform challenge the values upon which the program is built.

Canada↗
PubMed1981

Kidneys, ethics, and politics: policy lessons of the ESRD experience.

This article examines the policy lessons to be learned from the American experience with the End-Stage Renal Disease program. This program was instituted in 1972 as an amendment to the Social Security Act to provide reimbursement for the costs of therapy to those persons suffering from renal failure. The article tries to debunk certain common myths that have arisen concerning the ESRD program, by examining the history and evolution of renal dialysis technology as well as the social policies concerning dialysis pursued in England and Sweden. It argues that while the ESRD program is not a genuine instance of a 'mini' national health insurance program, there are important moral, social, and policy lessons to be learned from this unique effort to provide renal therapies to those Americans in need.

Ethics, Medical↗
PubMedDate not supplied

Impact of a collaborative immunisation programme in an inner city practice.

OBJECTIVES: To describe the impact of a collaborative immunisation programme, between an inner city practice and the Eastern Health Board (EHB). DESIGN: An observational study using a computer database formed from practice and EHB records. SETTING: One Dublin inner city practice with three partners located in an area with a deprived socio-economic profile. SUBJECTS: All patients in the practice aged more than six months and less than five years identified both from practice registers and opportunistically during study period. RESULTS: 342 children, older than six months and less than five years were identified at start and 464 (a 36% increase) by end of the programme. Uptake changed for DPT from 30% before, to 57% after the programme (p < 0.0005), for DT from 15% to 13%, for Hib from 7% to 50% (p < 0.0005) and for MMR (over 15 months) from 53% to 75% (p < 0.0005). Uptake of the DPT, Hib and MMR was 35% among GMS eligible, 51% among GMS ineligible (p < 0.005). CONCLUSION: A collaborative immunisation programme significantly improved practice uptake rates. These improved rates still do not attain declared national targets. To achieve these targets, radical overhaul of the immunisation service is required.

Cooperative Behavior↗
PubMed1998

Sustainable introduction of affordable new vaccines: the targeting strategy.

Immunization prevents over 3 million child deaths from vaccine preventable diseases such as diphtheria, pertussis, tetanus, measles and polio every year. New vaccines against respiratory and diarrhoeal diseases have the potential to prevent an additional 8 million deaths. Assuring that the existing and new vaccines are available to all children in the world is a global health priority. The health benefits of new vaccines like hepatitis B and Haemophilus influenzae type B (Hib) are indisputable. In the case of hepatitis B, over 1.2 millions deaths could be prevented each year if children and at risk adults were immunized with the hepatitis B vaccine. However, despite the clear health need and benefit, many countries have been unable to provide the 'new' vaccines, like hepatitis B vaccine, to their populations. For these countries, the limitation is not the delivery structure. Most countries now have immunization delivery structures which can provide immediate access to 80% of the country's newborns. Nor is it the vaccine availability as adequate capacity exists to meet the demand. The limitation has been the inability of governments to finance the vaccine because of a combination of factors including dependence on donors, donor policy, inadequate recognition by governments of the value of vaccines and, for some countries, the absolute price of the vaccines. The successes and failures in introducing a 'new' vaccine like hepatitis B vaccine into the world have clearly illustrated that it is economics and not epidemiology which dictates introduction of the vaccine into national immunization programmes. UNICEF and the WHO Global Programme for Vaccines and Immunization (GPV), have now developed and adopted a framework which differentiates countries based on their capacity to be financially self-sufficient for their vaccine needs. This framework forms the basis of strategies designed to co-ordinate the actions of governments, donors, agencies and vaccine manufacturers in order to ensure all countries have rapid access to affordable vaccines.

Adult↗
PubMed2005

Disparities in varicella vaccine coverage in the absence of public funding.

Varicella vaccine has been licensed in Canada since December 1998 but not provided free in all provinces. Through a cross-sectional telephone survey to a random sample of parents, we assessed factors associated with varicella vaccine uptake in the absence of public funding. Parents of children aged 2-3 years (Group I) and 6-7 years (Group II) were contacted between March and May 2003 in British Columbia, Canada. Response rate was 82% (Group I=571; Group II=704). Among susceptible children, varicella vaccine coverage was 21% (95% CI 18-25%) and 28% (95% CI 22-33%), respectively. There were significant disparities in vaccine coverage based on income and residence. Physician or nurse recommendation was a strong determinant of vaccine uptake as were belief in the safety and efficacy of vaccine. Among parents of susceptible children, 59% (343/582) would vaccinate their child if it were provided free; 25% (148/582) were undecided.

British Columbia↗
PubMed1998

Hepatitis B vaccination of adolescent and adult high-risk groups in the United States.

