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COLUMBIA, Md.---A mere three years ago, workers at Green Spring Mental Health Services--a company that tracks patients' health-care treatment and records for such companies as Blue Cross/Blue Shield had just […]

Purpose: Hospital information system (HIS) can be examined as a vital factor for developing the quality of health care and cost managing. There exists abundant literature on HISs, but implementation-based literature of HIS is rare, typically about progressive countries. However, a study that can comprehensively review published articles is scarce. Therefore, this paper aims to examine the systematic and comprehensive study of HIS in developed countries. Together, the benefits and harms relevant to HIS's different mechanisms have been considered, and the fundamental challenges of them are addressed to design more efficient HIS in the future. Design/methodology/approach: HIS has been used globally for numerous years and is now being used in a wide area. HIS is broadly used in clinical settings. Information technology (IT) and information system have been suggested as a required piece to solve the health-care-related issues. Hence, to improve HIS's ability, this paper conducted a review method concentratating on research related to HIS until 2019. A total of 21 papers were recognized and examined as principal research for the summary. Findings: The authors found that HIS can help in reduction of medical mistakes, enhancement doctors' performance and increase in the quality of the care provided. HIS management can be used to provide better health-care services. Therefore, HIS must be sensible and use clear structures. The authors conclude that, generally, with an increase in awareness, acceptability and the need for HIS worldwide, there will be more strategies and approaches available. Research limitations/implications: First, this paper provides an outline of the status of HIS. Second, it identifies some distinct research gaps that could be worth studying. Some flawless work may be removed because of applying some filters to select the original articles. Surveying all the papers on the topic of HIS is impossible, too. Practical implications: Design and sustainability of HIS is still a big issue for most developing countries, despite its wide usage in the developed countries. The technology is changing rapidly, so the field should be reviewed regularly. This paper suggests a suitable framework that will guide HIS in the local conditions of developing countries. Social implications: The government will be assisted by the suggested solving ways in its performance and design of electronic health-care projects. Originality/value: The study brings the viewpoints on the state of HIS mechanisms in developing countries. The paper's results can offer visions into future research requirements. By providing comparative information and analyzing the current growths in this area, this study will support researchers and professionals to understand the progress in HIS mechanisms better. [ABSTRACT FROM AUTHOR]

The article offers information on various industries. It states that the U.S. Congress will approve a fund of 500 million dollars as liability coverage for nuclear weapon developers. It mentions that the tallest building in London, England will be built that will amount to 12 million dollars and featuring 700 luxury rooms. It adds that the paper industry in the U.S. have been experiencing rough situations such as the anti-merger complaints between Crown Zellerbach Corp. and Scott Paper Co.

Purpose: Economists have recognized knowledge management as a promising tool regarding all aspects of the economy, including health care. The volume of biomedical literature is currently growing at an exponential rate, and the vast number of studies makes it extremely difficult for researchers to keep up with new developments in their research areas. Therefore, the efficient management of huge amounts of data and the accuracy of the knowledge thus obtained are vital concerns. Electronic health (e-health) has emerged as a useful concept to provide data for solo self-care management. Although health care is a common topic on the internet, patients rarely share their health care-related knowledge on social media. This study aims to examine the impact of knowledge on e-health. Design/methodology/approach: This paper complies with the methodological requirements of systematic literature reviews. The present paper has investigated the newest systems and studied their practical techniques in detail. The effects of knowledge on e-health have been categorized into major groups. Findings: The outcomes indicate that the capabilities of information and communication technology certainly promote the exchange of knowledge within clinics. The results also show that institutional architectures have significant impacts on knowledge-sharing exercises, significantly improving patient safety. Practical implications: These findings will be essential in the understanding of the interplay among various signals in theory and in the understanding of patients' choice in the e-health community in practice. The results have implications for existing health management and e-health literature. The present paper will help policymakers, health-care executives and project managers to effectively set their operations and make them maintainable, prevent unpredicted obstacles and better allocate their resources. Overall, the results of this paper will guide researchers who are working in the field of e-health. Originality/value: E-health attempts have mostly focused on answering questions using context-specific technical answers, regardless of the key role of knowledge resources. The present paper has provided an innovative viewpoint on how knowledge resources and knowledge-sharing initiatives may have a role in the innovative work behaviors shown by health-care employees. As noted before, there have been only a few studies regarding the effects of knowledge on health care, so the present paper contributes to the previous literature, particularly about e-health. [ABSTRACT FROM AUTHOR]

