Attitudes of private general practitioners towards health care in South Africa

The need for health care reform in South Africa is acknowledged by the govermnent as well as by the non-governmental health sector. There is, however, no unanimity regarding the nature of the envisaged reform. A country-wide postal survey of 700 private sector general practitioners (GPs) from a commercial database of 5 000 was conducted to explore attitudes towards health care. A response rate of 67,4% was obtained. Respondents were mostly male (92%) and urban-based (64%). The median age was 42 years. Most respondents:(i) believed health care to be a right for all citizens; (ii) favoured private or a combination of private and public funding mechanisms with fee-for-service arrangements; (iii) opposed cost-containment measures imposed by funders, e.g. medical aids; and (iv) believed doctors should be responsible for primary care in under-served areas. After sex, age, location (urban versus rural) and GP postgraduate qualification had been controlled for by means of logistic regression techniques, the university at which a respondent's basic degree was obtained emerged as the only independent predictor of attitudes to the following: (i) comprehensive care as a right; (ii) integration of the public and private sectors; (iii) preferred funding source for a future health system; and (iv) preference for fee-for-service remuneration. Both university and gender independently predicted attitudes on GPs' income. Graduates of white, Afrikaans-medium universities were strongly in favour of a privately funded and fee-for-service orientated system. Those who qualified at black universities, on the other hand, favoured public funding with less emphasis on fee-for-service. White, English university graduates, while expressing a preference for fee-for-service remuneration, were less enthusiastic about private funding, favouring a mixed funding approach (private and public) instead. This is the first systematic study of GP attitudes to health care in South Africa. Further research is recommended to understand the significance of the attitudes expressed and to investigate the role of the university medical school and other factors in practitioners' attitudes to health care

The Oxford Myocardial Infarction Incidence Study

SIGLEAvailable from British Library Document Supply Centre-DSC:D198148 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Incidence of acute rheumatic fever in the world: A systematic review of population-based studies

Background: There is no systematic overview of prospective studies of incidence of acute rheumatic fever (ARF) in the world. Aim: To summarise all population-based studies of the incidence of ARF world wide. Method: A systematic review of prospective population-based studies of the overall mean and annual specific incidence of the first episode of ARF was carried out. Results: A systematic literature search identified 10 eligible studies from 10 countries on all continents, except Africa. The overall mean incidence rate of first attack of ARF was 5-51/100 000 population (mean 19/100 000; 95% CI 9 to 30/100 000). A low incidence rate of ≤ 10/100 000 per year was found in America and Western Europe, while a higher incidence (>10/100 000) was documented in Eastern Europe, Middle East (highest), Asia and Australasia. Studies with longitudinal data displayed a falling incidence rate over time. Conclusion: Despite an apparent fall in incidence over time, ARF incidence rates remain relatively high in non-Western countries. No information is available for Africa.Revie