Primary Health Care: Public Involvement, Family Medicine, Epidemiology, and Health Economics

271 Pages·1990·38.367 MB·English

by  Petra Bergerhoff, Dieter Lehmann, Peter Novak (eds.)

HEALTH SYSTEMS RESEARCH
Edited by K. Davis and W. van Eimeren
Petra Bergerhoff Dieter Lehmann
Peter Novak (Eds.)
Primary Health Care
Public Involvement, Family Medicine, Epidemiology,
and Health Economics
With 36 Figures and 56 Tables
Springer-Verlag Berlin Heidelberg New York
London Paris Tokyo Hong Kong Barcelona
Dr. phil., dipl. pad. Petra Bergerhoff
University of Ulm, Department of Medical Sociology
Am HochstraG 8, 7900 Vim, Federal Republic of Germany
Dipl. oec. Dieter Lehmann
Community of Vim, Social Welfare Office
and Youth Welfare Office
SchwambergerstraBe 1,7900 Vim, Federal Republic of Germany
Professor Dr. med. Dr. phil. Peter Novak
University of VIm, Department of Mcdical Sociology
Am HochstraB 8, 7900 VIm, Federal Republic of Germany
ISBN-t3: 978-3-540-18426-3 e-ISBN-t3:978-3-642-83240-6
001: to.l007/978-3-642-83240-6
Library of Congress Cataloging-in· Publication Data
Primary health care: public involvement, family medicine, epidemiology. and health eco,
nomics / Petra Bergerhoff. Dieter Lehmann. Peter Novak, eds. p. cm.-(Htalth systems
research) Proceedings of a conference organized by the University of Ulm, Department of
Medical Sociology (Springer-Verlag Berlin Heidelberg New York).
(SpringcrNerlag New York Berlin Heidelherg) I Medical care-Con
gresses. 2. Medical policy-Cong,es",s. 3. Medical economics-Congresses. 4. Family medi
cine-Congresses. I. Bergerhoff, Petra, \953-. II. Lehmann. Dieter. 1956- . III. Novak,
Pcter, 1937- IV. Universitiit Ulm. Abtci!ung Medizinischc Soziologie. V. Se.ie •.
RA4l2.P734 1990 362.I-dc20 90-10203 CIP
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Acknowledgements
This volume of proceedings shows the discussion of an international
symposium and an associations-forum entitled Primary Health Care,
Epidemiology and Health Economics. The conference was orga
nized by the University of Vim. Department of Medical Sociology, and
supported by the Gennan Ministry of Youth, Family. Women and
Health (BMJFFG) in cooperation with the European Regional Bureau
of the World Health Organization (WHO).
We want to express our thanks
to the German Ministry of Youth, Family. Women and Health and to
the WHO EURO for their financial and active support of the con
ference
to the administration of our university for supporting the edition of
this volume
to the authors and participants of the symposium and the associations
forum for turning the conference into a lively meeting and an inter
disciplinary discussion
to Jennifer Hartog for the precise and sensitive translating
to Sabine Bottcher and Rita Linderunayer for the excellent typing
and, last not least, to the Springer Publishing Company, especially to
Dr. Graf-Baumann, for remaining patient even though the com
pletion of the proceedings volume took a "little bit" more time than
planned.
Vim, May 1990 P. Bergerhoff
D. Lehmann
P. Novak
Table of Contents
Introduction
P. Bergerhoff, D. Lehmann, P. Novak . ........ . . .. •...•.... 1
Part 1: Primary Health Care and Public Involvement
Principles and Aims of a Future Health Policy
H. Stein . ..................................... •..... 9
Health for All by the Year 2000: Economic Aspects of
a European Health Policy for the 19805 and 1990s
H. F. K. Zollner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 15
Conditions of Regional Health Care in Research and Practice
P. Novak . .......................... '. .............. 23
The "Primary Health Care of a Region" Associations Forum:
A First Report
D. Lehmann . ....................................... 30
Part 2: Primary Health Care and Familiy Medicine
The Use of Clinical Judgment to Evaluate the Therapeutic
Efficacy of Critical Care Units
F.L. Sax & ME. Charlson . ............... .............. 45
Education and Research in Family Medicine
G.R. Parkerson, Jr .. .....................•............ 56
Towards Family Sensitive Health Care
fl.L. Lennard . .................. .. ................. . 65
Analysis of the Scope of Action in General Medicine and Its
Empirical Control
n
... . ..................
