Changing Health care  in west (UK, USA), we need better understanding of medical health insurance and future needs ?

We did not  dream that this would be happening to health care industry in United Kingdom three decades back. It seems, Since its establishment in July, 1948, the aim of the NHS has been to offer a comprehensive service to improve health and prevent illness, available to all in England and Wales (and then extended throughout the UK), which is largely free of charge. Health care for all, for free, has been the common ethos and philosophy throughout the NHS. But in 60 years things changed, it has been forced to look for better ways to provide health care even in the countries like United kingdom and few others.The money barrier, of course is crucial in making decisions.Now, GPs will return to the market place and will decide what care they can afford to provide for their patients, and who will be the provider and insuring agent. There is fear that the emphasis will move from clinical need (GPs' forte) back to cost (not what GPs were trained to evaluate). The ethos will become that of the individual providers and insurers, and will differ accordingly throughout England, replacing the philosophy of a genuinely national health service. We in Andhrapradesh India, introduced a system to reach people known as "Aarogyasree" public(Govt) funded health insurance scheme, managed through the web (internet) approval of patient selection and procedures and release of money. I forsee that there is going to be a need for similar systems (with modifications) in the other countries also to reach the needy people. That means the robust medical insurance has come to the lime light in many parts of the world by force. We need to understand more about the Medical insurance and It should be a subject for study during undergraduate studies for Medical graduates.

Can we make the vascular access for hemodialysis through the neck lines (central lines) more safer and long lasting?

Vascular access for hemodialysis is known to frequently thrombose and force us to go for revision or create a new vascular access. Central lines are flushed with heparin to prevent the thrombosis but even then some catheters get blocked due to thrombosis and others develop the infection. Such catheters are treated with rtPA (1mg) to lyse the clots in the catheter. Loss of access can be expensive and one has to go for another one. In a recent study published in NEJM it was observed routine use of rtPA (1mg) once in a week in addition to twice a week Heparin irrigation of the catheter can prevent the thrombosis and bacteremia. Brenda RH ( preCLOT study group) did this study and it is very interesting to findout that elective use of rtPA can increase the patency and prevent the bacteremia in those patients undergoing dialysis through the central neck lines. Soon the 1mg rtPA prefilled syringes may be available in many countries to irrigate the the central lines for better patency. We can congratulate Brenda R H et al for conducting this study which can help the hemodialysis patients.