Research Korner: Health Care System

Effects of Smoking - A Case Study Analysis

table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%"> Introduction The tobacco industry all over the world has been a monolith in terms of scope and coverage with regards to its consumers. Moreover, tobacco consumption has been among the major causes of death among individuals in recent years. The prevalence of smoking has triggered an epidemic brought about by the open sale of cigarettes to the public. It is this habit that triggered the surge of deaths caused by pulmonary illnesses and other conditions that could be described as cancerous in nature. Illnesses like bronchitis, emphysema, and lung cancer are among the major consequences of prolonged smoking among people.   It is a continuing issue in society. The prevalence of smoking and the recognition and awareness of its effects on the health of individuals remains to be a hot topic for discussion. Moreover, there is similarly a growing concern that the advertising that tobacco industries create and shows to the public espouses the habit of smoking. Not only that, it is similarly possible that the tobacco industry’s advertising activities helps in espousing smoking to the younger part of the population. With most of their consumers dying at a young age, the tobacco industry anchors almost completely upon new smokers going into the market before they reach eighteen years old. These young individuals have to be persuaded and influenced to take up smoking. This is scarcely a static market where players in the industry contend with one another to a collection of long-existing consumers. Undeniably, if the tobacco industry was doubling in its magnitude due to the number of new entries into the group was two times those dying or have given up smoking, this would be labeled as a growth industry. As it takes place, in the struggle involving the parties contending to youth in opposition to smoking and the tobacco industry, the former are carrying out unpretentious inroads and, at any rate today, to some extent more smokers are giving up the habit or passing away than are taking on smoking. This assumption leads us to the intention to look into the basic tools that the tobacco industries employ to encourage smoking as a habit. Specifically, the study will be taking a hand in the study of youth smoking and its relationship with the advertising done by the tobacco industries. For clarity and coherence of the discussions, the paper is going to be divided into several parts. At the end of the said discussions, the author will then provide a summary and conclusion of the findings established in the study.     Effects of Smoking   Smoking is characterized as the act of inhaling tobacco fumes from a pipe, cigar, or cigarette. It has been performed by people for centuries, together with early North-American natives. (Covey and Seidman, 1999) Europeans had initiated it into the Old World by the earlier part of the 16th century. It was recurrently practiced ever since then all over the world, with tobacco corporations coming up and packed up cigarettes soon accessible. Smokers had no acquaintance of cigarette smoke's adverse effects to their wellbeing until 1964, the time when the surgeon general of the US Public Health Service stated that smoking was dangerous to a person's health. Smoking influences an individual's health in a lot of ways, possessing both instant and long-standing effects. It is a severe compulsion, brought about by the drug nicotine that once breathed in nicotine contacts the brain almost instantaneously. Smoking is a dangerous practice, because it brings about addiction, illness, and high-risk pregnancy, and smokers are supposed to do everything to give up the habit.   A lot of smokers maintain that smoking alleviates them of stress and calms them down and soothes them, even as in recent years it has been established that the only thing smoking does is endangering an individual’s life. There are a lot of dangerous components in cigarette tobacco. A number of the said ingredients are toxic and addictive. (Covey and Seidman, 1999) Cigarette smoke generates thousands of chemicals that are perilous to a smoker's physical condition. The dangers of smoking bring about a lot of deadly illnesses and are supposed to encourage smokers to give up the habit. First, a main cause why user of cigarettes is supposed to quit smoking is that a lot of smokers are acquiring cancer, which eventually leads to their demise. This illness kills people if it is not discovered on time. Another rationale why smokers are supposed to quit smoking is because of heart disease and its effects. (Covey and Seidman, 1999) For instance, a lot individual undergo from heart failure, but even supposing they are aware about smoking and its hazards, they do not discontinue their habit until they grow to be in poor health. Regrettably, in a lot of instances, smokers are vulnerable to live with heart complications for the remainder of their lives. Lastly, another vital cause for people to stop smoking is the danger of acquiring emphysema. This is similarly a fatal illness that affects lungs and entire respiratory system. These numerous reasons are supposed to demonstrate to the smokers that this practice places their health in jeopardy, and brings about a lot of diseases that bring about death.   Youth Smoking   This study attempts to establish that the use of tobacco products among the youth is predominantly based on the advertisements played by the tobacco companies. In the study of Beltramini and Bridge (2001) it claimed that the advertising activities of tobacco products are “casually related” to the inception of smoking. It even goes further by stating that tobacco advertising are related to the addiction of young people to smoking cigarettes based on their capacity to acknowledge extensively advertised brands that are directly targeting the youth themselves. Seeing this, this study argues that advertising could have a major role in the onset of smoking among these young individuals. However, there are other causes and factors that could similarly bring about the habit of cigarette smoking. It is similarly important to present several other perceived causes of smoking among the younger population. One of these includes the easy access to merchandise associated with tobacco, and even though fewer sellers vend tobacco to youngsters, youth still have easy access to these products (Johnston et al., 1999). Behavioral psychologists have created successful methods to control youth access to viable sources of cigarettes (Jason, Billows, Schnopp-Wyatt, & King, 1996). Even supposing commercial sources of cigarettes are controlled, it is likely for the young population to get hold of tobacco by means of social sources. Studies have revealed that youth who smoke cigarettes willingly offer cigarettes to their friends and acquaintances (Wolfson, Forster, Claxton, & Murray, 1997). Essentially, studies has recognized that a correlation involving the propensity of young people to smoke and the amount of their peers who do so reveals the range of the peer group by the youth under consideration and not "pressure" presented by the smoking friends or acquaintances. The individual teenager starts the development, surveying the assemblage of smoking friends, engrossed