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FPGEE certification - Foreign Pharmacy Graduate Equivalency Updated: 2023 FPGEE Brain Dumps with Real Questions
Exam Code: FPGEE Foreign Pharmacy Graduate Equivalency certification November 2023 by team

FPGEE Foreign Pharmacy Graduate Equivalency

The Foreign Pharmacy Graduate Equivalency Examination®, or FPGEE®, is one of the examinations required as part of the FPGEC Certification Program (You must also take and pass the TOEFL iBT, the English-language test administered by Educational Testing Service. Applications submitted after January 1, 2020 must complete the TOEFL iBT requirement prior to sitting for the FPGEE).

The FPGEE is offered once per year, and it is administered at Pearson VUE test sites throughout the continental United States. Only individuals made eligible during the FPGEC application process can take the FPGEE.

You will be notified via your e-Profile that you are eligible to sit for the FPGEE after successfully completing the FPGEC evaluation process. You must pass the FPGEE within two years of having your FPGEC application accepted or your application will expire, and you will need to submit a new FPGEC application.

An overview of FPGEC Certification

FPGEC and ECE application procedures

Documentation of pharmacist credentials

Registering for the FPGEE

FPGEE administration

FPGEE score results

The FPGEE Competency Statements provide a blueprint of the subjects covered on the examination. A strong understanding of the Competency Statements will aid in your preparation to take the examination. The 200 questions on the FPGEE are divided among four content areas:

Basic biomedical sciences – 10%

Pharmaceutical sciences – 33%

Social, behavioral, administrative pharmacy sciences – 22%

Clinical sciences – 35%

The statements can be found in the FPGEC Candidate Application Bulletin.

Foreign Pharmacy Graduate Examination Committee™ (FPGEC®) Certification is required for
foreign-educated pharmacists seeking to apply for the pharmacy licensing exams (including the North
American Pharmacist Licensing Examination® (NAPLEX®) and Multistate Pharmacy Jurisprudence
Examination® (MPJE®)) in the United States and NABP member jurisdictions. To obtain FPGEC
Certification, a candidate must have their required documentation and application accepted, including
a passing score on the Test of English as a Foreign Language Internet-based Test (TOEFL iBT), and
pass the Foreign Pharmacy Graduate Equivalency Examination® (FPGEE®). The information below is
provided to guide you through the key steps in applying for FPGEC Certification, including instructions
for registering to take the FPGEE. It answers the most frequently asked questions about the FPGEC
application process. Please read this information carefully and refer to the appropriate sections of this
Application Bulletin for detailed information.

NABP provides the FPGEC Certification Program to document the educational equivalency of
a candidates foreign pharmacy education, as well as their license and/or registration to practice
pharmacy. To achieve FPGEC Certification, candidates must:

• Provide documents that verify their education background.

• Provide documents that verify licensure and/or registration to practice pharmacy.

• Pass the Test of English as a Foreign Language Internet-based Test (iBT).

• Pass the FPGEE.

Candidates who receive an FPGEC Certificate may be qualified to take the pharmacy licensing
examination in jurisdictions that accept this Certification. All 50 US states, the District of Columbia,
Guam, and Puerto Rico require foreign-trained pharmacists to achieve FPGEC Certification before
applying for a license from a state board of pharmacy

- Physiology

- Function of the major body systems and homeostatic impact at organ and system level

- Biochemistry

- Chemistry and utilization of biomacromolecules including proteins, lipids, carbohydrates, nucleic acid, intermediary metabolism of energy and nutritional molecules

- Enzymology and coenzymes and kinetics

- Cell chemistry, signal transduction pathways

- Transport and mobility

- Recombinant DNA and molecular biotechnology

- mRNA translation and protein synthesis

- Microbiology Related to Human Disease

- Structure, function, and characteristics of microorganisms: microbe classification, structure, metabolism, genetics

- Pathogenic microorganisms of humans

- Immunology

- Innate and adaptive immunity

- Principles of antibody actions

- Hypersensitivity and types of reactions

Area 2.0 - Pharmaceutical Sciences (Approximately 33% of Test)

- Medicinal Chemistry

- Physicochemical properties of drugs in relation to drug absorption, distribution, metabolism, and excretion (ADME)

- Chemical basis for drug action

- Fundamental pharmacophores for drugs used to treat diseases

- Structure-activity relationships in relation to drug-target interactions

- Chemical pathways of drug metabolism

- Applicability to making drug therapy decisions

- Pharmacology and Toxicology

- Mechanisms of action of drugs of various categories including biologics

- Pharmacodynamics of drug binding and response

- Adverse effects and side effects of drugs

- Mechanisms of drug-drug interactions

- Drug discovery and development

- Acute and chronic toxic effect of xenobiotics, including drug and chemical overdose and antidotes

