Health care rationing: the public's debate

OBJECTIVE: To elicit the views of a large nationally representative sample of adults on priorities for health services. DESIGN: An interview survey based on a random sample of people aged 16 and over in Great Britain taken by the Office of Population Censuses and Surveys. SUBJECTS: The response rate to the survey was 75%, and the total number of adults interviewed was 2005. MAIN OUTCOME MEASURES: A priority ranking exercise of health services supplemented with attitude questions about priorities, who should set priorities, and budget allocation. RESULTS: The results of the main priority ranking exercise of 12 health services showed that the highest priority (rank 1) was accorded to "treatments for children with life threatening illness," the next highest priority (rank 2) was accorded to "special care and pain relief for people who are dying." The lowest priorities (11 and 12) were given to "treatment for infertility" and "treatment for people aged 75 and over with life threatening illness." Most respondents thought that surveys like this one should be used in the planning of health services. CONCLUSIONS: The public prioritise treatments specifically for younger rather than older people. There is some public support for people with self inflicted conditions (for example, through tobacco smoking) receiving lower priority for care, which raises ethical issues.     

Investor-owned or not-for-profit health care. A conundrum for communities

Imaging of the kidneys following acute closed renal trauma may be undertaken using one of several available modalities. Ultrasound evaluation is often the first choice of imaging modality, as it is quick, non-invasive and often readily available for urgent assessment. We report three cases in which significant under-evaluation of major renal parenchymal injury occurred using B-mode ultrasound; the injury was detected only by subsequent computerized tomography (CT) imaging.     

When life is ending, there is the right to death with dignity

BACKGROUND: This report summarizes an institutional review board-approved 6-month study with the NovaPulse carbon dioxide (CO2) laser utilizing the NovaScan handpiece in facial skin resurfacing applications. OBJECTIVE: This study comprised the initial clinical evaluation (pre-FDA approval) of this device. METHODS: A total of 54 patients underwent 56 laser procedures: 36 full face and 20 regional procedures. RESULTS: Following healing, there was a 91% satisfaction rate. The mean laser-on times were: full face, 27 min; perioral, 7 min; periorbital, 3 min; glabellar, 2.5 min; scar, 5 min; and epidermal lesions, 6 min. CONCLUSIONS: The NovaScan CO2 laser handpiece is a safe tool for skin resurfacing. In its initial use over a 6-month period there were no device-related complications.     

The family life cycle seminars: An innovative health care psychology program.

Views psychologists as having the skills but lacking the confidence, poise, and authoritative stance to design, implement, and evaluate innovative programs in various medical settings. The latter characteristics are needed if psychologists are to interface with their medical colleagues and, operating from a good data base, build credibility when proposing a new program. A literature review provided the data base for family life cycle seminars, a program that meets both academic and nonacademic needs in a university family practice department. It is concluded that health care psychologists should design innovative programs that will ultimately best serve the public. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health incongruence in later life: Implications for subsequent well-being and health care.

Objective: The premise that pessimistic health appraisals compromise well-being whereas optimistic appraisals are compensatory was examined in a longitudinal study of 232 community-dwelling older adults (ages 79-98 years). Design: Subjective health (SH) appraisals were contrasted with objective health (OH) to identify realists, whose ratings were congruent (SH = OH), distinguishing them from health pessimists (SH OH), whose ratings were incongruent. Analyses of covariance were used to examine group differences 2 years later on well-being and health care. Main Outcome Measures: Outcome measures were psychological well-being (life satisfaction, positive and negative emotions), functional well-being (objective and perceived physical activity, activity restriction), and health care (health care management, hospital admissions, length of hospital stays). Results: Compared with realists, pessimists had significantly poorer outcomes and optimists had better outcomes. Because perceived control (PC) was weaker among pessimists and stronger among optimists, supplemental analysis determined whether PC differences explained these findings. When accounting for PC, many pessimism and optimism effects became nonsignificant, yet effects on functional well-being remained unchanged. Conclusion: Findings have implications for older adults at risk of functional decline. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of asthma or allergies on the utilization of health care resources and quality of life of college students

The objectives of this study were to describe the treatment regimens of college students with asthma or allergies, to determine how asthma or allergies affect the lives of college students, and to evaluate the health care resources utilized by college students with asthma or allergies. A mail survey was sent to 275 students who received treatment for asthma or allergies at the Thomson Student Health Center at The University of South Carolina (TSHC-USC) during the fall 1991 semester. This survey, consisting of 46 questions, covered three key areas: current asthma or allergy management, class and work days missed, and utilization of health care resources. Students with "asthma and allergy" missed on average 2.4 days of class during the fall semester, whereas those with "asthma only" and "allergy only" missed on average 0.8 day and 1.5 days of class, respectively. Students with "allergy only" appeared to have a greater interference in their daily class and academic activities than students with "asthma and allergy" and "asthma only." In conclusion, students reported interference in their college activities and reported missing days of work and school because of asthma or allergies. This study also showed that a majority of these college students have not received asthma or allergy patient education nor utilized appropriate asthma or allergy management skills.     

Managed care: rationing without justice, but not unjustly

Three ethical criticisms of managed care are often voiced: (1) by "skimming the cream" of the patient population, managed care organizations fail to discharge their obligations to improve access, or at least, to not worsen it; (2) managed care organizations engage in rationing, thereby depriving patients of care to which they are entitled; and (3) by pressuring physicians to ration care, managed care organizations interfere with physicians' fulfillment of their fiduciary obligations to provide the best care for each patient. This article argues that each of these criticisms is misconceived. The first rests on the false assumption that the health care system includes a workable division of responsibility regarding access that assigns obligations concerning access to managed care organizations. The second and third criticisms wrongly assume that we in the United States have taken the first step toward assuring equitable access to care for all, articulating a standard for what counts as an "adequate level of care" to which all are entitled. These three misguided criticisms obscure the most fundamental ethical flaw of managed care: the fact that it operates in an institutional setting within which no connection can be made between the activity of rationing and the basic requirements of justice.