to them because of the reality that their use of tobacco products is a representation that has been popularized and glamorized by means of advertising. The causal course is the opposite of what is characteristically recommended by those who would put stock in the peer pressure impression In addition, family members, who are considered smokers, like older brother or a younger sister and even guardians, are another major resource of tobacco for youth (Robinson, Klesges, & Zbikowski, 1998). Similarly, youth have been established to come up to strangers who are smokers to ask cigarettes from them (Ribsl, Norman, Howard-Pitney, & Kim, 1999). For the reason that a large quantity of children acquires tobacco from social sources, attempts and other activities concentrated on getting rid of retail sources of tobacco may possibly be crucial yet lacking to lessen smoking of cigarettes among youth. Similarly, tobacco ownership prohibition may make it much more difficult for minors to acquire tobacco from their peers, as lesser minors may possibly be enthusiastic to endanger the possibly of being caught with tobacco products. Tobacco ownership prohibitions similarly make it simpler to decrease understated peer pressure when young people gather together at social events and openly smoke and persuade others to participate in this activity. As a result, it is likely that fining minors for ownership of tobacco products may possibly be an essential element in conjunction with enforcement of legislations to lessen merchant sales of cigarettes to minors so as to trim down teenage use (Jason, Pokorny, & Schoeny, 2003).   Advertising Tobacco   Undeniably, there are several billions of dollars annually of advertising and promotion (FTC, 2003) brings about a soaring level of acquaintance and awareness with tobacco brands on the side of the consuming public. An article in Business Week (2003) has anticipated that the equity such promotion has instituted for the Marlboro brand making it as the ninth most valuable brand in the global context. In addition, more or less as many 6-year-olds could recognize Joe Camel in his prime as could recognize Disney characters (Fischer et al., 1991). In the said period, the Joe Camel character presented a camel looking suave and cool by sporting a cigarette lodged in his mouth. The thing that is really bothering is the fact that the young population recognizes this character and is aware of what the said character is doing; enjoying the activities he is engaging in with a stick of Camel cigarette lighted.        Long-term studies have recognized a sequence where awareness with or even fondness for cigarette advertising does allow adolescents on engaging to smoking (Biener and Siegel, 2000). Similarly, the wider marketing literature has recognized that augmented fondness for the commercial ad is connected to augmented fondness for the brand and for the product category (Kelly, Slater, and Karan, 2002). This study acknowledged how successful image advertising for cigarettes and other sin products like beer boosts fondness for the whole product category and not merely the specific brand of cigarettes promoted and advertised. The sad thing is that advertisers’ intention on this aspect is not merely to entertain. Advertisers intend to acquire an extensive familiarity with the brands in order to develop and expand the market and to boost market share.   However, the direct advertisement of cigarettes is not the sole means of presenting and initiating smoking towards the younger generation. Movies and television shows similarly have been used as a medium of tobacco companies to present their merchandise. Paid placement of tobacco products in films has traditionally been an essential component of the tobacco industry's marketing policies (Mekemson and Glantz, 2002). Throughout the 90s the frequency of smoking depicted in American films augmented sharply corresponding to the two preceding decades (Stockwell and Glantz, 1997). Throughout the most recent decade, one tobacco or any tobacco product was employed approximately in every three to five minutes in the films sampled as measured up with once in every ten to fifteen minutes in the 70s and 80s (Stockwell and Glantz, 1997). The amount of young adults smoking in films increased more than twofold (Hazan, Lipton, and Glantz, 1994). The depiction of cigarettes and smoking has usually been encouraging in nature (Stockwell and Glantz, 1997). However, a recent research that looked into the highest grossing PG-13 films before the 1998 settlement (1996, 1997) and the a couple of years following (1999, 2000) discovered that the standard number of time tobacco products were engaged on the screen augmented by 50% (Ng and Dakake, 2002).   A manner in which films can manipulate the smoking activities of youths is by the procedure identified as social modeling. This is the watching and emulation of attitudes of other individuals that they apparently admire or look up to (Bandura and Waiters, 1959). Therefore, for instance, adolescents whose preferred film stars smoke on or off the silver screen are more probable to have smoked than those whose favorite film celebrities do not smoke. Among adolescents who have by no means smoked, those whose much loved film celebrities do smoke are more vulnerable to start smoking proportionate to those whose favorite celebrities  do not smoke (Distefan, Gilpin, Sargent, and Pierce, 2004).   In addition, a study by Pechmann and Shih (1999) recognized the causal consequences of contact to the incidence of smoking in films on youths' intention to smoke in addition to their insights of a smoker's social standing. In one research, acquiring a film sated with cigarette smoking scenes, a professional editor was employed to generate a version of the motion picture without the scenes showing acts of smoking. Nonsmoking ninth graders were then exposed either the adaptation of the film with or without the smoking scenes. Those who watched the film with the smoking scenes were more expected to point out that they planned to smoke and more expected to look upon those who smoke as more intelligent, more successful, healthier, and sporty (Pechmann and Shih, 1999).   Another aspect that appears to have been associated with teenage smoking includes depression and the level of self esteem of the said population. The study of Cole, Hurford, Smith, and Vogel (2003) established that there are a considerable number of relationships involving depression and the smoking among teenagers. The said study employed the MDI to measure the level of depression of the respondents. According to the study, young individuals have a high propensity to smoke if have reveal high levels of “instrumental helplessness and social introversion.” These said aspects of depression are considered by the study as among the most alienating aspects of depression.  This means that young people that feel detached to society may well be on the express lane to the habit of smoking. Apparently, the said aspects of depression could reflect the person’s incapability of feeling a sense of connection with the people around him/her, including his/her family. This is compounded with the inability of the said person to get away from this state of depression.   