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Studies the practice variation of total knee replacements (KR) in the elderly in the United States. Medicare-funded KRs; Annual rate of increase; Factors influencing the likelihood of receiving KR.

Presents information on a study which examined preventive care use among infants and toddlers continuously enrolled in the Santa Barbara Health Initiative and the Health Plan of San Mateo programs in California. Background of the study; Methodology used; Health supervision visits of infants and toddlers; Childhood immunizations.

The article reports that that with the exception of 9.2% of the population who remain uninsured, the U.S. citizens with health insurance have coverage for prescription drugs. Pharmaceutical expenditures are increasing more than overall healthcare expenditures, which is due to the opaque nature of the drug pricing process in the U.S.

In the past three decades, the shortage of nurses willing to work in hospitals has been a persistent challenge in the United States. Hiring supplemental registered nurses-nurses on short-term contracts obtained through an external staffing agency-has been common to fill gaps in nurse staffing. But there has been insufficient evidence about supplemental nurse workforce trends to inform workforce policy. To address this concern, we compared qualifications and characteristics of supplemental nurses with those of permanent nurses during 1984-2008. The two groups shared similar education levels in terms of possessing a baccalaureate or higher degree. Supplemental nurses were somewhat less experienced than permanent nurses, averaging fifteen years of experience in 2008 compared to eighteen years for permanent nurses. The supplemental nurse workforce was more diverse racially and ethnically and more likely to be male than the permanent nurse workforce. These data show that employing supplemental nurses could help meet the challenges of an aging nursing workforce, the projected future shortage of nurses, and an increasingly diverse US population. [ABSTRACT FROM AUTHOR]

Background: Canada, which has universal single-payer health insurance, is often criticized for waiting times for surgery that are longer than those in the United States. We compared waiting times for orthopedic consultations and knee-replacement surgery and patients' acceptance of them in the United States and in the province of Ontario, Canada. Methods: A stratified random sample of 1486 Medicare recipients (629 from the U.S. national sample, 428 from Indiana, and 429 from western Pennsylvania) and 516 people from Ontario who had been hospitalized for knee replacement between 1985 and 1989 were surveyed by mail in 1992. Patients were asked how long they had waited to see an orthopedic surgeon and to have surgery, the acceptability of these waiting times, and their overall satisfaction with surgery. Results: About 80 percent of the questionnaires were returned, but not all the respondents answered all the questions. The rate of response to specific questions was about 60 to 65 percent in both countries. The median waiting time for an initial orthopedic consultation was two weeks in the United States and four weeks in Ontario. The median waiting time for knee replacement after the operation had been planned was three weeks in the United States and eight weeks in Canada. In the United States, 95 percent of patients in the national sample considered their waiting time for surgery acceptable, as compared with 85.1 percent in Ontario. Overall satisfaction with surgery (“very or somewhat satisfied”) was 85.3 percent for all U.S. respondents and 83.5 percent for Canadian respondents. Conclusions: Waiting times for initial orthopedic consultation and for knee-replacement surgery were longer in Ontario than in the United States, but overall satisfaction with surgery was similar. (N Engl J Med 1994;331:1068-71.) [ABSTRACT FROM AUTHOR]