- Pharmacognosy and Dietary Supplements

- Concepts of crude drugs, semi-purified, and purified natural products

- Classes of pharmacologically active natural products

- Science and regulation of dietary supplements (vitamins, minerals, and herbals)

- Pharmaceutics/Biopharmaceutics

- Biopharmaceutical principles of drug delivery to the body via dosage forms: liquid, solid, semisolid, controlled release, patches, implants

- Materials and methods used in preparation of drug forms

- Physicochemical properties relating to drug entities and dosage forms

- Principles of drug and dosage form stability, including chemical degradation and physical instability

- Pharmacokinetics

- Basic principles of in-vivo drug kinetics (linear and nonlinear)

- Principles of bioavailability and bioequivalence

- Physiologic determinates of drug onset and duration, including disease and dietary influences on absorption, distribution, metabolism, and excretion

- Pharmacogenomics and Genetics

- Molecular genetics, genomic, proteomic, and metabolomic principles that serve as a foundation for pharmacogenomics and the genetic basis of disease

- Genetic variants affecting drug action and metabolism, adverse drug reactions, and disease risk that influence the practice of personalized medicine

- Sterile and Nonsterile Compounding

- United States Pharmacopeia guidelines on sterile and nonsterile compounding, hazardous drugs, and FDA regulation of compounding

- Techniques and principles used to prepare and dispense individual extemporaneous prescriptions, including dating of compounded dosage forms

- Dosage form preparation calculations

- Sterile admixture techniques, including stability, clean-room requirements, sterility testing, and dating

Area 3.0 – Social/Behavioral/Administrative Sciences (Approximately 22% of Test)

- Health Care Delivery Systems and Public Health

- Organization of health care delivery systems at the national, state, and local levels: various settings where pharmacy is practiced and the structure of health care delivery systems such as managed care organizations, accountable care organizations, health departments

- Health care delivery financing in the United States

- Social, political, and economic factors that influence the delivery of health care in the United States

- Public Health and Wellness: chronic disease prevention, health promotion, infectious disease control, demographics, physical, social, and environmental factors leading to disease, comparing and contrasting public health with individual medical care

- The health care delivery system compared and contrasted with that of other industrialized nations

- Population-Based Care and Pharmacoepidemiology

- Data sources and analytic tools that provide an estimate of the probability of beneficial or adverse effects of medication use in large populations

- Application of epidemiological study designs to evaluate drug use and outcomes in large populations

- Methods for continually monitoring unwanted effects and other safety-related aspects of medication use in large populations

- Economic and Humanistic Outcomes of Health Care Delivery

- General microeconomic and general macroeconomic principles

- Pharmacoeconomic analysis and its application to Improve the allocation of limited health care resources

- Humanistic outcomes and their application to Improve the allocation of limited health care resources

- Pharmacy Practice Management

- Management principles (planning, organizing, directing, and controlling pharmacy resources) applied to various pharmacy practice setting and patient outcomes

- Personnel management

- Planning, including delineation between business and strategic planning

- Marketing of goods and services: product versus service pricing, distribution, promotion

- Accounting and financial management

- Budgeting

- Risk management

- Pharmacy Law and Regulatory Affairs

- Legal and regulatory principles applied to pharmacy practice: dispensing, professional services, drug use control

- Administrative, civil, and criminal liability

- Authority, responsibilities, and operation of agencies and entities that promulgate or administer laws, regulations, or guidances related to practice and prescription and nonprescription medications

- Biostatistics and Research Design

- Research study designs used in medical research

- Application and interpretation of statistical tests and data collection instruments

- Ethical Decision Making

- Principles of biomedical ethics

- Ethical dilemmas in the delivery of patient-centered care including, conflicts of interest, end-of-life decision making, use of codes of ethics, oaths of the pharmacist

- Research ethics

- Professional Communication

- Communication abilities (appropriate verbal, nonverbal, visual, and written) with patient and caregivers, including empathetic communication

- Communication abilities with other health care providers

- Assertiveness and problem-solving techniques in relation to difficult social and professional conflicts and situations

- Measurement and use of health literacy in pharmacy communications

- Development of cultural competency in pharmacy personnel such that services are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patient populations

- Social and Behavioral Aspects of Pharmacy Practice

- Health-, illness-, and sick-role behaviors of patients

- Principles of behavior modification

- Patient adherence to therapies and recommendations

- Caregiving throughout the lifecycle

- Death and dying

- Medication Dispensing and Distribution Systems

- Systems for safe and effective preparation and dispensing of medications in all types of practice settings

- Role of automation and technology: pharmacy informatics, information management

- Continuous quality improvement programs or protocols in the medication-use process, including identification and prevention of medication errors, and establishment of error reduction programs

Area 4.0 – Clinical Sciences (Approximately 35% of Test)

- Evidence-based Practice

- Interpret and evaluate drug information

- Apply drug-information skills for the delivery of medication therapy management