The said study similarly claimed that the adolescents that have commenced in their smoking habits would be unconcerned with regards to seeking help for their depressed state. (Cole, Hurford, Smith, and Vogel, 2003) This could be damaging considering that their emotional state requires a lot of support to get them away from the said condition. The experiences that bring about a sense of inadequate assistance and understanding from other people probably leave adolescents feeling defenseless and secluded. The activity characterized by smoking as a way of acquiring social acceptance or to self-rehabilitate depressive sentiments among the adolescents.   In addition, several demographic variables were connected with adolescent smoking and depression as stated in the study of Cole, Hurford, Smith, and Vogel (2003). In their study, the respondents were more likely to smoke if their parents or guardians smoked or if they were grown-up. They were similarly more likely to articulate the intent to smoke potentially if their parents indeed used tobacco products, if they lived with a guardian, or if they were old enough. Possessing parents who used tobacco products was similarly connected with smoking for a considerable number of years. Higher depression marks were connected with lower marks and parents who used tobacco products. Parental smoking is tremendously powerful in shaping the probability of smoking in adolescents, while genetics may possibly have a say to this connection, modeling most possibly functions a great part in the association involving parental and adolescent smoking.   The said study shows that the family setting has a similarly great influence in the possibility of an individual to smoke. This is further backed up by the study of Borowsky, Ireland, and Scal (2003). They claimed that parent-family connectedness develops the possibility of the adolescents maturing free from smoking or any use of tobacco products. The sense of being close to, appreciated, loved and content with the relationship involving an adolescent and his or her parents is defensive and shielding with regards to the possibility of smoking in term of the gender and developmental stage among the respondents.   The said authors similarly employed the academic achievement as an indicator of smoking among the youth. Academic achievement was similarly strongly protective in opposition to transitioning to present smoking among all study groups. The study employed a self-reported grade point average to measure this variable. This means that a child who is doing well in school may well be free from any probability of smoking or using any other tobacco based products. This finding may reveal that education and awareness among the youth could present a great assistance with regards to providing information with reference to the dangerous consequences of smoking to one’s health.   Another protective factor that is present in the same study revealed that emotional well-being as a powerful variable among the respondents. The findings of the study revealed that the female respondents showed that this was a much greater protective factor to them as compared to the male respondents. This shows how females regard emotional elements as among the more important and more dependable wall to fall back on with regards to the temptation of smoking. The male respondents, on the other hand, could have established that they are more likely to be influenced into taking on the habit of smoking considering the appeal to their emotional well-being ranks less than other aspects, like being ”cool.”   The study of Borowsky et al. (2003) shows that even regardless of numerous risk factors for changing to smoking, specific elements can radically decrease and trim down the probability of growing to be a smoker. Even among the young individuals of society without recognized risk factors, the protective components additionally lessen the possibility for smoking. Smoking prevention schemes have conventionally embattled smoking-particular attitudes, beliefs and refusal skills. Browsky et al (2003) labeled these as proximal factors. Their investigation bears the impression that encouraging healthy adolescent maturity by improving components in opposition to smoking instigation, particularly in the areas of family and school setting, lessens the possibilities of becoming caught up in health risk attitudes like the use of tobacco products.   Use of Advertising to Discourage Smoking   When teenagers are asked why they smoke, the most commonly reported reasons were “curiosity, social norms, and offers/pressures, while for current smoking, the main reasons were pleasure/affect, addiction/habit, and desire.” (Dinh, 1992) In the said study, the order of the said reasons is based on the ranking on which the responses were given. Thus, it means that the top reason for teenagers to smoke was due to curiosity, followed by social norms. The problem with the study is that these are actual reason why kids start smoking. It did not establish why the respondents are currently smoking. However, given that curiosity turned out to the top reason, the advertising that the tobacco companies show all over the world to present and market their merchandise could still be among the factors that triggered that curiosity. Thus, the argument presented earlier in this study still holds.    Moreover, individual and social components, like curiosity, social norms, were regularly reported as causes for beginning use of tobacco, while physiological or affective grounds were more regularly accounted for current use of tobacco, such as pleasure/reduction of negative affect, and addiction/habit. (Dinh, 1992) Furthermore, a quantity of gender distinctions was established in the same study. As a cause for present smoking, more girls than boys indicated pleasure/affect, and for starting smoking, girls accounted both social norms and offers/pressure as grounds for starting to smoke more commonly than did the boy respondents. (Dinh, 1992) The grounds accounted for starting to smoke were connected with the persons' succeeding smoking experience. Elements in the said study like social norms, desire, and pleasure/affect were accounted as grounds for starting to smoke tobacco products more often among continuers than non-continuers, and curiosity less regularly. These grounds for beginning tobacco utilization may possibly be construed as risk factors for consequently growing to be regular tobacco smokers. Moreover, the similar study presented among current smokers, the intensity of smoking was positively associated the stated employment of tobacco because of elements likes addiction/habit and pleasure/affect. Insights with regards to the capability to give up were negatively connected addiction/habit as a reason for utilization. Adolescents' grounds for smoking change as a purpose of their smoking accounts. Students who had simply tried out tobacco (non-continuers) accounted more regularly curiosity and offers/pressure as grounds for commencing to use cigarettes than students who had experimented with tobacco and developed to weekly or more recurrent employment (continuers). Although curiosity and offers/pressure were frequent grounds indicated for the start of employing tobacco, they did not seem to be significant risk factors the moment regular use was taken on by adolescent smokers. In the study of Luna and Peracchio (1998), they looked at the attempts ti similarly use advertisement to provide information with regards to the harmful effects of smoking. The ad campaign concentrates on conveying the long-standing health consequences of smoking in a real manner by generating correspondences involving the consequences of smoking and things with which kids could relate to, like insecticide and vehicle exhaust. The intention of the said ad campaign is to offer both possible smokers and nonsmokers with germane and evocative representations and meaning with reference to the long-standing consequences of smoking tobacco products. With regards to the findings of the said study, it revealed a number of the attitudinal distinctions involving adolescent smokers and nonsmokers. The findings point out that adolescent smokers do not have tangible internal images of the unconstructive health consequences of smoking, but nonsmokers do appear to have such images. (Luna and Peracchio, 1998) If efforts to convey the lasting unconstructive and depressing health consequences of smoking are to sway possible prospective smokers, they have to represent those consequences in a manner to which young individuals could really associate.   Conclusion   Involvements pointed at adolescent smoking, in that case, is supposed to vigilantly appraise primary behavioral, normative, and control attitudes acquired by the target group and then advance with educational movements exclusively intended to considerably vary these convictions and the positions, standards, and apparent controls they generate. Specifically, instead of depending on customary methods anchoring on the negative effects of smoking, future studies is supposed to concentrate on how antismoking interventions might have an effect on individual outlooks with reference to one's personal smoking, the manner in which one appraises the suggestions of significant others on the subject of one's smoking, and one's attitude with reference to the capability to control one's smoking. This importance on positive reinforcement and developmental orientation gives confidence to customers to integrate longer-term and wider concerns of self-concept, family orientation, social concern, risk acquisition, and various added variables in appraising the efficiency of intervention schemes. Undeniably, attempting to resolve causality in preceding studies noted earlier, the viscous circle of growth, evaluation, execution, and amendment of antismoking educational involvements continues to become demanding.   References Bandura, A., And Walters, R. (1959) Adolescent Aggression. New York: Ronald Press. Beltramini, R. and Bridge, P. (2001) Relationship between Tobacco Advertising and Youth Smoking: Assessing the Effectiveness of a School-Based, Antismoking Intervention Program. Journal of Consumer Affairs. 35(2) Biener, L., And Siegel, M. (2000) "Tobacco Marketing and Adolescent Smoking: More Support for a Causal Inference." American Journal of Public Health 3 (98): 407-11. Avialable at: www.ajph.org/cgi/content/abstract/90/3/407. [Acccessed 26 April, 2006] Borowsky, I., and Ireland, M., (2003) Smoking among American Adolescents: A Risk and Protective Factor Analysis. Journal of Community Health. 28(2) Cole, A. Hurford, D., Smith, J. (2003) The Relationship between Depression and Smoking in Adolescents. Adolescence. 38 (149). Dinh, K. (1992) Adolescents' reasons for smoking. Journal of School Health. Available at: www.highbeam.com/doc/1G1:12983553/ Adolescents+reasons+for+smoking.html?refid=SEO.  . [Acccessed 26 April, 2006] Distefan, J., Gilpin, E., And Pierce, J., (2004) "Do Favorite Movie Stars Influence Adolescent Smoking Initiation?" American Journal of Public Health. 94(7). Available at: smokefreemovies.ucsf.edu/ pdf/Pierce-AJPH%20Movie%20Paper.pdf. [Acccessed 26 April, 2006] Fischer, PM., Schwartz, M., Richards, J., Goldstein, A., and RojasT., (1991) "Brand Logo Recognition by Children Aged 3 to 6 Years." Journal of the American Medical Association 22 (266): 3145-48. Available at: dx.doi.org/10.1001/jama.266.22.3145. [Acccessed 26 April, 2006] FTC. (2003) Cigarette Report for 2001." Federal Trade Commission. Available at: http://www.ftc.gov/bcp/ menu-tobac.htm. [Acccessed 26 April, 2006] Hazan, A., H. Lipton, And S. Glantz. (1994) "Popular Films Do Not Reflect Current Tobacco Use." American Journal of Public Health 84(6): 998-1000. Available at: www.ajph.org/cgi/content/abstract/84/6/998. [Acccessed 26 April, 2006] Jason, L. A., Billows, W., Schnopp-Wyatt, D., & King, C. (1996). Reducing the illegal sales of cigarettes to minors. Journal of Applied Behavior Analysis, 29, 333-344. Available at: seab.envmed.rochester.edu/ jaba/articles/1996/jaba-29-03-0333.pdf. [Acccessed 26 April, 2006] Jason, L. A., Pokorny, S. B., & Schoeny, M. E. (2003). Evaluating the effects of enforcements and fines on Youth Smoking. Critical Public Health, 13, 33-45. Available at: www.ingentaconnect.com/content/ routledg/ccph/2003/00000013/00000001/art00003 [Acccessed 26 April, 2006] Johnston, L. D., O'Malley, P. M., & Bachman, J. G. (1999). Cigarette Smoking among American teens continues gradual decline. Available at: www.umich.edu/~urecord/0405/Dec13_04/mtf_smoking.shtml. [Acccessed 26 April, 2006] Kelly, KJ., Slater, M., and Karan, D. (2002) "Image Advertisements' Influence on Adolescents' Perceptions of the Desirability of Beer and Cigarettes." Journal of Public Policy and Marketing. 2(21) 295-304. Available at: bear.cba.ufl.edu/centers/jppm/dmp/kelly.pdf. [Acccessed 26 April, 2006] Luna, D. and Peracchio, L. (1998) The Development of an Advertising Campaign to Discourage Smoking Initiation among Children and Youth. Journal of Advertising. 27(3) Mekemson, C., And Glantz. S.A. (2002) "How the Tobacco Industry Built Its Relationship with Hollywood." Tobacco Control 11 (1): 81-91. Available at: www.sacbreathe.org/Tobacco/ tobacco%20control%20article-Curt.pdf. [Acccessed 26 April, 2006] NG, C., and DAKAKE, B. (2002) "Tobacco at the Movies: Tobacco Use in PC-13 Films." Available at: http://masspirg.org/reports/TobaccoattheMovies.pdf. [Acccessed 26 April, 2006] Pechmann, C. And Shih. C. (1999) " Smoking Scenes in Movies and Antismoking Advertisements Before Movies: Effects on Youth." Journal of Marketing. 3(63): 1-26. Available at: http://www.scenesmoking.org/research/pechshih.pdf. [Acccessed 26 April, 2006] Ribsl, K. M., Norman, G. J., Howard-Pitney, B., & Kim, K. A. (1999). Which adults do underage youth ask for cigarettes? American Journal of Public Health, 89, 1561-1564. Available at: www.ajph.org/cgi/content/abstract/89/10/1561. [Acccessed 26 April, 2006] Robinson, L. A., Klesges, R. C., & Zbikowski, S. M. (1998). Gender and ethnic differences in young adolescents' sources of cigarettes. Tobacco Control, 7, 353-359. Available at: tc.bmjjournals.com/cgi/content/abstract/7/4/353. [Acccessed 26 April, 2006] STOCKWELL, T., and GLANTZ. S. (1997) "Tobacco Use Increasing in Popular Films." Tobacco Control 6 (1997): 282-84. Available in: tc.bmjjournals.com/cgi/content/abstract/6/4/282. [Acccessed 26 April, 2006] Wolfson, M., Forster, J. L., Claxton, A. J., & Murray, D. M. (1997). Adolescent smokers' provision of tobacco to other adolescents. American Journal of Public Health, 87, 649-651. Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9146446&dopt=Abstract. [Acccessed 26 April, 2006]

