Competition, Productivity and the Cult of 'More is Good' in the Australian Health Care Sector

Economic policy discussions emphasise growth, the maximisation of output, efficiency and the pursuit of rational self-interest. Many policymakers, bureaucrats and managers in health care have been influenced by economists who believe that competition and the marketplace will provide maximum output and efficiency. Thus, for some, health care involves treating more and more patients for the same money. They argue for strategies such as reducing waste, lowering costs, increasing inpatient throughput and introducing competition between providers, especially hospitals, in order to stimulate productivity to achieve their aim. Yet in health care more is not necessarily good. Embracing the culture of the marketplace in a predominantly publicly funded system runs the risk of failing to distribute health care services equitably, and leads to more inappropriate and unnecessary care. An approach that merely strives to treat more patients and lower costs should be rejected in favour of a health system that values effectiveness, health outcomes, quality and the public good, and is patient-centred not delivery system-centred.     

Family Representative Payeeship and Violence Risk in Severe Mental Illness

Although representative payeeship is prevalent among people with mental illness and shows promise to positively influence clinically relevant outcomes, research also suggests this legal mechanism could be implemented in ways that are problematic. The current study examined whether family representative payeeship was associated with elevated risk of family violence perpetrated by persons with severe mental illness (SMI). Data were collected every 4 months for 1 year in structured interviews with N = 245 persons with SMI who received disability benefits. Multivariate analyses showed that substance abuse, history of violence, frequency of family contact, and family representative payeeship were associated with elevated odds of family violence. Analyses also showed family contact and family representative payeeship had a cumulative effect on increasing the predicted probability of family violence (controlling for covariates such as violence history and substance abuse). The data shed light on the potential for family representative payeeship to be associated with increased risk of interpersonal conflict and violence in SMI.     

Sudden death due to asphyxia by esophageal polyp: two case reports and review of asphyxial deaths

Asphyxia, not an uncommon cause of sudden death, may result from numerous etiologies. Foreign-body aspiration and strangulation are 2 extrinsic causes. Airway obstruction may also be caused by laryngeal edema, asthma, infection, or anaphylaxis. Chronic causes of asphyxia include musculoskeletal diseases (eg, muscular dystrophy, amyotrophic lateral sclerosis), neurologic disorders (eg, myasthenia gravis, multiple sclerosis), respiratory disease (eg, emphysema, chronic bronchitis), or tumors. The manner of death in cases of asphyxiation may be natural, accidental, homicide, or suicide. For the death investigator, determining the cause and manner of death can often be quite challenging.We report here 2 cases of an esophageal fibrovascular polyp causing sudden asphyxial death, review of the literature, and discussion of other differential diagnoses in the case of asphyxial death.     

Review articles

Patrick Duncan: South African and Pan‐African by C. J. Driver Heinemann, London, 1980. xiv plus 326 pp. including illustrations, maps, notes, bibliography and indexes. £19,50.     

Differentiation of black gel inks using optical and chemical techniques

Gel ink pens have become a common writing instrument in the United States. Questioned document examiners often attempt to optically differentiate gel inks from each other and from other non-ballpoint ink writings (e.g., those from roller-ball pens). Since early formulations were primarily pigment-based, they do not elute when analyzed by thin-layer chromatography. However, recent gel ink formulations (i.e., within the past five years) include dye-based inks that can be easily separated. This study differentiates black gel inks using optical and chemical techniques. The techniques include: microscopy, visible and near infrared reflectance, near infrared luminescence, thin-layer chromatography (TLC), spot tests, and gas chromatography/mass spectrometry (GC/MS). As a result of this study a flow chart has been developed allowing for a systematic determination of a questioned ink. In addition, an analysis of volatile compounds found in gel inks revealed that there are some unique ingredients that may be found in gel inks that are not typically found in other non-ballpoint inks.