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Palestinian Authority encourages health insurance
people
Palestinian Authority encourages health insurance
who pay
at
the beginning of the
year.
The "huge pressure : from hospitals" has prevented
on government Fees for families will be reduced them from delivUS$38 to$25 per month, and family ering services to many insured. The hope coverage will extend not only to spouse is that raising hospital fees, especially for and dependent children under age 18, but maternity services, will alleviate this probalso to dependent nieces and nephews lem. The increase to about$100 per day and unmarried or divorced daughters, as ($200 for intensive care) is not intended well as to parents aged over 60 years. to restrict health care but to encourage the Youths over 18 years of age must pay uninsured to enrol. For example, of 485 $15 and students$6-60 per month. In cases entering the Alia Hospital in Hebron addition a 10% discount will be given to during May, only 80 were insured. In Gaza, some 70 000 families are insured today. Progress is slow for religious and cuts demolish USAID Palestinian health cultural reasons; many devout Moslems When the U S Congress approved an increase in the annual appropriation to consider insurance a form of gambling. the Palestinian Authority from US$22 to$75 million as of the new fiscal year, The PA is working on broad public health this promised support was made simultaneously with deep cuts to the USAID education (panel) as well as on revisions budget. Virtually overnight, the pen stroke wiped out the services of the to the health insurance plan to make it hundreds of local NGOs supported globally-not necessarily a bad move, say more attractive. some, arguing that "most NGOs have failed to democratise" (ie, work on Also to be resolved are the administrative and financial problems leading to specific projects with specific goals and budgets, professionally organised and run). shortages of medicines and supplies that are attributed in large part to widespread Ironically, at the same time, USAID reduced the PA’s Health Ministry budget million. in This cut USAID has demolished the Palestinian smuggling. In addition, the Ministry of by$23.5 funding Health is working to increase the number Health Systems Support Project (see Lancet 1994; 343: 1149)-a true of hospital beds from around 1000 in setback. Planning for this project began in 1993 with visits from American Gaza and in the West Bank. Finally, the an health and human services design teams and was intended to put in place of tertiary care, previously problem efficient, sustainable health-care system not only by developing end-user obtained by referring patients to Israel, is in public health information and distribution systems, but also by assisting dealt with in the short term by being training, with software and hardware supplementation for administrative and negotiating with Jordanian and Egyptian financial management. health ministries, and also by developing In the meantime, about$2 million has come from the Italian government and their own services.
To encourage greater enrolment in the Palestinian Authority’s health-insurance programme, insurance fees have as of this month been lowered, while hospital costs to the uninsured have been raised. Deputy Minister of Health, Dr Munzer Al-Sharif, also announced that there will be a uniform health-insurance system in Gaza and the West Bank, which used to be administered separately.
project
from the continuing support of the American-Jewish Joint Distribution Committee, to support health-information programmes.
Latvia
ceases
to
provide free health
Free medical care came to an end in Latvia last week. Under provisional rules that became operative on Aug 1, patients now have to pay up to 25% of the cost of treatment provided by the state medical sector. Many doctors have expressed fears that poorer patients will be unable to afford the charges. Some months ago, in a pilot scheme at the Riga clinical emergency hospital, one in eight of the patients were unable to pay the relatively modest charge of 45 santims a day. The new rules, being temporary, do not indicate what measures can be applied in the case of non-payment. : The introduction of the new rules comes at a time when the Latvian state sector generally, and the health service in : particular is increasingly strapped for : cash, partly because of the transitions : now taking place in the Latvian economy. : At the same time, epidemiologists report a significant increase in poverty-related : illnesses, in particular tuberculosis. Over : 1000 new cases of this disease were regis- : tered in 1994, and there is pressure for : ,
i
compulsory screening and,
:
necessary, compulsory treatment. is on the increase-213 too, Diphtheria, cases were reported in the first 6 months
:
regular
mass
if
of this year
(81 in June alone), of which
.