- Evaluate the reliability of various sources of information

- Interpret guidelines as they apply in a clinical setting

- Utilize core scientific and systems-based knowledge in the patient care decision-making process

- Utilize basic science principles in the development and/or implementation of drug treatment protocols and clinical practice guidelines

- Evaluate clinical trials that validate clinical appropriateness

- Clinical Pathophysiology

- Apply concepts of pathophysiology to clinical decision making

- Clinical Pharmacokinetics

- Utilize pharmacokinetics to calculate, evaluate, and individualize drug therapy

- Interpret clinical pharmacokinetics of commonly used and low-therapeutic-index drug
- Clinical Pharmacogenomics

- Utilize pharmacogenomics to calculate, evaluate, and individualize drug therapy

- Disease Prevention and Population Health

- Recognize the proper use of nonpharmacologic therapies, including complementary and alternative medicines

- Describe measures to promote wellness and disease prevention

- Identify the role of immunizations in disease prevention and health promotion

- Patient Assessment

- Describe techniques for obtaining a comprehensive patient history

- Describe how to perform patient physical assessments: inspection, palpation, percussion, auscultation

- Differentiate between normal physical assessment findings and modifications caused by common disease states and drug therapy

- Interpret common clinical laboratory values and diagnostic tests

- Perform calculations related to patient assessment: BMI, CrCl, lab adjustments

- Describe the use of OTC point-of-care testing devices: glucometers, pregnancy tests, home testing for HbA1c, drug screening

- Clinical Pharmacology and Therapeutic Decision Making

- Make therapy recommendations based on dosage calculations, specific uses and indications of drugs and nutritional and support therapy

- Interpret therapeutic drug concentrations

- Assess pharmacotherapy considering contraindications, therapeutic duplications, dietary interactions, adverse drug reactions and interactions, and allergies

- Triage and identify when to refer patients to other health professionals

- Design patient-centered, culturally-relevant treatment plans

- Apply evidence-based decision making to patient care

- Recommend nonprescription and natural product therapies

- Identify and manage drug toxicity, drug-induced diseases, and misuse or abuse

- Monitor drug therapy for misuse, abuse, and non-adherence
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Foreign Pharmacy Graduate Equivalency
Question: 90
Class of nystatin is:
A. Thiazides
B. Antiprotozoan agents
C. Autonomic nervous system drugs
D. Polyenes
E. Oral hypoglycemics
Answer: D
Question: 91
Indication of ticarcillin is:
A. Streptococcus pneumoniae
B. Varicella zoster virus
C. Myocardial infarction
D. Generalized motor seizures
E. Bone marrow failure states (aplastic anemia, myelodysplasias) (investigational)
Answer: A
Question: 92
Side effect of clindamycin is:
A. Colitis (by Chlostridium difficili)
B. Malabsorption
C. Constipation
D. Hypoglycemia
E. Hepatotoxicity
Answer: A
Question: 93
Route of administration of ofloxacin is:
A. Intra-auricular
B. Sublingual
C. Oral
E. Intramuscular
Answer: C
Question: 94
Which of the following Cytochrome P450 isozymes is responsible for the bulk of phase I metabolism?
E. CYP51
Answer: E
Question: 95
Which of the following causes the smallest change in solubility?
A. Hydroxylation
B. Glucuronidation
C. Sulfation
D. Glutathione conjugation
Answer: A
Question: 96
For the majority of drugs, which of the following equations correctly defines clearance?
A. Cl = Elimination rate/Cp
B. Cl = QxE
C. Cl = .7VD/t1/2
D. All are correct
Answer: D
Question: 97
Side effect of dipyridamole is:
A. Diarrhea
B. Headache
C. Bleeding
D. Hypercalcemia
E. Pseudothrombocytopenia (clumping of platelets)
Answer: B
Question: 98
Site of metabolism of zolpidem is:
A. Liver
B. None
C. Reticuloendothelial system
D. Leukocytes
E. Unknown
Answer: A
Question: 99
Which of the following is considered a class IA Sodium Channel blocker?
A. Mexiletine
B. Aminodarone
C. Quinidine
D. Procainamide
Answer: B
Question: 100
Potassium sparing diuretics have the primary effect upon the _____ found in the kidney.
A. Proximal convoluted tubule
B. Loop of Henle
C. Collecting duct
D. Distal convoluted tubule
Answer: D
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Medical Equivalency certification - BingNews Search results Medical Equivalency certification - BingNews Medical Devices and Technologies Certificate

Learn to Innovate, Evaluate, and Regulate Health Technologies

Get the skills and competences to innovate, evaluate, and regulate biomedical devices and technologies with the graduate on-campus certificate in Medical Devices and Technologies. Medical device, medical imaging, and device packaging industries innovate medical practice and provide patients with greater agency in the management of their own health. The current drive for miniaturization of medical devices, including diagnostics and wearables, has led to renewed need for continuing education and growing job demand.

