Vaccination -- Philippines -- History -- 20th century.
Public health -- Philippines -- History -- 20th century.
Vaccination and the enforcement of stipulations of personal hygiene can be viewed as different mechanisms of colonial government. Immunization campaigns reach and register populations, but they may also appear to obviate the need for behavioral reform. Hygiene education implies the development of a disciplined, self-governing citizenry, although in the colonial setting validation of such attainment is usually deferred. This article explores the tension between mechanisms of security (immunization) and drill (hygiene) in the Philippines, under the United States' colonial regime, in the early twentieth century.
Immunization, vaccination, public health, state medicine, colonial, race, United States, Philippines.
Medical care -- United States -- Finance -- History -- 20th century.
Medical policy -- United States -- History -- 20th century.
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.
Medicare, prospective payment, hospitals, diagnosis-related groups (DRGs), Social Security, Nixon, Carter, Reagan.
Influenza -- Treatment -- Ontario -- Toronto -- History -- 20th century.
SARS (Disease) -- Treatment -- Ontario -- Toronto -- History -- 21st century.
This article compares the Toronto Health Department's role in controlling the 1918 influenza epidemic with its activities during the SARS outbreak in 2003 and concludes that local health departments are the foundation for successful disease containment, provided that there is effective coordination, communication, and capacity. In 1918, Toronto's MOH Charles Hastings was the acknowledged leader of efforts to contain the disease, care for the sick, and develop an effective vaccine, because neither a federal health department nor an international body like WHO existed. During the SARS outbreak, Hastings's successor, Sheela Basrur, discovered that nearly a decade of underfunding and new policy foci such as health promotion had left the department vulnerable when faced with a potential epidemic. Lack of cooperation by provincial and federal authorities added further difficulties to the challenge of organizing contact tracing, quarantine, and isolation for suspected and probable cases and providing information and reassurance to the multi-ethnic population. With growing concern about a flu pandemic, the lessons of the past provide a foundation for future communicable disease control activities.
Influenza, SARS, Toronto, epidemic, public health, disease control, pandemic.