Effects of Smoking - A Case Study Analysis

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Health Care Investment Reform Hong Kong

Health Care Investment Reform Hong Kong   Introduction             Hong Kong is considered to be one of the most advanced and successful cities in Asia today. Almost in all attributes, Hong Kong serves to be one of the most regarded cities having the best services, information, and the latest technologies, being termed as “Asia Pacific’s Information Gateway and Hub” (Wong, 2002). This has prompted the city to be one of the Asian cities having the latest advancements, not only in products and services, but also in fashion, latest gadgets, and technologies as well. In addition, the healthcare system of Hong Kong serves to be of high standard and quality, and nearly comparable with the healthcare systems of other Western countries. It has many attributes that may be considered Asia’s edge and pride, and thus the commencement of continuous improvement and development not only in the medical field, but also in other aspects, such as the economy, politics and society. In this regard, with the use of the latest technologies in Hong Kong, it can be perceived that the latest technologies and health care can also be observed and rendered by the medical and healthcare systems of Hong Kong. However, given the increasing needs of the citizens of the city and the continuous changes in terms of technology and society, its health care system also needs reforms and changes in order to accommodate the needs of the citizens.   Hong Kong’s Current Health Care System             It has been reported that Hong Kong’s demographic and epidemiological profiles are closely similar to that of most advanced economies. This is because the city’s population is aging and increasingly suffers from chronic diseases. In the year 2003, the share of population having ages of 65 years old and above was about 10-11% and was predicted to increase to 13.3% in 2016. With increased life expectancies and a diet typical of well off countries, its population is increasingly suffering from diseases such as diabetes, heart diseases, and cancer. Moreover, similar to other wealthy countries, Hong Kong faces socio-health problems, such as mental disorders, alcoholism, sexually transmitted diseases, violence and substance abuse. Such conditions require a health care system that emphasizes primary and community care, and integrates prevention, outpatient, inpatient, community and other social services. However, despite such needs, the Hong Kong health care system remains public hospital-led and compartmentalized, with little communication between the secondary/tertiary level, and the primary and outpatient level. In addition, the majority of the private doctors providing outpatient services do not have family medicine training, nor do they perform gate-keeping functions or referrals to higher levels of care. Most private doctors work as solo practitioners on a fee-for-service basis. Clients often doctor-shop and their medical records are not transferred from one provider to the other. Thus, the lack of coordination among providers often results in duplicated services, repeated tests, discontinuity of care and confused clients; therefore, adversely affecting their health and unnecessarily increasing health care expenditures (Yip and Hsiao, 2004).             Furthermore, it has also been emphasized that Hong Kong has an incoherent financing strategy that has created inequity as well as the lack of universal medical insurance. Public funding from government revenue primarily funds acute and specialty care, thus, cannot be used to purchase private care and no universal medical insurance scheme is present. On the other hand, the private sector collects fee-for-service revenue from clients and primarily provides outpatient services. From this it can be observed that both sectors are not coordinated. This is because the government adopts a laissez-faire policy towards the private sector and allows physicians and hospitals to charge ridiculous fees that are very highly unaffordable for most of the population. There is no fee schedule and fees that can segregate one provider from the next. In the absence of any universal medical insurance scheme, clients mainly pay out-of-pocket and are left vulnerable to major financial risks. In turn, equal access to care is also compromised. The choice of provider is dictated by the ability of clients to pay. Those who can afford it seek treatment from the private sector, thus, are able to choose their own doctors. On the other hand, those without means seek care from the overcrowded public sector where they fact no choice of doctor and long waiting lines (Yip and Hsiao, 2004).             From this situation, it can be perceived that the reform for the health care system and investment in Hong Kong is badly needed. This is because through a significant and useful reform, the citizens of Hong Kong would be able to be provided with better health care services that they deserve. In addition, they would also be entitled to lessen their health care expenses, thus, not intimidating them to spend for their health care needs.   Health Care Reform in Hong Kong             It has been indicated that the government of Hong Kong Special Administrative Region or HKSAR launched a healthcare reform consultation to seek public views on the future development of the city’s healthcare system and financing arrangements. The healthcare reform is said to be a cross-generation project that concerns everyone in the society. The Chief Executive of the city, Donald Tsang described the healthcare reform as important for the future of the whole community of Hong Kong, the next generation, and the entire development of the city. Noting that it is a comprehensive package of proposals to address healthcare financing, the city’s Chief Executive urged all the political parties in the Legislative Council and the whole community to analyze the advantages and disadvantages of suggested reform and supplementary financing options rationally and practically and give their views. In addition, the reform is aimed at maintaining the quality healthcare service, enhancing the efficiency of the healthcare system, promoting competition in service delivery, while at the same time improving health through preventive care, and ensuring that no one would be left unattended (“HKSAR gov’t calls for healthcare reform consensus”, 2008).             Moreover, it has been emphasized that the first stage of the healthcare reform will last for three months until June 13. It is indicated in the consultation paper that the government will plan to undertake reform in five areas, which include enhancing primary care to put greater emphasis on preventive care; promoting public-private partnership in healthcare; developing electronic health-record sharing, strengthening the public healthcare safety net, and reforming healthcare financing arrangements. Furthermore, six options for providing supplementary financing have been outlined in the consultation paper for discussion. These six options include increasing user fees for public healthcare services; requiring the workforce to contribute a certain percentage of their income to fund healthcare for the whole population; encouraging more individuals to take out private health insurance in the market; setting up personal healthcare reserve; establishing medical savings account, as well as mandatory private health insurance (“HKSAR gov’t calls for healthcare reform consensus”, 2008).             Furthermore, the reform of the health care delivery in Hong Kong is unquestionably one of the most pressing health and medical care issues facing the city, but so far, the members of the government do not have yet agreement on the definition of problems, let alone the solutions. In relation to this, there are three principles guiding the reform of the health care system in Hong Kong, namely, the system should use scarce resources efficiently to deliver care, which is acceptable to the users and which consistently reduces inequalities in health across the community (Hedley, 2001).   Need for Health Care Reform             It has been mentioned earlier that the need for the reform of Hong Kong’s health care system lies on the lack of coordination of both public and private health sectors and the lack of adequate health care services provided for health clients. In addition, it has also been indicated that Hong Kong has a public/private sector imbalance, which creates problems both in terms of sustainability and overall system efficiency. Such inefficiencies spring from an over-reliance on hospitals due to an inadvertently flawed incentive system. Moreover, fragmentation of care despite the government’s best efforts is also a significant problem, which is most problematic outside the Hospital Authority. This is because in the private sector, it has about 80% of the market share in outpatient services, but provides only 6% of hospital care. This becomes ironic as half of all health expenditures are in the private market. With the rigid separation of the public and the private sectors, patients either go for a very high level of subsidy in the public sector, or no subsidy in the private sector. Given such observations, the Harvard Report regarding the city’s healthcare reform concludes that Hong Kong’s healthcare system has a variable quality of care, particularly in the private sector. A systematic quality framework, similar to that of the Hospital Authority does not exist in the private sector (Garnett, 2002).             