Who is This Certificate For?

This certificate is for qualified professionals who want to enhance their skill set and can be a foundation to continue toward a graduate degree. It is also valuable for degree-seeking students looking to develop a concentration that gives them an edge in their career path.

What You Need to Know

In the graduate certificate in Medical Devices and Technologies program, students learn to develop specific solutions by working with experienced faculty in the Department of Biomedical Engineering. Get the knowledge you need to design, develop, and implement diagnostic and/or therapeutic devices for biomedical applications. Understand the principles and applications of medical imaging systems, and microelectromechanical system fabrication techniques. You will also learn to assess and interpret regulatory device requirements.

If you're an experienced industry professional or a Michigan Tech graduate student interested in developing skills in this field, this program can benefit you.


To enroll in this certificate program, students must have a bachelor's degree in any engineering discipline. See complete admissions requirements.

Accelerated Option

Michigan Tech Bachelor's + 1 Semester = Accelerated Graduate Certificate

Current Michigan Tech undergraduates or exact alumni, get started right away. Our accelerated graduate certificates are a fast, affordable way to add graduate credentials to your bachelor's degree in as little as one semester. Be more marketable in your industry or prepare for your master's degree. Explore accelerated certificate options.


This graduate certificate requires a minimum of 10 total credits. Students may apply the credits earned for this certificate toward a graduate degree at Michigan Tech.

Related Certificates

You might also be interested in:

Mon, 23 Nov 2020 21:39:00 -0600 en text/html
Medical Imaging Certificate

Gain High-demand Medical Imaging Skills

It's easy to see why the call for medical imaging professionals continues to grow. Imaging technology, using both ionizing and non-ionizing radiation, is vital to medical diagnostics and therapeutics. Michigan Tech's Medical Imaging on-campus Certificate gives new graduates and experienced industry professionals thorough grounding in the basic skills essential to the principles, development, and characterization of medical imaging devices.

Who is This Certificate For?

This certificate is for qualified professionals who want to enhance their skill set and can be a foundation to continue toward a graduate degree. It is also valuable for degree-seeking students looking to develop a concentration that gives them an edge in their career path.

What You Need to Know

The graduate certificate in Medical Imaging program allows students to delve deeper into imaging requirements in biomedical applications, engineering and physics principles to specific biomedical imaging problems, imaging device development and theory of operation, and design of medical imaging tools. Develop an appreciation of the design, development, and applications of diagnostic and/or therapeutic imaging devices for biomedical applications. Get familiar with how to apply these skills in real-world problems and implement application-specific solutions.


To enroll in this certificate program, students must have a bachelor's degree in any engineering discipline. See complete admissions requirements.

Accelerated Option

Michigan Tech Bachelor's + 1 Semester = Accelerated Graduate Certificate

Current Michigan Tech undergraduates or exact alumni, get started right away. Our accelerated graduate certificates are a fast, affordable way to add graduate credentials to your bachelor's degree in as little as one semester. Be more marketable in your industry or prepare for your master's degree. Explore accelerated certificate options.


This graduate certificate requires a minimum of 10 total credits. Students may apply the credits earned for this certificate toward a graduate degree at Michigan Tech.

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Wed, 12 May 2021 11:37:00 -0500 en text/html
Understanding Japan’s Medical Device Certification System



Japan's consumption of medical devices makes it an attractive market for global medical device manufacturers. But manufacturers hoping to sell their devices in Japan must pay careful attention to the revised Pharmaceutical Affairs Law (PAL). It aligns Japan's regulatory requirements more closely with those of other advanced nations. In this article, we examine the changes, challenges, and benefits of the revised PAL.


After the financial slowdown in the mid-1990s, Japan's economic fortunes have begun to increase—and so has the country's appetite for medical devices. In 2004, medical devices constituted an estimated $19 billion–market in Japan, larger than all other Asian markets. During the next few years, as Japan's economy continues to grow, imports of foreign medical devices are expected to grow by 5–8% annually and continue to represent 10% of the world market for medical devices.1


Despite the favorable prospects for exporting medical devices to Japan, all foreign medical manufacturers must still contend with a legal requirement stipulating that all medical products be registered with the Japanese Ministry of Health, Labour, and Welfare (MHLW), Japan's equivalent of FDA. This law has become increasingly instrumental to Japan's device market because products grandfathered in prior to 2005 must comply with the revised PAL when their existing Shonin (regulatory approval) expires. Manufacturers will also have to deal with the PAL when they need to make a significant change to a product that would require premarket clearance. In Japan, medical device manufacturers and importers are also expected to demonstrate certain behaviors associated with corporate social responsibility. Hence, the Japanese government requires foreign device manufacturers to maintain a physical presence in Japan so that remedies for identified safety problems with a device can be applied immediately.

