Showing papers in "Risk Management and Healthcare Policy in 2008"
TL;DR: Japan’s healthcare system is near collapse because physicians are utterly demoralized, and no resolution can be achieved unless trust exists between physicians, patients, the public, the media, bureaucrats, politicians and jurists.
Abstract: The past few decades have witnessed bleak pictures of unhappy physicians worldwide. Japanese physicians working in hospitals are particularly distressed. Today, Japan's healthcare system is near collapse because physicians are utterly demoralized. Their loss of morale is due to budget constraints, excessive demands, physician shortages, poor distribution, long working hours, hostile media, increasing lawsuits, and violence by patients. Severe cost-saving policies, inadequate distribution of healthcare resources, and the failure to communicate risks has damaged physicians' morale and created conflicts between physicians and society. Physicians should communicate the uncertainty, limitations, and risks of modern medicine to all members of society. No resolution can be achieved unless trust exists between physicians, patients, the public, the media, bureaucrats, politicians and jurists.
30 citations
TL;DR: The Pressure and Release (PAR) model is used, used to predict the onset of natural disasters as the conceptual framework, in making the case that HIV/AIDS can be characterized as a slow onset disaster.
Abstract: Understanding the way perception of risk is shaped and constructed is crucial in understanding why it has been so difficult to mitigate the spread of HIV/AIDS. This paper uses the Pressure and Release (PAR) model, used to predict the onset of natural disasters as the conceptual framework. It substitutes vulnerability and risk perception as the trigger factors in the model, in making the case that HIV/AIDS can be characterized as a slow onset disaster. The implications are that vulnerability must be managed and reduced by addressing root causes, dynamic pressures, and unsafe conditions that contribute to the HIV/AIDS pandemic. HIV/AIDS programs must be culturally appropriate and work toward influencing risk perception, while addressing social norms and values that negatively impact vulnerable populations. By impacting cultural and social expectations, individuals will be able to more readily adopt safer sex behaviors. The development of policies and programs addressing the issues in context, as opposed to individual behaviors alone, allows for effective public health intervention. This may have implications for public health measures implemented for combating the spread of HIV/AIDS.
17 citations
TL;DR: The standard for mortality was increased to 20%, and the new indicators for postoperative monitoring were developed, and it was indicated that the postoperative observation of patients was insufficient.
Abstract: BACKGROUND In 2005, The Danish National Indicator Project (DNIP) reported findings on patients hospitalized with perforated ulcer. The indicator "30-days mortality" showed major discrepancy between the observed mortality of 28% and the chosen standard (10%). RATIONALE An audit committee was appointed to examine quality problems linked to the high mortality. The purpose was to (i) examine patient characteristics, (ii) evaluate the appropriateness of the standard, and (iii) audit all cases of deaths within 30 days after surgery. METHODS Four hundred and twelve consecutive patients were included and used for the analyses of patient characteristics. The evaluation of the standard was based on a literature review, and a structured audit was performed according to the 115 deaths that occurred. RESULTS The mean age was 69.1 years, 42.0% had one co-morbid disease and 17.7% had two co-morbid diseases. 45.9% had an American Association of Anaesthetists score of 3-4. We found no results on mortality in studies similar to ours. The audit process indicated that the postoperative observation of patients was insufficient. DISCUSSION As a result of this study, the standard for mortality was increased to 20%, and the new indicators for postoperative monitoring were developed. The DNIP continues to evaluate if these initiatives will improve the results on mortality.
15 citations
TL;DR: It was found that the total economic burden in the study population was much higher for patients with MRM than for Patients with CS, and the direct and indirect costs of treating female outpatients diagnosed with BC at a Mexican public hospital were much higher.
Abstract: Breast cancer (BC) is the second leading cause of death as a result of neoplasia in Mexico. This study aimed to identify the direct and indirect costs of treating female outpatients diagnosed with BC at a Mexican public hospital. A cross-sectional, observational, analytical study was conducted. A total of 506 medical records were analyzed and 102 were included in the cost analysis. The micro-costing process was used to estimate treatment costs. A 17-item questionnaire was used to obtain information on direct and indirect costs. Of the 102 women with BC included in the study, 92.2% (94) were at Stage II, and only 7.8% at Stage I. Total direct costs over six months for the 82 women who had modified radical mastectomy (MRM) surgury were US$733,821.15. Total direct costs for the 15 patients with conservative surgery (CS) were US$138,190.39. We found that the total economic burden in the study population was much higher for patients with MRM than for patients with CS.
10 citations
TL;DR: The number of civil lawsuits in Japan concerning medical accidents has been increasing gradually, and emotional reports in the media about medical accidents have amplified people’s distrust of physicians.
Abstract: The number of civil lawsuits in Japan concerning medical accidents has been increasing gradually Emotional reports in the media about medical accidents have amplifi ed people's distrust of physicians Since 2002, the police have been more actively involved, and the number of criminal prosecutions against physicians as a result of medical accidents has increased Fear of litigation and arrest has demoralized physicians Communication of the risks associated with various medical practices is considered vital if physician-patient relationships are to be improved Moreover, there needs to be a reconsideration of legal interventions into medical affairs
9 citations
TL;DR: There was no trend toward an increase in the rate of tertiary care and decrease in the rates of secondary care from 2003 to 2006, but behavior of patients to seek secondary care was significantly influenced by distance to adjacent general hospitals and seize of these hospitals.
Abstract: In Japan, all citizens are covered by the national insurance system in which universal free access to healthcare services is promised to everybody. Even in tertiary care university hospitals, considerable numbers of secondary care inpatients are supposed to be treated. We studied the mixed state of secondary care and tertiary care in university hospitals in Japan and its year-to-year trend. Based on the results of a national survey, we could statistically classify Japanese case-mix classification into 821 groups that are supposed to need tertiary care (group A) and 296 groups that are supposed to need secondary care (group B). Sixty percent of patients admitted to the university hospitals belonged to group A, and 25% belonged to group B. Despite of the implementation of government policies to differentiate functions of hospitals, there was no trend toward an increase in the rate of tertiary care and decrease in the rate of secondary care from 2003 to 2006. Patient behavior to seek tertiary care was simply influenced by distance from university hospital. However, behavior of patients to seek secondary care was significantly influenced by distance to adjacent general hospitals and seize of these hospitals.
2 citations