ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00263.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.tb00264.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:Between September 1988 and February 1989, Anyinginyi Congress, an Aboriginal community‐controlled health organisation, facilitated a collaborative community action against striptease shows in public bars in Tennant Creek. This action resulted in changes to the guidelines of the Northern Territory Liquor Act to regulate striptease shows in public bars and began other processes of addressing alcohol related problems in the community. The composition and strategies of both the pro‐ and anti‐striptease lobbies are analysed within the context of changing power relationships between Aboriginal and non‐Aboriginal people, as epitomised in the growth and consolidation of Aboriginal community‐controlled organisations in Tennant Creek. The role of the media in shaping the course and direction of the debates as well as the response of the Northern Territory government as the final arbiter in the striptease conflict are scrutinised. The use of sex to sell alcohol is a legitimate public health concern and community action for healthier public policy is an important strategy in creating supporting environments f

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00265.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:This study identified illnesses Australians most feared getting, and determined whether there had been any changes between 1986 and 1993. An open‐ended question about illnesses was embedded in an omnibus face‐to‐face survey of representative samples of Australians (1986,n= 1213; 1993,n= 1268). Cancer was by far the most feared illness, with over 60 per cent of first mentions and around 80 per cent of first or second mentions. Acquired immunodeficiency syndrome (AIDS) and heart disease were the only other illnesses mentioned by more than 10 per cent of the sample as the first or second most feared illness. There were no differences across time in first mentions of these illnesses, but cancer had more mentions overall in 1993. Concern about cancer may have increased over the seven years. Mentions of dementia and blindness also increased across the two su

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00266.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:A purchaser/provider separation and managed competition have been recommended as options for reform of Australia's health system. This paper presents the theoretical basis and supposed advantages of each model. The introduction of the purchaser/provider separation in the United Kingdom and New Zealand is described, as are the proposals for implementation of managed competition in the United States and the Netherlands. The potential for either model to deliver its promised benefits is critically evaluated in the light of existing evidence. As yet neither model can command unqualified support but both are worthy of further consideration.

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00267.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:The purpose of this study was to estimate the inpatient costs of road crashes in Western Australia, and to investigate factors relating to casualties and their injuries that affect the hospital costs resulting from road crashes. All road crash casualties who were injured severely enough to be hospitalised in Western Australia in 1988 were included. A casemix classification system was used to classify patients into diagnostic related groups. Hospital costs were assigned to individual patients on the basis of their diagnostic related group and length of hospital stay. The annual cost of hospital treatment for road crash casualties was estimated as $13.9 million, and 33 per cent of this was incurred by those with lower extremity injuries and 27 per cent by those with head injuries. Hospital costs per casualty ranged from an average of $1388 for those sustaining minor (Abbreviated Injury Scale severity score of 1 or 2) spinal injuries to $16 580 and $33 424, respectively, for those sustaining severe (Abbreviated Injury Scale severity score of 4 or 5) head and spinal injuries. A multivariate analysis of variance revealed the following factors as having a significant independent effect on the hospital inpatient costs of road crash casualties: type of hospital (teaching or nonteaching), body region of injury, injury severity level and road user group. There were also significant interaction effects between different factors. Since hospital inpatient costs vary considerably across factors, using average cost data in the specific economic evaluation of road safety interventions for groups of road users is inappropriate.

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00268.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:A substantial investment in resources is required to provide a population‐based mammography screening program. At the same time, screening may also reduce the costs of treating breast cancer. Empirical evidence to support such cost savings, however, is limited. This paper presents a simulation of the impact on treatment costs of a population‐based mammography screening program in New South Wales. A 1991 cohort of women aged 45 to 69 years is followed for the period 1991 to 2023. With two‐yearly screening, the present value of the total health service costs for this cohort would be approximately $112 million. Primary treatment, at $60 million, would cost $5 million more with screening than without. Treatment for advanced stages of the disease would cost $22 million less. Overall, this analysis suggests that savings in treatment costs are relatively small in relation to the overall resource requirements of organised scre

