- Email: [email protected]
Canada's health ministry gains new chief
THE LANCET
POLICY AND PEOPLE
Canada’s health ministry gains new chief “We’re going to find out how such a he Canadian government will thing can be done and what it might not relinquish its authority to cost and after we’ve looked at it fully, unilaterally interpret and enforce the we’ll come forward to cabinet with Canada Health Act. This is despite proposals and see what happens.” provincial demands for a redefinition The former trial of “core” services and lawyer was appointed the creation of an indeto the Health ministry pendent board to arbrion June 11 in a federal trate disputes between cabinet shuffle to shore levels of government. up regional losses the The provinces have Liberals suffered in the indicated that such June 2 election which changes must be implesaw their commanding mented before they will majority shaved to five agree to expand public seats. Rock served as health-insurance plans. Justice minister, where With the governing he spearheaded two of Liberals having vowed the government’s most during the recent elec- Rock—ready to talk controversial pieces of tion campaign to examlegislation—the introduction of ine the possibility of expanding mandatory registration of all guns, Medicare to include prescription and the amendment of human-rights drugs and home care, the impasse is legislation to prohibit discrimination likely to present a obstacle for new on the basis of sexual orientation. Health minister Allan Rock. But Rock says he still hopes that an accommodation can be reached. Wayne Kondro Canapress
T
African countries unite against malaria and be backed up with drug supplies, alaria experts in Africa have insecticides, and trained personnel. succeeded in persuading the A proposed plan of action urges region’s governments that the situathat priority be given to updating tion demands action and cooperation national drug policies, and to develop at the highest level. Ministers from mechanisms to ensure adequate Africa who attended the Organisation deliveries of drugs, insecticides, and of African Unity summit 2 weeks netting materials in ago in Harare, each country. Staff at Zimbabwe, unaniall levels are to be mously supported trained in case manthe adoption of a agement, disease draft declaration on prevention, and surregional malaria conveillance based on trol. It is the first WHO standards. time African leaders Dominic Mutie, have acknowledged disease-control offithe need to work cer for the WHO, together to control Kenya, said that the disease. High-level cooperation required politically the move “Many people are was timely since WHO was already dying across the continent and working to implement its regional African leaders want to redouble malaria-control strategy in Kenya, their efforts to fight this disease”, said one of the model countries. “We’ve Zimbabwe Foreign Minister Stan already taken the position that Mudenge, whose delegation promalaria must be tackled more aggresposed the declaration. Ministers of sively, and that we must see results in health in each of the OAU members terms of falls in mortality.” He added countries have now been mandated that the programme was community to implement malaria-control stratebased and implemented at district gies in line with WHO recommendalevel, and would be evaluated every 6 tions. The OAU also proposes that a months for the next 4 or 5 years. rapid epidemic response system be developed, which would alert national programmes to outbreaks Sam Crowe Panos Pictures
M
1824
Managed-care restrictions gain ground in US Congress
T
he ongoing managed-care “backlash” that last year led Congress to require insurers to allow new mothers to spend at least 48 hours in hospital is finding its way into legislation now under consideration that will write into law the Medicare and Medicaid portions of the balanced budget deal. During the week of June 9, two separate House committees approved proposals that included requirements for insurers to pay for emergency-room visits if a “prudent layperson” would deem the situation to warrant immediate care. In many cases, consumers have complained that plans have refused to pay after the fact, based on the discharge diagnosis. The plans approved by the House Ways and Means and Commerce committees would also bar “gag clauses” in managed-care contracts that limit what physicians may tell patients about specialists or treatments not covered by that plan. At the House Commerce Committee, the combination of Republican physicians and Democrats sympathetic to consumer complaints pushed the restrictions even further. Members approved amendments that would give health professionals rather than plans final say over whether care is “medically necessary”, would require plans to give patients information about consumer complaints and how those complaints were resolved, and would allow doctors and patients alone to determine the appropriate lengths of stay for hospital care. “This just says that no longer will an insurance clerk who may be 600 miles away mandate that a patient be discharged”, said Representative Tom Coburn (Republican, Oklahoma), a physician who led the charge on many of the managed are restrictions. Spokespeople for managed-care companies complain that the changes, if they were to become law, would radically raise costs. They have vowed to fight to have the restrictions removed as the bills work their way through the House and Senate over the next several weeks.
