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UN soldiers prepare for a different battle in Angola
THE LANCET
POLICY AND PEOPLE
No bypassing Dutch waiting lists by employed utch hospitals that have fixed contracts with insurance companies to enable employed people to bypass waiting lists face cuts in their budget. Public health minister Els Borst-Eilers said it is “unacceptable” for hospitals to give priority “on nonmedical grounds”. The Dutch health care system is characterised by equality and a difference in treatment for workers and non-workers is contrary to that principle, the minister said. Dutch hospitals have been short of eye, hip, and heart facilities and of personnel for some time. The inefficiency of the waiting lists has long been the subject of clashes between the employers’ organisation and insurance companies. Now, so called business-policlinics have been developed to bypass waiting lists for orthopaedic surgery and psycho-therapy, both of which normally have waiting lists of 3 months or more. The Health Inspectorate has been asked to investigate all existing plans to bypass waiting lists, and whenever the business plans or contracts include profits for the hospitals concerned, the minister will give orders
D
to the Economic Control Agency to cut their budget because these hospitals trespass the rules of the Health Care Charges Act. The employers’ organisation VNO/NCW has reacted angrily, saying that “the minister would be better using her energy to solve the waiting list problems, because they cost lots of money, instead of accusing the cooperating hospitals”. According to the employers’ organisation, waiting lists cost them between DFl 400 and 900 million each year. Since the government partly privatised health insurance last year, the employers pay these costs themselves. When questioned by socialist party member of parliament Jan Marijnissen, Borst-Eilers answered that the employed should not be ranked above jobless persons in Dutch public health institutions. An employers’ spokesman told the media “we need practical solutions instead of principled discussions”. Marjanke Spanjer
Mongolia fights cholera
S
ix people have died and a further 52 admitted to hospital in a cholera outbreak centred on the settlement of Khoetol in the Selenge province of Mongolia, Health Minister Lhagvajaviyn Zorig stated last week. 496 known contacts are also under medical observation. Zorig, addressing a special briefing of foreign diplomats and media correspondents, said that “experts” had tentatively attributed it to “low quality food”. An alternative explanation, according to the Yugoslav news agency Tanjug, is that it was triggered by the floods 2 weeks ago. In the past Mongolia depended largely on the Soviet Union for pharmaceutical supplies and now has few resources to deal with an outbreak. The government has imposed restrictions on rail travel hoping to contain the spread of the disease. At the same time, Zorig stressed, “all possible measures” are being taken to reduce public tension evoked by the news.
Vera Rich
UK interferon -1b trial for treatment of multiple sclerosis shelved iscussions about a proposed UK national trial to evaluate interferon -1b (IFN- ) for the treatment of multiple sclerosis (MS) have been “put on hold until a satisfactory outcome measure has been agreed”, says a Department of Health (DoH) spokesperson. Where this leaves patients who qualify for IFN- is unclear, because there is a widespread belief among patients and MS charities that some health authorities are withholding funding until the outcome of such a trial is known. The MS Society regrets the
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shelving of the trial but hopes it will end uncertainty for patients: “If the trial is not planned for the foreseeable future”, said the society in a statement issued on Aug 19, “there exists no reason for further delay on policy decisions by those health authorities who have been awaiting results of what has only ever been a potential national trial . . .” Another DoH spokesperson denied that IFN- treatment (which costs about £10 000 per patient per year) is being rationed but emphasised that patients considered for
IFN- had to meet strict criteria drawn up by the DoH in conjunction with the Association of British Neurologists and the MS Society. Only ambulant patients with relapsing-remitting MS are eligible for treatment, and they must have had at least two relapses in the 2 years before treatment starts. About 45% of the UK’s 80 000 MS patients have relapsing-remitting disease, and about 10 000 of these could qualify for treatment. Dorothy Bonn
UN soldiers prepare for a different battle in Angola
U
nited Nations soldiers will be joining relief workers in Angola in a massive effort to immunise children. Although the goal of this initiative is the complete eradication of poliomyelitis in Angola by the year 2000, UNICEF officials have their sights set on the elimination of all preventable childhood diseases throughout Africa. Relief workers are taking advantage of the relative calm brought about by a series of internationally brokered peace treaties
538
between the government and the rebel movement UNITA to start their immunisation programme. Originally, money for the programme was to have come from Olympic Aid, a fund that brought together the city of Atlanta, the International Olympic Committee, and UNICEF. The money raised had been earmarked for vaccination programmes in several African nations, including the Sudan and Afghanistan. But in Angola money
from Olympic Aid was needed to fund “trauma counselling” for youths (along with all the other horrors of civil war, Angola has gained something of a reputation for its large numbers of child soldiers). Consequently, it is the European Union that will actually be footing the bill for the immunisations in Angola, according to UNICEF officials. Robert Ivker