care
Rachelle H B Fishman
Central ethics committee symptomsformed in Germany
13 proved fatal. Other medical of economic malaise are a rise in drug addiction (with ephedrine from St Petersburg and the Kalinngrad region of Russia and opium from Lithuania and Ukraine being the preferred drugs) and sexually transmitted diseases. The latter is now so pressing a problem in the capital Riga that the city authorities recently launched a voluntary scheme of "health passports" for infection-free prostitutes and brothels. Most worrying of all, in the long run, is the falling population. Life-expectancy is among the lowest in Europe (61 for men, 73 for women), there is a regular excess of deaths over births, and abortions outnumber livebirths. According to a recent conference organised by the Latvian Academy of Sciences, the low birthrate is largely due to economic factors. 85% of all newly-weds in Latvia say they ’, want two or more children, yet only 8% have three children or more, 20% two, and 25% one. Various strategies were proposed to help remedy the situation. But the extra strain on the family budget produced by the new health-care charges will almost certainly prove yet another disincentive to parenthood.
i
Vera Rich
The Federal Medical Council (Bundesarztekammer) has founded a central ethics committee for Germany. It will act as an independent body with a maximum of 16 members from medical specialties and from philosophy, theology, natural sciences, social sciences, law, and politics. Patients are not represented. Prof Heinz Pichlmaier, a surgeon from Cologne will chair the committee for 3 years. The committee’s task is to define ethical priniciples for important medical issues. It will also develop ethical guidelines for medical practice. Local ethics committees at the regional medical councils or medical faculties, whose function is to give ethical approval for clinical studies can turn to the central committee for advice. An issue that will require ethical guidelines in the near future is preimplantation diagnoses. Scientists in Liibeck hope to test fertilised eggs for diseases such as cystic fibrosis before implanting them. However, apart from ethical issues, there is uncertainty about whether this practice contravenes the embryo-protection law, which forbids experiments with embryos. Annette Tuffs
433
Palestinian Authority encourages health insurance
who pay
at
the beginning of the
year.
The "huge pressure : from hospitals" has prevented
on government Fees for families will be reduced them from delivUS$38 to$25 per month, and family ering services to many insured. The hope coverage will extend not only to spouse is that raising hospital fees, especially for and dependent children under age 18, but maternity services, will alleviate this probalso to dependent nieces and nephews lem. The increase to about$100 per day and unmarried or divorced daughters, as ($200 for intensive care) is not intended well as to parents aged over 60 years. to restrict health care but to encourage the Youths over 18 years of age must pay uninsured to enrol. For example, of 485 $15 and students$6-60 per month. In cases entering the Alia Hospital in Hebron addition a 10% discount will be given to during May, only 80 were insured. In Gaza, some 70 000 families are insured today. Progress is slow for religious and cuts demolish USAID Palestinian health cultural reasons; many devout Moslems When the U S Congress approved an increase in the annual appropriation to consider insurance a form of gambling. the Palestinian Authority from US$22 to$75 million as of the new fiscal year, The PA is working on broad public health this promised support was made simultaneously with deep cuts to the USAID education (panel) as well as on revisions budget. Virtually overnight, the pen stroke wiped out the services of the to the health insurance plan to make it hundreds of local NGOs supported globally-not necessarily a bad move, say more attractive. some, arguing that "most NGOs have failed to democratise" (ie, work on Also to be resolved are the administrative and financial problems leading to specific projects with specific goals and budgets, professionally organised and run). shortages of medicines and supplies that are attributed in large part to widespread Ironically, at the same time, USAID reduced the PA’s Health Ministry budget million. in This cut USAID has demolished the Palestinian smuggling. In addition, the Ministry of by$23.5 funding Health is working to increase the number Health Systems Support Project (see Lancet 1994; 343: 1149)-a true of hospital beds from around 1000 in setback. Planning for this project began in 1993 with visits from American Gaza and in the West Bank. Finally, the an health and human services design teams and was intended to put in place of tertiary care, previously problem efficient, sustainable health-care system not only by developing end-user obtained by referring patients to Israel, is in public health information and distribution systems, but also by assisting dealt with in the short term by being training, with software and hardware supplementation for administrative and negotiating with Jordanian and Egyptian financial management. health ministries, and also by developing In the meantime, about$2 million has come from the Italian government and their own services.