Julie Rovner
Vol 349 • June 21, 1997
POLICY AND PEOPLE
Canada’s health ministry gains new chief “We’re going to find out how such a he Canadian government will thing can be done and what it might not relinquish its authority to cost and after we’ve looked at it fully, unilaterally interpret and enforce the we’ll come forward to cabinet with Canada Health Act. This is despite proposals and see what happens.” provincial demands for a redefinition The former trial of “core” services and lawyer was appointed the creation of an indeto the Health ministry pendent board to arbrion June 11 in a federal trate disputes between cabinet shuffle to shore levels of government. up regional losses the The provinces have Liberals suffered in the indicated that such June 2 election which changes must be implesaw their commanding mented before they will majority shaved to five agree to expand public seats. Rock served as health-insurance plans. Justice minister, where With the governing he spearheaded two of Liberals having vowed the government’s most during the recent elec- Rock—ready to talk controversial pieces of tion campaign to examlegislation—the introduction of ine the possibility of expanding mandatory registration of all guns, Medicare to include prescription and the amendment of human-rights drugs and home care, the impasse is legislation to prohibit discrimination likely to present a obstacle for new on the basis of sexual orientation. Health minister Allan Rock. But Rock says he still hopes that an accommodation can be reached. Wayne Kondro Canapress
T
African countries unite against malaria and be backed up with drug supplies, alaria experts in Africa have insecticides, and trained personnel. succeeded in persuading the A proposed plan of action urges region’s governments that the situathat priority be given to updating tion demands action and cooperation national drug policies, and to develop at the highest level. Ministers from mechanisms to ensure adequate Africa who attended the Organisation deliveries of drugs, insecticides, and of African Unity summit 2 weeks netting materials in ago in Harare, each country. Staff at Zimbabwe, unaniall levels are to be mously supported trained in case manthe adoption of a agement, disease draft declaration on prevention, and surregional malaria conveillance based on trol. It is the first WHO standards. time African leaders Dominic Mutie, have acknowledged disease-control offithe need to work cer for the WHO, together to control Kenya, said that the disease. High-level cooperation required politically the move “Many people are was timely since WHO was already dying across the continent and working to implement its regional African leaders want to redouble malaria-control strategy in Kenya, their efforts to fight this disease”, said one of the model countries. “We’ve Zimbabwe Foreign Minister Stan already taken the position that Mudenge, whose delegation promalaria must be tackled more aggresposed the declaration. Ministers of sively, and that we must see results in health in each of the OAU members terms of falls in mortality.” He added countries have now been mandated that the programme was community to implement malaria-control stratebased and implemented at district gies in line with WHO recommendalevel, and would be evaluated every 6 tions. The OAU also proposes that a months for the next 4 or 5 years. rapid epidemic response system be developed, which would alert national programmes to outbreaks Sam Crowe Panos Pictures
M
1824
Managed-care restrictions gain ground in US Congress
T
he ongoing managed-care “backlash” that last year led Congress to require insurers to allow new mothers to spend at least 48 hours in hospital is finding its way into legislation now under consideration that will write into law the Medicare and Medicaid portions of the balanced budget deal. During the week of June 9, two separate House committees approved proposals that included requirements for insurers to pay for emergency-room visits if a “prudent layperson” would deem the situation to warrant immediate care. In many cases, consumers have complained that plans have refused to pay after the fact, based on the discharge diagnosis. The plans approved by the House Ways and Means and Commerce committees would also bar “gag clauses” in managed-care contracts that limit what physicians may tell patients about specialists or treatments not covered by that plan. At the House Commerce Committee, the combination of Republican physicians and Democrats sympathetic to consumer complaints pushed the restrictions even further. Members approved amendments that would give health professionals rather than plans final say over whether care is “medically necessary”, would require plans to give patients information about consumer complaints and how those complaints were resolved, and would allow doctors and patients alone to determine the appropriate lengths of stay for hospital care. “This just says that no longer will an insurance clerk who may be 600 miles away mandate that a patient be discharged”, said Representative Tom Coburn (Republican, Oklahoma), a physician who led the charge on many of the managed are restrictions. Spokespeople for managed-care companies complain that the changes, if they were to become law, would radically raise costs. They have vowed to fight to have the restrictions removed as the bills work their way through the House and Senate over the next several weeks.
Julie Rovner
Vol 349 • June 21, 1997