Substantial progress has been made in implementing routine infant hepatitis B vaccination in the United States. However, in 1996, an estimated 65,000 acute hepatitis B cases occurred, the majority of which were among young adults in high-risk groups. Recent surveys have found very low vaccination coverage among several high-risk groups, including men who have sex with men and patients with sexually transmitted diseases (STDs). Targeted vaccination of persons with risk factors for hepatitis B virus (HBV) infection can be provided in a variety of settings including family planning clinics, STD clinics, drug treatment centres, detention centres, jails and prisons. However, vaccination programmes have been infrequently implemented in these settings and the majority of persons with acute hepatitis B cases have had a missed opportunity for vaccination in the past. Thus, in order to accelerate elimination of HBV transmission in the United States, increased efforts are needed to implement effective hepatitis B vaccination programmes targeted to adolescents and adults in high-risk groups.

Adolescent↗
PubMed1998

Success stories in the implementation of universal hepatitis B vaccination: an update on Italy.

Compulsory universal vaccination against hepatitis B was introduced in 1991 in Italy for all newborns and 12-year-olds. Despite the decreasing circulation of the virus noted in the late-1980s, it was clear that only universal immunization would control hepatitis B infection and limit the transmission of the virus. Data collected during the first six years after vaccination was implemented show the success of the strategy. Over 90% of infants in the country and adolescents living in north-central Italy were immunized. Since 1995, the decrease in acute cases of hepatitis B has accelerated in the age groups 0-14 and 15-24, particularly in two regions of the north; during the same period, no comparable decrease in incidence was seen in older age groups. Monitoring coverage of vaccination and incidence of acute disease and seroepidemiological studies will continue and should show a rapid progression towards the elimination of HBV circulation in the country.

Hepatitis B↗
PubMed1998

Progress toward elimination of hepatitis B virus transmission in the United States.

The strategy to eliminate hepatitis B virus (HBV) transmission in the United States is comprised of the following components: (1) preventing perinatal transmission, (2) routine infant vaccination, (3) catch-up vaccination of children in high-risk groups at any age, (4) catch-up vaccination of all children at 11-12 years of age and (5) vaccination of adolescents and adults in high-risk groups. According to recent surveys, > 85% of pregnant women are screened for hepatitis B surface antigen (HBsAg). Of infants born to HBsAg-positive women identified in 1995, 93% received appropriate immunoprophylaxis at birth; however, only 69% were fully vaccinated by 6-8 months of age. From 1991 (when routine infant hepatitis B vaccination was first recommended) to 1996, the proportion of 19-35-month-old children who have received three doses of hepatitis B vaccine has increased from < 10 to 83%. During this time, rates of acute hepatitis B in children 7-10 years of age have declined by 27% and rates among children 3-6 years of age have declined by 62%. Implementation of programmes for catch-up vaccination of all adolescents at 11-12 years of age and for vaccination of adolescents and adults in high-risk groups have only recently begun and no data are available to assess the progress of these programmes. However, 26% (13/50) of states now have laws requiring adolescents to be vaccinated in order to enter school. Current data indicate that substantial progress has been made in implementing a strategy to eliminate HBV transmission in the United States. Future efforts need to be focused on improving complete immunoprophylaxis of infants of HBsAg-positive mothers, increasing vaccine coverage among 11-12 year old children and implementing programmes to vaccine adolescents and adults in high-risk groups.

Adolescent↗
PubMed2000

DANMAP: monitoring antimicrobial resistance in Denmark.

The objectives of the Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP) are to monitor trends in resistance among bacteria from animals, food and humans, to monitor the consumption of antimicrobial agents and to determine the association between consumption and occurrence of resistance and to model transmission of resistance from animals to humans. DANMAP is based on the examination of representative bacterial isolates of animal and human pathogens, of zoonotic bacteria and of indicator bacteria. For food animals, both diseased and the healthy populations are studied. Isolates from all three reservoirs are examined for their susceptibility to a basic panel of antibiotics that includes representatives of the major classes of compounds, making comparison of resistance levels in the reservoirs possible. Isolates are stored in a strain collection and are available for further study. The data are stored in databases as MIC values or mm inhibition zones with all identifiers. A system for recording all use of the veterinary medicines, VETSTAT, is currently under implementation. For production animals, the consumption will be recorded for each herd, providing a basis for detailed modelling of the effect of consumption on resistance.

Animal Diseases↗
PubMed2000

Toward a new communications framework for HIV/AIDS.

In response to the overwhelming burden of new cases of human immunodeficiency virus (HIV) in Africa, Asia, Latin America, and the Caribbean, the Joint United Nations Programme on HIV/AIDS (UNAIDS), in 1997, initiated a project to examine the application of existing communication theories/models to HIV/acquired immune deficiency virus (AIDS) prevention and care in these regions. In the past 2 years, 103 leading researchers and practitioners from different parts of the world were invited by the UNAIDS to participate in one of five consultative workshops designed to review these theories/models and rethink their adequacy for Africa, Asia, Latin America, and the Caribbean. A new communications framework for HIV/AIDS was developed to move from a focus on the individual to a focus on five domains of "contexts" that influence behaviors: government policy, socioeconomic status (SES), culture, gender relations, and spirituality.

Attitude to Health↗