case for user charges in public hospitals

The present decline in per capita expenditure on health in Saudi Arabia requires private funding to reduce pressure of health expenditure on the government budget. User charges would be an important source of revenue in the Kingdom where services cannot be cut and taxes are not imposed. User charges in public facilities would curtail over-utilization and reduce inefficient use of resources by providing a link between financial responsibility and the provision of services. The financial implication facing patients would encourage them to be more cost-conscience, and therefore their physicians would be encouraged to limit practices such as over prescribing drugs and the use of highly specialized diagnostic procedures for routine investigation or minor illnesses. Lack of economic incentives have led to a lack of concern for the cost of medical care. User charges would not only encourage both consumers and providers to be cost-conscious, but would raise revenue to ease pressure on the health budget, combat moral hazards and assert priorities. However, to be effective, and in order to make a serious impact on the health system, user charges must be extended to all government sectors and specialist hospitals and charges must be high enough to discourage inappropriate use of services

Treatment of non-union with implanted direct current stimulator and bone grafting

This study presents the results of 38 cases of ununited long bone fracture treated by a totally implanted direct current bone growth stimulator and by bone grafting. The patients were grouped into A, B, C, and D. Ten patients in Group A and 10 patients in Group B were cases of non-union with an average duration of 1 year, and had no history of a previous bone grafting procedure. Eight patients in Group C and 10 patients in Group D were cases of non-union with an average duration of 2 1/2 years and had multiple previous unsuccessful attempts to achieve union. Patients in Group A were treated by a bone growth stimulator and internal fixation; in Group B, by internal fixation and bone grafting; in Group C, by a bone growth stimulator combined with internal fixation and bone grafting; and patients in Group D were treated by internal fixation and bone grafting. The success rate of sound bone union in Group A was 90%, in Group B 80%, in Group C 62.5%, and in Group D, 70%. This study suggests that the bone growth simulator, combined with internal fixation is a satisfactory method for the treatment of non-union operated first time and it avoids the need of bone grafting. The use of a bone growth stimulator, in conjunction with bone grafting in cases of non-union with a history of previous failed surgical procedures, did not make any difference to the results

Prime factors in the etiology of congenital dislocation of the hip and talipes equinovarus in Riyadh

This paper reports a prospective controlled study over a period of two years. One hundred thirty-seven patients [79 with congenital dislocation of the hip [CDH] and 58 with talipes equinovarus [TEV] and 144 controls were studied t find out if there is any association between several possible etiologic factors and CDH or TEV deformities in Riyadh. The study demonstrated a strong association between CDH and breech presentation, younger age of the mother, and prematurity, and TEV and low birth weight of the newborn. On the other hand, there was no significant association between TEV and breech presentation or prematurity, and neither CDH nor TEV and disease of pregnancy, consanguinity of parents, parental history of malformation, X-ray exposure, or rubella infection during pregnancy. No single theory can explain the etiology of all idiopathic TEV and CDH. Different causative factors can produce the same deformity. Both mechanical and genetic factors appear to combine in variable digress to cause TEV. In the case of CDH, in uteri conditions appear to play an important role