Evaluation of educational interventions for three lesser-known illnesses.

BACKGROUND: Lesser known illnesses (LKI) such as hemochromatosis, celiac disease, and Lyme disease are likely to be under-diagnosed due to the often varied and sometimes vague symptoms and lack of familiarity with testing. Insufficient testing and diagnoses of these LKI could result in poor outcomes for patients and unnecessary costs. OBJECTIVES: The objective of this research was to evaluate the effectiveness of educational campaigns designed to inform physicians about the symptoms of LKIs and the basis to test patients for the diseases. METHODS: A multi-level educational intervention was designed and conducted. The prevalence rate of testing, diagnosis, and the ratio of diagnoses to testing (D/T ratio) for hemochromatosis, celiac disease, and Lyme disease were determined for pre-intervention, intervention, and post-intervention time periods. Using the prevalence rates, ANOVA regression analysis was used to estimate the effect of the educational intervention on clients in Medicare Professional System, Medicare Institutional System, and Christiana Care outpatient data. RESULTS: The educational intervention appeared effective at increasing the rate of testing, diagnosis, and the ratio of diagnoses to tests, within the Medicare Institutional System. Generally low rates of the LKI were observed, with large monthly volatility in testing and diagnosis rates. CONCLUSION: The low yields of diagnosis, represented by small D/T ratios, indicate that considerable financial resources have been employed for testing without increased detection of cases above those that would have otherwise been identified.

The economics of public health: financing drug abuse treatment services.

Drug abuse treatment financing exhibits a heterogeneous set of sources from federal, state, and local governments, as well as private sources from insurance, patient out-of-pocket, and charity. A public health model of drug abuse treatment is presented for a market that can be characterized by excess demand in many communities and an implied policy of rationing. According to best estimates, as many as 6.7 million individuals may need treatment, but only an estimated 1.5 million individuals actually participated in treatment episodes. Since, as demonstrated empirically, drug abuse treatment has a robust and positive social net benefit to society, it is perplexing that treatment financing stops with a rationing outcome that inhibits social welfare. The justification for public financing is centered on the external costs of drug addiction, but subsidization is grounded in the reality that a large number of addicted individuals do not have sufficient resources to pay for treatment out-of-pocket, nor do they have private insurance coverage. Social welfare losses are generated by financial arrangements that are inconsistent with rational budgeting theory and as such would lead to non-optimal organization and management of the drug abuse treatment system.

Reconsideration of contemporary U.S. drug policy.

In their recent book Drug War Heresies: Learning From Other Vices, Times, and Places (Cambridge: Cambridge University Press, 2001), MacCoun and Reuter challenge the continuation of contemporary U.S. drug policy. Depenalization and legalization of illicit drugs are evaluated as alternatives to U.S. prohibition policy, with harm reduction (mitigation of social damages) as the criterion for guiding drug regime change. The appraisal encompasses an analysis of underlying philosophical and social mechanisms of current U.S. policy as well as drawing analogies from a comprehensive review of American vices and also Western European governmental interventions into illicit drug activities. What is apparent is that the evaluation and the available evidence entail substantial complexity and do not readily present unequivocal positions. The evaluation also strongly indicates that considerable difficulty would be encountered not only for the implementation of alternative regimes but also for the engagement in open political discussion of prohibition alternatives.