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Swiss review their health-insurance burden
THE LANCET
POLICY AND PEOPLE
Japanese hospital list starts worry about HIV
J
apanese medical hotlines were flooded with hundreds of inquiries last week from non-haemophiliac patients concerned that they may have received HIV-contaminated blood products in the 1980s. On Oct 7, the Ministry of Health and Welfare released a partial list of hospitals that purchased unheated blood-clotting agents between 1978 and 1988 and urged people who were treated for excessive bleeding and were most at risk, to have HIV tests. Of the 2413 hospitals which received unheated blood products during the 10 years, 344 hospitals were selected for the ministry’s list. 57 of these had closed down before the search began and 287 could not provide adequate patient records. The remaining hospitals were considered to have sufficient patient records and were not placed on the list. However, many administrators at hospitals on the list expressed anger about the sloppy way in which the list was compiled. The search to identify nonhaemophiliac patients of the blood scandal began after haemophiliacs and their families won an out of court settlement against the government and five pharmaceutical companies in late March. A search had not begun earlier, claimed Akihito Matsumura, former head of the ministry’s Biologics and Antibiotics Division, because the risk to nonhaemophiliacs was not known until June, 1994, when a ministry study team reported on the first HIV infection of a non-haemophiliac. Yet a top ministry official had testified in 1988 before a Lower House committee, that unheated blood products had been used to treat nonhaemophiliacs. Prosecutors have also argued that Matsumura and others ignored an US Food and Drug Administration memo warning blood producers to dispose of unheated blood products as early as 1983. Matsumura, along with a doctor and three drug firm executives, has since been arrested on charges of professional negligence resulting in the death of two patients. So far 12 non-haemophiliacs and more than 1800 haemophiliacs have been infected in the nationwide tragedy. Ed Gutierrez, Guy Netley
Vol 348 • October 19, 1996
Swiss review their health-insurance burden
A
lthough originally intended to ensure equitable basic premiums throughout the country and curb health-service costs, the new Swiss sickness-insurance law, in force since Jan 1, has had the opposite effect. Charges for 1997 show wide regional variations and continue to rise. If the overall average increase of 12% is half that introduced in the current year, more substantial rises are forecast as likely for 1998. Premiums for 1997 are strikingly higher in French-speaking Suisse Romande than in the German-speaking cantons. An extreme example is the SwFr298 (US$225) being paid in Geneva compared with SwFr127 in Appenzell Inner-Rhodes Since the actual rise in Geneva health-service costs has been under 3%, the authorities there propose asking the federal government if they can inspect the accounts of medical insurance companies and set premiums—which is what they did for two decades until, under the new law, this responsibility passed to the Office of Social Affairs in Bern. Emphasising that the politicians
are failing to appreciate the gravity of the situation, Hans Heinrich Brunner, the President of the Swiss Medical Federation, has said that further “overloading” could lead to the collapse of the system, as health insurance companies compete in advertising inducements for new members. As a result, for many thousands of patients changing their insurer has become like a lottery. By what seems an unlikely co-incidence, a survey just published compares the incidence within Switzerland of five types of surgical interventions with rates in France. Based on 1992–93 official statistics and interviews with 15 288 people aged 15–74, the survey finds that tonsil, uterus, gallbladder, appendix, and hip operations are 40% more common among the Swiss than they are among the French. It also notes how some cantons seem to “specialise” in certain operations—eg, residents of Vaud canton are twice as likely to lose their appendix as those of Zurich (33% vs 17%). Alan McGregor
Israel’s food labels get specific guidelines
T
he Israeli parliament’s Labour and Social Affairs Committee on Oct 7 passed amendments prepared by the Health Ministry that would allow food companies to make specific nutritional health claims for their products. The previous blanket ban on such claims was replaced by specific rules indicating exactly what wording may be used. Also, a standard definition was drafted of how many grammes per hundred constitutes a “low” or “high” amount of sodium, dietary fibre, or fat. For example, the labelling for foods low in saturated fats (no more than 1·5g per 100g food) can state that a reduction in fat intake might decrease risk of development of cardiovascular disease. Low salt products (no more than 40mg sodium per 1200g of food) can advertise that the prevention of the development of
hypertension could be enhanced by low salt foods. High-fibre food products (at least 6g per 100g of food) may be labelled as part of a nutritional prevention diet against development of cardiovascular disease and certain cancers. “The Ministry saw the trend in the United States to help consumers who are seeking a healthier life style to choose certain kinds of diets that have been shown to decrease risk of developing certain kinds of diseases. Like the USA, Israel has a mandatory nutritional labelling law, similar to the voluntary labelling recommended by the European Union (eg, if a label claims to be low fat it must specify contents). This regulation is in no way related to claims about herbal medicine”, said Elana Mayshar, an attorney in the Ministry of Health who was influential in drafting the regulation. Rachelle HB Fishman
