National Medical Services Research Articles

Foreign Practices: Immigrant Doctors and the History of Canadian Medicare by Sasha Mullally and Wright David (review)

Reviewed by: Foreign Practices: Immigrant Doctors and the History of Canadian Medicare by Sasha Mullally and Wright David Heather MacDougall Mullally, Sasha and David Wright–Foreign Practices: Immigrant Doctors and the History of Canadian Medicare. Montréal and Kingston: McGill-Queen’s University Press, 2020. 366 p. Foreign Practices by medical historians Sasha Mullally and David Wright is an ambitious effort to decentre the historiographical focus on politics in making the icon of Canadian health care policy: Medicare. Mullally and Wright focus on the crucial role immigrant doctors played in providing medical services during the early phases of government action in health care, starting with the Hospital Insurance and Diagnostic Services Act (1957) and its successor, the Medical Care Act (1966). As they cogently argue, Canada had always relied on international medical migrants but rapid population growth in the 1950s and the Royal Commission on Health Services’ (RCHS) pointed references to the lack of health care professionals in all disciplines made its recommendation for publicly funded “medically necessary services” the issue at the top of the policy agenda. But the timing of the “socialization” of Canadian health care meant that Canada also participated in the transnational movement of highly trained professionals with its expected and unexpected consequences. But how did health care become so intimately entwined with immigration policy? This important question highlights the second significant component of their analysis and justifies their mixed methodology for the study. In essence, their work is intended to bring social history into current and future discussions of the history of Medicare by examining the impact of both legislation and policy implementation through the lived experiences of migrant practitioners. Placing their work within the field of transglobal migration studies requires Mullally and Wright to describe the complexities of the division of powers between the federal and provincial governments succinctly since the comparator nations, such as the United States, the United Kingdom, Australia, and other western nations, generally have different political approaches to health care policies and the groups being covered. By focusing primarily on the period from 1957 to 1984, Mullaly and Wright demonstrate the way doctors and nurses migrated in response to “push” (rigid hierarchies and racism) and “pull” (better salaries, adventure, opportunity) factors that reflected both personal imperatives and national policies. Using personal recollections to open each chapter also illustrates the gap between accepted sociological interpretations and individual motivations for emigration. The key events in immigration policy include the Fairclough Initiative in 1962, which lifted the restriction on Commonwealth migration and thus contributed to the [End Page 230] arrival of doctors and nurses from India, Pakistan, South Africa, and the Caribbean. World conflicts throughout the period also meant that doctors from Egypt, Hungary, Czechoslovakia, Haiti, Uganda, and Taiwan also joined the Canadian workforce, especially after 1967 when a new Immigration Act introduced the “points system.” This legislation identified training and education as highly desirable criteria for immigrants and was to be particularly important since studies prepared for the provinces in the early 1950s and the Royal Commission on Health Services in the 1960s revealed a significant shortfall in health care personnel despite increasing medical migration from Great Britain and the arrival of nurses trained in the Caribbean and the Philippines in the 1950s. Why was this so important? What did it mean for the implementation of a national medical services program? As the introduction of national hospital insurance between 1958 and 1961 had demonstrated, Canada needed many more doctors, nurses, and allied health care personnel than were currently available. The country also required better distribution of resources rather than the growing concentration of medical education and services in rapidly expanding urban areas. To deal with the pent-up demand that would arise when the national medical services program was implemented, the RCHS recommended not only hiring many more foreign health care workers but also creating seven new medical schools and expanding hospitals and postgraduate specialty training. The Pearson government responded with the Health Resources Fund, which provided federal support for expanding universities and hospitals in all the provinces and funding three new medical schools in Quebec (Sherbrooke), Ontario (McMaster), and Alberta (Calgary). The deans at each school looked overseas as...

PENITENTIARY MEDICINE IN THE CONTEXT OF NATIONAL HEALTH CARE REFORM IN UKRAINE.

