'A Theory of the Allocation of Time' Turns Fifty: Its Impact on the Field of Health Economics.

The year 2015 is the 50th anniversary of the publication of 'A Theory of the Allocation of Time,' by Gary S. Becker in the 1965 volume of The Economic Journal. To mark that occasion, this editorial focuses on the importance of that paper in the history and evolution of the field of health economics.

[Civil hospital of Zamora de Hidalgo]. / Hospital Civil de Zamora de Hidalgo.

The city of Zamora de Hidalgo is home to one of the most important hospitals in the region, built in 1841 and named the Civil Hospital of Zamora. Built following demand for municipal health needs and with the support of the City Council of Zamora and private donations, it functioned as a hostel for pilgrims, the destitute and the sick. It was administered and maintained by residents, subsequently by the mothers of the Sacred Heart of Jesus, and finally by the federal Government. It currently gives the Zamorano community services, and admits sick people from other locations such as Jacona, Jiquilpan, Patamban Ocumicho, Chavinda, Tangancicuaro, Chilchota, and Tangamandapio, among others. It was called the Civil hospital because as the only hospital that operated in Zamora, it ceased to be administered by the Ecclesiastic Chapter, and passed into the hands of the State.

[Diego Rivera: a great master and a didactic and discerning medical historian]. / Diego Rivera: gran maestro y un didáctico y lúcido historiador de la medicina.

Diego Rivera is one of the artistic giants of the 20th century. His many original creations included landscapes, portraits and large murals created in both Mexico and the United States. Rivera ventured into many styles-cubism, naturalism and narrative realism-with great success. Rivera's murals build on those of the Renaissance, pre-historic and colonial civilizations of Mexico. Biological and medical topics and their history form an important concern in Rivera's work, present in many of his murals in a highly informative and creative manner. His two History of Cardiology murals present an original and comprehensive account of the developments of this medical specialty from pre-historic to modern times. His History of Medicine in Mexico (The people demands health) mural is a creatively and vigorously fashioned and highly dynamic and synthetic vision of the relationships between pre-historic and modern medicine in Mexico and its social foundations. Medical topics such as vaccines and vaccination, embryology and surgery are inventively and accurately presented in the large mural, Detroit Industry. The trigger and impetus for the concern of Rivera for these topics of life and death, and the exceedingly ground-breaking way he presents them, appear to stem from his rational materialism, his concern for collective wellbeing, his belief in progress through scientific developments and political action and his commitment to understand Mexican and American history.

Nursing education development in China (1887-1949): influences on contemporary nursing.

BACKGROUND: On 8 May 2013, the Chinese Nursing Association joined the International Council of Nurses. It is hoped that by sharing the history of nursing in China, scholars globally can incorporate into current thinking the challenges that Chinese nurses have faced in pursuing educational development and professional acknowledgement. AIM: To review the history of nurse education in China between 1887 and 1949 and summarize events marking its development; and to provide historical references for considering contemporary nurse education and discipline development in China. METHODS: Content analysis using bibliometric and historical research methods on available documentation sources. Milestone events were listed and their historical significance analysed. RESULTS: Nurse education development during this period was affected by three major influences: (1) international nursing collaboration and involvement with Chinese nursing in China and abroad, (2) the determination of leaders to develop nursing as a unique and ethical profession, and (3) the pressure of war and civilian need on the focus of nursing development in China. CONCLUSION: The development of nurse education in China occurred within an environment of social change, war and international collaboration. Throughout the Modern China period (1887-1949), nursing leadership has guided the growth of nurse education to be responsive to individual and community needs as well as ensuring nurse accountability for conduct and nursing practice. Contemporary Chinese nursing and education owes much to those throughout the Modern China period, who laid the foundations that support the current position and status of nursing. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The study displays the benefits and challenges of participation in policy and forums that help nurse scholars and practitioners understand the development of nurse education in China.

History counts: how history can shape our understanding of health policy.

