Public money, private control: a case study of hospital financing in Oakland and Berkeley, California

Government support of public and private hospitals in Oakland and Berkeley, California was investigated. The private hospitals received government subsidies amounting to at least 60 per cent of their total revenues. The dollar amount of the subsidies to private hospitals was four and one-half times greater than government expenditures on the public hospital. In Oakland and Berkeley, as in many cities, public medical services have been reduced while both government health expenditures and private hospital revenues have increased sharply. The private hospitals, although all nominally non-profit, exhibit revenue maximizing behavior which results in socially unjust and medically irrational resource allocation. Funds might be found for public hospitals and clinics, and resources allocated more justly and rationally, if government expenditures in the private sector were brought under greater public scrutiny and control.

[What determines the prognosis following cholecystectomy: anamnesis, surgical findings, postoperative complications?]

In 346 patients followed up 6, 12, 24 and 48 months after cholecystectomy the clinical results (VISICK and self-assessment) were very good in over 80%, 1% had symptoms due to organic disturbances and 15-20% had mostly mild symptoms (pain, fullness, food tolerance) without detectable causes. These functional disorders were found frequently in female patients with long preoperative history and frequent attacks of pain. Age of patient, character of pain, therapy before the operation, postoperative complications or change of body weight showed no correlation with later results. The results were almost always good in patients with acute pancreatitis or acute cholecystitis before the operation, or who underwent choledochotomy.

[Long-acting secretin for the prevention of stress ulcers in surgery (author's transl)]

A double-blind trial with placebo conducted on 100 patients likely to develop stress ulcers after major surgery showed that prophylactic treatment with a long-acting secretin in doses of 10 clinical units twice daily is extremely effective.

[Prevention of stress ulcers with synthetic depot secretin]

The pathogenesis of stress ulcers is still far from being understood. It is reported about a synthetic secretin (Hoe 069 + depot component) given prophylactically to 100 patients postoperatively. It eliminated or ameliorated stress ulcers. The result, confirmed by gastroscopy, demonstrates the treatment with secretin plus depot component as a highly recommendable prophylaxis in the postsurgical intensive care treatment.