The illegality of private health care in Canada

WE ADDRESSED THE QUESTION OF WHETHER PRIVATE HEALTH CARE IS ILLEGAL in Canada by surveying the health insurance legislation of all 10 provinces. Our survey revealed multiple layers of regulation that seem to have as their primary objective preventing the public sector from subsidizing the private sector, as opposed to rendering privately funded practice illegal. Private insurance for medically necessary hospital and physician services is illegal in only 6 of the 10 provinces. Nonetheless, a significant private sector has not developed in any of the 4 provinces that do permit private insurance coverage. The absence of a significant private sector is probably best explained by the prohibitions on the subsidy of private practice by public plans, measures that prevent physicians from topping up their public sector incomes with private fees.     

The role of physicians in prevention and health promotion

Physicians play an essential role in promoting healthier lifestyles and preventing disease in Canada. This statement outlines the CMA's policy on the role of physicians in prevention and health promotion and provides recommendations for strengthening this role in the future.     

市场经济时代开展健康教育的实践与体会

目的 总结开展健康教育工作经验，探索在市场经济时代开展健康教育工作的有效做法。方法对近三年景德镇市在市场经济时代开展健康教育的实践进行总结。结果 景德镇市健康教育馆在与外界的合作中取得了良好的社会和经济效益。结论 健康教育工作人员要充分把握和认识健康教育的自身优势，将健康教育服务市场做好、做大。     

Trends in private and public health insurance for adolescents

Context  Previous studies (1984-1995) of adolescent health insurance have shown little change in the proportion with coverage. Federally mandated expansions in Medicaid were offset by declines in private coverage. Further expansions of Medicaid and implementation of the State Children's Health Insurance Program (SCHIP) have opened new avenues for increasing coverage rates. Objectives  To assess the current health insurance status of adolescents, the demographic and socioeconomic correlates of insurance coverage, and document recent changes in public and private coverage rates. Design, Setting, and Participants  We analyzed data on 12 995 adolescents aged 10 to 18 years, who had been included in the 2002 National Health Interview Survey. We conducted multivariate analyses to assess the independent association of age, sex, race, poverty status, family structure, family size, and region on the likelihood of having insurance coverage. Results are compared with previously published findings on adolescent health insurance coverage spanning 1984 to 1995. Main Outcome Measure  Insurance coverage for adolescents. Results  An estimated 12.2% of adolescents were uninsured in 2002, which is a decrease from 14.1% in 1995 (P<.003). The decrease occurred entirely because of an expansion of public coverage and is concentrated among children in poor (<100% of the federal poverty level) and near-poor (100%-199% of the federal poverty level) families. A substantial decrease in the differences between poor and higher-income groups occurred between 1995 and 2002 due to gains in coverage for adolescents in poor and near-poor families and losses in coverage among those in middle- and upper-income families (=" BORDER="0">200% of the federal poverty level). Specifically, the proportion of adolescents in poor families without coverage declined from 27.4% in 1995 to 19.7% in 2002 (P<.001). The proportion of adolescents in near-poor families without coverage declined from 24.8% in 1995 to 19.2% in 2002 (P<.002). In contrast, the proportion of adolescents in middle- and higher-income families without insurance increased from 4.1% in 1995 to 6.3% in 2002 because availability of insurance through the private market declined (P<.001). Conclusions  A modest but significant reduction in the percentage of adolescents without insurance has occurred since 1995, largely as a result of expansions in public coverage. An even larger reduction in the proportion of adolescents without coverage would have occurred, if not for a reduction in private coverage for adolescents in middle- and higher-income families.      

How physicians can change the future of health care

Michael E. Porter, PhD, MBA; Elizabeth Olmsted Teisberg, PhD, MEngr, MS

JAMA. 2007;297:1103-1111.

Today's preoccupation with cost shifting and cost reduction undermines physicians and patients. Instead, health care reform must focus on improving health and health care value for patients. We propose a strategy for reform that is market based but physician led. Physician leadership is essential. Improving the value of health care is something only medical teams can do. The right kind of competition—competition to improve results—will drive dramatic improvement. With such positive-sum competition, patients will receive better care, physicians will be rewarded for excellence, and costs will be contained. Physicians can lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care. Three principles should guide this change: (1) the goal is value for patients, (2) medical practice should be organized around medical conditions and care cycles, and (3) results—risk-adjusted outcomes and costs—must be measured. Following these principles, professional satisfaction will increase and current pressures on physicians will decrease. If physicians fail to lead these changes, they will inevitably face ever-increasing administrative control of medicine. Improving health and health care value for patients is the only real solution. Value-based competition on results provides a path for reform that recognizes the role of health professionals at the heart of the system.

     

US physicians in international health. Report of a current survey

Little is known about the magnitude and specifics of current involvement of US physicians in international health. This report presents results of a survey of 1,257 organizations with interests in international health work and discusses career opportunities and needed training for US physicians in international health.     

三亚市私立学校学生健康体检结果分析

目的了解三亚市私立学校学生常见病患病情况,为防治工作提供科学依据。方法对三亚市9间私立学校学生健康体检资料共5485人份进行统计分析。结果视力低下率为：32．53％,女生明显高于男生,中学生明显高于小学生;龋齿患病率为50．32％,小学生明显高于中学生,小学男生明显高于女生,中学女生明显高于男生;沙眼患病率为0．46％,中学男生最低为0．17％;营养不良患病率为31．78％,中学生明显高于小学生,女生明显高于男生;超重率为6．62％,肥胖率为5．98％,小学生超重率和肥胖率明显高于中学生,超重率男女生无明显差别,肥胖率小学男生高于女生。结论三亚市私立学校学生视力低下、龋齿患病情况较严重,应加强防治工作。营养不良和超重、肥胖率处于较高水平,应加强学生营养教育,平衡膳食,预防学生肥胖。     

乌鲁木齐市民营医院卫生资源与服务现况调查

目的了解乌鲁木齐市民营医院的基本情况和业务状况,分析其卫生资源利用效率,为医院管理者与投资者提供参考依据。方法采用普查的方法,对乌鲁木齐市民营医院的数量与分类、规模与投资、床位设置情况、人力资源及业务状况,进行调查。结果截止2010年底,乌鲁木齐市共有民营医院66家,占全疆民营医院的20.63%,卫生人员3 071人,拥有床位2 743张,病床使用率53.7%,投资总额近469 764万元,房屋建筑物面积102 646m2,总诊疗人次数90.42万人次,收治住院病人3.77万人次。结论乌鲁木齐市民营医院规模较小,人力资源不足,资金还不雄厚,可满足部分群众的卫生需求。在现有政策环境下,卫生行政部门要充分认识到民营医院的作用和目前的困境,创造一个公平有序的环境,积极引导其健康发展。     

私立学校中学生心理健康及社会问题

目的 :分析私立学校初中三年级学生心理健康 ,评估贵族子女在社会、家庭、群体中的适应性。 方法 :3 76名中学生男 2 0 0例女176例来自私立学校初中三年级学生。 结果 :症状自评量表 (SCL -90 )私立学校学生的抑郁、恐怖、强迫、焦虑 (P <0 .0 5 )明显高于常模 (P <0 .0 1)差异有显著性。 结论 :SCL -90量表适用于私立学校毕业生的评估