Historians of nursing can inform and provide perspective and context to the discipline and to policy makers. This article provides several examples of the interplay of history and health policy debates across time and place. From issues of the nursing workforce to discussions about the skill level needed to safely care for patients and the issues of practice boundaries, history provides evidence for shaping our understanding of and engagement with health policy. History offers a way to understand the present and think about the future. It illustrates a critical perspective for both action and advocacy.

Status of the anesthesia workforce in 2011: evolution during the last decade and future outlook.

The purpose of this review is to present a comprehensive assessment of the anesthesia workforce during the past decade and attempt forecasting the future based on present knowledge. The supply of anesthesiologists has gradually recovered from a deficit in the mid to late 1990 s. Current entry rates into our specialty are the highest in more than a decade, but are still below the level they were in 1993. These factors along with slower surgical growth and less capital available for expanding anesthetizing locations have resulted in greater availability of anesthesiologists in the labor market. Despite these recent events, the intermediate-term outlook of a rapidly aging population and greater access of previously uninsured patients portends the need to accommodate increasing medical and surgical procedures requiring anesthesia, barring disruptive industry innovations. Late in the decade, nationwide surveys found shortages of anesthesiologists and certified registered nurse anesthetists to persist. In response to increasing training program output with stagnant surgical growth, compensation increases for these allied health professionals have moderated in the present. Future projections anticipate increased personnel availability and, possibly, less compensation for this group. It is important to understand that many of the factors constraining current demand for anesthesia personnel are temporary. Anesthesiologist supply constrained by small graduation growth combined with generation- and gender-based decrements in workforce contribution is unlikely to keep pace with the substantial population and public policy-generated growth in demand for service, even in the face of productivity improvements and innovation.

[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.

Italian psychiatric reform 1978: milestones for Italy and Europe in 2010?

The Italian psychiatric reform of 1978 was one of the most radical attempts in history to abolish the practise of custodial psychiatry using legislation. The work of the charismatic reformer Franco Basaglia had four main objectives, which have taken more than 30 years to achieve. Although the creation of outpatient mental health centres and a reduction in involuntary commitments occurred rapidly, the expensive development of small acute psychiatric departments in general hospitals as an alternative to psychiatric hospitals was implemented very slowly. According to a national survey by the Italian Ministry of Health, in 2001, there were a total of 9,300 acute beds for all of Italy, of which as many as 4,000 were in private facilities. With 1.72 acute beds per 10,000 inhabitants, Italy has one of the lowest figures in Europe of psychiatric beds. However, Italy's apparent and often praised low bed requirement places a large burden on families. The implementation of the reform process was most delayed and occurred at its worst in South Tyrol, in North Italy. In an effort to achieve a modern and progressive community-based psychiatric service, in particular one with more specialised services, mental health providers in this region have examined German, Austrian and Swiss models of psychiatric practice.

The early years of Title V: extending and improving care for children with special health care needs, 1935-1941.

This historical study examines the early years of the federal program of services for children with physical disabilities in the United States (US) during the 1930s, known today as services for Children with Special Health Care Needs (CSHCN). Established as part of the Social Security Act (SSA) of 1935, the Crippled Children Services (CCS) program was one of the first medical programs for children supported by the federal government. Under the SSA, states and territories quickly developed state-level CCS programs during the late 1930s. The US Children's Bureau administered the program for the federal government and helped states to incorporate preventive services and interdisciplinary approaches to service provision into state-level CCS programs. Factors that influenced the implementation of these programs included the availability of matching state funds, the establishment of state programs for crippled children prior to the SSA, and the accessibility of qualified health care professionals and facilities. The early efforts of this federal program on behalf of children with disabilities can be seen in services for CSHCN today.

Rising inability to obtain needed health care among homeless persons in Birmingham, Alabama (1995-2005).

