In vitro metabolism of cyanohydroxybutene: formation of a glutathione-S-transferase catalyzed product

This paper examines the financing of elderly health care in Japan for medical institutions, nursing homes, and at home. The analysis demonstrates that the conventional figures for elderly health expenditures in Japan systematically underestimate the real costs by excluding the costs of uninsured services, nursing homes, and home health care. The paper estimates these costs and shows that they add about 10% to the conventional figure for elderly health care costs in Japan. This inquiry also shows how government policy for health care financing shaped distinctive Japanese patterns of elderly care provision. The financing system provided a hidden subsidy--through national health insurance coverage of long-term hospitalization--that encouraged high institutionalization rates of elderly in medical facilities. Public financing for long-term elderly hospitalization, however, has not been matched by government attention to quality of care, resulting in serious quality problems and reflecting a social trade-off between cost and quality. Also, until recently the financing system rarely reimbursed home health care, thereby creating strong disincentives to the development of formal home health care services. This analysis has important implications for reforms now being considered by the Japanese government in the financing and provision of health care for the elderly, especially the limitations of relying on reimbursement price policy. The reforms could have unintended negative consequences for equity, efficiency, and quality of care.     

Gene-expression screens in vertebrate embryos: more than meets the eye

The health control of the travellers and medical assistance for them and their families is one of the oldest and most fundamental missions of the "Office des migrations internationales" (OMI) as defined by the reglementary treaties of November 1945 and June 1946. More recent reglementations have broadened the competence of the OMI to include certain categories of foreigners who had been exempt from all controls. Finally, the ministerial order of November the 7th 1994 specifies means of the health screening. Medical examinations are carried in various French and foreign institutions. It nowadays has become a consultation aiming at prevention and orientation. The medical examination has three principal objectives: the detection of little known abnormalities; the contact between the medical service of the OMI and regional services in charge of the first check-up; the health education of the examined persons. The clinical and paraclinical results are communicated to the patient who is also informed of the most serious health questions, as well as ways of gaining access to medical care in France; this is done by taking into account all medical parameters and health conditions prevailing in the patient's native country. All detected abnormalities are brought to the attention of the head physician of the OMI who in turn informs the medical inspector of the "Direction départementale des affires sanitaires et sociales" (DDASS) in charge of making sure that the migrant benefits from health and social assistance and receives medical treatment. All pathological results are given to the examined persons in form of a written and confidential report, enabling them to visit a doctor of their choice. A network has thus been built up throughout the various departments involved in the first medical examination and the DDASS has made available for the OMI medical staff listings of public institutions likely to welcome the migrants.     

Lipid disorders in NIDDM: implications for treatment

BACKGROUND: In France health insurance coverage is universal (see note at the end of the text), nevertheless some people remain uninsured. In this high-risk population, the lack of insurance coverage contributes to the aggravation of health, by reducing access to medical care. In 1992, the Baudelaire consultation was incorporated into the outpatient clinic of Saint-Antoine hospital (Paris, France), to provide the uninsured with the same access as any other patient--but free of charge--to medical care. Social care was also provided in particular by assisting the uninsured in applying for insurance coverage. Our objectives were to quantify the delay in obtaining insurance coverage and to study whether the sociodemographic characteristics of these patients were associated with inequalities in terms of delays. METHODS: All patients attending the consultation for the first time in 1994 were included (n = 623). Because of differences linked to the French social security system, analysis was performed into two groups according to the existence of a prior insurance coverage. Delay in obtaining or recovering insurance coverage was considered as the key variable. The socio-demographic factors linked to the rates of access to insurance coverage were determined using Cox proportional hazards regression models. We also examined the factors linked with the existence of a prior insurance coverage by logistic regression modeling. RESULTS: Within one year 96% of the patients who had had insurance coverage in the past, and 63% of the patients who had not, were insured. No factor, whether nationality, educational level, socio-professional category, family situation, type of housing, made of income was found to be linked with obtaining or recovering insurance coverage. However, nearly all these factors were related with the existence of prior insurance coverage. CONCLUSIONS: Our approach of systematically providing social care allows 70% of uninsured patients to obtain insurance coverage within one year. This approach probably contributes to an improvement by facilitating access to mainstream health care. Moreover, no difference in delay in obtaining insurance coverage was found associated with sociodemographic characteristics.     

