Balancing Equity and Efficiency in Kidney Allocation: An Overview.

Organs for transplantation are a scarce resource. Markedly, the transplant community's primary challenge is the stark disparity between the number of patients awaiting deceased donor organ transplants and the rate at which organs become available. However, the allocation of a limited number of organs poses another constant challenge: maintaining an equilibrium between renal transplant utility and equity, that is, striking a balance between the utilitarian argument of medical efficiency and the principle of equity.

Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review.

Objectives: To review the characteristics and motivations of patients seeking second opinions, and the impact of such opinions on patient management, satisfaction and cost effectiveness.

Data Sources: Embase, Medline, PsycINFO and Health Management Information Consortium (HMIC) databases.

Study Design: A systematic literature search was performed for terms related to second opinion and patient characteristics.

Attitudes, knowledge, and preferences of the Israeli public regarding the allocation of donor organs for transplantation.

Background: There is a stark disparity between the number of patients awaiting deceased-donor organ transplants and the rate at which organs become available. Though organs for transplantation are assumed to be a community resource, and the organ supply depends on public willingness to donate, current allocation schemes do not explicitly incorporate public priorities and preferences. This paper seeks to provide insights regarding the Israeli public's preferences regarding criteria for organ (specifically, kidney) allocation, and to determine whether these preferences are in line with current allocation policies.

Second opinion utilization by healthcare insurance type in a mixed private-public healthcare system: a population-based study.

Objectives: To evaluate the utilisation (overall and by specialty) and the characteristics of second-opinion seekers by insurance type (either health fund or supplementary insurance) in a mixed private-public healthcare.

Design: An observational study.

Setting: Secondary care visits provided by a large public health fund and a large supplementary health insurance in Israel.

Reasons, perceived outcomes and characteristics of second-opinion seekers: are there differences in private vs. public settings?

Background: In most countries, patients can get a second opinion (SO) through public or private healthcare systems. There is lack of data on SO utilization in private vs. public settings.

Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel.

Background: Seeking a second-opinion (SO) is a common clinical practice that can optimize treatment and reduce unnecessary procedures and risks. We aim to characterize the composition of the population of SO seekers, their reasons for seeking a SO and choosing a specific physician, and their perceived outcomes following the SO.

Methods: A cross-sectional national telephone survey, using a representative sample of the general Israeli population (n = 848, response rate = 62%).

Second Medical Opinion: Utilization Rates and Characteristics of Seekers in a General Population.

Background: Second opinion (SO) is common in medical practice and can reduce unnecessary risks and costs. To date, there is no population-based estimation of how many people seek SOs and what the characteristics of second-opinion seekers are.

Objectives: To estimate how many people seek SOs, and what the characteristics of second-opinion seekers are.

Enhancing patient-doctor-computer communication in primary care: towards measurement construction.

Objective: The traditional dyadic dynamics of the medical encounter has been altered into a triadic relationship by introducing the computer into the examination room. This study defines Patient-Doctor-Computer Communication (PDCC) as a new construct and provides an initial validation process of an instrument for assessing PDCC in the computerized exam room: the e-SEGUE.

Material And Methods: Based on the existing literature, a new construct, PDCC, is defined as the physician's ability to provide patient-centered care while using the computer during the medical encounter.

Role of intervention programs to increase influenza vaccination in Israel.

Background: Influenza vaccination is the most efficient and cost-effective method to prevent influenza. To increase vaccination coverage, health authorities use various intervention programs (IPs), such as cost subsidies or placing vaccination centers in malls to make vaccination more accessible. Nevertheless, vaccination coverage has been sub-optimal in most developed countries, including in Israel.

An innovative influenza vaccination policy: targeting last season's patients.

Influenza vaccination is the primary approach to prevent influenza annually. WHO/CDC recommendations prioritize vaccinations mainly on the basis of age and co-morbidities, but have never considered influenza infection history of individuals for vaccination targeting. We evaluated such influenza vaccination policies through small-world contact networks simulations.

Existing instruments for assessing physician communication skills: are they valid in a computerized setting?

Objectives: This study aims to highlight the differences in physicians' scores on two communication assessment tools: the SEGUE and an EMR-specific communication skills checklist. The first tool ignores the presence of the EMR in the exam room and the second, though not formally validated, rather focuses on it.

Methods: We use the Wilcoxon Signed Ranks Test to compare physicians' scores on each of the tools during 16 simulated medical encounters that were rated by two different raters.

Orthopedic surgeons' and neurologists' attitudes towards second opinions in the Israeli healthcare system: a qualitative study.