The aim: Identify the main issues in the penitentiary medicine functioning in the context of National Health Care Reform in Ukraine and determine the state of realization of the right to health care and medical assistance of convicts and detainees. Materials and methods: This article used a set of general and special methods of scientific cognition. The empirical basis of the research consists of: inter¬national acts and standards in the penitentiary field and health care, statistics of the Ministry of Justice, reports of international organizations, the case law of the European Court of Human Rights (ECHR), scientific publications in databases of systematic reviews MEDLINE, PubMed, reports on the results of monitoring visits to prisons and pre-trial detention centers. Conclusions: Penitentiary medicine continues to be a separate departmental system, which does not consider the positive changes in the National Medical Services System. Such a superficial imitation of the method of guaranteeing prisoners' rights to medical care is a kind of cargo cultism of public institutions designed to ensure non-discriminatory conditions for implementing the right to health care for all population segments.

Transformation of the national medical services market: A review of the works of modern Russian authors

Aim. The presented study aims to assess the current state and possible vectors of changes in the Russian medical services market by analyzing the results of secondary data of Russian researchers. Tasks. The authors analyze existing scientific and theoretical approaches to the problem under consideration; identify patterns in the development of the medical services market in Russia; determine regulatory mechanisms for the medical market. Methods. This study is based on multidisciplinarity, methods of related scientific disciplines, quantitative and qualitative tools. The diversity of research tools is due to the specifics of a particular subject area and its social necessity. Results. The structure of the medical services market, which includes related sectors associated with the development of pharmaceutics, medical equipment, and specialized software, poses a wide range of challenges for researchers. There is an ongoing discussion in the Russian scientific community about the mechanisms for the incentivization of such a market. The number of publications by Russian authors on this problem is growing. Conclusions. Competition in the medical services market is caused by the existence of public and private medicine (some researchers also distinguish the informal shadow sector). The emergence of competition has a positive effect on the quality of medical care and medical services, making it possible to enhance the prestige of the medical profession and the income of medical workers. However, there are also specific regional problems related to pricing in private medicine and compliance with quality standards. Other significant issues include overcoming the existing state paternalism and forming a new perception of medical services in general, which most consumers in Russia find difficult to accept.

Effect of depression on health service utilisation in men: a prospective cohort study of Australian men aged 35 to 80 years

ObjectivesTo examine the relationship between depression burden, health service utilisation and depression diagnosis in community-based men.DesignProspective cohort study.SettingCommunity-based.ParticipantsMen aged 35–80 years at recruitment (2002–2005), randomly selected from the northern and...

ВЛИЯНИЕ КОРОНАВИРУСНОЙ ИНФЕКЦИИ НА МИРОВУЮ ЭКОНОМИКУ: СОЦИАЛЬНЫЕ И ЭКОНОМИЧЕСКИЕ ПОСЛЕДСТВИЯ

The COVID-19 coronavirus pandemic seriously affects the world economy: it became a challenge for the world economy and the institutes of global economic regulation. This paper considers possible social and economic consequences of the COVID-19 coronavirus pandemic for the world economy, analyzes the incidence of this infection in the countries of the world, and examines the COVID-19 impact on employment and personal incomes, on the loss in the global GDP. The study identified that the COVID-19 would most seriously influence the loss of revenues of the population and the growth in the number of poor people, the increase in unemployment in some industries, such as in the service industry. At the same time, the development of online technology and artificial intellect became promising areas. The author proposes the ways to reduce social and economic consequences of coronavirus pandemic on the global economy, which are based on the provision of national medical services with the sufficient amount of public funds; the adoption or strengthening of targeted measures to support individuals (for example, self-employed), companies, and local communities; the provision of macroeconomic insurance as the targeted measures will not cover many of the secondary consequences of social and economic shock. The paper concludes that COVID-19 can influence the global economy in three ways: directly affecting production, creating a supply chain, and violating market relations, as well as financially affecting firms and financial markets. However, much depends on the reaction of the public to this disease.

Strategic management of healthcare institution development of the national medical services market