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.     

Medico-socioeconomic impact of anxiety disorders

Budgetary control policies implemented in order to cope with the increase in health costs in industrialized countries and with the desequilibrium of the national health insurance accounts, give rise to the problem of preserving the quality of care and quality of life of the patients. Only health economic studies evaluating the possible different therapeutic strategies, will enable us to reconcile the 2 terms of the equation whose contradiction might be only apparent. This is particularly true for the treatment of psychiatric diseases, and especially anxiety. Budgetary control cannot be reduced to a simple management of penury, since the cheapest treatments are not necessarily the most profitable. In this context, new strategies are proposed: it is suggested that thorough diagnosis (avoiding both the non acknowledgement of the illness and the overconsumption of anxiolytic drugs) and early optimal treatment, of adequate duration, of the anxiety disorders might be the most economic attitude in the management of this pathology. On the other hand, the impact of the treatment of anxiety on the quality of life of the patient has a direct effect on costs if one considers the supplement to medical consumption and the social deficit induced by therapeutic failure in particular anxiety disorders. It remains that the evaluation of the health economics of anxiety is difficult, because of the complexity of the parameters involved. Though rather well developed in the UK and in North America, this evaluation still has to be introduced in France.     

The medical service of compulsory health insurance--quo vadis? The law, responsibility and interests of those involved

In contrast to all predictions and expectations the Medical Advisor of Health Insurance (MDK) still has to cope with an enormous quantity of medical examinations and reports. As long as the capacities of the MDK are completely absorbed by this task it cannot fulfill its legal commission as a medical consultant of the health insurance in an economical and highly qualified way. The present economical crisis of the health insurance can also be regarded as a challenge to overcome this situation.     

Access to health care for destitute persons at Public Assistance Hospitals in Paris

All legal French residents are entitled to health care. The 1992 regulatory measures, which create a contractual agreement between the government and public medical institutions, aim at facilitating access to health care by resolving the financial obstacles to accessing health care. The Assistance Publique-H?pitaux de Paris (AP-HP) has set up a medical reception center in several hospitals since 1993. This system is integrated in the general structure of each hospital: in some cases, there is a single and centralized unit; in other cases, all departments of the hospital, including the emergency room, are involved in caring for destitute patients. Whatever the type of the structure may be, social workers are a key element to helping the patients recover their social rights. Thirty to seventy-percent of patients visiting these centers regain access to social and health care coverage. The epidemiological survey of the active file of patients revealed that 70% are male, more than 50% are non-French nationals, half of which do not have legal immigration status in France. Homeless people represent 40 to 80% of the population. The average age is around 35. The number of medical visits varies greatly from one hospital to another and range from 20 to 60 per month. The reasons for visiting the center and the identified medical disorders are strongly related to the patients' life conditions and vary significantly with the risk factors related to the social and economic situation. The frequency of some diseases (psychiatric disorders, tuberculosis, infections by the HIV and HCV) is higher in this population than in general population. Delayed visits to the medical center represents a severity factor. The hospitals' mission statement is not only to ensure that patients facing a precarious social and professional situation have equal access to health care, but also to help such patients recover their social rights, facilitate their integration in the society and fight against social exclusion.     

天铁医疗保险基金支付管理系统的设计与应用

天铁集团为加强社保的信息化管理,设计开发了天铁医疗保险基金支付管理系统.对该系统的主要功能、算法和约定进行了详细叙述.该系统的可靠性和实用性强,提高了工作效率和准确率,实现了医疗保险基金的高效监管和有效合理使用.     

Mental health services in the public and private sectors

Analysis of data on mental health service providers indicates that in 1971 the private sector accounted for 34% of inpatient days, 86% of outpatient visits, 44% of expenditures by source of funds, and 51% of expenditures by receipt of funds. The author believes that mental health professionals must familiarize themselves with the economic interests influencing national health insurance proposals and with public policy making processes if they are to help preserve appropriate roles for the public and private sectors in mental health service delivery.     