Vol 348 • August 24, 1996
POLICY AND PEOPLE
No bypassing Dutch waiting lists by employed utch hospitals that have fixed contracts with insurance companies to enable employed people to bypass waiting lists face cuts in their budget. Public health minister Els Borst-Eilers said it is “unacceptable” for hospitals to give priority “on nonmedical grounds”. The Dutch health care system is characterised by equality and a difference in treatment for workers and non-workers is contrary to that principle, the minister said. Dutch hospitals have been short of eye, hip, and heart facilities and of personnel for some time. The inefficiency of the waiting lists has long been the subject of clashes between the employers’ organisation and insurance companies. Now, so called business-policlinics have been developed to bypass waiting lists for orthopaedic surgery and psycho-therapy, both of which normally have waiting lists of 3 months or more. The Health Inspectorate has been asked to investigate all existing plans to bypass waiting lists, and whenever the business plans or contracts include profits for the hospitals concerned, the minister will give orders
D
to the Economic Control Agency to cut their budget because these hospitals trespass the rules of the Health Care Charges Act. The employers’ organisation VNO/NCW has reacted angrily, saying that “the minister would be better using her energy to solve the waiting list problems, because they cost lots of money, instead of accusing the cooperating hospitals”. According to the employers’ organisation, waiting lists cost them between DFl 400 and 900 million each year. Since the government partly privatised health insurance last year, the employers pay these costs themselves. When questioned by socialist party member of parliament Jan Marijnissen, Borst-Eilers answered that the employed should not be ranked above jobless persons in Dutch public health institutions. An employers’ spokesman told the media “we need practical solutions instead of principled discussions”. Marjanke Spanjer
Mongolia fights cholera
S
ix people have died and a further 52 admitted to hospital in a cholera outbreak centred on the settlement of Khoetol in the Selenge province of Mongolia, Health Minister Lhagvajaviyn Zorig stated last week. 496 known contacts are also under medical observation. Zorig, addressing a special briefing of foreign diplomats and media correspondents, said that “experts” had tentatively attributed it to “low quality food”. An alternative explanation, according to the Yugoslav news agency Tanjug, is that it was triggered by the floods 2 weeks ago. In the past Mongolia depended largely on the Soviet Union for pharmaceutical supplies and now has few resources to deal with an outbreak. The government has imposed restrictions on rail travel hoping to contain the spread of the disease. At the same time, Zorig stressed, “all possible measures” are being taken to reduce public tension evoked by the news.
Vera Rich
UK interferon -1b trial for treatment of multiple sclerosis shelved iscussions about a proposed UK national trial to evaluate interferon -1b (IFN- ) for the treatment of multiple sclerosis (MS) have been “put on hold until a satisfactory outcome measure has been agreed”, says a Department of Health (DoH) spokesperson. Where this leaves patients who qualify for IFN- is unclear, because there is a widespread belief among patients and MS charities that some health authorities are withholding funding until the outcome of such a trial is known. The MS Society regrets the
D
shelving of the trial but hopes it will end uncertainty for patients: “If the trial is not planned for the foreseeable future”, said the society in a statement issued on Aug 19, “there exists no reason for further delay on policy decisions by those health authorities who have been awaiting results of what has only ever been a potential national trial . . .” Another DoH spokesperson denied that IFN- treatment (which costs about £10 000 per patient per year) is being rationed but emphasised that patients considered for
IFN- had to meet strict criteria drawn up by the DoH in conjunction with the Association of British Neurologists and the MS Society. Only ambulant patients with relapsing-remitting MS are eligible for treatment, and they must have had at least two relapses in the 2 years before treatment starts. About 45% of the UK’s 80 000 MS patients have relapsing-remitting disease, and about 10 000 of these could qualify for treatment. Dorothy Bonn
UN soldiers prepare for a different battle in Angola
U
nited Nations soldiers will be joining relief workers in Angola in a massive effort to immunise children. Although the goal of this initiative is the complete eradication of poliomyelitis in Angola by the year 2000, UNICEF officials have their sights set on the elimination of all preventable childhood diseases throughout Africa. Relief workers are taking advantage of the relative calm brought about by a series of internationally brokered peace treaties
538
between the government and the rebel movement UNITA to start their immunisation programme. Originally, money for the programme was to have come from Olympic Aid, a fund that brought together the city of Atlanta, the International Olympic Committee, and UNICEF. The money raised had been earmarked for vaccination programmes in several African nations, including the Sudan and Afghanistan. But in Angola money
from Olympic Aid was needed to fund “trauma counselling” for youths (along with all the other horrors of civil war, Angola has gained something of a reputation for its large numbers of child soldiers). Consequently, it is the European Union that will actually be footing the bill for the immunisations in Angola, according to UNICEF officials. Robert Ivker
Vol 348 • August 24, 1996