Organ allocation and utilization in pediatric transplantation.

Pediatric transplant candidates include heart, lung, liver, pancreas, small intestine, and kidney. The purpose of this article is to review the history and current methods for determining priority of the above-mentioned transplantable organs. The methods used by the authors involved the review of historical and current manuscripts and UNOS policy documents. We summarized the findings in order to create a concise review of the current policies and wait times for transplantation in pediatric transplant patients.

[Salomon Neumann (1819-1908) and the Right to Health]. / Salomon Neumann (1819­1908) und das Recht auf Gesundheit.

The "Universal Declaration of Human Rights (UDHR)" of the United Nations (UN) of 1948 sets out a right to health as a common ideal and aspiration. In his writings on the reform of the Prussian Medical Charter "Public Health and property" 100 years before the UDHR was set out, the Jewish physician Salomon Neumann had defined health as a right for every citizen, a right that should to be protected by a public system of health care. His reasoning went beyond contemporaneous critical social discussion. Right of humans to health has been acknowledged nationally and internationally; in the Federal Republic of Germany, the question as to whether there is a basic right to health is still open.

Inclusiveness in the value base for health care resource allocation.

This paper provides an overview of Mooney's contributions to the use of community values in priority setting and resource allocation in health care. It focuses on his 'communitarian claims' perspective and highlights how moral arguments for community involvement can be translated into specific processes needed to implement this approach in practice. Different examples of where Mooney sought to define and measure the constituents of claims and their relative importance in relation to equity in resource allocation are discussed. The paper also highlights challenges around the weighing up of claims and the elicitation of community preferences, many of which were acknowledged and debated by Mooney himself.

Proceduralism and its role in economic evaluation and priority setting in health.

This paper provides a critical overview of Gavin Mooney's proceduralist approach to economic evaluation and priority setting in health. Proceduralism is the notion that the social value attached to alternative courses of action should be determined not only by outcomes, but also processes. Mooney's brand of proceduralism was unique and couched within a broader critique of 'neo-liberal' economics. It operated on a number of levels. At the micro level of the individual program, he pioneered the notion that 'process utility' could be valued and measured within economic evaluation. At a macro level, he developed a framework in which the social objective of equity was defined by procedural justice in which communitarian values were used as the basis for judging how resources should be allocated across the health system. Finally, he applied the notion of procedural justice to further our understanding of the political economy of resource allocation; highlighting how fairness in decision making processes can overcome the sometimes intractable zero-sum resource allocation problem. In summary, his contributions to this field have set the stage for innovative programs of research to help in developing health policies and programs that are both in alignment with community values and implementable.

[Illness, conflicts, and medical supply problems: patients and their petitions in the last decade of the GDR]. / Krankheit, Konflikte und Versorgungsmängel: Patienten und ihre Eingaben im letzten Jahrzehnt der DDR.

This article contributes to historical research on medical care in the GDR by using patients' written petitions to the Central Committee of the Socialist Party submitted in the 1980s. It investigates how patients experienced everyday medical care in the GDR beyond the ideals of official health policy. What were their experiences with doctors and nurses and what possibilities for managing conflicts did sick and needy people have? Starting with a critical consideration of sources and some remarks about the culture of petitioning in GDR society, the article provides insight into the lives of patients in the late GDR. An analysis of medical petitions reveals individual ways of coping with disease and indicates that patients made particular demands of the socialist state and its health system. Patients articulated their expectations quite critically, using characteristic patterns of argumentation and, at times, successfully exerting pressure on the regime to answer their demands.

The relevance of personal characteristics in health care rationing: what the Australian public thinks and why.

This article examines the preferences of the general public in Australia regarding health care resource allocation. While previous studies have revealed that the public is willing to give priority to particular groups of patients based on their personal characteristics, the present article goes beyond previous efforts in attempting to explain these results. In the present study, there was strong support among respondents for giving "equal priority" to people regardless of their personal characteristics. However, respondents did reveal a preference for married patients over single, for children over adults, for carers of children and the elderly, sole breadwinners, and good community contributors. Further, they would give a lower priority to those perceived as "self-harmers"­smokers, individuals with unhealthy diets, and those who rarely exercise. Variation in the answers according to broad economic and social beliefs across seven different categories ("factors") influenced the pattern of the public's attitudes towards rationing. The Principal Components Analysis (PCA) indicated that most of the items in our survey are associated with seven factors that explain or capture much of the variation. These relate to a patient's avoidance of self-harm behaviors (Safe Living), their Life Style (diet, exercise, etc.), their contribution to the community through caring for others (Caring), their talents (Gifted), their sexual behavior (Sexuality), their age and marital status (Family), and whether they are an Australian citizen or employed (Citizen). The strength of social preferences­e.g., how strongly respondents would "discriminate" against a recreational drug user or preference a person with a healthy diet­is related to the particular class of preferences.