Based on this, the different reasons for change in Hong Kong’s health care system must be emphasized. Primarily, the health care financing system, in which the main funding was from taxation and Government provided most of the hospital services, had remained unchanged for decades, in fact, it was almost the same as when introduced in the early days of the British colony. In this the city differed from the other cities in Asia. Taiwan had introduced national health insurance two years ago, South Korea over ten years ago, and Singapore introduced its Medisave system in the 80’s (Yuen, 1999). From this, it can be perceived that other advanced cities in the Asia Pacific region have already decided to fix their health insurance policies and laws in order to further provide healthcare services to its citizens. If Hong Kong wants to stay ahead and on top of other cities and be able to sustain it, it must also be able to improve its healthcare system. Another reason is that the population of Hong Kong is now an aging population, with the percentage of those aged 65 or over rising from 7% in 1985 to 12% in 2001 (Yuen, 1999). With an aging population, it can be distinguished that older citizens or individuals need more attention and care from both public and private hospitals. In this case, an aging population would suffer more from different fatal diseases, such as heart disease, diabetes, cancer, and obesity. As such, the lack of proper and adequate services from both the public and private health institutions means placing the lives of the aging in danger.             Third reason is that high-tech medicine and expensive drugs would push health care costs up (Yuen, 1999). It is already recognized worldwide that the use of advanced and more sophisticated technologies has already extended to the medical and healthcare field, thus, making diagnosis and treatment of patients or clients more appropriate and more easily done. With this, it can be perceived that due to the use of more advanced and high-tech equipments, the costs for healthcare services would be far more expensive. In order to provide better services for the citizens of Hong Kong, the Government must then decide to implement the reform. Fourth, rising patient expectations, driven by the increase in affluence, would also raise costs. In the old days patients had been laid on camp beds in wards with little public complaint; now the papers were full of criticisms of medical services (Yuen, 1999). Due to the drastic changes in the society, it can be observed that consumers, including patients are becoming much more demanding and decisive of what they want and need. In this case, slight mistakes and inefficient services would make the reputation of a particular hospital have a bad record. Adding to the keen eye and sharp words of the media, the criticisms of Hong Kong’s medical and healthcare services must serve as a wake-up call for a reform. Lastly, the reason for a health care reform is due to the fact that Hong Kong’s economic growth is slowing, thus, limiting the Government’s ability to pay (Yuen, 1999). This limits the ability of the public health sector to provide health care services to the citizens of Hong Kong, forcing them to opt for seeking services from private health care sector, which is more expensive. This then serves to be a major dilemma for poor citizens in the city.   Comment and Critique on Supplementary Financing Options             The supplementary financing option describes mandatory private health insurance as supplementary financing. Such options require or mandate the citizens of Hong Kong, particularly to the working citizens to pay extra costs for their health insurances, thus, providing coverage for their private hospital services and charges. Because it is mandated by law on a population-wide basis, all the insured irrespective of age, gender and health conditions are charged the same premium for the same insurance plan of the same coverage and benefits. As such, it can be perceived that equality among the citizens of Hong Kong is being promoted in terms of providing better health care services. Because each working individual in the society are required to give taxes for the provision of better health care in the city, each individual would be able to obtain appropriate services, regardless of social or economic status, as the taxes paid by working citizens become the source of the premiums. In addition, this serves to be a good way for providing health care and health services to the aging population of Hong Kong, as anybody would be able to obtain healthcare services regardless of age or regardless of any existing medical disease. In this regard, it can be seen that such financing options would be able to help sustain the population of Hong Kong, thus, promoting health, long lives, and the provision of better health care services.             It can also be emphasized that supplementary financing options in Hong Kong, which are implemented along with the health care reform initiative would do the citizens of the city good because it provides wider range of health care services that would help further cater to the needs of the citizens. The option enables the city’s health care services to be personalized or customized according to the specific needs of the patients or customers, thus, providing a wider scope of the level of benefits and the amenities to be provided by the health care institution. Significantly, the mandatory financing option would relieve the pressure on public health care services, as providing health care services to less fortunate citizens in Hong Kong. Through the insurance, each individual would be able to avail of the health care services provided in private hospitals. This is not to say that private hospitals are far better than public hospitals. However, there are some equipment and services offered in private hospitals that are not being offered in public hospitals. As such, it can be given emphasis that the provision of better and longer lives is being achieved. However, not all advantages can be indicated, as this financial option would serve as additional costs or burden to the working class, thus, not allowing them to freely tend to their needs or even save the extra money, as it is allotted for health care or medical services, which would be given to other individuals. Thus, this might create further problems in the future, such as in personal expenditures and family crises.             In terms of criticizing the supplementary financing options, number 12.3 of the Chapter 12, subsection (d) emphasizes that the financing option may encourage tendency to overuse healthcare. This is because mandatory private health insurance is susceptible to moral hazards, when providers and patients may have the incentives to over-supply and over-use healthcare. This is related to the Theory X of Health Economics, which emphasizes that financial rewards get in the way of high quality care and reduce caring. Nowhere can this be seen more clearly than in the ownership and control of health care facilities. Physicians want to own pharmacies, hospitals, and medical laboratories to exploit patients. Their ownership and control simply demonstrates how these greedy profiteers expand their monopoly control (Musgrave, 1995). The Theory X of Health Economics is most relevant to the identified supplementary financial option because of the fact that money matters complicate things, thus, either over- or under-supply health care services provided to citizens. This is because the amount of financial rewards to be received by many medical or health care institutions might somehow be the focus of that medical or health care institution and not the appropriate services that must be provided to the patients or clients. Thus, in this sense the amount of money or financial rewards involved in the process may either complicate or improve the medical or health care services provided to patients.             Another supplementary financial option is emphasized in Chapter 12, 12.3, which indicates that the mandatory private health insurance provides broad coverage for essential healthcare services ranging from in-patient services, out-patient services to prescription drugs, as well as other related healthcare services. This is related to the Theory Y of Health Economics, wherein financial rewards are the driving force generating the highest health care quality in the world. It is the financial rewards that bring caring people into the industry and maintain the high level of compassion. Ownership is anything but greed. Providers are in the best position to access need for facilities and to understand the importance of high quality. They are not satisfied with inferior services and want to have control so that they can insure high quality and access to care (Musgrave, 1995). In this regard, it can be emphasized that due to financial rewards, the extent of the medical or healthcare services provided for the citizens of Hong Kong would be wider, thus, further catering to their needs better. In this sense, it can be understood that due to the increase in finances, all the medical and healthcare needs of Hong Kong patients are given utmost importance.              Based on this, a recommendation would be to increase the salaries of the working class in order to have the ability to comply with the new policy. In this regard, the personal expenditures of the citizens in Hong Kong would not be entirely affected. On behalf of our department, another recommendation for the government would be to ensure that policies regarding the provision of equal medical and healthcare services to all citizens in relation to the mandatory private health insurance. This is to make sure that the government would be able to support the rights of each citizen and to guarantee them their rights for medical and healthcare services.       References Chapter 12 Supplementary Financing Option (5) – Mandatory Private Health Insurance, 1-7. Garnett, L.R. (2002). Harvard Medical International. Retrieved June 3, 2008, from http://www.hmiworld.org/hmi/issues/March_April_2002/forum.html. Hedley, A.J. (2001). Health Care Reform in Hong Kong. HKMJ, 7(2), 1-2. “HKSAR gov’t calls for healthcare reform consensus”. (2008). People’s Daily Online. Retrieved June 3, 2008, from http://english.people.com.cn/90001/90782/90880/6372879.html. Musgrave, G.L. (1995). Health economics outlook: two theories of health economics. Business Economics, April, 1-9. Wong, R. (2002). TDC Trade. Retrieved June 3, 2008, from http://www.hktdc.com/econforum/hkcer/hkcer021201.htm. Yip, W. and Hsiao, W. (2004). A systemic approach to reform Hong Kong’s health care financing: the Harvard proposal, 1-11. Yuen, P. (1999). Hong Kong Democratic Foundation. Retrieved June 3, 2008, from http://www.hkdf.org/newsarticles.asp?show=newsarticles&newsarticle=92.