This paper presents the position of the Latin American working group of the International Foundation for Integrated Care (IFIC). The working group brings together various Latin American actors and organizations in support of actions that facilitate the transformation of health systems in the region towards integrated systems that focus on people not as isolated individuals but as subjects of law in the complex social and environmental contexts where they live and interact. The working group proposes nine pillars of integrated care to be used as a conceptual framework for policy development and changes in practices: 1) shared vision and values; 2) population health; 3) people and communities as partners; 4) resilient communities; 5) capacities of human resources for health; 6) governance and leadership; 7) digital solutions; 8) aligned payment systems; and 9) public transparency. Based on these pillars, lines of work are proposed to strengthen alliances and networks, advocacy, research, and capacity-building, in order to help develop health and social systems that are effectively integrated and focused not only on people but also on communities in Latin America. [ABSTRACT FROM AUTHOR]

Natural raw materials such as essential oils have received more and more attention in recent decades, whether in the food industry, as flavorings and preservatives, or as insecticides and insect repellents. They are, furthermore, very popular as fragrances in perfumes, cosmetics, and household products. In addition, aromatherapy is widely used to complement conventional medicine. This review summarizes investigations on the chemical composition and the most important biological impacts of essential oils and volatile compounds extracted from selected aromatic blossoms, including Lavandula angustifolia, Matricaria recutita, Rosa x damascena, Jasminum grandiflorum, Citrus x aurantium, Cananga odorata , and Michelia alba. The literature was collected from PubMed, Google Scholar, and Science Direct. Blossom essential oils discussed in this work are used in a wide variety of clinical issues. The application is consistently described as safe in studies and meta-analyses, although there are notes that using essential oils can also have side effects, especially dermatologically. However, it can be considered as confirmed that essential oils have positive influences on humans and can improve quality of life in patients with psychiatric disorders, critically ill patients, and patients in other exceptional situations. Although the positive effect of essential oils from blossoms has repeatedly been reported, evidence-based clinical investigations are still underrepresented, and the need for research is demanded. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to assess the potential factors that may generate complexity in managing operations in home care (HC) organizations. Hence, a framework which might assist decision making regarding complexity-driven issues in HC organizations is developed. Design/methodology/approach – Based on a systems thinking view, a framework was developed identifying complexity factors in HC organizations. The paper is based on field research to explore the practical challenges of managing operations in HC structures. The authors additionally give a state of the art in many scientific domains; definition of complexity and its implications; complexity in health care; description of home care operations and their management. The literature review enlightens the lack of consensus on HC complexity and thus provides a broad view and a critical analysis of the underlying concepts. Findings – Proposal of a HC operations complexity model (and validation due to a practical application). Practical implications – The framework developed by the authors permits one to identify rapidly the existing complexity factors which may create potential damages regarding value creation and cost improvement in HC. Two kinds of HC complexity are identified: HC organization complexity and HC individual patients' therapeutical projects complexity. Complexity factors are grouped into five categories: factors related to size; factors related to variety; interdependence factors; factors related to uncertainties; and factors related to context. By identifying the factors, decision support systems and response plans may be more adapted to the potential existing short comings of operations. Originality/value – Based on authors' extensive knowledge of HC practices, as well as an international systematic review of literature, this paper contributes to a better characterization of factors inducing complexity in the HC context. To the best of the authors' knowledge, operations management literature lacks a general framework enabling a better identification and understanding of what makes HC operations specific. The paper presents an innovative way to analyze HC complexity using a systems thinking-based approach. In this sense, its contribution is very complementary to traditional operations management models. [ABSTRACT FROM AUTHOR]

While horticultural therapy (HT) has a long history in the United States, the profession has not had the acceptance and growth that related fields, such as art, music, recreational, occupational, and physical therapies have experienced. The objective of this study was to identify the current challenges and opportunities of HT in the United States. Maximum variation sampling was used to select current and former members of the American Horticultural Therapy Association (AHTA) for interviews. A total of 27 participants were interviewed between Nov. 2019 and Jan. 2020 using semi-structured qualitative interviews by Zoom. The interviews revealed six themes: 1) current state of the profession, 2) AHTA operations/structure, 3) education/credentialing, 4) funding/job opportunities, 5) public awareness/networking, and 6) research. This paper will discuss the challenges and opportunities presented in the six themes and provide recommendations for the future growth of the HT profession. [ABSTRACT FROM AUTHOR]