[Financing the public health services. 1967]. / Financiamento dos serviços de saúde pública.

Federal statistic figures show that the Brazilian States altogether have, in their respective territories, a collection of taxes which is higher than the Union one. The highest collection of the Central Government which is shown at the official statistics is due to the excess of collection of the federal taxes over the ones of the States; this usually happens in five or six states, of which, in 1964 Guanabara and São Paulo were responsible for 91% of this difference. One can not change the present system of competence in Public Health Services in the three levels--central, regional and local--without modifying at the same time the present Brazilian tributary system, where the municipal governments received back in 1962 only 5.6 of the general collection of taxes. Figures from 1955 show that the per capita cost of Public Health Services in Brazil, comprising the three levels, was Cr 123 Cr dollars dollars ( 1.82 US dollars), and in 1962, Cr 827 (US 2.30 US dollars). These three levels of government reserved in 1955, 5.6% of the money spent in its total expenditure for Public Health activities; this percentage declined to 4.5% in 1962. In relation to the sum invested on Public Health government activities, the Union spent in 1962, 36.4% of the total expenses, the States 59.3% and the counties only 5.5%. There is a great disproportion in the distribution of Public Health expenditure among the various Brazilian States, ranging from a minimal percentage over the total public expenses such as the case of Goiás (1.6% in 1964) up to a maximum of 17.2% in Pará in the same year. There is also a considerable variation from one state to another and in 1964 it ranged from the lowest limit of 70 Cr dollars in Maranhão up to 5.217 in Guanabara. If we analyze the per capita expenses of each state with Public Health activities, using 1964 and 1954 figures represented in 1964 monetary values, we can verify that the expenditure of 20 states dropped of 17.2%. One can not know, without an adequate planning, whether theses per capita expenses with Public Health government-owned services should be increased or not. It is not advisable to perform an international comparison; the figures on hand are not reliable due to the lack of a rational public accountancy system.

The opsonic rejuvenation of tuberculin as portrayed in Bernard Shaw's Doctor's Dilemma.

In 1906, at a late evening tea party in Sir Almroth Wright's laboratory when the pathologist was working on his opsonic index as a guide to the therapeutic use of tuberculin, Bernard Shaw instigated a discussion on patient selection in the face of limited resources. In converting the various responses into a play Shaw turned the choice between a rogue artist and an honest doctor into a moral dilemma, and then thickened the plot by involving the artist's beguiling wife innocently in the decision. He added a blackly comedic denouement to answer a public challenge that he could not write a convincing death scene. With his penchant for irrepressible exaggeration, his doctors are amiable but inordinately opinionated, each convinced that he alone holds the secret of healing. The senior physician escapes censure and even measured praise is bestowed on the panel doctor who accepts a full-time public post. This article summarises the play and how it came to be written.

Renal dialysis: counting the cost versus counting the need.

The relatively "lean and mean" provision of renal dialysis in Britain is a notorious example of "covert rationing", apparently achieved by a lack of central policy. Then in its first experiment in "target-setting" in the NHS in 1984, central government used the profession's preferred measure of need, thus promoting expansion of renal services, at almost exactly the time when the "quality-adjusted life year" (QALY) developed by health economists indicated that renal dialysis scored low in cost-benefit terms. This chapter examines these conundrums in terms of centre-periphery relations, clinical autonomy versus collective direction, and the politics of competing ways of counting need and cost.

The history, economics, and financing of mental health care. Part 2: The 20th century.

1. To understand how mental health nursing practice was affected by the financing and policy changes occurring rapidly in the second part of the 20th century, sources can only be found in the literature in psychiatry, the social sciences, and economics. There was no psychiatric nursing journal until the 1950s, and no article by a nurse in the general nursing literature about finances. 2. Deinstitutionalization was really transinstitutionalization. Changes in regulations in Medicaid allowed the shifting of mentally ill people who were older than age 65 to nursing homes. 3. Community mental health centers never developed programs to serve people who were seriously mentally ill. Rather than serving clients who were psychotic, the community mental health centers marketed their treatment programs to people with anxieties, who were undergoing divorce, or who had mildly troubled children.