Adolescent pregnancy prevention in managed care

Efforts by the US government, employers, and insurance industry to address women's health issues have neglected the problem of adolescent pregnancy. 30 million of the 37.4 million US adolescents have health insurance coverage and 20-40% of them are enrolled in managed care plans, either through private insurance or Medicaid. Each year, managed care insurance plans pay for 150,000-300,000 adolescent pregnancies, half of which end in a live birth. There are many gaps in current approaches to adolescent health care that can be filled by physicians and managed care organizations. Prevention of adolescent pregnancy would have immediate, cost-effective results. Managed care insurance, with its organizational structure, has the potential to address the traditional obstacles to adolescent reproductive health of lack of confidentiality and difficulties with access. An adolescent health care coordinator could be hired to track teen care within the insurance plan, educate staff, and arrange and enforce protocols. It would be instructive to see whether such case management could achieve reductions in repeat adolescent pregnancies by targeting follow-up activities to this risk group. Finally, managed care organizations should analyze teen pregnancy prevention programs in their own setting and select the most effective interventions on the basis of cost and medical outcome rather than political expediency.     

The health and welfare system for elderly in France

Dichotomy is the main characteristic of the Health and Welfare system in France. This system lies on two distinct fields, the medical field which is managed by the National Government, and the social field managed by the Local Government. The French home care policy for the elderly has developed a large number of services to assist in activities of daily living, to provide nursing and medical care at home, to improve living conditions, to maintain social relationships, and to postpone institutionalization and hospitalization, respectively. The main home care service is represented by "home helpers" who provide maid Notiniralics services. The second widely used service is the "home care service" performed by a team of nurses, assistant-nurses, psychologists, physiotherapists. This team provides nursing care and assistance in activities of daily living. As for institutions for the elderly, they are divided into welfare and medical institutions. The welfare institutions include social establishments like shelter homes and nursing homes. The medical institutions are mostly represented by long-term care hospitals. One of the main goals of the aging policy is to create medical wards in welfare institutions in response to the increased dependency of the institutionalized elderly. Recent experimental and innovative concepts have been established, such as "shelter homes for dependent elderly" for physically or cognitively impaired elderly.     

Access to health care. Part 2: Working-age adults

OBJECTIVES: This report presents data on access to health care for U.S. working-age adults, 18-64 years old. Access indicators are examined by selected sociodemographic characteristics including sex, age, race and/or ethnicity, place of residence, employment status, income, health status, and health insurance status. METHODS: Data are from the 1993 Access to Care and 1993 Health Insurance Surveys of the National Health Interview Survey (NHIS), a continuing household survey of the civilian noninstitutionalized population of the United States. The sample contained 61,287 persons in 24,071 households. RESULTS: In 1993, approximately 3 out of 4 working-age adults had a regular source of medical care. Nine out of 10 adults with health insurance had a regular source of care compared with 6 out of 10 adults without health insurance. For adults with a regular source of care, 86 percent received care in a private doctor's office, 9 percent in a clinic, and 2 percent in a hospital emergency room. The two main reasons given for not having a regular source of care were "do not need a doctor" (49 percent), and "no insurance can't afford it" (22 percent). Persons in the highest income group were more likely to report no need for a doctor (59 percent) than persons in the lowest income group (35 percent). About 40 percent of uninsured persons and 16 percent of insured persons reported an unmet medical need. CONCLUSIONS: Health insurance plays a key role in the access to medical care services. Persons who are uninsured or have low incomes are at the greatest risk of having unmet medical needs.     

Relationship between medical expenditures and government-sponsored medical check-ups for the aged

Japanese law provides for regular medical examinations for the aged. A simulation study to determine the relationship between medical expenditures of cardiovascular disease patients and government-sponsored health check-ups for the aged was conducted in a small community town in Kanagawa Prefecture. The results showed that medical expenditures decreased in accordance with an increase in health screening. However, medical expenditure for out-patients increased slightly with an increase in screening for those cardiovascular disease patients who had not received treatment prior to the government health checkup.     

Redistributive aspects of psychotherapy's inclusions in national health insurance: A summary.

