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Friday, August 22, 2003Bureaucracy in the health care system accounts for about a third of total U.S. health care spending – a sum so great that if the United States were to have a national health insurance program, the administrative savings alone would be enough to provide health care coverage for all the uninsured in this country, according to two new studies. ....The first study, which is to be published Thursday in The New England Journal of Medicine, finds that health care bureaucracy cost U.S. residents $294.3 billion in 1999. The $1,059 per capita spent on health care administration was more than three times the $307 per capita in paperwork costs under Canada’s national health insurance system. Cutting U.S. health bureaucracy costs to the Canadian level would have saved $209 billion in 1999, researchers found. One of the authors of that study is co-founder of Physicians for a National Health Program. Not coincidentally, Marcia Angell, former editor of The New England Journal is also a member, which explains why the group can get its papers published in the medical journal of record. The study focuses on changes in U.S. and Canadian spending from 1991 to 1999, but it doesn't acknowledge that during that period, Canada's system was undergoing extreme cut-backs. Those cut-backs may have saved them money, but it cost them in quality, as this critique in the same issue of the Journal points out: ..during the 1990s, the federal government took aggressive action to cut spending. In essence, the federal government downloaded its operating deficit to the provinces and municipalities by reducing its cash transfers for a wide variety of programs, including health care. The proportion of provincial health care expenditures covered by a direct cash transfer from the federal government in Ottawa decreased from 30.6 percent in 1980 to 21.5 percent, on average, in 1996 and to much lower levels in richer provinces. ...The hospital sector took the brunt of the financial pressure as real spending decreased. Between 1986 and 1994, the number of staffed beds in short-term care units in all categories of public hospitals decreased by 30,023, or 27 percent, despite the ongoing growth and aging of the population. As noted above, in most provinces, countless hospital boards (and their hospitals) were consolidated under regional governance. In Ontario, with the absence of regionalization and with virtually no voluntary closures, the government appointed a Health Services Restructuring Commission in 1996 and gave it wide-ranging powers to rationalize hospital services. The commission ordered more than 40 institutions to close or merge during its term. ...Another strain arose from reduced access to physicians, particularly specialists. The sizes of medical school classes throughout Canada were reduced by 11.3 percent over a period of three years in the early 1990s, partly on the basis of the recommendations in a report produced by two health economists, Barer and Stoddart. These authors also recommended reforming the delivery of health care so that other professionals could substitute for physicians, but these recommendations were generally overlooked. Instead, restrictions on immigration were implemented that further reduced the supply of physicians. The public perception in the early 1990s of a surplus of physicians providing unnecessary services was transformed over less than a decade into a widespread public perception of a shortage of physicians, resulting in increased waiting times for appointments. Over-reliance on government and crystal-ball experts doesn't make for a good healthcare system. Canadians apparently agree: As recently as the early 1990s, Canadians who participated in international surveys consistently expressed the highest levels of satisfaction and confidence. However, with system restructuring and funding restrictions, public perceptions shifted sharply. In 1988, 56 percent of Canadians said that their system needed only minor changes, but by 1998 only 20 percent of Canadians had this level of comfort with the status quo. The same survey showed that although 18 percent of people in the United States believed that recent changes in health care had harmed the quality of care, 46 percent of people in Canada held this view. A national survey in 2001 showed that approximately 59 percent of Canadians believed that the health care system required some fundamental changes, and about 18 percent believed that a complete rebuilding of the system was in order. A more recent survey15 of noninstitutionalized adults with chronic health problems showed that more than half the Canadian respondents viewed shortages of health care professionals or hospital beds as the leading problem with the system. A similar proportion reported difficulties with outpatient access to specialists — a figure that had changed little since the 1998 survey. Surveys of Canadian physicians also show increasing dissatisfaction, with two thirds being very concerned that the quality of care would decline in the future and only 24 percent in 2000 feeling that the system worked well and required only minor changes — down from 33 percent in 1991. And Repatriate agrees, too. posted by Sydney on 8/22/2003 08:11:00 AM 0 comments
Tuesday, August 19, 2003A controversial new report questions US government plans to stockpile and administer fresh rounds of smallpox vaccine. Around half of the US population may already have sufficient immunity to save them from death, the report estimates, thanks to jabs given before 1978, when the world was rid of the disease. From a group of more than 300 people vaccinated between 1 and 75 years ago, 90-95% still carry antibodies against vaccinia, the cousin of smallpox used in immunizations, report Mark Slifka, of Oregon Health and Science University in Beaverton, and his colleagues There are a couple of problems. One, everyone under thirty is particularly vulnerable because they've neither been vaccinated nor exposed to the disease before, and thus have zero immunity. Two, the antibodies in immunized people, though detectable, may not be adequate to protect against the disease and its complications: Henderson and others question whether the antibodies that Slifka's team detected would be sufficient to repel a smallpox infection. They point to older studies, carried out when smallpox was still prevalent, suggesting that even vaccinated people began to catch the disease five to ten years after inoculation. Even if people do not die from smallpox, they might still become infected and spread the virus, points out Steve Leach, who studies smallpox epidemiology at the Centre for Applied Microbiology and Research in Porton Down, UK "It's just as important that people don't get the disease at all," he says. posted by Sydney on 8/19/2003 08:52:00 PM 0 comments
Monday, August 18, 2003The increasing rate of litigation means that there is a far higher chance that doctors will be asked in court to explain the exact meaning of NFN (Normal for Norfolk), FLK (Funny looking kid) or GROLIES (Guardian Reader Of Low Intelligence in Ethnic Skirt). Dr Fox recounts the tale of one doctor who had scribbled TTFO - an expletive expression roughly translated as "Told To Go Away" - on a patient's notes. He told BBC News Online: "This guy was asked by the judge what the acronym meant, and luckily for him he had the presence of mind to say: 'To take fluids orally'." Those British, they have such a way with words. (More British medical slang can be found here, including one that can be applied to all fields - "assmosis") An added bonus - one of the rapid responses gives an account of an unbelievably frivolous lawsuit that took two years to throw out of court. And we thought things were bad in the U.S. posted by Sydney on 8/18/2003 11:23:00 PM 0 comments
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