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Croatia starts to involve patients in medical decision-making
POLICY AND PEOPLE
US smoker awarded record-breaking compensation drug dealer in the world”. he US tobacco company Philip The jury ruled that Philip Morris Morris has been ordered to pay should pay Boeken US$5·5 million more than US$3 billion in compenin compensation and a further US$3 sation to a smoker after losing a billion in punitive damages. court case in Los Angeles on June 8. Whether Boeken gets to enjoy the Philip Morris must pay 56-year-old money is, however, Richard Boeken of more than doubtful. He Topanga, California, Rights were not is severely ill, and Philip who is seriously ill with granted to Morris, as in all similar lung cancer that has now include this US cases, has decided to spread to his brain. This appeal. Outside the image in is by far the largest USA winning a trial amount ever paid in any electronic against a tobacco comcase of this sort worldmedia. Please pany has proved more wide. refer to the difficult. Boeken started smokprinted journal. The first tobacco trial ing when he was 13ever in Europe was in years-old in 1957, and Finland in 1988, but the has been smoking two plaintiff Pentti Aho was packets of Marlboro Boeken with his son not able to convince the cigarettes a day for the court that the tobacco industry was past 40 years. His lawyer, Michael to blame for his ill health. Aho, born Piuze, argued that Boeken had no in 1925, was a smoker from 1941 to way of knowing how dangerous 1986 and got cancer and other severe tobacco smoking really was, and that smoking-related illnesses. But as the company had done nothing to opposed to the Boeken case and tell the public about the dangers of many other US cases, Aho was held smoking. Boeken, he argued, had partly responsible for his illness. become a heavy smoker in the late Since March, 1978, medical authori1950s, when there were no health ties in Finland have been allowed to warnings and smoking by young men print warnings on cigarette packets, “was not only accepted but which is considered proof of the fact expected”. Piuze went as far as to that smoking could be dangerous. name Philip Morris as “the biggest AP
T
In November, 2000, another heavy smoker, Robert Lund from Norway, lost a case against tobacco company Tiedemanns Tobaksfabrikk A/S. The trial was followed eagerly by other companies and by press. But although Robert Lund was supported by several experts claiming that nicotine could make people addicted to tobacco, he lost the case and his life. Lund, who kept smoking to the very end of his life, died of lung cancer a few weeks before the verdict. He had been a smoker since 1953 and kept on saying that he was just not able to stop. However a marked difference between the European and the US cases was that the court would not accept that dependency is the full responsibility of the producer. When adults smoke it is by their own choice, the court stated. “The verdict was very clear as to dependency of tobacco: you cannot get so dependent, that you lose your free choice. Everybody can quit smoking—it’s a question of motivation”, said Claus Bagger, chairman of Skandinavisk Tobakskompagni, which owns the Norwegian factory that made the cigarettes. Kaare Skovmand
Croatia starts to involve patients in medical decision-making
T
he Croatian Ministry of Health started a state-wide survey of patients’ opinions on health-care services in hospitals on March 1. The survey coordinator, Stjepan ˇ Oresˇkovic (Andrija Stampar School of Public Health, Zagreb) told The Lancet that the survey was the first comprehensive project of this kind in the Central and Eastern Europe transition countries. These countries have emerged from non-democratic and highly centralised systems, where the state has been the central instigator in all sectors of social life—including health—and where patient participation in planning and assessing healthcare programmes did not exist. With the introduction of market economy and decentralisation of some state functions, the practice of open bidding, contract negotiation, and customer sovereignty is being introduced in the health-care system. Patients are increasingly demanding more influence in health-care matters from the selec-
1958
tion of a physician or hospital and participation in medical decisionmaking to participation in local policy-making. The first part of the 1-year study will assess patients’ satisfaction with hospital care. Each patient will receive a short questionnaire when they are discharged from the hospital, to be filled in at home, and returned anonymously by prepaid mail. The questions will cover waiting times for admittance, satisfaction with staff and treatment, suggestions for improvement, and patients’ rights. The questionnaire was constructed after consultations with patients and medical staff. Patients were approached through patients’ associations, and medical staff through hospital boards and the Croatian Medical Association and the Croatian Chamber of Physicians. Oresˇkovic told The Lancet that 37 998 of 170 200 patients discharged from Croatian hospitals in the first 3
months of the survey sent completed questionnaires to the Ministry of Health. In his view, a response rate of 23% in a country where physician or hospital authority has never been questioned indicates a strong interest in participating in the improvement of the quality standards in the hospital sector. The survey will be used to assess the strengths of each hospital and to prioritise areas for improvement by identifying departments with disproportionate shares of patient complaints, types of complaints patients make, and the staff about whom the complaints are made. Oresˇkovic, who is also the director of the health-care reform programme, which is financed by the World Bank, expects that the assessment of patients’ opinions will be extended to other health sectors and make way for direct public participation in the ongoing health-care reform. Ana Maruˇsic
THE LANCET • Vol 357 • June 16, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.