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00269.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:Cost‐effectiveness and cost‐utility analyses of immunisation strategies against invasiveHaemophilus influenzaetype b (Hib) disease in Australia were based on a hypothetical birth cohort of 250 000 non‐Aboriginal Australian children. The model predicted that, without immunisation, 625 cases of invasive Hib disease would occur in under‐five‐year‐olds, with direct costs of $10.2 million. Universal public sector vaccination beginning before six months of age (6MVAC) prevented 80 per cent of cases; vaccination at 12 months (12MVAC) 62 per cent and at 18 months (18MVAC) 46 per cent At a vaccine cost of $15 per dose, 18MVAC gave the lowest cost per quality‐adjusted life year (QALY) over a wide range of model assumptions, with 6MVAC the ‘best’ alternative. The best estimate ($ per QALY) for 6MVAC was $6930 (three doses), for 12MVAC $9136 (two doses) and for 18MVAC $1231 (one dose). The cost per QALY of single dose catch‐up immunisation of older children was estimated at $8630 at two years, $27 000 at three years and $117 000 at four years if done at a scheduled visit; these values were increased if an additional medical visit was included. The threshold cost per vaccine dose at which an immunisation program became cost‐saving was estimated for 6MVAC, 12MVAC and 18MVAC as $11, $10 and $14. Even under a worst‐case scenario, an immunisation program at 6, 12 or 18 months became cost‐saving if indirect costs of death were included. Comparison with previous analyses revealed the importance of the incidence and age distribution of disability and assumptions about vaccine administration costs in d

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00270.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:To describe patterns of diagnostic testing during the antenatal period and to assess the potential benefit of using Medicare claims data in monitoring testing practice, we examined the matched claims data (with identifying details removed) on approximately 10 000 women having a confinement for which a Medicare benefit was claimed between 1 July and 30 September 1990. The results showed that almost all the women included in the study sample had an ultrasound and blood group and antibody examination. A smaller proportion had serological tests for syphilis (77 per cent), rubella (51 per cent) and hepatitis B carriage (73 per cent). Two‐thirds had urine microscopy and culture, and under half (40 per cent) had serum $aL‐fetoprotein estimation. Few (18 per cent) had a claim processed for microscopy and culture of a genital swab and fewer than 8 per cent claimed for any other pathology tests. There were differences in the proportions having tests, depending on whether the clinician managing the confinement was a specialist obstetrician or a general practitioner, and depending on geographic area and age group. While the data do not represent all women having a confinement in New South Wales, the selective use of antenatal diagnostic tests found in this study is of considerable public health importance and analysis of claims data can provide useful information for health profession

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00271.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:The aim of this study was to determine whether Pap smear screening at adequate intervals is associated with area of residence, frequency of consultations with a general practitioner, socioeconomic status and non‐English‐speaking background. A representative 10 per cent sample of women from New South Wales and the Australian Capital Territory, aged 25 to 69 years and registered with the Health Insurance Commission (Medicare) (N= 155 281) was used to obtain age, postcode, frequency of Pap smears and frequency of consultations with general practitioners in the three‐year period from February 1985 to January 1988. Census data for each postcode area were used as an indicator of other sociodemographic characteristics. Age‐specific screening rates did not vary between Sydney, Newcastle/Wollongong, Canberra, and nonmetropolitan areas. In all age groups, having had a smear was most strongly associated with the frequency with which a woman consulted a general practitioner. Women who visited a general practitioner at least four times a year on average were about twice as likely to have had a recent Pap smear as those who averaged less than one visit per year. Screening rates were lowest among women living in areas with the most non‐English‐speakers and the lowest socioeconomic status. Sociodemographic factors and health service usage patterns influence the proportion of women who are currently being screened. Evaluation of interventions to improve Pap smear screening rates should consider whether the percentage of women screened increases overall, and also whether the imbalances in screening rates between different groups are

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00272.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY