Health insurance and private providers: A study of the civil servants' medical benefit scheme in bangkok,Thailand

Compulsory health insurance schemes have received attention recently as a means of creating a reliable extra-budgetary source of health care funding. Yet, the full implications of such schemes in a developing country context are unclear; in particular, the impact on and relationship with private sector providers has infrequently been explored. This study examines patterns of public and private sector utilization under the Civil Servants' Medical Benefit Scheme (CSMBS) in Bangkok, Thailand. The CSMBS currently provides limited reimbursement for private inpatient care, but recent proposals suggest increasing benefit levels for care sought in the private sector. The study shows that despite high level of cost recovery in the public sector, charges were much lower than those in the private sector. Different patterns of diagnosis in the two sectors were found with private hospitals tending to treat a less complex case mix. Within the private sector, there was a limited tendency to specialize in certain types of care. It is concluded that under the current payment mechanism of fee-for-service reimbursement, measures to enhance access to private sector care should be approached with caution. In the long run, the scheme should merge with the recently established social security scheme.     

Students teaching students: a medical school peer tutorial programme

A peer tutorial programme which is available to all first- and second-year medical students has been in operation at Case Western Reserve University School of Medicine since 1972. A retrospective study of the classes of 1982, 1983 and 1984 was undertaken to assess the participation levels in the tutorial programme and to compare the participation level to available performance parameters. The analysis revealed that 54% of the first-year classes and 22% of the second-year classes participated in the peer tutorial programme. X2 analysis of the data demonstrated that the relationship between participation in the tutorial programme and performance on examinations reached statistical significance. The results suggested that an open peer tutorial programme responded to the needs, both cognitive and affective, of medical students.     

Teaching school health to undergraduate medical students

This paper describes a teaching programme for final- (sixth-) year undergraduate medical students during their 10-week term in child health. Students attend schools on two occasions and are actively involved in the physical, educational and emotional assessment of children. The advantages of the programme include active participation by the students, contact with children in a less threatening environment, learning new skills in the assessment of children, and knowledge of common screening procedures. Student evaluation of the programme has been positive.     

Can past academic criteria predict students at risk of future failure?

A significant minority of medical and dental students fail their undergraduate courses. Early warning systems (EWSs) have been developed in some areas of higher education to predict 'at-risk' students at an early remedial stage. An attempt is made to develop an EWS to predict failure in the bacteriology component of the Batchelor of Dental Surgery course at Manchester Dental School. A system based on class tests and previous end-of-year performance is derived which is used to predict those students likely to fail or fall in the bottom 20-25% in their finals examination. The predictors are combined by a simple equal weights method, which is found to have the same predictive power as using multiple regression. Failure was correctly predicted in 60% of cases, at the expense of 71% false alarms. The high number of false alarms reflects the low failure rate rather than the lack of predictive information. The need for effective cross-validation of EWSs is discussed; many previous studies have not been tested on independent data.     

Computers in the Kindergarten

The computer use of two classrooms of kindergarten aged children in private school in Chicago were compared for variance in terms of the age and sex of the children, for variance by classroom, and for variance in the software selected. The major statistical method used was analysis of variance. There were two dependent variables: total frequency of computer use and the difference between the frequency in the first half and that in the second half (in order to examine the changing pattern of computer use in the two classrooms). There was no significant difference in computer use by sex or age, but there was a significant difference in the frequency of computer by classroom in the second half of the project compared to the first half. There was no significant difference in the software selected.     

An Approach to Emergency Department Photography

In the emergency department, photography requires an expedient, portable, adaptable, and relatively simple camera system to take advantage of fleeting opportunities for recording visually educational material. These prerequisites are different from those for traditional medical photography, for which relatively plentiful time and advanced equipment are routinely available. Medical photography departments provide an invaluable service, but are rarely convenient for immediate or spontaneous emergency. department photographs. Although no single system or technique is optimal in all these areas, the authors find certain components and approaches work well. They review photographic equipment, paying attention to speed, ease of use, and quality of output. They also review simple techniques such as film choice, lighting, close-up photography, standardization, copy work, and radiographs. Attention to these details can help the inexperienced photographer obtain a system and begin to enjoy the rewards of effective photography in the emergency department.     

医疗卫生服务价格改革方向初探

医疗卫生服务价格改革是要理顺价格构成成份之间量的关系，使每个构成成份的价格值都在供求关系的约束中，在政府的有效管制中，从而成为医疗卫生资源合理配置的有效工具。为此：①对生产要素分别定价；②对劳动定价；③对资本和自然资源定价；④确定医疗卫生机构内部管理时劳动价格；⑤价格中的所有构成成份价格都置于供给和需求关系约束下；⑥确定医疗卫生服务价格的理想传递方式。     

Internet tools in the medical classroom

Summary: The Internet contains a vast amount of medically relevant information. In order to access this information, however, many networks require one to master applications written in UNIX, an operating system considered by many not to be user friendly. Although these tools may be available on the campus, it is difficult to teach their use unless there is some immediate benefit to the already busy user. From that standpoint, it is important for instructors to realize that common UNIX applications can be utilized as classroom tools to significantly enhance the learning experience by facilitating teacher/student communication. Also, whilst the student enjoys greater communication with the instructor (and with other students) he/she is also becoming adept at using information management tools.     

Effects of cadaver dissection on the attitudes of medical students

Summary: Summary. A study was conducted to determine whether the attitudes of medical students to death and caring changed during the 3 months following exposure to cadaver dissection. All first-year students were invited to complete a questionnaire immediately before their initial cadaver dissection experience, after 6 weeks, and after a further 3 months. The questionnaire reflected attitudes to death, violent death, death of someone known to the respondent and caring when someone known to the respondent is seriously injured. Ethnicity and previous exposure to dying has no effect on responses, but overall men students' reactions were significantly less than for women ( P < 0.001). The responses given on the final part of the questionnaire after 3 months were significantly lower than those to most questions in the first part of the questionnaire. The exceptions were those questions where the subject in the given scenario was known to the respondent, where reactions were rated significantly greater ( P < 0.001) in the follow-up questionnaire and can be explained on the basis that they were a personal referent.
Students rapidly develop a coping mechanism which enables them to view cadaver dissection as an occupation quite divorced from living human beings. During these early months of training solicitude decreases for those who die who are unknown to them, but concern for personal referents increases. Educators should be aware of the dramatic change of attitudes among students and the process of professionalization which might influence their caring of future patients.