How health networks and HMOs could result in public utility regulation

Health networks and HMOs--as strategies to reform the American health system--are considered by many elected officials and providers to be the most effective way to improve the delivery of medical care at a reduced cost. Strongly swaying these proposals are the fiscal pressures that now require us to harness such entitlements as Medicare and Medicaid. As these health networks and capitated payment approaches are being aggressively forged by hospitals, physicians, and insurers, the probable consequences are that one alliance will eventually dominate most geographic regions (except for our nation's largest metropolitan areas) and these oligopolies will tend to behave as a monopoly. More simply stated, this article argues that many healthcare markets will either evolve into monopolies or, at best, oligopolies.     

The German health care system: a model for hospital reform in the United States?

Experience in Germany illustrates that the United States could potentially achieve universal access, comprehensive and high-quality services, and value for the money expended with what is often referred to as a "quasi-private and quasi-public" health care system. The German hospital system is analyzed from a number of perspectives, and it is concluded that this approach has some advantages over a single-payer, monolithic-type national health insurance model. This is primarily because of its pluralistic prepayment system and because the commencement of reimbursement negotiations are without direct governmental intervention. The adoption of the German design in the United States, it is concluded, would result in a sharp change in policy direction from a conceptually procompetitive, market-driven hospital environment to a highly federally regulated, state-administered one. The implementation of the German approach in this country would also require a shift from managed care plans and other third party payers having to micromanage the use of health care services for individual patients to tightly centralized national and state fiscal controls (e.g., institutional global capital and operating budgets) targeted at providers.     

Phase I study of Datelliptium chloride,hydrochloride given by 24-h continuous intravenous infusion

Summary Datelliptium chloride, hydrochloride (SR 95 156B, NSC 626718X, DHE) was studied in a phase I trial of escalating doses given on a single 24-h continuous intravenous infusion schedule. Doses were escalated from 40 to 500 mg/m² in 19 patients who received a total of 24 courses. Courses were repeated after a minimal interval of 3 weeks. Local venous toxicity occurred at low doses (100 mg/m²) and was circumvented by the use of a central venous access for higher doses. Other clinical adverse events occurred (330 mg/m²), including moderate nausea and vomiting, mild diarrhea, dry mouth, neuropsychiatric manifestations, and fatigue. All of these side effects were reversible and none was dose-limiting. The dose-limiting toxicity was related to hepatic laboratory-test abnormalities in the form of reversible elevations of levels of serum bilirubin and liver enzymes at doses of 330 mg/m². The maximum tolerated dose for this schedule is 500 mg/m². Hematologic toxicity was minimal and non-dose-limiting. Neither drug-related deaths nor objective complete or partial responses were observed. However, a minor response and a long-term disease stabilization were obtained.     

Parathyroid anatomy in hyperplasia.

Pathologically enlarged parathyroid glands offer the surgeon a vital medium for studying parathyroid anatomy. The advantages include gland magnification, rapid-section diagnosis to aid dissections, and postoperative clinical and laboratory responses to check for "missed" or supernumerary glands. In this series, each of 71 patients had at least four hyperplastic glands. Both mediastinal and intrathyroidal glands occurred in nine instances (13%), supernumerary glands in eight (11%), and ectopic neck glands in seven (10%). In total, anomalous parathyroid glands occurred in almost half (46%) of these patients with parathyroid hyperplasia.     

Results of 25 years of kidney transplantation

Between 1975 and 2000, 1008 renal transplantations were performed in 935 recipients at Henri Mondor hospital. The mean objective of this study is to analyse patient and graft survivals at long term. For kidney transplantations performed respectively before and after 1985, ten years patient survival was 74.3% +/- 0.03 and 85.7% +/- 0.01, p = 0.03 and ten years graft survival was 39.5% +/- 0.04 and 71.9% +/- 0.02 after 1985, p = 0.001. Since 1985, an enhancement in graft actuarial survival still improved (one year survival 86.1% +/- 0.01 versus 90.8% +/- 0.02, three years survival 78.5% +/- 0.02 versus 85.5% +/- 0.02, five years survival 71.7% +/- 0.02 versus 78.8% +/- 0.04, for the years 1985-1994 versus 1995-2000, p < or = 0.05). Immunosuppressive drugs may contribute to results enhancement in kidney transplantation while other non immunologic factors are becoming more predominant.     

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