[Determining priorities in German public health--triad between rationing, rationalization and rational allocation]. / Prioritätensetzung im deutschen Gesundheitswesen--die Triade zwischen Rationierung, Rationalisierung und rationaler Allokation.

Is there a crisis of the German health system? Will necessary medical services be rationed? These or similar questions have been intensely discussed in the public ever since the realization of reforming the health system by the Red-Green coalition. Opposers of the health structure reform 2000 have especially regarded the global budget, which was meanwhile stopped by the Federal Council, as an enormous threat for a functionable health system. Many actors of the health system have uttered deep apprehensions regarding a reform of the health system. As various attempts of legal controlling have proved during the last ten years, it will be necessary in our society to negotiate the health services which we will be able to afford in future at which price, and which we want to realize. Even presently it is not possible to guarantee maximum medical care according to the latest technology. The future question in the german health care system will no more be whether it will be necessary to set priorities, but only how they will have to be established.

Psychiatry and the elderly in the Middle East: a report from Iran.

One of the more firmly established generalizations in mental health concerns the positive correlation found between aging on the one hand and levels of psychiatric distress and utilization of mental health services on the other. It is also generally believed that the young, being more resilient and healthier, possess a greater capacity to cope with psychiatric stress than the elderly. The causal inferences are often unavoidable. Since cross-cultural studies can examine naturally occurring differences in exogenous factors, they may help clarify some of the causal connections. This paper presents utilization rates as well as the results of psychiatric tests on older and younger populations of psychiatric patients and addicts in Iran. The psychiatric population includes both inpatients and outpatients from hospitals and clinics in Tehran, and the provinces. The addicts' population includes a nationwide sample of registered addicts as well as illicit addicts from Tehran and other provinces. Psychiatric profiles are constructed from Symptom-Checklist-90 (SCL-90) questionnaire translated and adapted for use in Iran. For each individual, nine primary symptom distress levels together with three global indices are obtained. Primary comparison is made across age variable with fifty-five years and over age group versus those below fifty-five years of age. Secondary comparisons include psychiatric versus addicts, inpatients versus outpatients, male versus female, as well as comparisons across other socio-economic variables. Findings are discussed in the light of prevalent socio-cultural factors.

Psychiatric profiles of adolescents in pre-revolutionary Iran.

In 1977 when this research was undertaken, Iran was witnessing the emergence of growing numbers of distressed adolescents. Psychiatric profiles of adolescent outpatients (N = 110) and undiagnosed adolescents (N = 406) were obtained using an adapted version of the Johns Hopkins Symptom checklist-90. These profiles are compared with those from the American adolescent psychiatric outpatients. The results show that Iranian adolescents register significantly higher distress levels on nearly all the scales. The findings are discussed in the light of prevalent child rearing practices, rapid socio-economic transition and political-cultured factors dominating the pre-revolutionary Iran.

Dilemmas of Iran's opium maintenance program: an action research for evaluating goal conflicts and policy changes.

Much of evaluative research in the drug abuse field to date has centered on the outcome comparison of different treatment and rehabilitation modalities. Consequently, despite avowed interest in policy research by the students of drug abuse to a great extent and, in part, due to lack of research opportunities, there have not been many action-oriented evaluative policy researches even in the industrially advanced countries. On the other hand, the piecemeal accumulation of information through numerous ad hoc drug-related research activities has signaled the need for more integrated research activities on a comprehensive scale, embracing both the demand and supply dimensions of drug abuse. In the absence of substantive inputs from drug policy research, there is a real danger than the call for comprehensive approaches may once again, by default, neglect the crucial dimension of macro policy. This paper presents the findings of an action research design for evaluation of Iran's opium maintenance program. As such, the paper's primary focus is on the impact of unintended and unanticipated consequences of Iran's opium maintenance program upon treatment and rehabilitation efforts for the drug addicts. The findings here are based on a two-wave study. The first wave was carried out in the early summer of 1976. The major conclusions of the first wave suggested the need for fundamental revisions in both the eligibility requirements for and the the distribution system of opium coupons to those who legally received opium, the registered addicts. The findings of this study convinced the government to initiate a number of changes in the eligibility requirements. In addition, the authors were given the responsibility to design a new system of opium distribution for registered addicts. The second wave of the study was conducted in the spring of 1977, some 6 months after the policy revisions, in order to monitor their effects.