Setting limits through global budgeting: hospital cost containment in Rhode Island

In 1974, hospitals in Rhode Island have participated in annual negotiations with state officials and representatives from Blue Cross to determine the allowed increase in statewide hospital costs (the "Maxicap") for the next fiscal year, based on projected increases in hospitals' revenues, changes in patient volume and operating expenses. Individual hospital budgets may be above or below the Maxicap as long as the total increase in hospital costs for all hospitals in the state does not exceed the negotiated amount. At a time when regulatory solutions are increasingly under fire, continued support for Rhode Island's approach to hospital cost containment from third party payers, providers and public officials stands in stark contrast to other states where rate setting was either dismantled or discredited as a cost control strategy. A negotiated global cap on hospital expenditures offers an alternative to formula-based state rate-setting methodologies which could be incorporated as part of an all-payer reimbursement methodology or as an incremental step towards more comprehensive reform.     

Pathological myophosphorylase reaction in malignant hyperthermia

In malignant hyperthermia, myophosphorylase reaction shows characteristic changes that take place within minutes: (1) a generally strongly weakened reaction; (2) numerous negatively reacting fibres; (3) frequently, fibre sections that show spotty and/or striatal weak or negative reactions and fibre sections with strong striatal reactions with relatively narrow sarcomere spacings (a "sign of hypercontraction"). Obviously, the morphological findings that show characteristic "striated fibres" are typical of the malignant hyperthermia syndrome! It is important to note that the muscular fibres showing such changes are, as a rule, inconspicuous when using other stains and reactions. These pathological myophosphorylase reactions were observed in five deceased patients (one independently of anaesthesia after an extended walk) and in 19 pigs (18 times after halothane testing and once in an experimental animal with clinical evidence of the presence of malignant hyperthermia). These reactions were not noted in pigs with negative halothane reactivity or prior to halothane testing. They were also not seen in a large number of very different healthy and diseased control and reference cases from our biopsy and autopsy material. Myophosphorylase reaction enables convincing demonstration of malignant hyperthermia, past or present. Hence, it is possible to elucidate puzzling deaths or verify apparently clear death occurring during or subsequent to anaesthesia or simply following stress ("human stress syndrome"). Many of these deaths doubtlessly escape the attention of clinicians using the usual morphological examination methods. However, the reaction cannot be used to identify potential victims.     

Abortion laws in African Commonwealth countries

This paper provides an overview of the range of current (1981) abortion laws in the African Commonwealth countries, traces the origins of the laws to their colonial predecessors, and discusses legal reform that would positively provide for legal termination of pregnancy. The authors claim that the range of these laws demonstrates an evolution that leads from customary/common law (Lesotho and Swaziland) to basic law (Botswana, The Gambia, Malawi, Mauritius, Nigeria's Northern States and Seychelles) to developed law (Ghana, Kenya, Nigeria's Southern States, Sierra Leone, and Uganda), and, finally, to advanced law (Zambia and Zimbabwe). The authors call for treating abortion as an issue of health and welfare as opposed to one of crime and punishment. Since most of the basic law de jure is treated and administered as developed law de facto, the authors suggest decriminalizing abortion and propose ways in which to reform the law: clarifying existing law; liberalizing existing law to allow abortion based upon certain indications; limiting/removing women's criminal liability for seeking an abortion; allowing hindsight contraception; protecting providers treating women in good faith; publishing recommended fees for services to protect poor women; protecting providers who treat women with incomplete abortion; and punishing providers who fail to provide care to women in need, with the exception of those seeking protection under a conscience clause. The authors also suggest clarifying the means by which health services involving pregnancy termination may be delivered, including: clarification of the qualifications of practitioners who may treat women; specification of the facilities that may treat women, perhaps broken down by gestational duration of the pregnancy; specifying gestational limits during which the procedure can be performed; clarifying approval procedures and consents; and allowing for conscientious objections to performing the procedure.