Health Insurance Portability and Accountability Act: blessing or curse?

The health care industry has undergone dramatic changes over the past decade. Advances in technologies are being implemented, making the health care industry more complex. In response to increasing administrative costs, the inability to control the collection and distribution of an individual's health information, and the rising costs of health care, the Health Insurance Portability and Accountability Act (HIPAA) was passed as part of the Social Security Act in 1996 to address the emerging complexities of the industry. Over the past years, the health care system has focused efforts on compliance with HIPAA regulations. HIPAA compliance can improve efficiency, reduce costs, and protect the privacy of personal medical information; however, some health care providers and other health care entities have experienced various setbacks in efforts to comply with HIPAA. Health care providers may be reluctant to comply with HIPAA regulations because the rules are complex and result in short-term increases in administrative costs. Nevertheless, long-term HIPAA compliance could allow the health care system to improve its effectiveness and efficiency in health care delivery.     

Free formula milk for infants of HIV-infected women: blessing or curse?

There is vigorous controversy around whether HIV-infected women in developing countries should choose formula or breastfeeding for their infants. Formula eliminates HIV transmission but incurs risk of increased mortality, whereas breastfeeding has multiple benefits but entails risk of HIV transmission. International guidelines are available but need to be strengthened. This commentary summarizes data on the scale and rate of mother-to-child transmission (MTCT) of HIV through breastfeeding, and the hazards and benefits of breast- and formula-feeding. The case against providing free or subsidized formula to HIV-infected mothers is based on the following: it exacerbates disadvantages of formula feeding; compromises free choice; targets beneficiaries erroneously; creates a false perception of endorsement by health workers; compromises breastfeeding; results in disclosure of HIV status; ignores hidden costs of preparation of formula; increases mixed breastfeeding, which is an unsatisfactory method for all women; requires organization and management of programmes that are complicated and costly; and finally increases the 'spill-over' effect into the normal breastfeeding population. Recommendations to minimize these drawbacks include use of affordable antiretrovirals to reduce MTCT; investments in high-quality, widely available HIV counselling; support for choice of feeding; and exclusive breastfeeding for those who choose to breastfeed.     

Are vaccination sites in Bangladesh scale efficient?

OBJECTIVES: The overall aim of this study is to discern whether and to what degree vaccination sites exhibit constant returns to scale. METHODS: Data Envelopment Analysis is used to compare all the facilities in the sample in terms of input costs used to produce multiple outputs. The application considers the Expanded Program on Immunization (EPI), which operated in Dhaka City, Bangladesh, during 1999. RESULTS: A preponderance of EPI sites were determined to be operating at increasing returns to scale. CONCLUSIONS: Our findings question the applicability of cost-effectiveness analyses that assume constant returns to scale.     

Priority care for employees: a blessing in disguise?

This paper discusses the efficiency and equity effects of priority care for employees. Recent privatization of workers' compensation insurance in the Netherlands caused an increasing tension between public responsibility for health care cost-containment and private responsibility for sick pay. As a result of strict supply side regulation, waiting lists increased, while at the same time employers became fully responsible for sick pay. To reduce sick pay and production losses, employers are prepared to pay for priority care by using available excess capacity. We argue that the criteria of Pareto and Rawls can provide a rationale for the resulting differential treatment of employees and non-employees. However, such a justification crucially depends on weights society assigns to absolute versus relative improvements in access to health care.     

Self-care as a response to diarrhoea in rural Bangladesh: empowered choice or enforced adoption?

The literature is growing on the subject of coping strategies. However, with the exception of some work on the promotion of oral rehydration therapy (ORT), very few studies have examined coping strategies as a response to the ongoing diarrhoeal disease burden. This is particularly relevant in the case of self-care, previously documented as the most readily implemented treatment in the developing world and an increasingly common health behaviour in rural Bangladesh. This study analysed the socioeconomic factors that influence the adoption of self-care and the role that varied asset availability plays in relation to households choosing, or being forced to implement, a coping strategy. Qualitative methods were used to collect data from three villages in Nilphamari District, North West Bangladesh, in 2004. The findings produced a detailed picture of asset availability and its influence on household use of self-care treatment practices. The strong role of aspects of social capital in building human capital was highlighted, as well as how these aspects of social capital can assist household welfare through self-care in times of diarrhoeal disease. In contrast, households exhibiting weakened social and human capital were more excluded from information on appropriate self-care treatments. Development agencies and health care policies might therefore strengthen levels of household resilience to diarrhoeal disease more cost-effectively by focusing on activities that facilitate self-care through support of social networks and education channels.     

Is social support sometimes a mixed blessing?

BACKGROUND: Child behavioural problems in epilepsy originate from a poorly understood interplay between intrinsic, family and social factors. METHODS: We re-analysed data from a randomized controlled trial of antiepileptic treatment in rural India, using regression analysis to find risk factors for behavioural problems. RESULTS: Parental satisfaction with social support was positively and independently correlated with child behavioural problems (P=0.03). CONCLUSION: Our findings suggest parents' interactions within their informal social support network, contrary to expectation, may increase risk for behavioural problems in their children. We suggest a possible explanation for this correlation as well as follow-up studies to investigate the social support-as-risk factor hypothesis.     

Are they microcytes or macrocytes? Can we do a better job?

As an attempt to improve accuracy in the grading of microcytes and macrocytes, a custom reticle was developed and evaluated. The evaluation looked at grading accuracy, reproducibility, speed, and opinion. In this study, the reticle improved the grading accuracy and reproducibility of graders who were "poorer performers." The reticle offered no advantage to the speed of the evaluation. The opinion survey indicated improved confidence with the reticle, and most of the participants found the device useful. The improvement to "poorer performers" is sufficient to warrant use in actual practice.     

Are schizophrenia or antipsychotic drugs a risk factor for cataracts?

Lens changes and ocular disturbances have been reported in conjunction with the use of antipsychotic drugs. We estimated the incidence rate of a clinical diagnosis of cataract in patients with a psychotic disorder, schizophrenia, and compared it with the rate in the general population. Among the schizophrenic patients, we also examined the role of dose and duration of antipsychotic drugs on the risk of cataract development. We followed up two cohorts of patients 30-85 years of age who were included in the United Kingdom General Practice Research Database. Patients in one group had a diagnosis of schizophrenia (N = 4,209). The other group was an age- and sex-matched cohort of 10,000 patients sampled from the source population. The incidence of cataracts was 4.5 per 1,000 person-years among the general population and 3.5 in the schizophrenia population. Overall, antipsychotic drug use was not associated with the occurrence of cataracts. Nevertheless, among long-term users of chlorpromazine at daily doses of 300 mg or greater, and among users of prochlorperazine, the relative risks were 8.8 (95% confidence interval = 3.1-25.1) and 4.0 (95% confidence interval = 0.8-20.7), respectively. There is no indication that schizophrenia per se is associated with an increased risk of developing cataracts.