The article reviews the current state of the market of medical services in Europe and comparatively results with the health care system in Ukraine. The main problems of reforming the health care system of Ukraine, which is characterized by the reduction of public health institutions, insufficient funding and an increase in the number of private clinics aimed at maximizing profits, are analyzed. On the one hand, this improves the quality of medical services, as private clinics, not having public funding, but financed by consumers purchase expensive equipment and make decisions in market conditions, which contributes to the introduction of new methods and innovative technologies, while on the other hand private medicine is inaccessible to the vast majority of the population of Ukraine due to the low economic status of citizens. The article considers the problem of remoteness of settlements from health care institutions and gives recommendations for further development and management of the health care system on the national market of medical services to reduce the risk of premature loss of population and improve the health of patients. The main reasons for the decline of the population of Ukraine are described and recommendations for the transition from public to public private medicine are provided. It was found that it is necessary to increase funding for public healthcare institutions and increase their total number to preserve the human potential of Ukraine. It was concluded that the strategic management of the development of the health care system should constantly monitor the effectiveness of implementation of changes, develop a flexible system of reform and control, which would take into account regional characteristics and mentality of the Ukrainian population. In order to increase the results of public medicine functioning and improve its availability and competitiveness, it is necessary to reorganize the system of control over the targeted use of monetary resources and develop a step-by-step strategy of Ukraine's development in all areas of the medical services market.

Fatal overdoses involving carfentanil: A case series

Carfentanil, an ultrapotent analog of fentanyl, has invaded the street drug market, unbeknownst to many heroin users. About 10,000 times more potent than morphine, it was initially suspected that 20 μg of the substance was lethal. In this case series, we present 17 confirmed carfentanil overdoses in Michigan, with a primary focus on the concentration levels. Through a retrospective review, each public death reported in Oakland County, Michigan, with a subsequent toxicology report was investigated for suspected carfentanil use. To characterize each fatality, the autopsy results were collected, including the postmortem findings at scene and the decedent's medical and social history. Carfentanil levels were measured through liquid chromatography and tandem mass spectrometry (LC-MS-MS) by National Medical Services (NMS) Laboratories. Our case series found postmortem carfentanil concentrations as low as 10 ng/mL, with a mean concentration of 0.387 ng/mL. Ultimately, there are implications on law enforcement, first responders, and health care providers when dealing with this emerging illicit substance, and there is an alarmingly high mortality rate associated with the abuse of carfentanil.

Surge in Fentanyl Toxicity Deaths in Jefferson Parish, LA, 2013-2018.

Background: The opioid epidemic in the United States has resulted in a significant increase in fentanyl-related overdoses nationwide since 2013. Because of an increased rate of fentanyl-related overdoses seen in Jefferson Parish, LA, the Jefferson Parish Coroner's Office (JPCO) hypothesized that the opioid epidemic, specifically related to fentanyl, had reached this region. To test this hypothesis, JPCO analyzed fentanyl overdose deaths to determine if the deaths had increased during a 6-year period and if the change met the definition of an epidemic.Methods: In the toxicology laboratory at JPCO, enzyme-linked immunosorbent assay screening and gas chromatography/mass spectrometry are used in-house to determine the presence of drugs. Drug-positive samples are sent to National Medical Services (NMS) Labs to quantify the analyte concentration in each sample. Data for each decedent were extracted from the Medicolegal Death Investigation Log (MDILog) database for the years 2013 through 2018.Results: A slow increase in fentanyl-related deaths during the first 3 years of the study period was followed by a near doubling of cases in 2016, a tripling of cases in 2017, and a 6-fold increase in incidence in 2018. During the 6-year study period, fentanyl-related deaths increased from 6 in 2013, to 8 in 2014, to 14 in 2015. Twenty-five deaths in 2016 spiked to 66 in 2017 and increased to 78 fentanyl-related overdose deaths in 2018. The percentage of fentanyl-related overdose deaths increased from 4% of all drug deaths in 2013 to 45% in 2018.Conclusion: The data validate the hypothesis that the fentanyl epidemic has affected Jefferson Parish in southeast Louisiana.

Impact of primary care funding on secondary care utilisation and patient outcomes: a retrospective cross-sectional study of English general practice.

