Acid rain: What we know,what we did,what we will do

This paper reviews the involvement of the Canadian province of Ontario in the acid rain issue. Ontario is a major producer of acid gas emissions and suffers significant environmental consequences because of acid rain. The province's substantial contribution to the scientific understanding of acid rain is summarized with emphasis on the extent and origins of the deposition it receives, the impact on the aquatic environment, and the impact on the terrestrial environment.This paper discusses the history of the government's success at reducing acid gas emissions through the 1970's when legislators set out to enhance local or ambient air quality, the first legislation to require SO₂ reductions from companiesalready in compliance with ambient air quality legislation, and the currentCountdown Acid Rain program which reduces SO₂ emission limits by 67%. The process used to establish the tough new limits while reasonably anticipating the development of SO₂ control technologies is detailed along with the specific requirements of the major emitters controlled by the regulations.Projections confirm that while theCountdown reductions will bring about significant reductions in deposition, adequate environmental protection in Canada cannot be achieved without some comparable U.S. acid gas abatement effort.     

Preventive care: do we practice what we preach?

We used insurance claims from enrollees in the Rand Health Insurance Experiment to determine the amount of selected components of preventive care received by a representative sample of the non-aged population in the United States and to determine whether insurance coverage was an important determinant of that amount. Only 45 percent of infants received timely immunization for DPT and polio; 93 per cent received some well child care by 18 months of age. In the three-year experimental period, only 4 per cent of adults had a tetanus shot, 66 per cent of women aged 17-44 and 57 per cent aged 45-65 received a Pap smear, and 2 per cent of women aged 45-65 had a mammogram. Cost sharing was associated with even less preventive care: 60 per cent of children on the free plan and 49 per cent on cost sharing plans received preventive care of any type. For adults, women on the free plan received more preventive care of several kinds, and those aged 45-65 received more Pap smears than those on cost-sharing plans. Even with free care, most enrollees did not receive adequate preventive care. Thus, free care alone, while significant, is not a sufficient incentive to providing recommended levels of preventive care. The average per person insurance charge for increasing the amount of preventive care to a level consistent with that recommended would be $22 for a complete set of immunizations by age 18 months, $9 for a Pap smear every three years, and $97 for a Pap test and mammogram every three years.     

Closing the gap between what we know and what we do

Too often, clinical investigators have identified techniques to improve patient care for certain conditions, but those techniques slowly find their way into practice. At the Institute for Healthcare Improvement, new methods that accelerate the implementation of improved clinical practices are being taught to participants in Breakthrough Series collaboratives. These methods have to do with testing change in small increments, based on "just enough" measurement; analyzing the results to ensure the change is an improvement; and moving on to the next small-scale change test. Several experts and participants talk about breakthroughs they've seen as a result of several incremental improvements. Using breakthrough methods, they've dealt with several clinical problems, resulting in improvements such as reduced emergency room delays and improved scheduling of i.v. therapy.     

De we know what we've been doing? do we know what we are trying to do?

Summary Pursuit of the word “hospital” and of the continuation and maximization of Federal dollars has led to a distortion in our distribution of skilled resources. If these resources can be redeployed in a manner more nearly matching how the needs are distributed, the entire system can be made more productive. This redeployment, once started, might develop a leverage effect over succeeding years. Certainly, we would be trying to do things more in the way various groups of patients seem to want and that alone should increase the effectiveness of the entire system.     

What do we mean when we say palatable food: Conclusion

The word palatability and related words have not been used in a consistent way. Palatability may be a property of a food, of the organism eating the food, or both. Investigators have failed to distinguish different possible meanings of the statement: “palatable foods increase intake”. This may indicate: (1) a simple observation that some foods stimulate more intake than others, (2) an innate response to the taste of foods that alters appetite, (3) a correlate of food intake that does not itself affect intake, and (4) a link in a causal chain involving prior associations between foods and their postingestive consequences.     

US health economists: who we are and what we do

This paper reports the results of a Fall 2005 survey of US health economists, the first in over 18 years. Where appropriate, the results are compared with the earlier findings of Feldman and Morrisey (J. Health Politics Policy Law 1990; 15(3):627-646). The paper describes the demographics and training of health economists. It also describes how employers view the substitutability between a Ph.D. in economics and a Ph.D. in health services research, which is a key question because self-identified health economists increasingly include health services researchers trained in schools of public health or medicine. This study also reports the expectations of various, employers of health economists regarding external grant and contract support. It also reports health economists' perceptions of the processes that allocate resources and recognition: promotion review, journal refereeing, and grant review.     

Quality down under: if we knew then what we know now

Australian health care's approach to performance improvement increasingly includes the use of total quality management (TQM) and its component principles and methods. Implementation experiences have confirmed TQM's relevance in the Australian health care environment, senior management's pivotal role, and the range of factors required for success. Ways of influencing executive behavioral change and streamlining implementation are discussed.