Headed for a collision?

Pay-for-performance is a powerful tool for containing costs and improving quality, but will it run afoul of efforts to increase access to care?     

Caring for the infirm: a task for the individual or for a social insurance programme?

In West Germany, seventy per cent of all nursing home patients receive only a pocket-money, for social health insurances are responsible only for the care of "sick" people, but not of those needing only "care". The infirm individual, however, rarely can pay for the costs of nursing homes out of his own revenue. Despite general agreement that guarding against the financial risks of becoming dependent on nursing is insufficient there is little consensus on what a new concept should look like. Some proposals are more concerned with avoiding cost-expansion than with effective health care. On the one hand, the implementation of a new branch in the social insurance system, called "nursing insurance", is demanded, which would pay for the stay in nursing homes. On the other hand, it is emphasized that the capacity for voluntary individual provision should be strengthened as well as the families' means to care for their bedridden members. This paper presents the discussion and outlines implications for health care of the various proposals.     

Marek's disease vaccines: a solution for today but a worry for tomorrow?

Marek's disease (MD) is a lymphoproliferative disease of chickens that, in the absence of control measures, is capable of causing devastating losses in commercial poultry flocks. MD has been successfully controlled by vaccination since 1968. However, vaccine efficacy has decreased concomitantly with the increase in virulence of Marek's disease virus (MDV). The constant evolution of MDV has forced the development of new vaccines or vaccine strategies that control the more virulent emergent strains. However, this race between the introduction of new vaccines and the evolution of MDV represents a major threat for the poultry industry. In addition to vaccination, other factors might have contributed to the evolution of MDV (intensive methods of chicken production, early exposure of the chickens to MDV and administration of vaccines at very low doses). From all the possible factors influencing MDV evolution, the effect of vaccination has received the greatest attention. MD vaccines protect with great efficacy against the development of the disease but they do not prevent infection or transmission. Sterilizing immunity could be a solution to stop the evolution of the virus but it has been proven to be extremely difficult, if at all possible, to obtain with MDV or with other herpesviruses. Other solutions to improve vaccine-induced protection are discussed in this paper.     

Estimating a constant WTP for a QALY—a mission impossible?

Economic evaluations are an important input to decision-making and priority-setting in the health care sector. Measuring preferences for health improvements, as the demand-side value (willingness to pay) of gaining a quality-adjusted life year (QALY), is one relevant component in the interpretation of the results from health economic evaluations. Our article addresses whether willingness to pay for a QALY (WTP-Q) is sensitive to the size of the health differences and the probability for improvement. We use data from a contingent valuation survey based on 1400 respondents conducted in the spring of 2014. The results show that the expectation of sensitivity to scope, or higher WTP to the larger expected quality of life improvement, is not supported. We find WTP-Q values that conform reasonably well to previous studies in Sweden.     

Haemochromatosis: a time for guidelines?

Hereditary haemochromatosis is an autosomal recessive metabolic abnormality which causes excessive absorption of dietary iron. Iron accumulation leads to potentially fatal damage to organs such as the heart, liver and pancreas. Normal life expectancy can be restored simply by therapeutic venesection. Discovery of the gene, HFE, has rekindled interest in pathogenesis, management and screening strategies.     

Is cannabis a stepping-stone for cocaine?

This paper uses a unique dataset on the inhabitants of Amsterdam, to study the dynamics of the consumption of cannabis and cocaine. People are most likely to start using that drugs at ages 18-20 and 20-25. An analysis of the starting rates shows some evidence of cannabis being a "stepping-stone" for cocaine. However, the fact that some individuals use both cannabis and cocaine has to do mostly with correlation through (unobserved) personal characteristics and not with cannabis causing the use of cocaine.     

New medicine for the new millennium: a time for change?

Health care is under scrutiny. Demand exceeds supply and funding is insufficient. Rationing is a reality while providers feel persecuted. Yet patients remain patient--and continue to suffer. What can be done to improve the present situation?     

Need a physician? You may qualify for a free doctor search

A pro bono search is available to Southern rural hospitals in areas where the doctor shortage is particularly acute. Find out how to qualify and how to submit your application.     

Does work have a meaning? Basis for a positive work culture

From the anthropological point of view work is the expression and fulfilment of the absolute spirit in the finite sense and is, by its essence, cooperation. This obliges us to reverse the question: "does work have a meaning?", to: "does work have a meaning for workers? Does it allow self-fulfilment?" Work has a meaning if the worker's psychophysical integrity is safeguarded, if by working the individual achieves self-fulfilment as a person, if it has a sense of community. Man as an "actor" achieves self-fulfilment through technical and professional competence, thereby overcoming organizational and social conflicts. Today reducing human and social relations to an economic transaction will lead to the destruction of the meaning of life and work. The study of suicide cases in France Telecom shows that a human being inserted in the working environment wants most of all to obtain recognition. He or she will accept praise or even punishment if this is done with transparency, because the person will acknowledge in such decisions a recognition of his/herself. Many enterprises and consequently many personnel managers do not, in their essence, perceive of any meaning of work, but consider only the instrumental element. The workforce cannot be considered as a commodity, work is embodied in human beings. So either people aim at self-fulfilment or fall into anomie and depression, even to the point of the destructive impulse of elimination. The re-humanization of work and the treatment of enterprises (which are "ill" because they no longer possess any meaning of work) is the challenge that awaits us.