The drinking water supply is a core element of national regulations for normal and emergency supply as well as coping with crisis events. Particularly with regard to the interdependence of critical infrastructures means that water supply failures can have far-reaching consequences and endanger the safety of a society, e.g., by impairing hospital operations. In case of an emergency in the drinking water infrastructure, minimum supply standards, e.g., for patients in hospitals, become important for emergency management during crisis situations. However, wider recognition of this issue is still lacking, particularly in countries facing comparably minor water supply disruptions. Several international agencies provide guideline values for minimum water supply standards for hospitals in case of a disaster. Acknowledging these minimum standards were developed for humanitarian assistance or civil protection, it remains to be analyzed whether these standards apply to disaster management in countries with high water and healthcare supply standards. Based on a literature review of scientific publications and humanitarian guidelines, as well as policies from selected countries, current processes, contents, and shortcomings of emergency water supply planning are assessed. To close the identified gaps, this paper indicates potential improvements for emergency water supply planning in general as well as for supply of hospitals and identifies future fields of research. [ABSTRACT FROM AUTHOR]

Medicines Regulatory Authorities (MRAs) are an essential part of national health systems and are charged with protecting and promoting public health through regulation of medicines. However, MRAs in resource-constrained settings often struggle to provide effective oversight of market entry and use of health commodities. This paper proposes a regulatory value chain model (RVCM) that policymakers and regulators can use as a conceptual framework to guide investments aimed at strengthening regulatory systems. The RVCM incorporates nine core functions of MRAs into five modules: (i) clear guidelines and requirements; (ii) control of clinical trials; (iii) market authorization of medical products; (iv) pre-market quality control; and (v) post-market activities. Application of the RVCM allows national stakeholders to identify and prioritize investments according to where they can add the most value to the regulatory process. Depending on the economy, capacity, and needs of a country, some functions can be elevated to a regional or supranational level, while others can be maintained at the national level. In contrast to a "one size fits all" approach to regulation in which each country manages the full regulatory process at the national level, the RVCM encourages leveraging the expertise and capabilities of other MRAs where shared processes strengthen regulation. This value chain approach provides a framework for policymakers to maximize investment impact while striving to reach the goal of safe, affordable, and rapidly accessible medicines for all. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to propose a service quality evaluation model for health-care services. Design/methodology/approach: In this study, a service quality evaluation model is proposed based on the service quality measurement (SERVQUAL) scale and machine learning algorithm. Primarily, items that affect the quality of service are determined based on the SERVQUAL scale. Subsequently, a service quality assessment model is generated to manage the resources that are allocated to improve the activities efficiently. Following this phase, a sample of classification model is conducted. Machine learning algorithms are used to establish the classification model. Findings: The proposed evaluation model addresses the following questions: What are the potential impact levels of service quality dimensions on the quality of service practically? What should be prioritization among the service quality dimensions and Which dimensions of service quality should be improved primarily? A real-life case study in a public hospital is carried out to reveal how the proposed model works. The results that have been obtained from the case study show that the proposed model can be conducted easily in practice. It is also found that there is a remarkably high-service gap in the public hospital, in which the case study has been conducted, regarding the general physical conditions and food services. Originality/value: The primary contribution of this study is threefold. The proposed evaluation model determines the impact levels of service quality dimensions on the service quality in practice. The proposed evaluation model prioritizes service quality dimensions in terms of their significance. The proposed evaluation model finds out the answer to the question of which service quality dimensions should be improved primarily? [ABSTRACT FROM AUTHOR]

The article presents a list of the world's most admired companies, in which overall leaders include technology company Apple Inc., Internet-search firm Google Inc., and conglomerate Berkshire Hathaway, and also presents lists within selected subcategories such as Computers & Communications, Consumer Products, and Financials.

The article discusses how much of the international community has failed to deal with a war in Sudan, focusing on allegations of war crimes against members of Sudan's military forces, Sudan's Foreign Minister Ali Ahmed Karti, and the U.S. government's inclusion of Sudan on a list of state sponsors of terrorism. A genocide in Darfur, Sudan is mentioned, along with the indictment of Sudanese President Omar Hassan al-Bashir by the International Criminal Court for crimes against humanity.

