摘要:

Abstract:This paper presents an economic analysis of three obstetric early discharge schemes operating in western Sydney. The primary objective was to examine the net economic value of health service resources released due to each early discharge scheme. Conventional postnatal obstetric care comprised an inpatient stay of four to five days. Early discharge provided an alternative location. Clients who chose to participate in the scheme were discharged two to three days earlier than usual and visited at home by a midwife for up to seven days. Other studies of early discharge schemes have shown that resulting maternal and infant morbidity were no higher than with conventional care. This study took the form of a cost analysis. The early discharge schemes at Blacktown and Westmead Hospitals used more resources than they released, whereas the scheme at Auburn Hospital released resources in excess of those it used. Sensitivity analysis showed that the results for Westmead and Auburn Hospitals were sensitive to changes in key assumptions used in the analysis. The number of domiciliary visits per client was an important determinant of the ability of schemes to release resources in excess of their costs. The existence of early discharge provides an extra choice to clients in the location of postnatal care. The question for decision makers is whether this choice is worth the extra cost of early discharge schemes.

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00203.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:The New South Wales health system aims to provide the most effective and efficient health care in a context of scarce resources and increasing availability of expensive technologies. The aging of the population and the management of chronic disease place further demands on the health system. Examination of the pattern of provision of services over time and between groups can serve to illustrate trends in clinical management practices which may affect other elements of the health system. In this paper we report an evaluation of the patterns of coronary artery bypass graft surgery (CABG) in New South Wales, within subgroups of the population and over time. The results demonstrate increased utilisation of this procedure in the population over recent years, particularly among the older age groups. We found differences in procedure rates between geographic areas which suggest that there are differences in the management of ischaemic heart disease between population subgroups. These patterns are examined in the context of the available literature on the health outcomes of CABG relative to other management options for ischaemic heart disease.

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00204.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:We aimed to compare the cost‐effectiveness of two screening strategies and a population strategy for lowering blood cholesterol to prevent coronary heart disease. Census data, known risk‐factor profiles, known coronary heart disease event rates and costs in 1988‐89 Australian dollars for all men aged 35 to 64 in the Lower Hunter region of New South Wales (n= 67 651) were used to compare a high‐risk strategy identifying and treating men with cholesterol levels above 6.5 mmol/L with diet and drug (cholestyramine), a moderate/high‐risk strategy where in addition diet counselling was offered to those with levels 5.5 to 6.5 mmol/L, and a population strategy where the diet of the whole population was changed regardless of blood cholesterol. Costs of implementing strategies, heart disease events saved, discounted and undiscounted cost‐effectiveness ratios and savings in initial treatment costs over five years were measured. For the high‐risk, moderate/high‐risk and population strategies, the costs of implementation were $50.1m, $53.1m and $5.4m respectively; the numbers of events saved were 104, 144, 116 respectively; cost‐effectiveness ratios were $482 224, $369 098, $46 667 (per event saved) respectively. Cost savings for each strategy were approximately half a million dollars. The moderate/high‐risk strategy was more cost‐effective than the high‐risk strategy but the population strategy cost one‐tenth that of the two screening strategies per event saved. More research is required to design and test strategies that alter the eating habit

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00205.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:This paper draws on data from the Health Care for Children Project to consider issues of access to health care for children in low‐income families in three geographic areas. Group and individual interviews were held with mothers in an innercity area and two outlying suburbs. Financial, geographic, sociocultural and other barriers to use of health services are discussed. Major obstacles to access to health care for their children identified by the mothers included cost of medication, hours of opening, transport and language. The paper highlights the impact of even quite small charges for health services on low‐income famil

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00206.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:Injecting drug users in prisons may reuse and share contaminated injecting equipment, increasing their risk of infection with blood‐borne viruses. We examined 58 syringes found in three metropolitan Adelaide prisons during a one‐year period: 95 per cent were one millilitre volume; blood was visible in 24 per cent; 58 per cent indicated repeated use; 33 per cent were wrapped in plastic; and 26 per cent had detachable needles, allowing more blood to be trapped in the dead space between the syringe barrel and needle than with the fixed‐needle variety. The nature and condition of some of these syringes suggested they might transmit contaminated blood. The ineffectiveness of present approaches to keeping injecting equipment out of prisons demands a more enlightened approach to harm minimisation. With doubts cast on the efficacy of bleach, education should be supported by practical means to reduce transmission of viruses. Provision of sterile injecting equipment is a possible o

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00207.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00208.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00209.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Biostatistics: experimental design and statistical inferenceJ. F. ZolmanRationing America's medical careM.A. Strosberg, J.M. Weiner, R. Baker, I.A. FeinHealth in rural North America: the geography of health care services and deliveryW.M. Gesler, T.C. RickettsA history of public healthGeorge Rosen

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00210.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY