Implications of the baby bust generation upon the health care market

Implications of the Baby Boomers upon the American society are well known. However, the effects of its successor generation, the Baby Busters, have not been as well documented nor reviewed. The next twenty years (1990-2010) will see the fabric of American society unfolded and rewoven as this phenomenon undergoes its place in history. It is not too early to examine the implications of the Baby Bust phenomenon. This study examines the implications and consequences of the Baby Bust for Health Care Marketers.     

Primary health care for the elderly

The health problems of the elderly can be analysed. General practitioners care for about 90 per cent of the aged population. The number of disorders increases with age and social factors are increasingly important. Doctors need to take the initiative, seeking opportunities to look beyond the actual complaint. Clinical and human wisdom are more important than technical skills. The characteristics of a health care system needed by the aged are listed.     

Primary health care in the Pacific

It is widely accepted that a Primary Health Care (PHC) response needs to be separately designed for each individual country, but less emphasis has been given to the need to consider different objectives under different circumtances.During the 1970s and 1980s the island States of the Pacific are facing their era of major movement towards political independence and self-sufficiency, which includes the need to redesign their health systems to fit their priorities and to match their particular geographic, demographic and cultural qualities. The priority problems do not appear to include a fight against poverty or a redistribution of resources in a manner which takes a special account of variations in wealth or socio-economic class. Instead, the next decades may have to mean a quite desperate effort to replace a very high external aid component in their budgets with comparable local resources, and the design of health systems for country units which may be as small as 35,000–50,000 and which are composed of widely dispersed populations living in small groups cut off from each other by sea.Even countries with resources and a reasonable health status cannot remain unchanged and the Pacific is a good model to consider what could be done in health terms in countries which are not poor, but which are unlikely ever to be rich.While the island States of the Pacific may be considered to be at present largely unsuccessful in applying international PHC principles, they already have a high health status ranking. The case is presented for them to take more positive PHC steps in the future. In the immediate future the national economic problems must be dominant, but there are technical health system possibilities which could assist them to minimise the inequities due to population dispersion and possibilities for regional collaborative action which would help to overcome the disadvantages of being a small State.     

Primary health care services through health centres

In South Madras, India, Voluntary Health Services (VHS) operates under the concepts that prevention is an important as cure, the family is the unit for medical care, and community participation. It uses a voluntary health plan as a means to provide preventive and curative health care for residents who pay a fee based on their income. Subscribing to this plan allows them access to preventive and curative services at the nearest VHS regional health center and hospital care at the VHS Medical Centre at Adyar, Madras, in India. Since the inception of this plan, VHS has expanded to rural areas using the Mini Health Centre (MHC) model. This model was developed at the St. Thomas Mount Community Development Block of Chingleput District of Tamil Nadu State in the mid-1960s and put into operation in the late 1960s. A male and female multipurpose worker in the MCH serves 5000 people. A physician is there at least 3 hours/day for 3 days/week. A lay worker staffs a health post and attends to 1000 people. The MHC provides maternal-child health, family planning, and referral services; health and nutrition education; control of communicable disease activities; curative care; and environmental sanitation. Community participation includes provision of buildings and minimal furniture, financial support (e.g., the community provides 33% of the total budget resources), and a nonpolitical local action committee. The state of Tamil Nadu and the central government provide financial incentives to other voluntary group to set up MHCs (as of June 1993, 261 MHCs existed). Vital statistics indicate that MHCs improve the health status of the population (e.g., infant mortality rate in 1977 = 134 and in 1989 = 36.5). Some weaknesses with MHCs are unmotivated medical officers, high turnover rate of staff due to low pay scales, and financial obstacles.     

Primary health care in the United Kingdom

General practice is one of the three bases of care in the British National Health Service (NHS); the other two are hospital and community services. Each is administered separately. There are 30,000 general practitioners (for a population of 57 million), who are independent and can organize their work as they see fit. Few are single-handed (13 percent) and the majority work in groups of three to five physicians. They are paid by capitation fees, and fees for specific services, and also receive reimbursements for staff, premises rental, and local taxes (rates). They work in close association with practice teams that include nurses, midwives, and social workers. There are no universal hospital privileges but many general practitioners hold appointments in local hospitals. Important trends in the NHS include mandatory vocational training of general practitioners for three years; the growing importance of attempts by the Royal College of General Practitioners to shift care from the hospital to the community; increased patient participation; clashes between the government and the medical profession over restricted funding of the NHS; definition and improvement of "quality," and a need for improved data collection; and long waits for hospital services.     

Primary health care for the children of Sarawak

Rosalind Benster and Judith Stanton went to Sarawak to study child health care. Their aim was to highlight areas of most need so that the tiny health budget could be channelled in the relevant directions. They found cultural and environmental differences to account for significant differences in the nutritional status of children from different tribes. They suggest remedies to this situation.     

Primary health care and health education in Japan

In this paper, the substance of the Alma Ata Declaration on Primary Health Care is discussed. Minimum requirements and working goals of Primary Health Care are reviewed. The health status of the Japanese people, and the medical and health delivery systems in Japan are considered, with reference to the Alma Ata Declaration.While the Alma Ata Declaration sets forth the goal of health for all by the year 2000, there is doubt as to whether, even in the developed countries, we will reach this goal. Health indices have improved considerably, but problems of delivery of medical care and health care still remain. Major problems discussed here are the regional disparity in availability of medical manpower and facilities, and the consequent disparity in health indices; sky-rocketing medical costs; the changing needs of Japan's aging population; and socialized medical care, and the lack of integration of insurance schemes. The most significant problem in delivery of Primary Medical Care in Japan is the lack of integration of health and medical services. This is discussed at length. In addition, the importance of health education to community health planning in Primary Health Care is discussed.     

加强母婴保健监督全面实施卫生监督综合执法

卫生监督体制改革工作已在全国范围内全面展开 ,黑龙江省卫生监督所自建所起 ,紧紧围绕全面实施卫生监督综合执法这一卫生监督体制改革的主题 ,对旧有的卫生监督体制革故鼎新 ,将母婴保健监督纳入卫生监督综合执法实践中 ,在难点、重点、关键点上进行了大胆突破 ,取得了一些经验和成绩。作者将就卫生监督综合执法中 ,母婴保健监督工作的一些做法、体会 ,与同行探讨。     

Primary health care is viable.

'Selective primary health care' and other recent vertical health strategies have been justified on the grounds that the broad primary health care (PHC) approach cannot be afforded by developing countries in the present constrained economic circumstances. This judgement is too sweeping. A simulated case example is presented, starting with baseline health expenditure data that are representative of the situation in many developing countries. It is assumed that real economic growth occurs and that government funding of health care is allowed to grow in parallel. Two annual growth rates are considered: 2 and 5 per cent. Two restrictive conditions are applied: none of the main health services is subjected to absolute cuts; and, additional funds from existing or new sources of finance are not considered. It is shown that, even with slow growth rates, substantial increases in the funding of priority (rural and PHC) services can be achieved if the growth in expenditures of lower-priority services is curtailed. Also, savings from improved health service efficiency can be channelled to priority services. The message is that the PHC approach is viable even with slow economic growth. What is required is the technical capacity to identify and plan resource flows in the health sector, and the political will to effect resource allocations according to PHC priorities. A strategic policy like PHC should not be 'adjusted' out of effective existence because of reversible economic problems. Rather, actions should be taken to reverse the adverse economic environment. International health-related agencies should continue to support countries to develop national health systems based on PHC, and should campaign for reforms in the world economy to create at least the minimum economic conditions necessary for PHC implementation.