Health care systems

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Professor and Deputy Chief of Psychiatry, Yale University School of Medicine, New Haven, Connecticut VA Connecticut Health Care System, West Haven, Connecticut... 

Over time, of course, such awareness has continued to grow, although so too has the realization that it should not be cost that drives macro or micro decision-making, but cost-effectiveness. That is, the health-care system needs to achieve a good balance between the resources it uses (the costs) and the outcomes it achieves (the effectiveness). More recent developments, such as the establishment of the National Institute for Clinical Excellence, make abundantly clear both the enduring relevance of economic considerations when deciding how to use health service resources and the pervasive need to balance economic with clinical (and related) objectives. 

Reid WH, Mason M (1998). Psychiatric hospital utilization in patients treated with clozapine for up to 4.5 years in a State mental health care system. J Clin Psychiatry 189—94. 

Extrapolation to other countries is not easy. Canada has a very different health-care system to the USA. A small-scale study involving 466 anxiety disorder patients in Quebec established a clear relationship between the severity of the disorder and utilization of health services (McCusker et al, 1997). Patients with obsessive-compulsive disorder were particularly likely to seek treatment. No information on dmg use was presented. 

At a time of rising expenditure and budget constraints, all health-care systems require evidence about the value for money of the care provided. This includes comparisons of the... 

Pharmacologically, a principal point relates to the cost-effectiveness of the newer indications for SSRIs in the less common disorders such as obsessive—compulsive disorder and social phobia. These conditions do place a disproportionate burden on health-care systems, and clinical trials of the newer indications are convincing. However, no cost-effectiveness study has yet been petformed to assess this, and prescribing will continue to be based on individual clinical need. 

Patient noncompliance with prescription regimens is one of the most understated problems in the health care system. The effects of noncompliance have enormous ramifications for patients, caregivers, and health professionals. Compliance with medications is a worldwide problem, and measures that are effective in one country may not have work elsewhere. 

VRE) may colonize hospitalized patients or patients who access the health care system frequently. It is key to know which patients have acquired these organisms because patients generally become colonized prior to developing infection, and colonized patients should be placed in isolation (per infection-control policies) to minimize transmission to other patients. 

Sepsis is a leading cause of morbidity and mortality and has a significant financial impact in our health care system. Treatment for sepsis should begin as soon as sepsis is recognized and key therapeutic priorities are ... 

Nosocomial infection An infection acquired within the health care system. Generally, symptoms of infection must occur after at least 48 hours of care to be considered nosocomial. 

University of North Dakota School of Medicine Physician Assistant Altru Health Care System Grand Forks, North Dakota... 

Seema S. Ahuja South Texas Veterans Health Care System, Audie L. Murphy Division, San Antonio, Veterans Administration Center for Research on AIDS and HIV-1 Infection, San Antonio, TX and Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA... 

Fabio Jimenez South Texas Veterans Health Care System, Audie L. 

Government intervention is not the only source of price variation between countries. Fluctuations in the exchange rate, price discrimination by the producer and indeed each country s health care system all contribute to perpetuate and extend these differences. 

However, the extensive and varied experience undergone in Europe and its trend towards greater participation by the user in the financing of pharmaceuticals does not seem to have made any substantial contribution to cost containment. Practically all European countries use drag co-payment with the imphcit objective of making the user jointly responsible for the cost, but not as an essential source of revenue for the public health care system, nor has it proved to be a political instrument with the ability to contain costs or substantially improve efficiency. 

There is no doubt that the eating patterns and physical activity of the adult have a direct effect on the prevalence of nontransmittable chronic illnesses. In recent decades, the prevalence of cardiovascular disease, obesity, cancer, hypertension, and diabetes, among others, has steadily increased, making these diseases the priority for health care systems in many countries, especially in developed countries. 

Kuttner, R., "The American Health Care System—Health Insurance Coverage," N. 

The prototypical form of error in the health care system that could be reduced by a systems approach is medication error. The kind of error identified in the literature—overdose of chemotherapy, injection of the wrong drug, etc.—sometimes leads to either injury or death, the kinds of harm that are the central concern of after-the-fact medical liability adjudication. Phar-macogenomics introduces not only another conception of harm—genetic risks—but also new ways of developing and prescribing drugs. 

Kohn, L.T., et al., To Err is Human Building a Safer Health Care System, Institute of Medicine, Washington, DC National Academy Press (2000). 

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