Sarcoma epidemiology and cancer-related hospitalisation in Western Australia from 1982 to 2016: a descriptive study using linked administrative data.

BACKGROUND: Sarcomas are a heterogeneous group of malignancies arising from mesenchymal cells. Epidemiological studies on sarcoma from Australia are lacking, as previous studies have focused on a sarcoma type (e.g. soft tissue) or anatomical sites. METHODS: Linked cancer registry, hospital morbidity and death registration data were available for Western Australia (WA) from 1982 to 2016. All new sarcoma cases among WA residents were included to estimate incidence, prevalence, relative survival and cancer-related hospitalisation, using the Information Network on Rare Cancers (RARECARENet) definitions. To provide a reference point, comparisons were made with female breast, colorectal, prostate and lung cancers. RESULTS: For 2012-16, the combined sarcoma crude annual incidence was 7.3 per 100,000, with the majority of these soft tissue sarcoma (STS, incidence of 5.9 per 100,000). The age-standardised incidence and prevalence of STS increased over time, while bone sarcoma remained more stable. Five-year relative survival for the period 2012-16 for STS was 65% for STS (higher than lung cancer, but lower than prostate, female breast and colorectal cancers), while five-year relative survival was 71% for bone sarcoma. Cancer-related hospitalisations cost an estimated $(Australian) 29.1 million over the study period. CONCLUSIONS: STS incidence has increased over time in WA, with an increasing proportion of people diagnosed aged ≥65 years. The analysis of health service use showed sarcoma had a lower mean episode of cancer-related hospitalisation compared to the reference cancers in 2016, but the mean cost per prevalent person was higher for sarcoma than for female breast, colorectal and prostate cancers.

O Tratamento dos doentes insanos de Vila Viçosa no hospital de Rilhafoles (segunda metade do século XIX) / The treatment of the insane patients at the hospital in Vila Viçosa rilhafoles (second half of the nineteenth century)

Neste trabalho analisamos os trâmites processuais respeitantes ao envio de doentes insanos de Vila Viçosa para o hospital de Rilhafoles, na segunda metade do século XIX, e as relações estabelecidas com o hospital desta vila alentejana relativamente ao pagamento do tratamento. A braços com uma grave crise financeira, o hospital de Vila Viçosa recusava sistematicamente a responsabilidade de enviar os alienados para Rilhafoles, numa tentativa de passar esse ónus para a administração do concelho, mostrando-se muito renitente no pagamento das faturas que lhe chegavam do hospital de São José. O conflito entre as duas instituições chegou ao monarca e sem outra alternativa que a do pagamento, o hospital da vila alentejana procedeu ao envio de parcelas de dinheiro, ainda que de forma muito atrasada. Para a realização deste trabalho servimo-nos dos livros de atas da Misericórdia e do fundo do Governo Civil de Évora, custodiadas pelo Arquivo Distrital da mesma cidade. Estas fontes resultam essencialmente da correspondência estabelecida entre a Misericórdia de Vila Viçosa, o administrador do concelho e o governador civil de Évora (AU)

In this work we examined the procedural requirements related to the sending of insane patients of Vila Viçosa to the hospital of Rilhafoles, in the second half of the 19th century, and the relationships established with the hospital of this Alentejo town relating to the payment of treatment. Faced with a severe financial crisis, the hospital of Vila Viçosa systematically refused the responsibility to send the insane patients to the Rilhafoles hospital in an attempt to pass this burden on the administration of the county, being very reluctant to pay the bills that came to him from the hospital of São José. The conflict between the two institutions came to the monarch with no other alternative than the payment, the hospital of village of the Alentejo region proceeded to sending parcels of money, albeit way too late. For the realization of this work we use the books of the Misericórdia and the documents of the Civil Governor found of the city of Évora under the custody of the Distrital Archive of the same city. This documents results, basically, from the correspondence between the Misericórdia of Vila Viçosa, the council administrator and the civil governor of Évora (AU)

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Early neonatal special care units and their scientific achievements.

Treatment of sick neonates originated in maternity and foundling hospitals in the 19th century. Nosocomial infections and difficult logistics of wet-nursing prevented admission of neonates in most children's hospitals well into the 20th century. In this article, 31 hospitals are described, all located in large cities, in which preterm and sick neonates were treated before the Great Depression. Even though mostly initiated by private charity, these institutions performed research right from the start. Topics included warming and feeding preterm infants, collecting and distributing human milk, developing and storing breast milk substitutes, prevention of rickets and nosocomial infections, maternal and public education regarding infection control, pathoanatomic characterisation of diseases and malformations and epidemiologic studies of infant mortality. These pioneering hospitals, their founding dates, researchers and classic publications are presented in a table.

The origins, development, and passage of Medicare's revolutionary prospective payment system.

This article explains the origins, development, and passage of the single most influential postwar innovation in medical financing: Medicare's prospective payment system (PPS). Inexorably rising medical inflation and deep economic deterioration forced policymakers in the late 1970s to pursue radical reform of Medicare to keep the program from insolvency. Congress and the Reagan administration eventually turned to the one alternative reimbursement system that analysts and academics had studied more than any other and had even tested with apparent success in New Jersey: prospective payment with diagnosis-related groups (DRGs). Rather than simply reimbursing hospitals whatever costs they charged to treat Medicare patients, the new model paid hospitals a predetermined, set rate based on the patient's diagnosis. The most significant change in health policy since Medicare and Medicaid's passage in 1965 went virtually unnoticed by the general public. Nevertheless, the change was nothing short of revolutionary. For the first time, the federal government gained the upper hand in its financial relationship with the hospital industry. Medicare's new prospective payment system with DRGs triggered a shift in the balance of political and economic power between the providers of medical care (hospitals and physicians) and those who paid for it--power that providers had successfully accumulated for more than half a century.

The cost of running American city hospitals: the Gorgas 1910 survey.

BACKGROUND: COL William C. Gorgas was appointed Chief Sanitary Officer of the Isthmian Canal Commission during construction of the Panama Canal (1904-1914). In 1910, Gorgas sought to determine the administrative and operating costs of major metropolitan hospitals in the United States and compare these with similar costs in the Canal Zone hospitals. METHODS: Gorgas sent a questionnaire to hospitals in Atlanta, Baltimore, Boston, Chicago, Cleveland, New York, Philadelphia, Pittsburgh, San Francisco, and Washington, DC. The information requested included number of beds, daily census, details about resident and nursing staff, salaries, length of stay, and hospital cost per patient per day. RESULTS: The survey results provide information about metropolitan hospitals in the United States at the turn of the century. Hospital costs varied from $.22 to $2.76 per patient per day. CONCLUSION: Gorgas concluded that the costs of operating hospitals in the Canal Zone compared favorably with those in the United States.

[Paris hospitals budget in 1848, from charity to care]. / Le budget des hopitaux de Paris en 1848: de la bienfaisance au soin.

Paris hospitals budget is, in the year 1848, the last before the "Assistance Publique" foundation. 1848 is characterized by important political troubles in Paris and an increased hospital activity. Nevertheless, the budget could suggest a certain wealth. Receipts are mainly based on financial funding and real estate incomes. Expenses are, for one half, linked to patients considered as hosts: food, heating, cleaning, etc. Staff expenses are moderate (12%). Various expenditures are in the same range within the different hospitals. It is interesting to outline the fact that drug expenses have the same importance than 150 years later: 4%. This feature is only an average insofar as general hospital spend about 10% of their budget in drugs as long-term care hospitals spend 1%. This disparity is clearly the proof of an increasing medicalization of Paris hospitals in the middle of the 19th century.