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At least 1,729 records · Page 96Linked to original sources
PubMed2002

Reimbursement and cost containment: a German perspective.

This paper distinguishes short- and long-term financing problems in social health insurance systems in Germany and other European countries. The first part focuses on recent healthcare reforms in Germany that are directed at short-term problems, in particular measures of cost containment in the pharmaceutical sector such as the introduction of a drug formulary and reforms in the system of risk adjustment to enhance competition between sickness funds. The second part discusses the likely effects of the aging of the population on the sustainability of present types of mandatory insurance coverage in Germany and possible reforms that could solve the problems. It is argued that the proposed distinction between basic and supplementary benefits requires a system of explicit rationing (e.g. by age), which determines the package of basic benefits several decades in advance.

Cost Control↗
PubMed2006

The impact of aging on long-term care in Europe and some potential policy responses.

The article examines recent data on the impact of increasing numbers of elderly people in Europe on expenditures for long-term care services. After reviewing recent and projected future costs of long-term care, the authors examine current national strategies for long-term care as well as potential policy options that could reduce future expenditures due to aging. Although long-term care expenditures in Europe will rise over the next several decades, countries can adopt a variety of strategies--many of them in social sectors outside the health system--to reduce or mitigate the overall effects of likely long-term care needs.

Aged↗
PubMed2004

Is the Canadian health care system fiscally sustainable?

Current concerns over escalating health care costs and the sustainability of the Canadian health care system are based on analytical concepts and models that have their own limitations and deficiencies. Measuring health care costs across subsectors over the long-term period, the authors argue that Canada's health care costs, especially those under the direct control of provincial governments, are relatively stable. Using appropriate measures of sustainability, there is no indication that Canada's public health care expenditure is unsustainable. Nor is there any indication that Canada's public health care expenditures are out of line with those of its main trading competitors, including the United States.

Bankruptcy↗
PubMed1981

Coping with stress at work.

This paper considers the quality-of-life concept from the point of view of harmony between fundamental human needs and environmental conditions. It is argued that the knowledge gained by research in psychobiology can aid in directing technological applications to suit human needs and abilities. Examples are given from a multidisciplinary research program concerned with the dynamics of stressful person-environment transactions, viewed from psychological and biological perspectives. Emphasis is placed on coping and adaptation in workers exposed to conditions characterized by underload, overload, and lack of control. On the basis of empirical results, it is argued that a moderately varied flow of stimuli and events, opportunities to engage in psychologically meaningful work, and to exercise personal control over situational factors, may be considered key components in the quality-of life concept.

Adaptation, Psychological↗
PubMed2001

Is German long-term care insurance a model for the United States?

German long-term care insurance, implemented in 1995, significantly extends the coverage of care-related risks. Given the similarities of German and U.S. institutional features, the German social insurance approach has been put forward as a possible model for long-term care in the United States. Using a political economy framework, the authors conducted a policy analysis that compares the main shortfalls of long-term care (LTC) provision in the United States and Germany, examines the responses provided by LTC insurance in Germany, and relates them to broader trends and proposals for change in welfare policy in both countries. German LTC insurance includes a high degree of consumer direction and compensation and protection for informal caregivers; it supports the extension of community-based services. Its shortfalls include the continued split between health and LTC insurance. In both countries, decentralization and institutional and financial fragmentation are some of the characteristics responsible for the failure to promote egalitarian social policy and substantially expand social protection to family- and care-related risks. The German LTC program is a good model for the United States. With a social insurance approach to LTC, costs are spread across the largest possible risk pool. Major goals that can be reached with such a program include establishment of universal entitlements to LTC benefits, consumer choice, and equitability and uniformity.

Activities of Daily Living↗
PubMed1997

Bladder dysfunction and management in multiple sclerosis.

Symptomatic bladder dysfunction occurs at some time in most patients with multiple sclerosis. The relapsing-remitting course and progressive loss of mobility associated with multiple sclerosis make management of urinary urgency and incontinence difficult. Urodynamic evaluation serves as a guideline for appropriate treatment. After accurate diagnosis of bladder dysfunction, a management program is developed with use of fluid schedules, voiding techniques, neuropharmacologic manipulation, intermittent catheterization, surgical treatment, and other adjunctive measures as indicated. The goals of treatment are to protect and preserve renal function, relieve symptomatic voiding dysfunction, and avoid subsequent urinary complications. A management program should be individualized, dynamic, and monitored with periodic, systematic urologic review to maintain these goals.

Humans↗
PubMed1997

Long-term care in Canada.

Problems associated with long-term care in Canada include the growing number of elderly citizens, inconsistencies in social policy and legislative initiatives among provinces, effective quality assurance, and cost containment. Deinstitutionalization and independent living have shifted the focus to community participation.

Aged↗
PubMed1999

Will DOTS do it? A reappraisal of tuberculosis control in countries with high rates of HIV infection.