Health Care Investment Reform Hong Kong

Health Care Investment Reform Hong Kong Introduction Hong Kong is considered to be one of the most advanced and succe...

The Impact of Health Care in the United States

Healthcare Organization And Delivery MT-371 Midterm Project           “The Impact of Health Care in the United States”                       Introduction Different diseases threaten the lives of many people around the world. But in particular, many diseases are now being treated in the United States, such as cancer, sexually transmitted diseases, flu, tuberculosis, and many more. This is why, each individual in the United States must have a health insurance to ensure that his or her health problems would be given a solution. It has reported that undisputedly, the wealth of a country is judged by the health of its people, and worldwide, nations are seeking viable answers to the question of how to offer a health care system, which leads to improvements in the health status of their citizens ( 2006). However, improving an individual’s health means more than a doctor visit, and instead is a collaborative approach, which involves financial support, strategic planning, and health prioritizing legislation involving the government, community leaders and private and public health care professionals ( 2006). This is why having a health insurance is a vital necessity. The impact in health insurance Health care is an important aspect in the lives of each individual. (1996) stated that to meet healthcare needs at all, a health service must be available, accessible, effective and relevant to needs . This is why people choose to have a good health care insurance from a company, which offers good services.  (2004) reported that when a person does not have a health insurance, the person can delay getting medical care until he or she can afford it. The delay in medical care increases the risk of complications and the advancement of health problems, and therefore, when a person without health insurance finally seeks medical care, the costs are normally greater ( 2004). In line with this, it was explained that efforts to increase access to health care typically focus on providing health insurance or on securing a place that will care for the uninsured. Strong evidence suggests that having a usual source of care produces better health outcomes, reduced disparities, and reduced cost ( 2004). Growing evidence suggests that the combination of health insurance and having a usual source of care has additive effects for quality, and that insurance changes that disrupt continuity relationships can lead to higher costs and poorer quality for up to a year ( 2004). Furthermore, it was reported that people without health insurance are consistently found to receive lower levels of essential care, education, monitoring and examinations, given that these preventive interventions are associated with decreased risk of disabling and life-threatening complications ( 2006). As a proof to this claim, a 2000 study focused on various aspects of diabetes care, including eye and foot examinations, monitoring and education, revealed that people with diabetes without insurance were significantly less likely to receive appropriate diabetes care when compared to those with private health insurance ( 2006).    The impact in medical care  (2004) reported that new medical technology, such as the MRI or the Magnetic Resonance Imaging, allows doctors to see inside the body and more accurately diagnose conditions. They also let doctors diagnose conditions earlier, leading to a more complete recovery for the patient. In addition, new surgical techniques involving little or no cutting are also improvements related to medical technology. New therapies and treatment improve the quality of life for patients suffering from chronic or terminal conditions, and new vaccines offer better prevention and are now part of routine child medical care ( 2004).             The author also added that one of the key drivers of the rising cost of healthcare is hospital care. Between 2001 and 2002, the cost of outpatient services was the fastest growing part of healthcare, increasing by about 15%, while the inpatient hospital costs, which make up the largest single component of healthcare costs, rose by 6% ( 2004). In line with this, most researchers agree that the primary reason the cost for outpatient care has increased is due to the cost of using the outpatient setting for medical procedures is no longer less expensive than having procedures done during hospital admissions. While inpatient hospital cost increases are due to the increase in the use of more expensive technology, higher labor costs because of the growing shortage of nurses, hospital consolidation and increasing costs for hospital admissions even though the length of hospital stays has decreased ( 2004). The impact of health care for the elderly             The United States is an aging population, as the average age of its members is 47 years old, and by 2008, about 15% of the general population will be 65 years of age or older (2004). Because of this, necessary health care programs and facilities must be given to the elderly. Some of the elderly in the United States reside in a nursing home. They are being sent there by their families to be taken care of because their family members themselves cannot take care of them. However, the elderly do not always achieve proper care in the nursing home. This is because, as  (2001) reports, the facilities in private as well as public nursing homes are understaffed, have high turnover rates and many of their workers, skilled or unskilled, leave as soon as they can find a position elsewhere with a little higher pay and a little lower patient loads ().              and  (2005) reported that the dominant issue in American medicine for the immediate future will be how we adjust to the demographic realities of an aging society. It will cause much agony in a medical profession trained to assume that there are virtually unlimited resources available and that cost is never a consideration. Today’s challenge is to see what the solutions to past problems are doing to the future (2005). This applies with special urgency to our health care programs especially for the elderly, as the government is less likely to support them to allocate people’s taxes to other things, despite the advancement of science and technology. Despite the cost cutting of the government regarding this matter, the care for the elderly must not be alleviated, but instead must be reinforced as a sign of respect to them and gratitude.  Government Support for Healthcare             It was reported that government health programs face critical business challenges in containing costs and ensuring citizen health and safety 2006). The United States government acts as the financer, deliverer and overall steward of health systems. As stated, the federal and state government funding of health care needs of its citizens is limited to Medicare and Medicaid insurance programs for the eligible senior, very poor or disabled persons (2006). In addition, health insurance must be paid for privately, otherwise, and, in most cases, is provided by a person’s employer. However, there are about 46 million Americans who do not have health insurance, and it is one of the most expensive items in the nation’s budgets (2006).             Furthermore, the government supports health care systems by funding and supporting the innovation and improvement of information technology. In this way, the advancement of science and technology can help in providing better cure and care for those who need them. Consumer Expectations             It was reported that people are getting much more sophisticated when it comes to their health care choices. With this, the direction from a provider and a health care plan perspective is to provide the end user, in this case the patient, with more information as well as robust tools to proactively manage their health and their finances ( 2006). For most health plans, consumer driven health has quickly evolved beyond the concept of a product to become a corporate-wide consumer driven strategy. Due to this, it requires health plans to shift the center of their operational focus from claims and payment transactions to high touch customer interactions. As stated, beyond simply designing and administering benefits and paying claims, health plans now need to deliver first class service that focuses on the experience and health of the consumer (2006).             Moreover, it has been reported that as new technologies and channels for communication become established, such as the Internet, distance is eliminated or minimized, and information is often available immediately (2001). With this, consumers become more demanding and are able to get what they want because of the amount of information that they have. Consumers now have the power to change their health insurances as soon as possible whenever they do not fully utilize them, and health insurance companies readily modify and improve their services to meet the consumers’ demands. In this fashion, it fosters a win-win situation and both parties benefit from the situation. Conclusion             A healthy nation should provide the necessary benefits for each and every of its citizens and one way to do this is to make health insurance available for each. We must also prioritize the health of individuals, as the work force is one way to determine the success and power of a country. As suggested, we need to promote healthy behavior by providing a range of exercise and sport activities for our youth, adults and elderly (2006).  We need to support an increase in health seeking behaviors motivated by education, through the school system, civic groups and public information. We must also strive to improve the health care system by creating an environment that encourages and rewards quality of care by the professionals.Through tightly coordinated partnerships with medical, social, educational, business, civic and religious organizations of this country, we can develop a comprehensive and coordinated health care system (2006).

The Impact of Health Care in the United States

Healthcare Organization And Delivery MT-371 Midterm Project “The Impact of Health Care in the United Stat...