Amended Legislation for Medical Devices

The PAL is the most important legislation for foreign device firms hoping to sell products in the Japanese market. In July 2002, the Japanese House of Representatives passed the amended PAL, which is applicable to all medical devices, drugs, quasidrugs, and cosmetics entering the Japanese market. It became effective April 1, 2005, and has the following objectives:

  • To enhance safety measures for medical devices sold in Japan.
  • To strengthen postmarketing safety measures for medical devices.
  • To align Japan's medical device regulatory system with prevailing international systems.

In order to apply for the necessary regulatory clearance to market a device, manufacturers outside of Japan must appoint a marketing authorization holder (MAH) as their representative in Japan. The MAH may be a subsidiary of the manufacturer through common ownership or may be an independent entity, but the manufacturer must establish a detailed contract with the MAH in accordance with the requirements of the amended PAL and related ministerial ordinance (MO).

If a manufacturer wishes to have its subsidiary or sales office as the MAH, then the subsidiary must be licensed as an MAH by the appropriate prefecture (comparable to county) government in Japan in accordance with MOs 135 and 136. This enables the MAH to be accredited by MHLW to apply for PAL certification. Only these legal license holders can apply for and hold PAL certification of medical devices. For a foreign manufacturer to become an MAH on its own, it must be accredited as a special MAH by the Pharmaceuticals and Medical Devices Agency (PMDA), an executive arm of MHLW also known as Kiko. The manufacturer must also nominate a representative in Japan.

Under the amended PAL, foreign manufacturers of all classes of medical devices are also required to obtain foreign manufacturing accreditation for their manufacturing facilities. This accreditation can only be obtained by applying through the MAH to PMDA. MO 2 outlines the requirements for accreditation. Manufacturers that sold products in Japan before the PAL was amended may have been granted temporary foreign manufacturing accreditation, which means they can delay their application for accreditation until 2008. After 2008, foreign manufacturing facilities must be reaccredited under the new regulation (MO 2).

The Quality Management Systems Ministerial Ordinance on Medical Devices and In Vitro Diagnostics (MO 169, also known as the QMS ordinance), implemented in 2005, lacked certain requirements integral to ISO 13485:2003. These requirements, which outlined management responsibility, risk management in production, design controls (if applicable), criteria for suppliers, process validation, and analysis of data, were not mandatory in Japanese regulations until April 2007. Therefore, it is possible that early accreditation assessments to MO 169 did not include these elements. Manufacturers with a current Japanese QMS and those submitting new applications should ensure that these requirements are properly satisfied in time for surveillance visits.

Another key change brought by the revised PAL is that Class II medical devices, which are designated as controlled medical devices, have now shifted from ministerial-level approval to designated third-party approval (see Table I). In other words, MAHs for Class II medical devices can obtain a certification of product conformance from a registered third-party certification body rather than directly from PMDA. This change allows manufacturers to get their products certified faster and also tap into the technical expertise of third-party certification bodies. However, only certain designated Class II medical devices can benefit from the third-party approval process. A Japanese Industrial Standard (JIS)—a mandatory performance standard—must be established for a medical device to be eligible. In many instances, the mandatory JIS standard is equivalent to an IEC standard, such as the second edition of IEC 60601-1. Class II devices for which no JIS standard has been established may not use a third-party certification body and must apply to PMDA directly.

Out of the 4044 total device types identified by MHLW, only 1785 are designated as Class II, and less than half of those are currently designated as controlled medical devices eligible for third-party approval. The JIS conformity assessment standard and essential requirements are designated by MHLW by device type, which enables third-party assessment of such Class II devices. Article 41 of the revised PAL requires the minister to establish necessary standards after seeking the opinion of the Pharmaceutical Affairs Food and Sanitation Council (also called Bukai). The list of devices eligible for third-party approval is continually growing as MHLW approves additional essential-principles checklists.

An application for a Class II device license requires an assessment of the quality management system of the device manufacturer (including foreign manufacturers) to the requirements of MO 169. This ordinance is based entirely on ISO 13485:2003, with some additional requirements for the Japanese market. Manufacturers of Class II active medical devices may include or exclude requirements for design and development depending on the designation by MHLW. This assessment may be carried out by local assessors trained on Japanese requirements and qualified by the third party. Some third parties, because of the location of their audit staff, must dispatch their assessors from Japan and coordinate logistics, including travel and lodging for the audit team and its translators.

Obtaining a device license also involves an evaluation of the technical documentation for the medical device. This is similar to the requirements outlined in the Global Harmonization Task Force's Summary Technical Documentation for Demonstrating Conformity to the Essential Principles of Safety and Performance of Medical Devices document. Japanese regulations may also require additional information, such as proof of compliance with the JIS performance standard. The MAH is required to present this information in Japanese to the third-party assessor.