In 1993 the WHO declared tuberculosis a global emergency, and subsequently introduced the DOTS strategy, a technical and management package based on earlier work of the IUATLD and international experience with directly observed therapy. Despite successful implementation of most of the elements of this strategy in several African countries and settings, tuberculosis case rates continue to escalate where the prevalence of HIV infection is high. We explore possible reasons for the failure to control tuberculosis even in the context of tuberculosis programmes that have been considered models for others to emulate. In many African countries half or more of tuberculosis patients are now HIV-infected; in such settings, the overall epidemiology of tuberculosis is disproportionately affected by what happens in the HIV-infected subpopulation of the community. Persons with HIV infection are at increased risk of rapid progression following primary infection or re-infection, and also from reactivation of latent infection with Mycobacterium tuberculosis. More intensive strategies need to be targeted to the HIV-infected to interrupt on-going transmission (active and passive case detection; prevention of nosocomial transmission) and reactivation (preventive therapy). The high burden of other HIV-related disease in patients with tuberculosis, such as other bacterial infections, toxoplasmosis and other manifestations of AIDS, require that tuberculosis programmes integrate their activities better with those of HIV/AIDS programmes, including those for provision of HIV/AIDS care. Enhanced epidemiological surveillance is required to follow tuberculosis trends in the HIV-positive and negative sub-populations of communities, which may respond differently to control efforts. Strategies for tuberculosis control programmes in countries of high and low HIV prevalence cannot be the same, but must take into account the epidemiology of HIV infection. HIV/AIDS in Africa poses severe challenges of purpose and identity to tuberculosis control programmes, which have not adapted to the altered realities of the HIV/AIDS era. DOTS alone is unlikely to control tuberculosis in sub-Saharan Africa; one major achievement of DOTS when implemented, however, has been its apparent ability to limit the development and spread of drug resistance.

AIDS-Related Opportunistic Infections↗
PubMed1999

Can patient registers give an improved measure of internal migration in England and Wales?

This article describes a new source of internal migration data for England and Wales. These data are extracted from the 98 Family Health Service Authority (FHSA) patient registers that hold the details of people in England and Wales who are registered with the National Health Service. Migration estimates are derived from changes in postcodes on the patients' records. The findings presented in the article show that the registers provide high quality estimates of migration into and out of the constituent areas of the FHSAs (as compared to other sources). Where limitations are identified, compensatory adjustments can be introduced to further enhance the quality of the estimates.

England↗
PubMed2000

[Prevalence of cardiovascular diseases in organized groups of employees and results of long-term multifactorial prevention].

AIM: Evaluation of cardiovascular diseases (CVD) prevalence and their dynamics after active prevention program. MATERIALS AND METHODS: 1382 male and 155 female volunteers were included into the group of active prevention in their office. 1024 males and 776 females with natural history were compared as a control group. 5-year follow-up was performed in 543 males and 569 females in comparison with 97 males and 119 females. 10-year follow-up covered 82 males and 191 females from the active prevention group and 178 males and 118 females from the referent group. RESULTS: The risk factor correction has resulted in a significant decrease in both systolic and diastolic BP mean levels, prevalence of ECG abnormalities, smoking habits, overweight and combination of the risk factors, general mortality rate, CHD and stroke mortality, number of days of temporary disability. CONCLUSION: The primary and secondary "in office" prevention for 5 to 10 years diminishes the prevalence of the risk factors. The temporary and primary disability rates were connected with the presence of CVD. CVD, in line with other risk factors, significantly increased cardiovascular and general mortality rates.

Adult↗
PubMed2000

Managing pain: the fifth vital sign.

Organizational endorsement for a dynamic, comprehensive pain management program began in the early 1990s, and included assessment, education, interventions, and reassessment. Based on study findings and pain management recommendations from national guidelines and authoritative resources, retooling and updating of the pain management program was shaped to include a multidisciplinary team approach, principles of Total Quality Improvement, and outcomes management. Guided by the Center for Advanced Nursing Practice's Evidence-Based Practice Model and the leadership of clinical nurse specialists, organization-wide pain management initiatives have contributed to improved pain management practices. The end-point goal of a comprehensive pain management program that demonstrates positive patient outcomes along the care continuum provides an opportunity for merged health care organizations at two sites. This challenge will be supported by the model and the principles of continuous quality improvement, two processes that are complementary in assuring best practice.

Evidence-Based Medicine↗
PubMedDate not supplied

Leading in a chaotic health care environment.

How can physician executives be effective leaders during a time of such upheaval in health care? How does anyone lead in a confusing environment where planning seems impossible? Is effective leadership even possible when no one seems to understand what is going on? These important questions are addressed in this article. Health care is a confusing field. But it still needs effective leadership. Even though nobody really knows what is going on, physician leaders can play a beneficial role by encouraging everyone they work with to experiment and innovate with ways to make health care work better for patients. Physician executives can insist on accountability and on implementing what really works in their given context, rather than what the latest theory states should work.

Guidelines as Topic↗