ATAXIA TELANGIECTASIA

Ataxia Telangiectasia (AT) is an autosomal recessive hereditary progressive neurodegenerative and multisystem disease characterized by cerebellar ataxia, telangiectasias, recurrent sinopulmonary infections, and variable immunologic defects. Its diagnosis is obvious when ataxia and telangiectasia are both present. However, the diagnosis can be made upon the onset of ataxia and before the appearance of telangiectasia if confirmed by laboratory tests. Early diagnosis is important for genetic counseling, appropriate care, and avoidance of unnecessary tests (Lederman, 1998).               Serum IgA is low to absent in 60 to 80% of cases; less common B cell defects include low to absent secretory IgA, increased catabolism of serum IgA, development of anti-IgA, and deficiency of serum IgE. Evidence of impaired T cell function includes periodic lymphopenia, a decreased response to delayed hypersensitivity tests and to in vitro tests of lymphocyte function, and thymus abnormalities (small gland; decreased lymphocytes; absence of Hassall’s corpuscles).               Both neurologic symptoms and evidence of immunodeficiency are variable in onset. Ataxia usually develops at about the time when patients begin to walk but may be delayed until the age of four years. Its progression leads to severe disability. Speech becomes slurred, choreoathetoid movements and opthalmoplegia occur, and muscle weakness usually progresses to muscle atrophy.               Telangiectasias develop between 1 and 6 years of age, most prominently on the bulbar conjunctiva, ears, antecubital and popliteal fossas, and sides of the nose. The recurrent sinopulmonary infections, which result from the immunologic deficits, lead to recurrent pneumonia, bronchiectasis, and chronic obstructive and restrictive lung disease.               Endocrine abnormalities may occur, including gonadal dysgenesis, testicular atrophy, and an unusual form of diabetes mellitus characterized by marked hyperglycemia, resistance to ketosis, absence of glycosuria, and a marked plasma insulin response to glucose or tulbutamide.               The incidence of cancer is increased, most often as lymphosarcoma but also including Hodgkin’s disease, leukemia, gastric adenocarcinoma, cerebellar medulloblastoma, reticulum cell carcinoma, and frontal lobe glioma.               Prognosis is usually poor, with death occurring from chronic sinopulmonary infections or malignancy. However, the progressively and severely handicapped patients may survive into their 30s.               Proper diagnosis of the hereditary disorder AT can be done when only the ataxia or staggering balance problems have appeared but not the telangiecatasia with its characteristic dilation of capillaries on the ears, faces, and eyes. The name of the disorder itself is an impediment to early diagnosis, as it includes both symptoms. A serum alpha-fetoprotein test done on all children who have a lasting ataxia would identify the AT earlier and allow treatment and counseling (Lederman, 1998).               Although it is difficult to reconstruct all the factors that lead physicians to a correct diagnosis of AT, we hypothesize that physicians rely on telangiectasia to make this diagnosis and do not consider AT until telngiectasia appear. This may be attributable to the fact that AT is a rare cause of ataxia and/or the physician's unfamiliarity with laboratory methods that may support a diagnosis at an earlier stage of the disease. Furthermore, affected children may not seem to deteriorate in function until the early school years so that the diagnosis of a static condition seems reasonable for a time. Our experience with AT suggests that the name, although a concise and memorable label for the disorder, is also a barrier to early diagnosis (Lederman, 1998).               Laboratory tests that may help support a diagnosis of AT include measurement of serum AFP levels and examination of the karyotype. AFP is a human fetal serum protein found at levels less than 10 ng/mL in children more than the age of 1 year. Rising levels of AFP in young children are distinctly unusual, and characteristic of patients with AT or certain rare tumors. Increased frequency of spontaneous- and x-irradiation-induced chromosomal breaks are also associated with the diagnosis of AT. Recent identification of the gene responsible for AT (ATM) may improve diagnosis and reveal a wider spectrum of the disease. However, the large size of the ATM gene and the finding that most pathogenic mutations are unique make genetic evaluation of the individual patient highly labor intensive and genetic diagnosis more specific than sensitive (Lederman, 1998).               Although the AT is diagnosed based on clinical presentation as is presented in the first few paragraphs, it is sometimes necessary to perform a cytological test to confirm diagnosis. This is done by demonstrating that cells from patients are sensitive to irradiation (IR). This procedure is done by irradiating blood lymphocytes, or skin fibroblast cells from AT patients followed by monitoring frequencies of CAs in metaphase cells relative to frequencies of CAs found in cells from normal, control individuals. In a typical analysis four cells sampled are generated: untreated AT sample, irradiated AT sample, untreated normal sample, and irradiated normal sample.               As the analysis is performed in a way that the person analyzing the samples is not aware of which sample is which, there is no chance for the experiment to be manually manipulated by the researchers in order to come up with the desired results.               The irradiated normal sample showed a total of 12 chromosomal aberrations. The irradiated AT sample on the other hand had a total of 35 chromosomal aberrations. The untreated AT sample had a total of 6 chromosomal aberrations.               The frequency of chromosomal aberrations induced by radiation in each of the samples was found to be similar in the cells irradiated. A similar frequency was recorded also in the cells of genetically or AT defective individuals. However, the incidence of aberrations in specific chromosomes of normal and genetically defective or AT individuals differed and the frequency was found to be higher in the latter group. From the data it is evident that the response of chromosomes of AT patients was significantly different compared to those of healthy individuals.               The radiosensitivity of individual chromosomes and the location of the radiation-induced chromosomal break points are found to be genetically controlled. There exists an intra and interchromosomal variation in the production of radiation-induced chromosomal aberrations.   A delay in the diagnosis of AT may compromise care of the patient and other family members. Early diagnosis of AT alerts the physician to possible immunodeficiency and the need to limit exposure to ultraviolet light and diagnostic radiographs. Early diagnosis also allows the opportunity for genetic counseling because parents are at risk for having other children with AT. Timely diagnosis identifies heterozygous parents who may have an increased risk for cancer or complications from cancer therapy.   Finally early diagnosis can avoid further costly and unnecessary tests. Many of our patients have had one, if not multiple, neuroimaging studies. In contrast, the cost of determining serum AFP levels is low. On a macroeconomic level, routine determination of AFP for all pediatric patients with chronic ataxia may be cost-effective. AFP measurements are certainly cost-effective in the evaluation of young children with progressive ataxia. In summary, the diagnosis of AT is often delayed, but can be made earlier with readily available and inexpensive laboratory studies. The delay is costly for the patient, family, and society (Lederman, 1998).             REFERENCES Lederman, H.M. 1998, Consequences of the Delayed Diagnosis of Ataxia- Telangiectasia, Pediatrics.

ATAXIA TELANGIECTASIA

Ataxia Telangiectasia (AT) is an autosomal recessive hereditary progressive neurodegenerative and multisystem disease characterized by ce...