BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7033.788 (Published 23 March 1996) Cite this as: BMJ 1996;312:788
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    Charging user fees is a contentious way of trying to reduce “inappropriate” demand for medical services. Evidence that it may work, however, comes from a study of attendance rates at accident and emergency departments by members of a Californian health maintenance organisation after the introduction of a $25-35 copayment fee (New England Journal of Medicine 1996;334:635-41). Among the 30 276 subjects who had to pay to be seen attendance rates fell by 15% over the subsequent year compared with those in matched controls who were not charged a fee.

    The search for an effective, reliable artificial heart continues: the “Canadian Medical Association Journal” (1996;154:515-7) believes that a team of 165 led by Dr Tofy Mussivand may hit the jackpot with an implantable electrohydraulic ventricular assist device. The cost so far has been $20m, but the backers hope that an artificial heart made in Canada would have “the export potential to help redress the country's large trade deficit in medical devices.”

    A report from Japan of 210 patients treated surgically for carcinoma of the pancreas says that 53 underwent macroscopically curative resection of the gland and eight of these survived for five years (Cancer 1996;77:640-5). The operation of extended radical pancreatectomy requires excision of the …

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