K~......
Organization and Research Program of The Netherlands
Institute of Primary Health Care
P.P. Groenewegen, J. van der Zee ............ ............ 89
vm
Table of Contents
Health Center - Integrated Primary Health Care Resources and
Services Within the District and Coordinative Role of General
Practice
H. Ramie . ........................................ 101
Part 3: Primary Health Care and Epidemiology
Health Promotion of Chronically III Heart Patients
B. Badura . ........................................ 121
Regional Variation in the Supply of Medical Care and
in "Avoidable Mortality" Within Countries of
the European Community
J.P. Mackenbach, A.E. Kunst . .......................... 136
Teaching Clinical Epidemiology in a School of Medicine:
Opportunities and Challenges
T.S. Carey . ....................................... 144
Results from a Hypertension Care Program in One of
the Swedish Counties
S.-O.lsacsson, L. Rastam .............................. 152
Part 4: Primary Health Care and Health Economics
Performance Review in British Primary Health Care:
An Epidemiological and Economic Evaluation
I. Russell, C. Donaldson, C Fay, E. Towner, P. Philips, L. Parker,
E. McColl, A. Hutchinson, R. Humphrey, M. Ho, J. Hewison,
E. Haimes, A. Barton, C. Bamford, J. Addington-Hall. . . . . . . .. 165
Primary Medical Care Finance and Physician Payment Systems:
A European Perspective
J. F. Forbes . .......... ............................. 181
Health Economic Aspects of Multimorbidity in Outpatient
Medical Care
J. John, D. Schwefel ........ ................ .. ....... 201
Medical Care and Social Security
K. Spremann ................... , ... , . , . , . , . , . • . . .. 223
Table of ConlenlS IX
Costs and Effectiveness of Alternative Approaches to the Care
of the Mentally Handicapped: Dlustrations with Irish Data
D. Brennan, B. Walsh . ............................... 232
Reducing the Social Costs of Alcohol Abuse - Selecting Targets
for Intersector Planning and Action
f.L. Roberts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 239
Part 5: Institutionalizing Primary Health Care
Institutionalizing Primary Health Care at the Level of Under
graduate Education - Didactic and Structural Considerations
fI.G. Pauli. . . . . . . . . . . . . . . . . . . . . . . . . . . ... . 2. 5.3 . . . . . . .
Institutional Requirements for a Regional Comprehensive Health
Care System: A Panel Discussion
P. Bergerhoff . ..................................... 263
List of Contributors
Badura, Bernhard, Prof. Dr.
Institute of Sociology, Technial University of Berlin, Fachbereich 2,
DovestraBe 1, D-1000 Berlin 10, Federal Republic of Germany
Bergerhoff, Petra, Dr.
Department of Medical Sociology. University of Vim, Am Hochstraess
8, D-7900 UIm, Federal RepubLic of Gennaoy
Brennan, David, Ph.D.
Department of Political Economy, Univer~ity College Dublin,
Arts/Commerce Building Belfield, Dublin 4, Ireland
Carey, Timothy S., M.D.
University of North Carolina, School of Medicine, Department of
Medicine and Clinical Epidemiology, Box 2, 5039 Old Clinic Building.
ChapeL Hill, NC 27514, USA
Char/son, Mary E., Prof. M.D.
General Medicine Consultation Service and Clinical Epidemiology
Unit, Cornell University Medical College, 515 East 71st Street, New
York, NY 10021, USA
Forbes. John F., Dr.
Social Paediatric and Obstetric, Research Unit, University of Glasgow,
64 Oakfield Avenue, Glasgow G12 81S, United Kingdom
Groenewegen, Peter P .• Dr.
Netherlands Institute for Primary Health Care (NIVEL), Poslbus 1568,
Drieharingstraat 26, NL-3500 Utrecht BN, The Netherlands
/sacsson, Sven·Oloj, Prof. Dr.
University of Lund, Department of Community, Health Sciences, Social
Medicine, Bangatan 5, S·214 26 Maimoe, Sweden
John, Jurgen. Dr.