Selecting a Third-Party Approval Body

There are a variety of services provided by third parties. By carefully choosing a third-party approval body, an MAH can take advantage of additional accreditations and services that the third-party organizations offer. Some third parties allow the supporting documents, which demonstrate a device's conformity to the applicable JIS or IEC standards, to be assessed in English (to provide a degree of confidence) before undergoing a costly translation process. Foreign manufacturers may want to consider this service when their original technical file has already been approved by another public health authority. Allowing supporting documents to be assessed in English would ensure that all requirements of the Japanese regulations are included in a device's technical file, since some requirements may be specific to the Japanese regulatory system.

A medical device company should also consider testing requirements when choosing its third party. Not all JIS standards are based on IEC requirements. If a device has already been tested for markets outside of Japan, it is possible that some of the mechanical and engineering decisions can be made based on previous tests, especially if the device is not electrical (nonactive) or if a switching power supply is used. (It is important to note that the electrical system in Japan is 100 V ac at both 50 and 60 Hz.)

Manufacturers that want to market devices in Japan should consider that marketing goal in their design phase and incorporate flexibility into their design to meet the country's requirements. This gives them a better opportunity to have EN (European Union), NRTL (United States and Canada), and JIS testing done simultaneously. Although additional samples and time may be needed to complete the JIS testing, a third party that is accredited in all of the company's current and anticipated sales markets can minimize redundant tests whenever possible.

As mentioned, the revised PAL brought with it a requirement to manufacture under an audited quality management system, which ensures conformity with JGMP requirements. When a device manufacturer chooses a third party, it should also consider the location of the JGMP-qualified auditors and whether the JGMP audit can be combined with the quality management system audits required by the United States, Canada, and the European Union.

FDA's accredited persons inspection program audits to 21 CFR 820 requirements, but the program is only open to those companies that are not under FDA scrutiny (i.e., increased FDA attention owing to nonconformities, product recalls, etc.). Because low-risk device manufacturers are only periodically audited by FDA and these audits cost very little, the only incentive for FDA establishments to use a third party for inspections is the predictability of the audit.

The European Union allows an ISO 13485–based audit to meet Annex V requirements under the Medical Devices Directive and Annex IV under the In Vitro Diagnostic Directive. The Canadian Medical Devices Conformity Assessment System is strictly based on ISO 13485. Therefore, many manufacturers maintain an ISO 13485 registration with many clauses and elements similar to JGMP requirements. As a result, third parties that offer accreditations for all of these regulatory programs can offer integrated audits, which are less time-consuming, less intrusive, and potentially less costly to the manufacturer.

Other considerations the MAH should make in choosing a third party are experience, trust, and the MAH's relationship with the organization. Bear in mind that all applications for device licensing to a third party can only be made through the MAH located in Japan to the third-party certification body in Japan. However, the value of local support for foreign manufacturers is worth considering in understanding the requirements these manufacturers must meet.

The Goal of Alignment

As indicated, one of the goals of the revised PAL was to align Japan's medical device regulatory system with those of other advanced nations, namely those of the United States and the European Union. Because these nations produce and consume the majority of the world's medical devices, the regulatory practices in these regions are generally the ones accepted and adopted by device manufacturers worldwide. Just as with the regulatory systems from these regions, Japan's revised PAL allows third parties to conduct assessments of Class II medical devices for certification to market and sell in a particular region. Both EU and U.S. health authorities also require an audit of each manufacturing location to ensure that the quality system conforms to GMPs. The last similarity is the identification of an in-country representative—the MAH in Japan, the agent in the United States, and the authorized representative (AR) in the European Union. The biggest difference is that the MAH, as the name implies, takes over ownership and responsibility for certification, whereas the AR and the agent work on behalf of the manufacturer.


Although the revised PAL aligns more closely with general international requirements for medical devices, demonstrating conformance with the PAL still requires manufacturers to invest time and effort to understand its requirements. Once the regulatory process is defined, manufacturers must still contend with the challenges and cost of device-specific processes for reimbursement, distribution, and packaging. However, if the Japanese medical device market continues to grow and maintains its need for foreign medical devices, meeting PAL and MHLW requirements may be a worthwhile investment for device manufacturers.

Steve McRoberts is Underwriters Laboratories' (UL) global principal engineer for medical regulatory programs. Seiko Ohyama is a lead engineering associate working for UL-Japan Inc. Tara Kambeitz is the global marketing manager for UL's medical business unit. She can be reached at [email protected].