US smoker awarded record-breaking compensation drug dealer in the world”. he US tobacco company Philip The jury ruled that Philip Morris Morris has been ordered to pay should pay Boeken US$5·5 million more than US$3 billion in compenin compensation and a further US$3 sation to a smoker after losing a billion in punitive damages. court case in Los Angeles on June 8. Whether Boeken gets to enjoy the Philip Morris must pay 56-year-old money is, however, Richard Boeken of more than doubtful. He Topanga, California, Rights were not is severely ill, and Philip who is seriously ill with granted to Morris, as in all similar lung cancer that has now include this US cases, has decided to spread to his brain. This appeal. Outside the image in is by far the largest USA winning a trial amount ever paid in any electronic against a tobacco comcase of this sort worldmedia. Please pany has proved more wide. refer to the difficult. Boeken started smokprinted journal. The first tobacco trial ing when he was 13ever in Europe was in years-old in 1957, and Finland in 1988, but the has been smoking two plaintiff Pentti Aho was packets of Marlboro Boeken with his son not able to convince the cigarettes a day for the court that the tobacco industry was past 40 years. His lawyer, Michael to blame for his ill health. Aho, born Piuze, argued that Boeken had no in 1925, was a smoker from 1941 to way of knowing how dangerous 1986 and got cancer and other severe tobacco smoking really was, and that smoking-related illnesses. But as the company had done nothing to opposed to the Boeken case and tell the public about the dangers of many other US cases, Aho was held smoking. Boeken, he argued, had partly responsible for his illness. become a heavy smoker in the late Since March, 1978, medical authori1950s, when there were no health ties in Finland have been allowed to warnings and smoking by young men print warnings on cigarette packets, “was not only accepted but which is considered proof of the fact expected”. Piuze went as far as to that smoking could be dangerous. name Philip Morris as “the biggest AP
T
In November, 2000, another heavy smoker, Robert Lund from Norway, lost a case against tobacco company Tiedemanns Tobaksfabrikk A/S. The trial was followed eagerly by other companies and by press. But although Robert Lund was supported by several experts claiming that nicotine could make people addicted to tobacco, he lost the case and his life. Lund, who kept smoking to the very end of his life, died of lung cancer a few weeks before the verdict. He had been a smoker since 1953 and kept on saying that he was just not able to stop. However a marked difference between the European and the US cases was that the court would not accept that dependency is the full responsibility of the producer. When adults smoke it is by their own choice, the court stated. “The verdict was very clear as to dependency of tobacco: you cannot get so dependent, that you lose your free choice. Everybody can quit smoking—it’s a question of motivation”, said Claus Bagger, chairman of Skandinavisk Tobakskompagni, which owns the Norwegian factory that made the cigarettes. Kaare Skovmand
Croatia starts to involve patients in medical decision-making
T
he Croatian Ministry of Health started a state-wide survey of patients’ opinions on health-care services in hospitals on March 1. The survey coordinator, Stjepan ˇ Oresˇkovic (Andrija Stampar School of Public Health, Zagreb) told The Lancet that the survey was the first comprehensive project of this kind in the Central and Eastern Europe transition countries. These countries have emerged from non-democratic and highly centralised systems, where the state has been the central instigator in all sectors of social life—including health—and where patient participation in planning and assessing healthcare programmes did not exist. With the introduction of market economy and decentralisation of some state functions, the practice of open bidding, contract negotiation, and customer sovereignty is being introduced in the health-care system. Patients are increasingly demanding more influence in health-care matters from the selec-
1958
tion of a physician or hospital and participation in medical decisionmaking to participation in local policy-making. The first part of the 1-year study will assess patients’ satisfaction with hospital care. Each patient will receive a short questionnaire when they are discharged from the hospital, to be filled in at home, and returned anonymously by prepaid mail. The questions will cover waiting times for admittance, satisfaction with staff and treatment, suggestions for improvement, and patients’ rights. The questionnaire was constructed after consultations with patients and medical staff. Patients were approached through patients’ associations, and medical staff through hospital boards and the Croatian Medical Association and the Croatian Chamber of Physicians. Oresˇkovic told The Lancet that 37 998 of 170 200 patients discharged from Croatian hospitals in the first 3
months of the survey sent completed questionnaires to the Ministry of Health. In his view, a response rate of 23% in a country where physician or hospital authority has never been questioned indicates a strong interest in participating in the improvement of the quality standards in the hospital sector. The survey will be used to assess the strengths of each hospital and to prioritise areas for improvement by identifying departments with disproportionate shares of patient complaints, types of complaints patients make, and the staff about whom the complaints are made. Oresˇkovic, who is also the director of the health-care reform programme, which is financed by the World Bank, expects that the assessment of patients’ opinions will be extended to other health sectors and make way for direct public participation in the ongoing health-care reform. Ana Maruˇsic
THE LANCET • Vol 357 • June 16, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.