Background: Second opinion is a treatment ratification tool that may critically influence diagnosis, treatment, and prognosis. Second opinions constitute one of the largest expenditures of the supplementary health insurance programs provided by the Israeli health funds. The scarcity of data on physicians' attitudes toward second opinion motivated this study to explore those attitudes within the Israeli healthcare system.

Patient-physician relationships in second opinion encounters - the physicians' perspective.

Theories on the patient-physician relationship have evolved within the last decades to portray a nuanced picture of the traditional patient-physician "dyad". Shifts in social, economic, and technological contexts in which the physician-patient encounters are taking place raised the need for more complex frameworks to study patient-physician encounters. One example of a change to this dyad is the increasing use of second opinions.

Do first opinions affect second opinions?

Background: Second medical opinions have become commonplace and even mandatory in some health-care systems, as variations in diagnosis, treatment or prognosis may emerge among physicians.

Objective: To evaluate whether physicians' judgment is affected by another medical opinion given to a patient.

Design: Orthopedic surgeons and neurologists filled out questionnaires presenting eight hypothetical clinical scenarios with suggested treatments.

[Second medical opinions].

Second opinion is a decision-support tool for ratification or modification of a suggested treatment, by another physician. Second opinion may have a critical influence on the diagnosis, treatment and prognosis. The patient can benefit from treatment optimization and avoid unnecessary risks.

Optimal timing of joint replacement using mathematical programming and stochastic programming models.

The optimal timing for performing radical medical procedures as joint (e.g., hip) replacement must be seriously considered.

[Can linking co-payment for drugs to evidence on treatment value improve health outcomes and contain healthcare costs?].

Co-payment strategies are frequently used by health insurers as a measure of containing healthcare costs. However, co-payments may reduce the use of essential drugs in chronically-ill patients. Recently, value-based insurance designs, where co-payments rates are determined by the value of the treatment, have been introduced in the United States.

Electronic notifications about drug substitutes can change physician prescription habits: a cross-sectional observational study.

Background: A health maintenance organization (HMO) provides physicians with electronic notifications regarding HMO-recommended drug substitutes.

Objective: Investigating factors affecting physicians' compliance and evaluating associated cost savings.

Design: A cross-sectional observational study of all physicians in the HMO's clinics from June 2005 to February 2006.

The process of updating the National List of Health Services in Israel: is it legitimate? Is it fair?

Objective: The Israeli National Health Insurance Law stipulates a National List of Health Services (NLHS) to which all residents are entitled from their HMOs. This list has been updated annually for almost a decade using a structured review and decision-making process. Although this process has been described in detail in previous papers, none of these have fully addressed legitimacy and fairness.

Peer review in publication: factors associated with the full-length publication of studies presented in abstract form at the annual meeting of the Society for Medical Decision Making.

Background: : Many studies are presented at scientific meetings and are summarized in abstract form prior to their full-length publication. Publication rates of these studies may be an indicator in judging their quality.

Objectives: To determine the rate at which studies reported in an abstract form are subsequently published in full length and identify factors associated with publication success.

A computerized surveillance system for the quality of care in childhood asthma.

This article describes the development of a novel model for quality assurance of pediatric asthma using administrative data and clinical guidelines. Children for whom drugs for asthma were dispensed during 1998 were recruited from the drug-dispensing registry of the largest health maintenance organization in the southern region of Israel. The Israeli clinical guidelines were translated into a list of six markers for inadequate treatment.

Evaluation of pooled screening for anti-HCV in two blood services set-ups.

Objective: Screening blood donations for anti-HCV is only partially performed in many developing countries due to the relatively high costs of testing. The screening expenditures can be reduced by testing donations in pools. This study evaluates the accuracy and feasibility of pooled screening procedure for anti-HCV in blood banks in Israel and the Palestinian Authority.

Accuracy and cost-benefit of pooled versus singleton screening blood donations for anti-HIV: impact on different blood bank set-ups.

This study evaluates the accuracy and cost-benefit of implementing a pooled screening procedure in blood banks in general and especially in developing countries. The sensitivity of pooled testing was found to be relatively high, with the lowest levels estimated at about 98% for pools consisting of three, six, and 12 samples. Screening in pools of up to 12 samples is expected to be economically beneficial in countries with HIV prevalence rates of 8-10%, which cannot afford the cost of care for an HIV-infected patient.

Defining localities of inadequate treatment for childhood asthma: a GIS approach.

Background: The use of Geographic Information Systems (GIS) has great potential for the management of chronic disease and the analysis of clinical and administrative health care data. Asthma is a chronic disease associated with substantial morbidity, mortality, and health care use. Epidemiologic data from all over the world show an increasing prevalence of asthma morbidity and mortality despite the availability of effective treatment.