1. U.S. International Trade Commission, Medical Devices and Equipment: Competitive Conditions Affecting U.S. Trade in Japan and Other Principal Foreign Markets, March 2007; available from Internet:

Copyright ©2008 Medical Device & Diagnostic Industry

Wed, 08 Nov 2023 10:00:00 -0600 en text/html
Army ROTC Scholarship Opportunities

This scholarship type is awarded to high school seniors who will soon graduate or obtain an equivalent certificate. Competition for these scholarships is keen, as over 6,000 students from across the country compete for them. Scholarships pay for full tuition and mandatory fees, for both resident and non-resident students. High School scholarship winners attending the Rochester Institute of Technology will also receive a  Room and Board Scholarship.  This scholarship value will equal the cost of a double dormitory room and the default meal plan. Those students living at home with parents are not eligible for this room/board scholarship. In addition, awardees receive a book allowance and a monthly tax-free stipend to defray the cost of living. 

There are two types of high school scholarships: 4-year and 3-year Advanced Designee. 3-year Advanced Designee scholarship winners must satisfactorily participate in Army ROTC. Their freshmen year in order for their 3-year scholarship to take effect at the beginning of their sophomore year.

Interested applicants will need to visit and create an account to get started.

Basic Eligibility Requirements

  • Must be a U.S. Citizen
  • Must be at least 17 years of age by October of the semester you are entering college
  • Must not reach 31 years of age by June 30 of the year you will graduate from college
  • If you are taking or have taken college courses you must be considered a freshman and have four academic years remaining for a baccalaureate degree upon enrollment
  • Have a minimum high school GPA of 2.5 on a 4.0 scale
  • Satisfactorily explain any record of arrest and/or civil conviction
  • Have no moral or personal conviction against bearing arms, or supporting and defending the Constitution of the United States
  • Those applicants advancing to further scholarship consideration are scheduled for a medical examination and a personal interview.

Personal Interview

This interview may be conducted by telephone or in person depending on the distance involved. Any travel to and from the interview is at your own expense.

Medical Examination

Individuals selected for an interview will be contacted and scheduled for a medical examination by the Department of Defense Medical Examination Review Board (DODMERB). Your medical condition is not a consideration in the selection of winners; however, all winners must be medically qualified and enrolled to receive scholarship benefits. Travel to and from the examination is at your own expense.

Military Obligation

If you are selected for a ROTC Scholarship, you are required to:

  • Sign a contract with the Secretary of the Army.
  • Attend a 5-week Leadership Development and Assessment Course between your Junior and Senior Year.
  • Accept a Commission to serve on Army active duty, National Guard, or Army Reserves upon degree completion.
  • Serve in the military for a period of 8 years. This may be fulfilled by:
  • Serving active duty, if selected, for 4 years followed by 4 years of service in the Inactive Ready Reserve(IRR)/National Guard/Army Reserves. You may elect to serve 8 years or longer on active duty, but only the first 4 are required. Terms of obligation begin at the time of commissioning.
  • Serve 8 years in the National Guard/Army Reserves, which includes a 3-6 month active duty term for initial training. Terms of obligation begin at time of commissioning.
Wed, 04 Jul 2018 06:25:00 -0500 en text/html
Medical Laboratory Science, Certificate

Saint Louis University's medical laboratory science certificate offers students who have already obtained an undergraduate degree in an alternate field and are pursuing a career change a certificate to become a medical laboratory professional.

The certificate has three concentration options: clinical hematology, clinical microbiology and clinical chemistry.

Curriculum Overview

SLU's medical laboratory science certificate program's curriculum provides students with a strong science background, medically applied coursework and corresponding practicum experiences in the clinical laboratory.

Each program consists of two semesters of didactic coursework at the undergraduate level, followed by a clinical practicum that varies in length between five to seven weeks. The typical program takes between 12-18 months to complete.

Clinical and Research Opportunities

Clinical internship experiences in clinical practice settings (e.g., hospitals, clinics, reference labs, etc.) are a required component of SLU's medical laboratory science certificate curricula. 


Graduates with a certificate in medical laboratory science are prepared to conduct and manage a broad spectrum of laboratory testing. Results of these tests are used to evaluate the health status of individuals, diagnose disease and monitor treatment efficacy. Graduates of this program frequently work in diagnostic, research and/or other laboratory settings.

Upon successfully completing the program, graduates are eligible for national certification by the American Society for Clinical Pathology (ASCP) as categorical medical laboratory professionals.

Admission Requirements

  • Completion of a conferred degree from an institution that is accredited by one of the regional accreditation agencies is required.
  • Students must complete a combination of 30 credits (45 quarter credits) of biology, chemistry and/or medical sciences for program admission consideration.
  • A college minimum cumulative grade point average of 2.50 on a 4.00 scale, including a minimum 2.50 science/math GPA with at least a “C” in all biological sciences, chemistry and math is required.

Transcript Evaluation

Students interested in clinical hematology, clinical microbiology or clinical chemistry should contact Amanda Reed at or 314-977-8686 for transcript evaluation. 

Admission Decisions

The number of students admitted into each certificate program is based on the availability of clinical placement sites for practicum experiences. No student will be admitted until clinical placement for practicum experiences has been secured.

