Despena Andrioti

Maritime Doctors and General Partitioners Service Profiles: a research protocol

Background: Maritime employees are a hard to reach population group. The mandatory medical examinations of seafarers, fishermen and offshore workers are performed by GPs with training in maritime medicine. However, they might as well consult their regular general practitioner for other health concerns. So far very little is known about the breadth of services and follow up practices offered to them by GPs as well as maritime doctors. The final goal is to determine GPs and maritime doctors’ perceived training needs so that relevant continuing medical education could be developed. Methods: This research project will involve 200 doctors (100 maritime doctors and 100 general practitioners) from all over Denmark using an electronic and anonymous questionnaire. This is based on international standards, adapted and validated. The scoping review helped in enriching the questions. The analysis of the results will give insight on the service profiles and draw conclusions regarding doctors’ attitudes and their perceived training needs. The gap analysis can show potential areas for in depth guidance. Discussion: The study is expected to identify areas of knowledge that may need to be updated so that doctors optimize their services to their seagoing populations. The results may be used as guidelines for continuing professional development of these medical specialties and contribute informed decisions making.

The costs of repatriating an ill seafarer: a micro-costing approach

Seafarers sail the high seas around the globe. In case of illness, they are protected by international regulations stating that the employers must pay all expenses in relation to repatriation, but very little is known about the cost of these repatriations. The objective of this study was to estimate the financial burden of repatriations in case of illness. We applied a local approach, a micro-costing method, with an employer perspective using four case vignettes: I) Acute myocardial infarction (AMI), II) Malignant hypertension, III) Appendicitis and IV) Malaria. Direct cost data were derived from the Danish Maritime Authority while for indirect costs estimations were applied using the friction cost approach. The average total costs of repatriation varied for the four case vignettes; AMI (98,823 EUR), Malignant hypertension (47,597 EUR), Appendicitis (58,639 EUR) and Malaria (23,792 EUR) mainly due to large variations in the average direct costs which ranged between 9560 euro in the malaria case and 77,255 in the AMI case. Repatriating an ill seafarer is a costly operation and employers have a financial interest in promoting the health of seafarers by introducing or further strengthen cost-effective prevention programs and hereby reducing the number of repatriations.

Do Danish Maritime Doctors Value Continuous Education Initiatives

Aims and objectives: Seagoing employees must undergo medical examinations every second year. Even though International Organisations issued guidelines for these pre-employment medical examinations there is a lack of an internationally accepted continuous training programme for the maritime doctors who perform these examinations. The aim of this survey was to examine the Danish maritime doctors perceived training needs as part of a planned comprehensive maritime occupational health prevention programme. Methods: A questionnaire based on international standards was distributed to all the maritime doctors (110) electronically in May 2017. The completed questionnaires were 46.4%. STATA was used for the statistical analysis of the data and correlations among the self-rated needs as dependent variables and the doctors characteristics were performed with Fisher exact test, with significance level at α=0.05%. Results: The maritime doctors considered very important to receive training in “Fitness evaluation and medical examinations guidelines” (76.47%) followed by “Rules and regulations within maritime medicine” (68.63%) and “Working conditions and health risks on board” (62.75%). The number of examinations influenced their preference with those with more than 20 patients to express a more pressing need for training. Age, gender and years of practice did not have any influence in their self-rated needs. Furthermore, they pointed out flexible ways of training including distance learning and the establishment of a webpage by the respective Authorities as one stop-shop. Conclusion: Maritime doctors are in favour of continuous education and training. The survey may help the respective Authorities to organise such short courses on targeted topics in the country.

Co-payments for general practitioners in Denmark: an analysis using two policy models

BackgroundThe increasing health expenditure for general practitioners (GPs) in Denmark requires that other ways of financing the health system are investigated. This study aims to analyse possibilities for implementing out-of-pocket payments to GPs in Denmark.MethodsThe study was conducted as a literature review with 11 articles included. The Health Policy Triangle and the Kingdon Model were used in analysing and discussing the implementation of a cost-sharing policy with an emphasis on the out-of-pocket payments method.ResultsThe Danish Parliament has expressed mixed opinions about out-of-pocket payments, whereas the Danish population, the GPs and the media are against introducing payments. The public debate and the fact that Danes are used to healthcare being free of charge both work against introducing co-payments. However, experiences from Sweden, Norway and OECD countries serve to promote implementation, but at the expense of decreased accessibility for the most vulnerable population groups.ConclusionsIntroducing out-of-pocket payments in Denmark may lead to decreased health expenditure, but also increased inequalities. Due to a lack of support from the relevant policy actors in the country, in addition to a lack of a policy window, it may not be possible to introduce out-of-pocket payments for GPs in Denmark in the short term.

Changes in the health care system of India have effects on management of human immunodeficiency virus infection and acquired immune deficiency syndrome epidemic

Sir, In India, a high number of human immunodefi ciency virus infection and acquired immune defi ciency syndrome (HIV/AIDS) cases are reported.1 The National AIDS Control Organization (NACO) bestows some rights for HIV patients the right to informed consent, the right to confi dentiality, and the right against discrimination that enables the patient to access to court if their rights are violated.2 After the formation of National AIDS Control Program (NACP), policy makers focused on the high-risk groups such as commercial sex workers and drug users due to the perception that HIV/AIDS will only be restricted to high-risk groups. The current NACP IV focuses more on reducing the incidence of HIV by 50% compared to NACP III, highlighting the need for increased awareness among the population and their active participation.3 A study showed that shared and informed decision along with involving patients in decision-making is one of the key steps to achieve high quality health care.3