Investigates redistributive aspects of national health insurance (NHI). Specifically, the charge that the inclusion of noncritical psychotherapy services in NHI represents a potential subsidy from the poor to the rich is explored. If universal insurance plans reduce the costs to those currently using these services with no substantial increase in demand by low-income persons, then inclusion of "luxury good" psychotherapy may be regressive in effect, thus reducing the program's overall redistributive intent. Recent public finance and health policy literature is reviewed with this question in mind. Experiences of existing government insurance and health programs (Medicare, Medicaid) suggest that there may be some truth to this charge. A simple impact model is included. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A health insurance scheme for hospital care in Bwamanda District, Zaire: lessons and questions after 10 years of functioning

A voluntary insurance scheme for hospital care was launched in 1986 in the Bwamanda District in northwest Zaire. The paper briefly reviews the rationale, design and implementation of the scheme and discusses its results and performance over time. The scheme succeeded in generating stable revenue for the hospital in a context where government intervention was virtually absent and external subsidies were most uncertain. Hospital data indicate that hospital services were used by a significantly higher proportion of insured patients than uninsured people. The features of the environment in which the insurance scheme thrived are discussed and the conditions that facilitated its development reviewed. These conditions comprise organizational-managerial, economic-financial, social and political factors. The Bwamanda case study illustrates the feasibility of health insurance-at least for hospital-based inpatient care-at rural district level in sub-Saharan Africa, but also exemplifies the managerial and social complexity of such financing mechanisms.     

Effects of distal cement voids on cement stress in total hip arthroplasty

Studies done by Médecins du Monde indicate that sanitary exclusion is a growing phenomenon in France, children included. Paediatricians must be concerned by this phenomenon, which is related to the social precarity of many families who do not use the standard health care structure. They must understand the reasoning behind the choices of these families, and be involved in the care of their children in places that they accept to visit. Paediatricians should also be present in institutions, conferences and debates where public health policy is discussed in order to defend the place of paediatrics in the sanitary organisation.     

Should ethambutol be recommended for routine treatment of tuberculosis in children? A review of the literature

The austerity legislation passed September 13, 1996 as well as the additional austerity measures pending for the field of rehabilitation in the framework of legislation aimed at refocusing self-government and self-responsibility in the statutory health insurance scheme (1. und 2. Gesetz zur Neuordnung der Selbstverwaltung und Eigenverantwortung in der gesetzlichen Krankenversicherung-1st and 2nd GKV-NOG) are going to jeopardize insurees' provision with medical rehabilitation generally. For 1997 alone, economies totalling some 3.2 billion DM have been legislated. By drastically increasing the additional payments to be made, the insured are to an intolerable extent being subjected to contributing towards the cost of their medical treatment. What is more, the 2nd GKV-NOG is to enable health insurance funds to totally exclude rehabilitation benefits from the standard catalog of benefits to be provided. Along with these spending limitations in the social insurance schemes, additional burdens have been imposed on the insured in gainful employment under regulations in the field of labour law effective as of October 1, 1996 applicable in case of participation in an in-patient rehabilitation measure. Thus, the employer is entitled to make deductions with regard to an employee's claim to continued remuneration during sick leave as well as part of his annual paid recreational leave for the duration of the inpatient rehabilitation measure. The population most adversely affected by this policy are those with chronic illness and disability.     

Hospices: Perspectives on the public policy debate.

The public policy debate on hospice care centers on the appropriate mix of medical and supportive services for terminal cancer patients and how such services should be paid for within existing insurance programs. Past decisions to change health care reimbursement that are applicable to the hospice debate are reviewed, the benefits and costs of hospice care are examined, and the role of research in the formulation of social policy is discussed. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Voluntary health insurance in Bwamanda, Democratic Republic of Congo. An exploration of its meanings to the community

An insurance scheme covering hospital care in the rural district of Bwamanda in the North-west of the Democratic Republic of Congo, which locally is called the mutuelle, was conceived and developed in 1986 on the initiative of Belgian doctors working in the district under the arrangements for bilateral Belgian aid. After more than 10 years of operation the Bwamanda scheme has achieved a high rate of coverage, contributed to a significant improvement in access to hospital-based in-patient care, and constitutes a stable source of revenue for the operation of the hospital. We present an investigation conducted through focus groups in 1996 of the population's social perceptions of this risk-sharing scheme to identify ways to improve it. The findings pertain to the reasons for people to subscribe to the scheme; to the perception of its redistribution effects; to people's frustrations and questions; and finally to the relationships between the insurance scheme and traditional mutual aid arrangements. The difference between a hospital insurance scheme (a logic of contract) and the traditional systems of mutual aid (a logic of alliance) is highlighted, and the impact of the hospital insurance scheme on social inequalities is discussed. The implications of this study on the management of the Bwamanda health insurance scheme are reviewed, and this study may be useful to health managers working in similar contexts.