An overview of the specialized alcoholism treatment field in Canada is presented based on a 1976 national survey of 338 programs. Descriptive information on these programs is presented to provide an understanding of the state of current treatment efforts and to identify emersent policy issues in this field. Programs activities are described under six headings: (1) the pattern of program development, (2) types of treatment agencies, (3) treatment capacity and utilization, (4) the characteristics of persons using treatment services, (5) approaches employed in treatment, and (6) program costs and financing of alcoholism treatment. Findings from the national study are related to three policy issues: access, quality, and cost. The need for future research aimed at these issues is discussed.
The replacement of old radiologic contrast media with supposedly safer but more expensive media has created a dilemma for radiologists and hospital administrators. To quantitate the nature of this trade-off we performed a cost-utility analysis using optimistic assumptions that favoured the new media. A complete conversion to the new media would result in an incremental cost of at least $65,000 to gain 1 quality-adjusted life-year (QALY). For a selective strategy in which only high-risk patients would receive the new media the cost would be about $23,000 per QALY gained. However, the incremental cost for low-risk patients is over $220,000 per QALY gained. Conversion to the new contrast media, although not necessarily the most efficient use of scarce resources, has already occurred in Ontario, primarily because of press publicity, pressure from insurers and a political unwillingness of policymakers to decide the fate of identifiable victims. We found that funding of a new intervention associated with a high cost-utility ratio rather than interventions with lower ratios might save some identifiable victims at the expense of a larger number of unidentifiable ones.
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