Das Gesundheitswesen
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Health Care Systems Clutch at a Straw: The health care systems of sub-Saharan Africa are facing a global crisis which is severely challenging their survival. Currently, alternatives to the traditional financing of health care by government grants and/or "fee for service" are sought. Otherwise the vast majority of poor rural inhabitants of these countries will lose access to Western medicine at the end of this century, making appropriate medical care a privilege of a small number of rich urbans. ⋯ However, the culture of African people must also be considered if one attempts to design and implement an insurance scheme. This paper reflects some of the problems of health insurance in an African context. Since the author contributed to the design of a "Community Based Health Insurance" of the Evangelical Lutheran Church in Tansania, this scheme is used here as an example.
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Applied epidemiology emphasizes the study of the distribution and determinants of disease and health in populations and the application of this study to the control of health problems of immediate public health consequence. Outbreak investigation symbolizes the use and methodology of applied epidemiology for public health. The steps of an outbreak investigation are summarized. Development of a network for applied infectious disease epidemiology involving health departments and other institutions is being built in Germany through epidemiologic training, building communication systems, providing support for outbreak investigation, development of national reference laboratories, and building a comprehensive research program.
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Advantages and setbacks of the existing Swiss disease notification system are reviewed. The public takes interest in the notification data output. ⋯ It is intended to lower this number to < 30. Other measures to upgrade the system include annual review and publication of an updated list of notifiable diseases, limitation to an essential core of parameters collected from physicians on initial and follow-up questionnaires, and practical advice on diagnostic and control measures provided for in questionnaires for the infectious disease under query.
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The development of the French mental health system of community psychiatry in the last few decades has led to a continuous augmentation of ambulatory care and a notable reduction of beds in psychiatric hospitals. There are considerable differences between different types of patients, hospitals, sectors and regions. ⋯ In the 90's, the deficit in the social security system resulted in great economic pressure. The care systems has introduced fixed budgets, financial autonomy of the hospitals and centralised coordination; the economic instrumentalisation of the intended economical cost assessment modest model of traditional means.