The article discusses several of the physicians, nurses, and advocates who were collectively honored by being named as "Time" Magazine's Person of the Year for 2014, focusing on information about Liberian surgeon Dr. Jerry Brown, health promoter Ella Watson-Stryker, and nurse's assistant Salome Karwah. Ambulance supervisor Foday Gallah and the World Health Organization (WHO) are mentioned, along with the Doctors Without Borders/Medécins Sans Frontiéres (MSF) medical care organization.

The article discusses how the Ebola virus outbreak is being handled in West Africa and focuses on emergency response efforts by those including the Red Cross humanitarian organization. Topics include a reportedly slow response for support from international organizations and governments such as the United Nations (U.N.) and the World Health Organization (WHO), the work of virologist Robert Garry, and purported shortfalls in the domestic health care system in West Africa.

Presents an inductive machine learning algorithm called CLIP3 (Cover learning using integer programming). CLIP3 is an extension of the CLILP2 algorithm. CLIP3 generates multiple rules for a given concept from two sets of discrete attribute data. It combines the best concepts of tree-based and rule-based algorithms to produce a highly reliable machine-learning algorithm. The algorithm is run on the benchmark "MONK's data sets". Compares the results of standard machine learning algorithms such as the ID and AQ families of algorithms. The algorithm is also run on the breast cancer data set and the results are compared with C4.5 algorithm results. [ABSTRACT FROM AUTHOR]

The article discusses the U.S. movement to eat a low-fat diet. Topics include flawed research by physiologist Ancel Keys suggesting that fat raised cholesterol levels, causing heart disease, research since the 1980s indicating a tenuous link between saturated fat and heart disease by multiple teams, including epidemiologist Rajiv Chowdhury, cardiologist Ronald Krauss and physician Dean Ornish and the conclusion that small LDL-cholesterol may be affected by carbohydrates rather than fat.

The article discusses why executives such as Charles Bancroft and Lamberto Andreotti at the pharmaceutical company Bristol-Myers Squibb is intentionally trying to pare down its operations. Topics include how it sold its diabetes business because, though there was demand for it, profit was small, how it also sold much of its non-pharmaceutical assets including its aviation unit, and its commitment to immuno-oncology cancer treatment including the drug Yervoy.

The article questions the availability of medical journals containing the results on various clinical trials in cancer research in the U.S. According to the article, clinical trials are crucials to advances in medical science. It reveals the move of some researchers in conducting a test on new drugs or treatments in patients and reported what they find. In turn, companies, scientists, and doctors learn what works and doesn't work.

The article offers information on the U.S. Department of Health, Education and Welfare (HEW), with particular focus on its programs that were considered corrupting and wasteful. It mentions that HEW offers regulations and funds for the handicapped and the disabled, gives money to the needy and opposes racial discrimination. It states that HEW, headed by secretary Joseph A. Califano Jr., is recognized as an institution which have the most impact on the American life. It says that various criticism were expressed against HEW in connection to the range of programs it established. It highlights the HEW programs which became corrupting and wasteful including their programs on disability insurance, hospital costs, and student loans as well as HEW's range of programs that are worthy in concept.

The article profiles Walter Gther, the number one choice to be the next minister of health in West Berlin in 1967. Gther is a war veteran and considered as the first-rate doctor who operated a model geriatrics clinic in 13 years. It points out that he was granted the title of "Doktor" in a Czech prison camp where he treated German prisoners. As hospital director, he limits his medical practice to diagnosis.