Gesellschaft fUr Strahlen· und Umweltforschung mbH (gsf),
KUhbachstraBe II, 8000 MUnchen 90, Federal Rebublic of Gennany
XlI List of Contributors
lark, Klaus, Prof. Dr.
Institute General Medicine, Hospital of the J .W. Goethe·University.
Theodor-Stem-Kai 7, D-6000 FrankfurtlMain 70, Federal Republic of
Germany
Kunst, Anton E., M.A.
Department of Public Health and Social Medicine, Erasmus University,
P.O. Box 1738, NL-3000 DR Rotterdam, The Netherlands
Lehmann, Dieter, Dip/. oec.
City of Uhn, Social Welfare Office, Schwambergstr. I, D-7900 Uhn,
Federal Republic of Germany
Lennard, Henry L. Prof. Ph.D.
t
106 Heady Creek Lane, Box QQQ, Southampton, New York 11968,
USA
Mackenbach, lohan p" Dr.
Department of Public Health and Social Medicine, Erasmus University,
P.O.Box 1738, NL-3000 DR Rotterdam, The Netherlands
Novak, Peter, Prof. Dr. Dr.
Department of Medical Sociology. University of VIm, Am Hochstraess
8, D-7900 Ulm, Federal Republic of Germany
Pauli, Hannes G _, Prof. Dr.
Institut fur Ausbildungs- Dod Examensforschung, Medizinische
Fakultat dec Universitat Bern, Inselspital14c, CH-3010 Bern,
Switzerland
Parkerson. George R .• Jr .• M.D.
Department of Community and Family Medicine. Duke University
Medical Center, 407 Chrutchfield Street, Durham, NC 27704, USA
Ramie. Hamdija, Dr.
Research and Education Unit, Institute of Social Medicine and
Organization of Health, 29 Novembra 54, YU-llOO Belgrade,
Yugoslavia
Rastam, Lennart, M.D., Ph.D.
University of Lund, Department of Community, Health Sciences,
ALLMANMEDIZIN, Bangatan 5, S-214 26 Mahnoe, Sweden
List of Contributors XlII
Roberts, John L., Dr.
Adhealth, Coach House, Hockerly Lane, Whaley Bridge, Stockport,
Cheshire - SK12 7AS, United Kingdom
Russell, lan, Dr.
Health Services Research Unit, University of Aberdeen, Department of
Community Medicine, University Medical Buildings, Foresterhill,
Aberdeen AB9 2ZD, United Kingdom
Julia Adding/on-Hall (also St George's Hospital Medical School,
London), Claire Bamford, Andrew Barton, Cam Donaldson (also
University of Sydney), Christopher Foy, Erica Haimes (also
University of Sterling), Jenny Hewison (also University of Leeds),
Mary Ho (also University of Hong Kong), Robin Humphrey, Allen
Hutchinson, Elizabeth Towner, Elaine McColl, Louise Parker and
Peter Philips are members of the research team.
Sax, Frederic L., M.D.
Francis Scott Key Medical Center, 4940 Eastern Avenue, Baltimore,
Maryland 21224, USA
SchweJel, DelleJ, Prof. Dr.
Gesellschaft fUr Strahlen- und Umweltforschung mbH (gsf).
Kuhbachstralle 11, 8000 Munchen 90, Federal Rebublic of Germany
Spremann, Klaus, Prof Dr.
Department of Economics, University of UIm, Oberer Eselsberg N 25,
D-7900 UIm, Federal Republic of Germany
Stein, Hans, Dr.
Bundesministerium fUr Jugend, Famiiie, Frauen und Gesundheit,
KennedyaUee 105-107, D-53oo Bonn 2, Federal Republic of Germany
Walsh, Brendan, Prof
Department of Political Economy, University CoUege Dublin,
Arts/Commerce Building Belfield, Dublin 4, Ireland
Zee. Jouke van der. Prof Dr.
Netherlands Institute for Primary Health Care (NIVEL), Postbus 1568,
Drieharingstraat 26, NL-3500 BN Utrecht, The Netherlands
Zollner, Herbert F.K., Ph.D.
Regional Officer for Health Economics, World Health Organization, 8,
Schetfigsvej, DK-2100 Copenhagen, Denmark