1093
POLICY AND PEOPLE
Japanese hospital list starts worry about HIV
J
apanese medical hotlines were flooded with hundreds of inquiries last week from non-haemophiliac patients concerned that they may have received HIV-contaminated blood products in the 1980s. On Oct 7, the Ministry of Health and Welfare released a partial list of hospitals that purchased unheated blood-clotting agents between 1978 and 1988 and urged people who were treated for excessive bleeding and were most at risk, to have HIV tests. Of the 2413 hospitals which received unheated blood products during the 10 years, 344 hospitals were selected for the ministry’s list. 57 of these had closed down before the search began and 287 could not provide adequate patient records. The remaining hospitals were considered to have sufficient patient records and were not placed on the list. However, many administrators at hospitals on the list expressed anger about the sloppy way in which the list was compiled. The search to identify nonhaemophiliac patients of the blood scandal began after haemophiliacs and their families won an out of court settlement against the government and five pharmaceutical companies in late March. A search had not begun earlier, claimed Akihito Matsumura, former head of the ministry’s Biologics and Antibiotics Division, because the risk to nonhaemophiliacs was not known until June, 1994, when a ministry study team reported on the first HIV infection of a non-haemophiliac. Yet a top ministry official had testified in 1988 before a Lower House committee, that unheated blood products had been used to treat nonhaemophiliacs. Prosecutors have also argued that Matsumura and others ignored an US Food and Drug Administration memo warning blood producers to dispose of unheated blood products as early as 1983. Matsumura, along with a doctor and three drug firm executives, has since been arrested on charges of professional negligence resulting in the death of two patients. So far 12 non-haemophiliacs and more than 1800 haemophiliacs have been infected in the nationwide tragedy. Ed Gutierrez, Guy Netley
Vol 348 • October 19, 1996
Swiss review their health-insurance burden
A
lthough originally intended to ensure equitable basic premiums throughout the country and curb health-service costs, the new Swiss sickness-insurance law, in force since Jan 1, has had the opposite effect. Charges for 1997 show wide regional variations and continue to rise. If the overall average increase of 12% is half that introduced in the current year, more substantial rises are forecast as likely for 1998. Premiums for 1997 are strikingly higher in French-speaking Suisse Romande than in the German-speaking cantons. An extreme example is the SwFr298 (US$225) being paid in Geneva compared with SwFr127 in Appenzell Inner-Rhodes Since the actual rise in Geneva health-service costs has been under 3%, the authorities there propose asking the federal government if they can inspect the accounts of medical insurance companies and set premiums—which is what they did for two decades until, under the new law, this responsibility passed to the Office of Social Affairs in Bern. Emphasising that the politicians
are failing to appreciate the gravity of the situation, Hans Heinrich Brunner, the President of the Swiss Medical Federation, has said that further “overloading” could lead to the collapse of the system, as health insurance companies compete in advertising inducements for new members. As a result, for many thousands of patients changing their insurer has become like a lottery. By what seems an unlikely co-incidence, a survey just published compares the incidence within Switzerland of five types of surgical interventions with rates in France. Based on 1992–93 official statistics and interviews with 15 288 people aged 15–74, the survey finds that tonsil, uterus, gallbladder, appendix, and hip operations are 40% more common among the Swiss than they are among the French. It also notes how some cantons seem to “specialise” in certain operations—eg, residents of Vaud canton are twice as likely to lose their appendix as those of Zurich (33% vs 17%). Alan McGregor
Israel’s food labels get specific guidelines
T
he Israeli parliament’s Labour and Social Affairs Committee on Oct 7 passed amendments prepared by the Health Ministry that would allow food companies to make specific nutritional health claims for their products. The previous blanket ban on such claims was replaced by specific rules indicating exactly what wording may be used. Also, a standard definition was drafted of how many grammes per hundred constitutes a “low” or “high” amount of sodium, dietary fibre, or fat. For example, the labelling for foods low in saturated fats (no more than 1·5g per 100g food) can state that a reduction in fat intake might decrease risk of development of cardiovascular disease. Low salt products (no more than 40mg sodium per 1200g of food) can advertise that the prevention of the development of
hypertension could be enhanced by low salt foods. High-fibre food products (at least 6g per 100g of food) may be labelled as part of a nutritional prevention diet against development of cardiovascular disease and certain cancers. “The Ministry saw the trend in the United States to help consumers who are seeking a healthier life style to choose certain kinds of diets that have been shown to decrease risk of developing certain kinds of diseases. Like the USA, Israel has a mandatory nutritional labelling law, similar to the voluntary labelling recommended by the European Union (eg, if a label claims to be low fat it must specify contents). This regulation is in no way related to claims about herbal medicine”, said Elana Mayshar, an attorney in the Ministry of Health who was influential in drafting the regulation. Rachelle HB Fishman
1093