Finding a lasting cure for U.S. health care

In "Making Competition in Health Care Work" (July-August 1994), Elizabeth Olmsted Teisberg, Michael E. Porter, and Gregory B. Brown ask a question that has been absent from the national debate on health care reform: How can the United States achieve sustained cost reductions while at the same time maintaining quality of care? The authors argue that innovation driven by rigorous competition is the key to successful reform. A lasting cure for health care in the United States should include four basic elements: corrected incentives to spur productive competition, universal insurance to secure economic efficiency, relevant information to ensure meaningful choice, and innovation to guarantee dynamic improvement. In this issue's Perspectives section, eleven experts examine the current state of the health care system and offer their views on the shape that reform should take. Some excerpts: "On the road to innovation, let us not forget to develop the tools that allow physicians, payers, and patients to make better decisions." I. Steven Udvarhelyi; "Health care is not a product or service that can be standardized, packaged, marketed, or adequately judged by consumers according to quality and price." Arnold S. Relman; "Just as antitrust laws are the wise restraints that make competition free in other sectors of the economy, so the right kind of managed competition can work well in health care." Edward M. Kennedy "Biomedical research should be considered primarily an investment in the national economic well-being with additional humanitarian benefits." Elizabeth Marincola.     

Reimbursing side effects of pharmaceutical drugs--a Scandinavian speciality

Pharmaceutical insurance applies to drugs which are approved by Swedish licensing authorities and are marketing in Sweden. This paper reviews the pharmaceutical insurance.     

Is this the right time to come out? Case study

In this fictional case study, Adam Lawson is a promising young associate at Kirkham McDowell Securities, a St. Louis underwriting and financial advisory firm. Recently, Adam helped to bring in an extremely lucrative deal, and soon he and a few other associates will be honored for their efforts at the firm's silver anniversary dinner. George Campbell, vice president in mergers and acquisitions, is caught unprepared when Adam tells him that, after serious reflection, he has decided to bring his partner, Robert Collins, to the banquet. George is one of Adam's biggest supporters at the firm, and he personally has no problem with Adam being gay. But it is one thing for Adam to come out of the closet at the office. It is quite another to do so at a public company-client event. After all, Kirkham McDowell's client roster includes some very conservative companies--one of the country's largest defense contractors, for example. George is concerned with how Adam's openness about his sexual orientation will play with their clients and, as a result, how senior management will react. Adam has not come to George for permission to bring Robert to the dinner. But clearly Adam wants some sort of response. George has never faced sexual diversity issues in the workplace before, and there is no company policy to guide him. Just how negative an effect could Robert have on Adam's career with the firm and the firm's relationship with its clients? Isn't it possible that even the firm's most conservative clients will simply decide that Adam's choice of guest is a personal matter--not a business one?(ABSTRACT TRUNCATED AT 250 WORDS)     

Health reform: let's do it right

Look inside Clinton's plan, and you can find the elements of a sleek, market-based system--but his proposed price controls could crush it.     

Case study on the implementation of deammonification for the process water treatment of Munich WWTPs

The two-staged WWTP 'Gut Grosslappen' has a capacity of 2 mio. PE. It comprises a pre-denitrification in the first stage using recirculation from the nitrifying second stage. A residual post-denitrification in a downstream sand filter is required in order to achieve the effluent standards. Presently the process water from sludge digestion is treated separately by nitrification/denitrification. Due to necessary reconstruction of the biological stages, the process water treatment was included in the future overall process concept of the WWTP. A case study was conducted comparing the processes nitritation/denitrititation and deammonification with nitrification/denitrification including their effect on the operational costs of the planned main flow treatment. Besides the different operating costs the investment costs required for the process water treatment played a significant role. Six cases for the process water treatment were compared. As a result, in Munich deammonification can only be recommended for long-term future developments, due to the high investment costs, compared with the nitritation/denitritation alternative realizable in existing tanks. The savings concerning aeration, sludge disposal and chemicals were not sufficient to compensate for the additional investment costs. Due to the specific circumstances in Munich, for the time being the use of existing tanks for nitritation/denitritation proved to be most economical.     

Characteristics of WWTP sludge after drying in greenhouse for agricultural purposes

The sludge generated by sewage treatment which meets regulatory standards can be used in agriculture. With this understanding, the focus of this study is the evaluation of the agricultural characteristics and inorganic substances in excess activated sludge, which was subjected to drying in a greenhouse. The variables (factor) evaluated during the drying process were: type of sludge (digested or not digested), addition of lime to the sludge, and the physical layout and rotation of sludge in the greenhouse. The parameters monitored for this assessment were moisture, volatile solids and pH. The greenhouse cover and sides were made of translucent plastic to allow the penetration of solar radiation and prevent water from entering. A impermeable floor was used. The sludge was generated in sewage treatment plants located in the metropolitan region of Grande Vitória, Espírito Santo, Brazil. The solar drying of wastewater sludge in a greenhouse presented satisfactory results.     

Odour emission ability (OEA) and its application in assessing odour removal efficiency

Odourous emissions from sewer networks and wastewater treatment plants (WWTPs) can significantly impact a local population. Sampling techniques such as wind tunnels and flux hood chambers are traditionally used to collect area source samples for subsequent quantification of odour emission rates using dilution olfactometry, however these methods are unsuitable for assessing liquid samples from point sources due to the large liquid volumes required. To overcome this limitation, a gas phase sample preparation method was developed for assessing the total Odour Emission Ability (OEA) from a liquid sample. The method was validated using two volatile organic sulphur compounds (VOSCs), dimethyl-trisulphide (DMTS) and bismethylthiomethane (BMTM) that are frequently detected from sewers and WWTPs and are relatively stable compared with common VOSCs like mercaptan or methyl mercaptan. The recovery rates of DMTS and BMTM were quantified by injecting a known volume of a standard liquid sample into Tedlar bags using a static injection and a dynamic injection methodology. It was confirmed that both dynamic and static injection methods at ambient condition achieved high recovery rates with no need to consider increasing evaporation by elevating the temperature. This method can also be used to assess odour removal effectiveness of liquids by comparing the OEA before and after the treatment tests. Two application examples were presented.