Literature on children's internal body knowledge has consistently indicated that knowledge about the body develops in an orderly sequence with increasing age. How much children currently know about their internal organs, however, may be influenced by the increase in health and body information available through school education programmes. As there is little recent research in this area, the present study aimed to provide an update on what Australian children currently understand about their anatomy, and to corroborate the developmental trends found in previous research. One hundred and eighty-nine school children aged 7 to 12 years were asked to draw the interior of the body in a body outline provided, with a subset of 54 children also being interviewed about their understanding of their anatomy. The developmental trends found in this study were broadly consistent with those reported in the existing literature on children's inside body knowledge, and are similar to those documented with children's human figure drawing; namely, that children's body knowledge and understanding increased with age. Although awareness of the integration of internal body parts amongst children in the present study seemed more developed than suggested in previous studies, the availability of educational resources influencing children's knowledge about their internal organs remains equivocal. Nevertheless, this research has relevance for those involved in children's health awareness and education, as well as direct implications for paediatric health care procedures. [ABSTRACT FROM AUTHOR]

The principle of subsidiarity is a bastion of Catholic social teaching. It is also a principle in the philosophy of the American Founding Fathers. In the USA, subsidiarity is ignored without a sense of the proper harmony between authority and responsibility. Human dignity and wise stewardship are compromised. Conscience protection becomes a concerning issue as highlighted by the conflicts arising after passing of the Patient Protection and Affordable Care Act. A reconnection of the patient to be steward of his health care is critical in addressing these issues. Third parties, including the government, business, and insurance companies, are firmly entrenched in health care oftentimes with the result being increased cost and detachment of the patient from the stewardship of his or her care. Vitally needed is a return to the principle of subsidiarity in health care. Hopeful solutions include the Zarephath Health Center, the Surgery Center of Oklahoma, and the clinic of Dr. Juliette Madrigal-Dersch. Summary: The principle of subsidiarity is a bastion of Catholic social teaching. It is a principle in the philosophy of the American Founding Fathers. In the US, subsidiarity is ignored without a sense of the proper harmony between authority and responsibility. Human dignity, wise stewardship, and solidarity are compromised. A reconnection of the patient to personal stewardship of his health care is critical in addressing these issues. Third parties are firmly entrenched in health care oftentimes with the result being increased cost and detachment of the patient from his or her care. Vitally needed is a return to the principle of subsidiarity in health care. [ABSTRACT FROM PUBLISHER]

The basis of a just and moral economic model for health care is examined in the context of Catholic social teaching. The performance of the current model of “central economic planning” in medicine is evaluated in terms of the core principles of the social doctrine of the Catholic Church and compared to freedom-based economic models. It is clear that the best way to respect and serve human dignity, the common good, subsidiarity, and solidarity in medicine is through the establishment of a true, free-market health economy. Lay Summary: This article reviews the impact of recent healthcare reforms as well as traditional “third party payment” models for healthcare financing in America (insurance). Impact on patients and doctors are evaluated in the context of Catholic social doctrine and theCatechism. The many shortcomings and negative consequences of an economy planned centrally by government are compared to the benefits of a true free-market medical economy with empowered individuals. The analysis shows that interference in the patient–physician relationship and the centrally planned medical economy itself violates Catholic teachings, harms patients and doctors, and create morally evil outcomes and economic structures. [ABSTRACT FROM PUBLISHER]

10 million are estimated to have insurance through the marketplace by 2016's end [ABSTRACT FROM PUBLISHER]

In some Asian countries, the poor are often denied access to health care. In the Philippines, we have thousands of Catholic doctors, Catholic nurses, even Catholic administrators, but not a Catholic, understood as “universal,” healthcare system available to all. This is a scandal and places heavy emotional and financial burdens on many families who need to pay the healthcare costs of sick loved ones. The Church teaches the principles of ordinary and extraordinary care, with only the former being morally obligatory. Extraordinary care, that involving excessive burden or cost may be foregone. Many families and healthcare professionals are uncertain about these principles and their application in practice. It would be helpful to more widely disseminate the Catholic Church teaching regarding ordinary and extraordinary care, especially in poor countries, to also avoid unnecessary or futile treatments, especially in critical or end-of-life situations. Lay Summary:The poor have limited access to health care in many countries. Even one episode of sickness often places the patient and their family under considerable financial strain. Many times they simply cannot afford even basic treatments. This is a scandal and an injustice which is the concern of us all. The Church teaches that when a treatment becomes very expensive it may be considered “extraordinary care” and not morally obligatory. It would be helpful to more widely disseminate this Catholic Church teaching, helping families to avoid unnecessary treatments especially in critical or end-of-life situations. [ABSTRACT FROM AUTHOR]

In reality, there are only 42 people that old worldwide [ABSTRACT FROM PUBLISHER]

The article offers information on the death of 13-year-old Jahi McMath at the Children's Hospital & Research Center in Oakland (CHO) in California. It mentions that a doctor told Nailah Winkfield, the mother of McMath, who was supposed to have a tonsillectomy and adenoidectomy, that the child had a heart attack and suffered brain swelling and was pronounced brain-dead. According to Winkfield, no one has been able to explain to her what went wrong with the tonsillectomy.

