[Health care systems and impossibility theorems].

Health care systems, amongst the most complicated systems that serve mankind, have been in turmoil for many years. They are characterized by widespread dissatisfaction, repeated reforms and a general perception of failure. Is it possible that this abominable situation derives from underlying causes, which are inherent to the most basic elements of these systems? Those elements compromise the use of words and definitions in the formulation of their principles and their way of action, in their logical structure as well as in the social order in which they exist.

[On healthcare quality].

The quality of health care can be defined and measured. The "health basket" and private practice are parameters on the quality of care, whilst each has its problems and is under attack. Additional factors influencing the quality of care are: under-use, over-use and ill-use.

Quantity in health care is not always a substitute for quality.

Examines the outcomes of attempts to improve health services in the former Communist countries of Eastern Europe and in the West European democracies. Discovers that while the East Europeans focused their efforts on increasing the numbers of doctors and beds per patient, while keeping to relatively low levels of investment in technological advances, West European countries have taken the opposite approach, emphasizing quality of care, particularly advanced care, reducing the numbers of physicians and hospital beds, acquiring advanced technological systems for diagnosis and treatment and spending ten times as much per patient as in Eastern Europe. Concludes that the West European approach has led to far better results.

Redesigning a national healthcare system: the Israeli experience.

In 1988 the Government of Israel appointed a Commission of Inquiry (of which the authors were members) to examine the state of its health-care services. Although relating to Israel, some of the problems contributing to the crisis in the health services are shared by other industrialized nations. In 1991 the findings and recommendations of the Commission were adopted by the Government.

Home care therapy for respirator-dependent patients.

Our experience with 13 patients suffering from various ventilatory disorders who received mechanical ventilation at home for periods between 1 and 12 years is presented. Seven of the 13 patients were ventilated by positive pressure via tracheostomy, 3 by negative body ventilators and 3 by exufflation belt and positive pressure. Only a few hospitalizations were required due to pulmonary complications, and there was no case of sudden death occurring at home.

Alternative methods of hospital remuneration in Israel.

The current method of remunerating hospitals by an average per diem fee tends to over-reimburse hospitals that have a concentration of departments whose true costs are less than the average price received. Hospitals with a high concentration of expensive high-technology service departments whose true costs are more than the average price received will be under-reimbursed and are obliged to cover their running deficits by other means, e.g.

Technique for cellular microsurgery using the 193-nm excimer laser.

A new cell surgery technique has been developed to produce well-defined alterations in cells and tissue without detectable heating and/or other structural damage in the surroundings. The technique involves the use of an argon fluoride excimer laser, in the deep ultraviolet (UV) region of the spectrum at 193 nm, which is guided through a glass pipette filled with a positive air pressure. To demonstrate the method, holes were drilled in the zona pellucida of mouse oocytes.

Israel's expenditure on health services.

In 1986, the State of Israel utilized 7.6% of its gross national product (GNP) for health care. At first glance this seems to be a reasonable level of expenditure when compared with the percentage of GNP devoted to health care in eight selected industrialized non-communist nations.

The choice between splenectomy and medical treatment in patients with advanced agnogenic myeloid metaplasia.

The objective of the study was to explore the risks and benefits of splenectomy in advanced agnogenic myeloid metaplasia (AMM). We searched the literature (Medline, 1970-1987) for studies of postoperative survival, operative mortality and effects of splenectomy on painful splenomegaly, and portal hypertension or transfusion requirements in patients with AMM. We employed formal decision analysis to determine the relative value of medical and surgical treatment of advanced AMM.

Toward the development of a technology assessment methodology in medical diagnosis and therapy.

Existing priorities for the provision of health care are increasingly seen to be arbitrary and inequitable. The informed public in developed countries is demanding a rational, consistent and responsible program for the apportioning of health resources, both in their own and in Third World nations. An evaluation methodology is proposed for measuring the main aspects of a nation's health.