In international studies, greater investment in primary health care is associated with improved population health outcomes. To determine whether investment in general practice is associated with secondary care utilisation, patient satisfaction, and clinical outcomes. Retrospective cross-sectional study of general practices in England, 2014-2015. Practice-level data were stratified into three groups according to GP contract type: national General Medical Services (GMS) contracts, with or without the capitation supplement (mean practice income guarantee), or local Personal Medical Services (PMS) contracts. Regression models were used to explore associations between practice funding (capitation payments and capitation supplements) and secondary care usage, patient satisfaction (general practice patient survey scores), and clinical outcomes (Quality and Outcomes Framework [QOF] scores). The authors conducted financial modelling to predict secondary care cost savings associated with notional changes in primary care funding. Mean capitation payments per patient were £69.82 in GMS practices in receipt of capitation supplements (n = 2784), £78.79 in GMS practices without capitation supplements (n = 1672), and £84.43 in PMS practices (n = 3022). The mean capitation supplement was £5.72 per patient. Financial modelling demonstrated little or no relationship between capitation payments and secondary care costs. In contrast, notional investment in capitation supplements was associated with modelled savings in secondary care costs. The relationship between funding and patient satisfaction was inconsistent. QOF performance was not associated with funding in any practice type. Capitation payments appear to be broadly aligned to patient need in terms of secondary care usage. Supplements to the current capitation formula are associated with reduced secondary care costs.

Patients’ satisfaction: The medical appointments valence in Portuguese public hospitals

Measuring patients’ satisfaction in secondary health care-based medical appointment services is a rarely addressed, though a very important, task. In general, this task is devoted to the emergency room. Improving (other) areas where patients are mostly dissatisfied assumes a relevant role since in Beveridge-based health systems providers are mainly financed through taxes. This paper aims to evaluate the satisfaction of Portuguese patients with reference to the national health system and public hospital medical appointment services, as well as to identify main priority areas of low performance. Data is collected from a report created and made available overtly by an official entity, managed by the Ministry of Health. Data consists of frequencies of patients assessing their own satisfaction (in four levels) regarding a set of seven criteria, five of them split into several subcriteria. These ones were selected based on their availability, suitability, and the literature review, and aimed to characterize the hospitals’ medical appointments valence concerning their image, cleanliness, facilities quality, technological progress, staff professional competence and care, as well as the waiting time in different stages before and after the medical appointment. This paper makes use of the so-called Multicriteria Satisfaction Analysis (MUSA) method, which is a very useful linear programming model developed and used with the intention of analyzing customer satisfaction and identifying priorities to improve the provider’s performance. Since data consists of frequencies in four satisfaction levels for a set of criteria and subcriteria, simulated patients were used based on a bootstrap-based technique, admitting independence between criteria/subcriteria. MUSA results allow the clustering of criteria according to Kano’s model and its refined version (must-be, one-dimension and attractive requirements), upon which satisfaction improving strategies must be formulated. Accordingly, the model identifies the waiting time (at any stage) as one of the most critical areas requiring enhancements. This is an expected outcome as these criteria corroborate the highest patients’ dissatisfaction scores.

A Pragmatic Guide to the Setting up of Integrated Hypnotherapy Services in Primary Care and Clinical Settings

Despite the continued debate and lack of a clear consensus about the true nature of the hypnotic phenomenon, hypnosis is increasingly being utilized successfully in many medical, health, and psychological spheres as a research method, motivational tool, and therapeutic modality. Significantly, however, although hypnotherapy is widely advertised, advocated, and employed in the private medical arena for the management and treatment of many physical and emotional disorders, too little appears to be being done to integrate hypnosis into primary care and national health medical services. This article discusses some of the reasons for the apparent reluctance of medical and scientific health professionals to consider incorporating hypnosis into their medical practice, including the practical problems inherent in using hypnosis in a medical context and some possible solutions.

Validation of an ELISA Synthetic Cannabinoids Urine Assay.

Synthetic cannabinoids are touted as legal alternatives to cannabis, at least when first released, and routine urine cannabinoid screening methods do not detect these novel psychoactive substances. Synthetic cannabinoids are widely available, are a major public health and safety problem, and a difficult challenge for drug-testing laboratories. We evaluated performance of the National Medical Services (NMS) JWH-018 direct enzyme-linked immunosorbent assay (ELISA) kit to sensitively, selectively, and rapidly screen urinary synthetic cannabinoids. The NMS ELISA kit targeting the JWH-018 N-(5-hydroxypentyl) metabolite was used to screen 2492 urine samples with 5 and 10 mcg/L cutoffs. A fully validated liquid chromatography-tandem mass spectrometry method for 29 synthetic cannabinoids markers confirmed all presumptive positive and negative results. Performance challenges at ±25% and ±50% of cutoffs determined intraplate and interplate imprecision around proposed cutoffs. The immunoassay was linear from 1 to 500 mcg/L with intraplate and interplate imprecision of ≤8.2% and <14.0%, respectively. No interferences were present from 93 common drugs of abuse, metabolites, coadministered drugs, over-the-counter medications, or structurally similar compounds, and 19 of 73 individual synthetic cannabinoids (26%) exhibited moderate to high cross-reactivity to JWH-018 N-(5-hydroxypentyl) metabolite. Sensitivity, specificity, and efficiency results were 83.7%, 99.4%, and 97.6%, as well as 71.6%, 99.7%, and 96.4% with the 5 and 10 mcg/L urine cutoffs, respectively. This high throughput immunoassay exhibited good diagnostic efficiency and documented that the NMS JWH-018 direct ELISA is a viable method for screening synthetic cannabinoids in urine targeting the JWH-018 N-(5-hydroxypentyl) and related analytes. Optimal performance was achieved with a matrix-matched 5 mcg/L urine cutoff.

