Local Government Hospital Research Articles

病院図書室機能標準化マニュアルからみた自治体病院図書室の実態

病院図書室機能標準化マニュアルからみた自治体病院図書室の実態

Rights of mentally retarded persons in New Zealand and the United States: A comparison

With a different form of government, New Zealand’s approach to legal rights for mentally retarded persons remains different from that of the United States. In New Zealand, the political arenas are smaller and primarily involve the parliament, some national agencies, and the local government hospital boards. With a federal system of government, the United States is influenced by more political factors. New Zealand’s more limited political arena accounts for the very prominent role of the New Zealand Society for the Intellectually Handicapped which is partially funded by the national government. However, the legislative approach in New Zealand remains long and arduous. Legislative changes currently being sought include adult guardianship, education rights, separate commitment legislation from the Mental Health Act, and employment rights. The judicial arena has proved a quicker route for establishing rights in the U.S.

The Organisation and Funding of Research into Public Health

aspects and types of research administration, has caused M v. 3 me to think seriously about the organisation and fund.c ing of research into public health. By "research into *A public health" I mean something much broader than simply "epidemiology" or "health services research." In the past public health was largely concerned with, for example, sewage disposal and the supply of clean water. Over the years, however, it has become a much broader field and it now embraces not only environmental services, such as control of air and water pollution, but also the planning of clinical services, screening and early disease detection, and research and action with regard to the effect of education and housing on health and illness. Thus it is concerned both with prevention of illness and with the organisation of optimal health services. This includes integrating the effects of housing and social amenities on health, and the organisation of social services, educational services, and other services to promote health. The term "public health" has generally gone into disuse in the United Kingdom because of the association with the old image of the medical officer of health, whose major concern was "drains." The Royal Commission on Medical Education (1) began to use the term "community medicine" by which was meant "the specialty practised by epidemiologists and administrators of medical services." These were to include medical officers of local authorities, central health or other government departments, hospital boards and industries, and the staff of corresponding academic departments. Community medicine is not concerned with the treatment of individuals, but with broader questions of promotion of health and prevention of disease, the assessment of community health needs, and the provision of services to communities in general and special groups within them.

The effects of unemployment and inflation on hospital-based ambulatory care.

Data about hospital ambulatory care utilization, unemployment, medical manpower, and population characteristics in the 147 major labor areas* of the United States were obtained from three sources: the tapes of the American Hospital Association's (AHA) Annual Survey from 1969 through 1975, the United States Department of Labor,' and the American Medical Association.2 The AHA tapes were cleaned by linear interpolation of missing data, and by editing for inconsistencies in the classification of total outpatient visits into emergency, clinic, and referred categories. The 147 major labor areas contained 2,440 community hospitals that reported emergency and/or clinic visits in one or more years from 1969 through 1974. Fifty-five per cent of the population of the United States, 85 per cent of all physicians in hospital-based practice, and 71 per cent of the physicians in officebased practice are located in these labor areas. Although hospitals in the major labor areas are, in general, representative of the 5,800 community hospitals nationwide, they are, on the whole, somewhat larger: while they comprise 42 per cent of the nation's community hospitals, they account for 62 per cent of the beds, 63 per cent of the emergency visits, and 79 per cent of the clinic visits. There are proportionately fewer state and local government hospitals

The Urban Fiscal Crisis in the United States, National Health Insurance, and Municipal Hospitals

The fiscal stress which many U.S. cities are currently experiencing, the persistent problems of large-city local government hospitals, the recent decisions for selected public hospital closings in New York City and Philadelphia, and the prospective enactment of a program of national health insurance collectively raise questions about the viability of the nation's major municipal hospitals. While the majority of the nation's 40 largest cities are in a state of economic and demographic decline, the diversity which characterizes their fiscal conditions and their responses to fiscal stress suggests caution in generalizing from the highly publicized New York City experience in asserting the ability of cities to continue to maintain public hospital activities. Indeed, there is considerable evidence to indicate that the staying power of municipal hospitals is quite substantial even in circumstances of severe fiscal stress. Further, analysis of the effect of Medicaid implementation on municipal hospital utilization and of the impact of prospective national health insurance programs on the demand for and supply of medical services suggests that municipal hospitals will continue to be important providers of health care services for many years to come.

Appendicitis in Saudi Arabia

To the Editor:— Until 1962, the only major surgical facilities available to the people of the eastern province of Saudi Arabia were those of an Arabian-American oil company. The first oil company hospital with modern and complete surgical facilities (Dhahran Health Center) was opened in 1950. Since 1962 a growing number of local government and private hospitals have been able to care for surgical patients who are not oil company employees or dependents. The surgical experience is a valid sample of the diseases affecting the people of the eastern province of Saudi Arabia. All surgery was performed by a slowly changing group of about 20 American, Arab, and Indian surgeons, with from five to eight general surgeons on the staff in any single year. All operation reports since January 1952 are on file, in English. In the early third of this series, if the operative findings did not clearly indicate