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Chapter 9 is on healthcare reforms. First, it examines different government health insurance programs: the new rural cooperative medical system, health insurance for urban workers, health insurance for urban residents, health insurance for government employees, and health insurance for urban and rural residents. Next, it analyzes the healthcare supply system, particularly the state-owned hospitals (SOHs). Then, it scrutinizes the problems with the healthcare system, including under-developed healthcare insurance, heavy government subsidies to SOHs, excessive government intervention in healthcare service provisions, the shortage of qualified doctors, urban-rural healthcare disparity, and unsustainability of the healthcare insurance system. Finally, it offers policy suggestions on healthcare reforms.
Under oath at the Dardanelles Commission, convened in 1917 to investigate the Gallipoli campaign, Surgeon General Sir Neville Howse, Director of Medical Services (DMS) for the Australian Imperial Force (AIF), stated that ‘as far as the Australian troops were concerned’ medical arrangements for the Gallipoli campaign ‘were so inadequate that they amounted to criminal negligence’.1 He squarely laid the blame for this ‘negligence’ on the shoulders of the British General Staff and informed the commissioners that he intended to share his concerns with Australia’s leaders. A palpably frustrated Howse stated: ‘I personally will recommend my Government when this war is over, that under no conceivable conditions ought they ever to trust to the medical arrangements that may be made by Imperial authorities for the care of their sick and wounded.’2 His scathing critique not only called into question the British General Staff’s ability to plan and execute a comprehensive strategy but also revealed his doubt regarding the benefits of Australian deference to Britain in medical–military matters.
A European Union (EU) Summit in Göteborg, Sweden, was held 15–16 June 2001. This meeting presented various security and medical concerns to city officials. In preparation for a large meeting such as the EU Summit, a plan should be established that includes basic facts, management organization, and guidelines. Clear communication beteween city agencies also must be established. Hospital inventories should be recorded daily and reported to medical staff. A command center must be in place for police and medical command. An emergency medical provider should ride in each police vehicle, so in case of a riot situation, victims can be treated quickly. An information officer should be assigned with the task of providing information regarding the injured to the media.
The goal of this literature review is to identify key issues in the patterns of medical care utilization of services for seniors as a contribution to the National Consensus process on designing and delivering health care reforms which foster seniors' independence (Shapiro & Havens, 2000). A search strategy used to identify the relevant literature since 1985 focussing mainly on peer-reviewed journal articles is described and the results of the search strategy are summarized. Key articles are identified, analysed and synthesized based on Canadian and American evidence covering patterns of institutional care, physician use, ambulatory care and the determinants of utilization of these services.
A comprehensive state wide emergency medical services and helicopter transport system has been developed in the State of Maryland on the principle that early definitive care improves patient out comes. The purpose of this study was to determine if empirical data exist to support the theory that air medical transportation services provided by the Maryland State Police (Maryland State Police) Aviation Division contribute to an improved trauma patient survival rate in Maryland.
A retrospective study was conducted on the records of all patients transported by helicopter or ground ambulance and admitted to the R Adams Cowley Shock Trauma Center (R Adams Cowley Shock Trauma Center of the University of Maryland Medical System) of the University of Maryland Medical System. Data were obtained from the Maryland Institute of Emergency Medical Services Systems (Maryland Institute for Emergency Medical Services Systems) Shock Trauma Clinical Registry for the period January 1988 through July 1995, covering 23,002 patients. Patients included those transported directly from the scene of injury to the Maryland Institute for Emergency Medical Services Systems as well as those from interfacility transfers. All patients were stratified by injury severity and compared by outcome (mortality) using Mantel-Haenszel statistics.
During the study period, 11,379 patients were transported by ground and 11,623 were transported by Maryland State Police helicopter. The mean Injury Severity Score (Maryland State Police) for patients transported by ground was 12.7 (standard deviation = 12.52) and the mean Injury Severity Score for patients transported by air was 14.6 (Injury Severity Score = 13.42), p <0.001. Among patients classified as having a high index of injury severity, the mortality rate was lower among those transported by Maryland State Police helicopter than among those transported by ambulance. The mortality rate was significantly lower for air transported patient with an Injury Severity Score higher than 31.
The State of Maryland has demonstrated a commitment to its citizenry and invested heavily in its public safety air medical service. This study suggests the rapid air transport of victims of traumatic events by specialized personnel in Maryland has a positive effect on the outcome of severely injured patients. Further research is necessary to clarify the causal relationships in order to more fully elucidate the value of this resource.
In the preservation of mental health, supportive social networks such as family, neighbours, and friends enjoy increasing importance. There are considerable quantitative differences in the structures of social networks of the population in general and those of persons suffering from mental disorders. Among the various benefits of membership in a social group, the social support and emotional ties it affords is of special importance for coping with stressful life events and the preservation of mental health. The few studies conducted far among elderly people have focused on the effects of the loss of close relatives. Especially in countries and areas with inadequate professional health services, lay referral systems play an important role in the counselling, care, and nursing of the sick. The influence social networks have on the decision to consult medical services suffices to illustrate their importance as normative reference groups.
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