The article discusses several strategies from experts and physicians how to create a doctor-patient relationship. Longtime patient advocate and author Judy Cook says that conversation or raising one's concern can help both patient and doctor to deal with misunderstanding. Clinical professor of medicine David G. Borenstein of George Washington University Medical Center in Washington, D.C. mentions to end the relationship if the patient has a chronic condition.

The article looks at the U.S. federal government's increased focus on individual responsibility as a means of deterring wrongdoing. It examines the criminal prosecution and subsequent acquittal of GlaxoSmithKline (GSK) lawyer Lauren Stevens who was accused of obstruction of justice and other charges. It also discusses the lessons to be learned from the enforcement actions by the government against general counsel Ted Urban and Forest Laboratories chief executive officer (CEO) Howard Solomon.

Describes how homeostatic models can be applied to modelling the normal processes, as well as the critical phenomena, such as paralysis, shock or collapse, which work in the polarised world. Discusses the development of civilisation against a background of the fight for resources, territories, spheres of influence, as well as the war between the technologies, behind which are the people. This produces an ultimately bad effect upon the ecology. Thus, unless the human race does not think better of it and changes the prevailing paradigm in relation to the nature and to the people themselves, a bitter pay-off – the global ecological catastrophe – is due. Outlines a created simulating model of the community, which shows that a global ecological catastrophe is likely to occur between 2020 and 2050. This time frame represents a zone of bifurcation, which, it is said, may result in either the death of civilisation, or an excruciating process of rebirth, which would also involve a transition to the new information technologies (based on the principles of the plasma, vacuum, or torsion fields, and so forth). In order to avert the global ecological catastrophe, suggests that it is necessary to accept the noospheric thinking code and, among other changes the organisational structure of the United Nations Organization (UNO), and the relationships between countries. [ABSTRACT FROM AUTHOR]

The article offers information on the increase of deficit in the U.S. in 1978. It notes that the deficit in the budget of President Jimmy Carter for fiscal 1979 is 60.6 billion dollars, and he promises of keeping the flood of red ink reaching at least through 1980 and likely much longer. It states that the increase of the deficit must be countermanded because it condemns the U.S. to unending inflation, sapping not just the economic vitality of the nation, but even the political institutions' strength.

The article discusses the significance for medical personnel to ensure quality of medical care provided to patients in the U.S. It notes that thousands of patients die needlessly or have the quality of their remaining life irreparably damaged due to incompetent medical care by physicians, stressing that few standards of ethics or practice have been set within the American Medical Association (AMA). Harvard University professor of legal medicine William Curan emphasizes the importance of including medical ethics which focuses more on patients' rights and patients' equity in medical care in medical schools curriculum.

The article discusses the U. of M. Interns and Residents Association, a union organized by its president, Jay Harness, along with other fellow physicians in the U.S. It states that organizing a union is the only way in which employees can protect themselves from being exploited by their employers. It notes that the rising trend of organizing unions has alarmed the American Medical Association (AMA). It also points out that like other labor organizations, some doctors' unions are formed to acquire more money from their members. Moreover, it mentions the issue of the handling of health-insurance claims and emphasizes that strikes are something unthinkable for doctors.

The article focuses on the effort by a group of medical men, with the funding from the U.S. Office of Economic Opportunity (OEO), to develop health centers across U.S. to solve medical poverty. It says that the effort was started by doctor H. Jack Geiger, who believes that it is necessary to help the rural areas and the Negro ghettos to counter urban crisis. It adds that OEO had allocated 94 million dollars for 51 neighborhood health centers, of which 33 are operating and 18 are being organized.

The article focuses on the success of the approval of Medicare and Medicaid in the U.S. It states that the Medicare has two parts wherein in Part A, the hospital bills of older people aging 65 will be paid by the Social Security Administration funds while in Part B, the patient can reimburse 80% of their bills. It says that the Medicaid will only give five essential services including doctor's care, in-patient and out-patient hospital care, and the nursing-home benefits.