Of orphans and balloons

Technologies with significant implications for expenditures continue to reach the health care system. These technologies range from orphan drugs/biologicals used to treat rare diseases to balloons used to treat the common occurrence of benign prostatic hyperplasia (BPH) in aging men. Because payment for these technologies can represent a serious financial drain on third-party payers, utilization has to be carefully evaluated, monitored, and controlled.     

Investigational: what's in a name

The term "investigational" has become the fulcrum upon which coverage decisions turn. All third-party payers, including the federal government, use varying definitions of the term for the purpose of excluding treatments from coverage for payment. Unfortunately, no consistent definition of the term is available to payers to guide them in their coverage decisions.     

Coverage, technology assessment, and the courts

Coverage decisions by third-party payers are relying more and more heavily on the conclusions of technology assessment programs about the safety and effectiveness of technologies applied in specific clinical situations. Assessment programs vary markedly in the sophistication and rigor of their methodology. Payers differ as to how such assessment information is integrated into their decision-making processes. Finally, coverage decisions about a specific technology can vary widely across the country.     

Assaultive behavior. Does provocation begin in the front office?

1. Provocation is an important risk predictor because these issues can be recognized, assessed, and appropriate interventions can be implemented to reduce the associated risks. It is only by the reduction of such "non-fixed" risk factors that any reduction of assaults can be accomplished. 2. Involuntary admission, patients with dementia or organic brain disorder, physical or verbal limits, staff attitude, denial of the possibility of assaults, and the educational level and clinical experience of the staff may help provoke an assaultive episode. 3. An important step is assessing the assault to identify provocation due to certain medical causes, and to document the extent of degeneration in patients with dementia or organic brain disorder. Medical intervention would be indicated and would appropriately address the causes of some violent episodes.     

Labour migration and the work permit system in the United Kingdom

"The aim of this paper is to examine the effects of the work permit today [in the United Kingdom], using official data. It first reviews the operation of the [labor migration] system and describes the main schemes incorporated. Then, it uses data for 1984-88 to describe the general characteristics of labor immigration through the schemes. Finally, by means of a small random sample of applications and issues, it presents details on particular aspects of the immigration. It demonstrates that current labour immigration through the system is selective: most of those entering with long-term permits are highly skilled, well paid, and moving within the internal labor markets of large transnational corporations." (SUMMARY IN FRE AND SPA)     

What lies ahead for medical management?

The consensus is that, in spite of a reluctance in Washington to undertake any drastic reform of the health care financing and delivery system, the changes that are already in place in individual organizations and that are in place or being contemplated at the state level are certain to make the health care system of tomorrow very different from that of today. Physician executives can play an important role in the transition that will be required, but they will have to use a flexible, especially nondogmatic approach if they wish to cope successfully in this increasingly whirling environment. For such physicians, the author says, the opportunities, though unknown, are enormous.     

Recent migrations from Morocco to Spain

"This study addressed the problem of the Moroccan immigration into Spain within the context of South-North movements, focusing on analyzing provisional data from the last immigrant regularization in the country completed during the end months of 1991."