To encourage greater enrolment in the Palestinian Authority’s health-insurance programme, insurance fees have as of this month been lowered, while hospital costs to the uninsured have been raised. Deputy Minister of Health, Dr Munzer Al-Sharif, also announced that there will be a uniform health-insurance system in Gaza and the West Bank, which used to be administered separately.
project
from the continuing support of the American-Jewish Joint Distribution Committee, to support health-information programmes.
Latvia
ceases
to
provide free health
Free medical care came to an end in Latvia last week. Under provisional rules that became operative on Aug 1, patients now have to pay up to 25% of the cost of treatment provided by the state medical sector. Many doctors have expressed fears that poorer patients will be unable to afford the charges. Some months ago, in a pilot scheme at the Riga clinical emergency hospital, one in eight of the patients were unable to pay the relatively modest charge of 45 santims a day. The new rules, being temporary, do not indicate what measures can be applied in the case of non-payment. : The introduction of the new rules comes at a time when the Latvian state sector generally, and the health service in : particular is increasingly strapped for : cash, partly because of the transitions : now taking place in the Latvian economy. : At the same time, epidemiologists report a significant increase in poverty-related : illnesses, in particular tuberculosis. Over : 1000 new cases of this disease were regis- : tered in 1994, and there is pressure for : ,
i
compulsory screening and,
:
necessary, compulsory treatment. is on the increase-213 too, Diphtheria, cases were reported in the first 6 months
:
regular
mass
if
of this year
(81 in June alone), of which
.
care
Rachelle H B Fishman
Central ethics committee symptomsformed in Germany
13 proved fatal. Other medical of economic malaise are a rise in drug addiction (with ephedrine from St Petersburg and the Kalinngrad region of Russia and opium from Lithuania and Ukraine being the preferred drugs) and sexually transmitted diseases. The latter is now so pressing a problem in the capital Riga that the city authorities recently launched a voluntary scheme of "health passports" for infection-free prostitutes and brothels. Most worrying of all, in the long run, is the falling population. Life-expectancy is among the lowest in Europe (61 for men, 73 for women), there is a regular excess of deaths over births, and abortions outnumber livebirths. According to a recent conference organised by the Latvian Academy of Sciences, the low birthrate is largely due to economic factors. 85% of all newly-weds in Latvia say they ’, want two or more children, yet only 8% have three children or more, 20% two, and 25% one. Various strategies were proposed to help remedy the situation. But the extra strain on the family budget produced by the new health-care charges will almost certainly prove yet another disincentive to parenthood.
i
Vera Rich
The Federal Medical Council (Bundesarztekammer) has founded a central ethics committee for Germany. It will act as an independent body with a maximum of 16 members from medical specialties and from philosophy, theology, natural sciences, social sciences, law, and politics. Patients are not represented. Prof Heinz Pichlmaier, a surgeon from Cologne will chair the committee for 3 years. The committee’s task is to define ethical priniciples for important medical issues. It will also develop ethical guidelines for medical practice. Local ethics committees at the regional medical councils or medical faculties, whose function is to give ethical approval for clinical studies can turn to the central committee for advice. An issue that will require ethical guidelines in the near future is preimplantation diagnoses. Scientists in Liibeck hope to test fertilised eggs for diseases such as cystic fibrosis before implanting them. However, apart from ethical issues, there is uncertainty about whether this practice contravenes the embryo-protection law, which forbids experiments with embryos. Annette Tuffs
433