[Relations with emergency medical care and primary care doctor, home health care].

Medical care for an ultra-aging society has been shifted from hospital-centered to local community-based. This shift has yielded the so-called Integrated Community Care System. In the system, emergency medical care is considered important, as primary care doctors and home health care providers play a crucial role in coordinating with the department of emergency medicine. Since the patients move depending on their physical condition, a hospital and a community should collaborate in providing a circulating service. The revision of the medical payment system in 2014 clearly states the importance of "functional differentiation and strengthen and coordination of medical institutions, improvement of home health care". As part of the revision, the subacute care unit has been integrated into the community care unit, which is expected to have more than one role in community coordination. The medical fee has been set for the purpose of promoting the home medical care visit, and enhancing the capability of family doctors. In the section of end-of-life care for the elderly, there have been many issues such as reduction of the readmission rate and endorsement of a patient's decision-making, and judgment for active emergency medical care for patient admission. The concept of frailty as an indicator of prognosis has been introduced, which might be applied to the future of emergency medicine. As described above, the importance of a primary doctor and a family doctor should be identified more in the future; thereby it becomes essential for doctors to closely work with the hospital. Advancing the cooperation between a hospital and a community for seamless patient-centered care, the emergency medicine as an integrated community care will further develop by adapting to an ultra-aging society.

Extra funds set to relieve pressure on staff this winter.

The NHS could not be better prepared for winter. At least that was the message when the Department of Health, NHS England and Public Health England launched their Stay Well This Winter campaign.

Austerity measures and the transforming role of A&E professionals in a weakening welfare system.

In 2010, the UK embarked on a self-imposed programme of contractionary measures signalling the beginning of a so-called "age of austerity" for the country. It was argued that budgetary cuts were the most appropriate means of eliminating deficits and decreasing national debt as percentage of General Domestic Product (GDP). Although the budget for the National Health Service (NHS) was not reduced, a below-the-average increase in funding, and cuts in other areas of public spending, particularly in social care and welfare spending, impacted significantly on the NHS. One of the areas where the impact of austerity was most dramatically felt was in Accidents and Emergency Departments (A&E). A number of economic and statistical reports and quantitative studies have explored and documented the effects of austerity in healthcare in the UK, but there is a paucity of research looking at the effects of austerity from the standpoint of the healthcare professionals. In this paper, we report findings from a qualitative study with healthcare professionals working in A&E departments in England. The study findings are presented thematically in three sections. The main theme that runs through all three sections is the perceptions of austerity as shaping the functioning of A&E departments, of healthcare professions and of professionals themselves. The first section discusses the rising demand for services and resources, and the changed demographic of A&E patients-altering the meaning of A&E from 'Accidents and Emergencies' to the Department for 'Anything and Everything'. The second section in this study's findings, explores how austerity policies are perceived to affect the character of healthcare in A&E. It discusses how an increased focus on the procedures, time-keeping and the operationalisation of healthcare is considered to detract from values such as empathy in interactions with patients. In the third section, the effects of austerity on the morale and motivations of healthcare professionals themselves are presented. Here, the concepts of moral distress and burnout are used in the analysis of the experiences and feelings of being devalued. From these accounts and insights, we analyse austerity as a catalyst or mechanism for a significant shift in the practice and function of the NHS-in particular, a shift in what is counted, measured and valued at departmental, professional and personal levels in A&E.

[Which physicians receive reimbursement for out-of-hours work?]. / Hvilke leger mottar trygderefusjon for legevaktarbeid?

BACKGROUND: Norwegian regular general practitioners (RGPs) are required to participate in out-of-hours duty. The aim of this study was to determine their actual participation rate. MATERIAL AND METHODS: Information was collected from the RGP Database, the Municipality Database and from physicians' bills to the National Insurance in 2004. The material consists of 3,751 RGPs and 2,317 other physicians claiming reimbursement for out-of-hours work. RESULTS: RGPs received 51.8% of the total reimbursement for out-of-hours work, and 35.6% of them did not have any such income. Male RGPs received almost twice as much reimbursement for out-of-hours duty as their female colleagues, and there was a strong tendency for older RGPs to receive less. Among all physicians, young men were those who generally worked most frequently out-of-hours. RGPs' reimbursement dropped with poorer coverage of doctors, increasing list size, if their list was full or overcrowded, and with increasing size and central localization of the municipality. INTERPRETATION: A large proportion of RGPs do not work out-of-hours in emergency services.

International EMS systems: The United States: past, present, and future.

Emergency medical services (EMS) is an organised system designed to transport sick or injured patients to the hospital. Though EMS system configurations can be quite varied in design depending on locale, we provide an overview of EMS as it has evolved and is currently modelled in the US. We outline the history of EMS in the US, including the major events and legislation that shaped the current models that are in existence. We provide an overview of provider training, system design, system funding, and dispatch issues. The concepts of medical direction for physician surrogates, as well as EMS as it relates to specialty care are also elucidated.

Costing of an ambulance system in a developing country, Turkey: costs of Ankara Emergency Aid and Rescue Services' (EARS) ambulance system.

The purposes of the study were to determine the total cost of Ankara Emergency Aid and Rescue Services (EARS), to calculate the cost of a single ambulance response and the cost per patient responded to. A descriptive study was planned to find out the cost of Ankara EARS, conducted between 1 October 1995 and 30 September 1996. The main variables of the study were the capital and recurrent costs of the system. The data relating to the costs were obtained from financial registries of various health institutes and personnel working in the system. The data was collected by two of the researchers. The total and average costs--cost per one ambulance run and cost per one patient--were determined. The total cost of Ankara EARS ambulance system in the period between 1 October 1995 and 30 September 1996 was US$918,877.90. The total capital costs of Ankara EARS was US$85,171.10 (9.3% of the total cost). The total recurrent costs of Ankara EARS was US$833,706.80 (90.7% of the total cost). The cost per one ambulance run was US$163.00. On the other hand the cost per patient or injured person was US$180.50. In Ankara, Turkey, the costs of such ambulance services could not be afforded by the private sector. The ambulance service activities should continue to be a part of primary health care services and the Ministry of Health should continue to serve in this field.

The increasing cost of health care--doctors suffer as well!

At long last there does appear to be general agreement that all is not well with the American health care system. Costs are out of control and the bureaucracy that has been spawned to control costs and administer the financial aspects of health care has developed a mind of its own. Two recent problems within our own department at the University of California, San Francisco, have shown that even doctors can be on the receiving end of these problems, with amusing but potentially serious consequences.