치과위생사에 대한 예비치과의사의 인식 조사

Objectives: The purpose of this study is to investigate third and forth year dental students' perception towards dental hygienists as professionals. Methods: A self-reported questionnaire was completed by 602 dental college students in Korea after receiving the informed consent. Except incomplete answers, 217 data were analyzed. The questionnaire consisted of three questions of the general perception towards dental hygienists, four questions of the cooperation relationship to the dental hygienists, four questions of oral health education, five questions of preventive dental health care, five questions of dental treatment cooperation, and five questions of dental health care management. The data were analyzed using PASW Statistics 18.0(SPSS Inc., Chicago, IL, USA). Results: Most of the dental college students viewed the dental hygienists as professionals. However, they did not exactly know the professional job of dental hygienists within the current national medical services system and they often viewed the dental hygienists as a medical assistant. The dental college students thought that the key role of the dental hygienists is the dental assisting. Only a small fraction of the participants recognized oral health promotion, preventive cares, and hospital management as professional roles of dental hygienists. Conclusions : Dental college students' perception towards dental hygienists as professionals needs to be improved. Understanding the job description of dental hygienists clearly is a crucial part of dental students' learning process and future practice.

Oncological translational research in the Spanish national health system: the INTRO study

Under the auspices of the Foundation for Excellence and Quality in Oncology (ECO), the Translational Research inOncologyMedical Services Study (INTRO) was conducted with the aim of describing the current state of, and future expectations for translational cancer research in Spanish medical centres. The first step in the investigation was intended to analyse the current condition of the national Medical Oncology Services network by examining different aspects of the oncology research field. A descriptive and observational multicentre study was performed at a statewide level; information was collected by surveying a cross-section of all those responsible for Medical Oncology Services in Spain. The survey was completed by key informants, who were selected independently by each service, between September 2010 and April 2011. We were able to gather comprehensive data from a total of 27 Spanish hospitals. These data enabled us to describe the allocation of human and material resources devoted to clinical and translational research across the Medical Oncology Services and to describe the organisational and functional components of these services and units. These data included information pertaining to the activities developed, their funding sources, and their functional dependence on other internal or external bodies. Finally, we explored the degree of dissemination and use of some specific techniques used for the genetic diagnosis of cancer, which have recently been introduced in Medical Oncology within the Spanish healthcare system. A wide range of variability exists between different oncology services in Spanish hospitals. Time should be spent reflecting on the need and opportunities for improvement in the development of translational research within the field of oncology.

Auditing Solomon Islands' health and medical governance

PurposeThis paper seeks to analyse the audit findings, by the Auditor General's Office of the Solomon Islands, of the Ministry of Health and Medical Services, Solomon Islands' main health and medical agency that aims to coordinate the country's health and medical services.Design/methodology/approachUsing electronic data from annual reports, audit findings on the Solomon Islands' Ministry of Health and Medical Services are textually analysed over a six year period (2006‐2011) to detect the milieu of reporting by Solomon Islands' main health agency.FindingsOver a six year period, the Ministry of Health and Medical Services consistently found it difficult to generate accurate and timely annual reports as mandated by legislation. Critical governance issues of internal control, asset management, stock control and bank reconciliations are given short shrift by the Ministry.Research limitations/implicationsThe findings presented here are derived exclusively from textual analysis rather than through the medium of open‐ended questionnaires and mixed methodological techniques. However, the paper used authoritative local texts and explanations to overcome these limitations.Practical implicationsIn low‐income countries, audit findings need to be fully integrated in the governance of the national health and medical services. The findings presented here provide practical guidance for those considering developing or improving health and medical services in low‐income countries.Originality/valueLocal audit findings have the major potential for improving health and medical services in low‐income countries within existing resource constraints. The audit findings presented here have relevance to the entirety of health and medical systems in low‐income countries.