BACKGROUND: Homeless persons depend disproportionately on the health-care safety net for medical services. National reports identify financial strains to this safety net. Whether this has affected homeless persons is unknown. OBJECTIVES: We quantified changes in the proportion of homeless persons reporting unmet need for health care in Birmingham, Alabama, comparing two periods, 1995 and 2005. We assessed whether a period effect was independent of characteristics of persons surveyed. DESIGN: Analysis of two surveys conducted with identical methods among representative samples of homeless persons in 1995 (n = 161) and 2005 (n = 161). MEASUREMENTS: Report of unmet need (inability to obtain care when needed) was the dependent variable. Two survey periods (1995 and 2005) were compared, with multivariable adjustment for sociodemographic and health characteristics. Reasons for unmet need were determined among the subset of persons reporting unmet need. RESULTS: Unmet need for health care was more common in 2005 (54%) than in 1995 (32%) (p < 0.0001), especially for non-Blacks (64%) and females (65%). Adjusting for individual characteristics, a survey year of 2005 independently predicted unmet need (odds ratio 2.68, 95% CI 1.49-4.83). Among persons reporting unmet need (87 of 161 in 2005; 52 of 161 in 1995), financial barriers were more commonly cited in 2005 (67% of 87) than in 1995 (42% of 52) (p = 0.01). CONCLUSION: A rise in unmet health-care needs was reported among Birmingham's homeless from 1995 to 2005. This period effect was independent of population characteristics and may implicate a local safety net inadequacy. Additional data are needed to determine if this represents a national trend.

Why policy needs history (and historians).

Policy makers like the idea of new initiatives and fresh starts, unencumbered by, even actively overthrowing, what has been done in the past. At the same time, history can be pigeonholed as fusty and antiquarian, dealing with long past events of no relevance to the present. Academic historians are sometimes bound up in their own worlds. The debates central to academe may have little direct relevance to the immediate concerns of policy making. The paper argues that history, as the evidence-based discipline par excellence, is as relevant as other approaches to evidence-based policy making. Case studies can show us the nature of that relevance. How to achieve influence for history also needs discussion. The relationship is not straightforward and will vary according to time and place. History is an interpretative discipline, not just a collection of 'facts'. The paper discusses how historians work and why it is important for policy makers to engage, not just with history, but with historians as well. Historians too need to think about the value of bringing their analysis into policy.

[Examples of physician-patient relations, Perche-government of Quebec: debts for medical expenses, 1690-1740-1770]. / Exemples de relations praticiens- patients, Perche-gouvernement de Québec: dettes pour frais médicaux, 1690-1740-1770.

This paper is a comparative study of debts for medical services among the populations of Perche (Low-Normandy, France) and Quebec during the 1690s, 1740s and 1770s, as presented in metropolitan-colonial reports. This socioeconomic study presents the social and geographic characteristics of patients who needed medical services, the debts incurred, the popularity of practitioners, and the level of medicalization in these two areas.

Do benefits in kind or refunds affect health service utilization and health outcomes? A natural experiment from Japan.

Although the payment systems of public health insurance vary greatly across countries, we still have limited knowledge of their effects. To quantify the changes from a benefits in kind system to a refund system, we exploit the largest physician strike in Japan since the Second World War. During the strike in 1971 led by the Japan Medical Association (JMA), JMA physicians resigned as health insurance doctors, but continued to provide medical care and even health insurance treatment in some areas. This study uses the regional differences in resignation rates as a natural experiment to examine the effect of the payment method of health insurance on medical service utilization and health outcomes. In the main analysis, aggregated monthly prefectural data are used (N=46). Our estimation results indicate that if the participation rate of the strike had increased by 1% point and proxy claims were refused completely, the number of cases of insurance benefits and the total amount of insurance benefits would have decreased by 0.78% and 0.58%, respectively compared with the same month in the previous year. Moreover, the average amount of insurance benefits per claim increased since patients with relatively less serious diseases might have sought health care less often. Finally, our results suggest that the mass of resignations did not affect death rates.