Mental Health Care Reforms in Asia: The Regional Health Care Strategic Plan: The Growing Impact of Mental Disorders in Japan

In April 2013 Japan designated mental disorders as the fifth "priority disease" for national medical services, after cancer, stroke, acute myocardial infarction, and diabetes. All prefectures will be required to assess local mental health needs and develop necessary service components. This column provides an overview of the Regional Health Care Strategic Plan in the context of mental health and welfare reforms. The goals of the plan are to alter the balance between institutional and community-based care for patients with severe and persistent mental disorders, integrate general medical and mental health care, and support greater independence for people with mental disorders. It is a political challenge for Japan to reallocate resources to rebalance care services while maintaining free access to care.

1．高齢者医療とうつ：ナショナルセンターの共同プロジェクト

Political attention is being increasingly directed to mental health in Japan. Mental disorders are now the fifth priority disease after cancer, stroke, acute myocardial infarction and diabetes for national medical services since April 2013. Each prefecture has to implement strategic mental healthcare plans at the regional level. With the increase in co-morbid mental and physical illnesses, patient information should be shared between psychiatric and non-psychiatric healthcare providers, and coordination is required in the healthcare systems. A better understanding of mental health between patients and medical staffs could contribute to improved access to psychiatric services in the integrated mental health care system. Collaborative care programs focusing on depression screening and management in the Mental Health Care Project for Patients with Physical Illness have been launched among six national specialized care and research centers (cancer, cardiovascular disease, diabetes, child care, geriatric care and neurology and psychiatry) since 2012. These efforts to integrate mental health care into the general health care system would help to improve psychiatric care for elderly patients with physical illnesses.

Poverty, Disparities, Disasters and Global Burden of Disease

AbstractThe world socio‐economic situation contributes to increasing poverty, disparities and poor accces to health. Rising poverty levels and disparities continue to slow, and in some cases negate, the hard won achievement in global health. Natural disasters are also on the rise, killing people, destroying services, communities and medical infrastructure, and further exacerbating the plight of the poor and already medically underserved populations. A more efficient use, collaboration and integration of national and international medical and health resources and services will help improve health in vulnerable populations.

The Common Ground Preparedness Framework: A Comprehensive Description of Public Health Emergency Preparedness

Currently, public health emergency preparedness (PHEP) is not well defined. Discussions about public health preparedness often make little progress, for lack of a shared understanding of the topic. We present a concise yet comprehensive framework describing PHEP activities. The framework, which was refined for 3 years by state and local health departments, uses terms easily recognized by the public health workforce within an information flow consistent with the National Incident Management System. To assess the framework's completeness, strengths, and weaknesses, we compare it to 4 other frameworks: the RAND Corporation's PREPARE Pandemic Influenza Quality Improvement Toolkit, the National Response Framework's Public Health and Medical Services Functional Areas, the National Health Security Strategy Capabilities List, and the Centers for Disease Control and Prevention's PHEP Capabilities.

Emerging tasks of specialty certifying examination: educational measurement considerations

Medical specialty systems were launched in 1951 by the National Medical Services Law. The following year, the specialty certifying examination had implemented in the form of portfolio evaluation. A paper-and-pencil type examination was implemented in 1960, and the 55th examination was carried out in January 2012. Currently, 26 specialties are represented, and the overall pass rate is over 90%. The examination consists of a step 1 paper-and-pencil test and step 2 skills test. In the step 1 test, the test items are multiple choice questions and short answer questions. Clinical performance examination is partially applied to the step 2 test. To cope with changes in the social situation and the growth of medical services, developmental changes are needed in the specialty certifying examinations. Performance assessment is an alternative worth considering. CPX should be a major part of the skill test. A computer-based test should be introduced as soon as possible, and it could eventually be developed into an adaptive test.