In the event of a limited number of available placement spots, a competitive entry process based on GPA, previous coursework, and letters of recommendation will be used to admit students. Admission decisions will be made on or before June 1 to enter the fall cohort.

All applicants must meet the professional performance standards required for the profession.

Required Background Check

Regulations require all students to complete a criminal background check and a drug test at least once during the program; either or both may be repeated as agency requirements demand. Positive results from the criminal background check or drug tests may result in ineligibility to attend clinical rotations and/or to graduate from the program. A felony conviction will affect a graduate’s professional certification and professional practice eligibility.


Tuition Cost Per Credit
Undergraduate Tuition $1,830

Additional charges may apply. Other resources are listed below:

Net Price Calculator

Information on Tuition and Fees

Miscellaneous Fees

Information on Summer Tuition

Scholarships and Financial Aid

Students who graduated with a bachelor's degree and are seeking a second bachelor's degree or post-baccalaureate certificate do not qualify for most SLU and federal financial aid. 
Financial aid may be available in the form of federal loans, which require repayment. Federal loan eligibility is based on what was borrowed as an undergraduate student. (Find more information on loan limits.) Federal loan consideration requires a completed Free Application for Federal Student Aid (FAFSA). 
Information on Federal and Private Loans

View the Preferred Private Lender List


The Medical Laboratory Science program at Saint Louis University has been continuously accredited since the graduation of its first class in 1933.

We are one of the oldest programs in the nation, founded in 1929, and boast over 90 years of educational service to the medical laboratory science profession.

Program Outcomes

The program is accredited by:

National Accrediting Agency for Clinical Laboratory Science 5600 N. River Road, Suite 720 Rosemont, IL 60018

phone: 773-714-8880
fax: 773-714-8886

BLS 4130 Principles & Techniques in Molecular Biology 0
BLS 4411 Fundamentals of Immunology 2
BLS 4420 Medical Immunology 2
MLS 3210 Clinical Education & Laboratory Management 2
MLS 3400 Laboratory Operations 1
Total Credits 21-23

Clinical Hematology Concentration 

BLS 3110 Urinalysis & Body Fluids 2
BLS 4210 Hematology 4
BLS 4220 Hemostasis and Thrombosis 2
MLS 3150 Urinalysis and Immunology Laboratory 1
MLS 4250 Hematology Laboratory 1
MLS 4740 Clinical Hematology Practicum 2
MLS 4750 Clinical Hematology 1
MLS 4821 Clinical Urinalysis and Phlebotomy 1
Total Credits 14

Clinical Microbiology Concentration 

BLS 4510 Medical Microbiology 4
MLS 4520 Medical Bacteriology 2
MLS 4541 Medical Mycology and Parasitology 3
MLS 4550 Medical Bacteriology Laboratory 2
MLS 4800 Clinical Microbiology Practicum 3
MLS 4811 Clinical Microbiology 1
Total Credits 15

Clinical Chemistry Concentration

BLS 3110 Urinalysis & Body Fluids 2
BLS 4110 Medical Biochemistry I 3
BLS 4120 Medical Biochemistry II 2
MLS 3150 Urinalysis and Immunology Laboratory 1
MLS 4150 Analytical Chemistry 2
MLS 4701 Clinical Chemistry Practicum 3
MLS 4710 Clinical Chemistry 1
MLS 4770 Clinical Phlebotomy Practicum 1
MLS 4820 Clinical Urinalysis Practicum 1
Total Credits 16

Continuation Standards

Students must maintain a minimum 2.50 grade point average (GPA).

Tue, 31 May 2022 05:27:00 -0500 en text/html
Changing Lives: Academically Helping Professionals Establish Foreign Medical Practice No result found, try new keyword!Academically, an innovative EdTech startup, has rapidly evolved into a pioneering force in the field of healthcare education. Thu, 16 Nov 2023 16:01:00 -0600 en-US text/html How Good is Government Medical Care?

There is a hospital bill on my desk. On October 10, Mrs. A—, a Boston resident, aged 66, fell and broke her hip. Her hip was operated upon and nailed, and she left the hospital on November 18. Excellent care contributed to her recovery. The hospital bill was $2949.38. The surgeon’s fee is not known. It is this problem of paying the cost of medical care that the Forand Bill and its many rivals, including a reluctant Administration’s proposal, have been attempting to solve. And yet there is more, much more, to the problem than the question of how, and how much, the government will pay.

The issues that the Forand Bill sought to deal with seem fairly clear: Man is mortal, a fact which is remorselessly driven home to the age group of over sixty-five years. They have more diseases and higher death rates than younger age groups. They visit their doctor’s each year half again as often as younger people, and they require about twice as much hospitalization. These fat medical bills must be paid from a thin purse. The Census Bureau reports that almost 60 per cent of persons over sixty-five years of age had cash incomes of less than $1000 in 1958, while about 70 per cent of couples had incomes of less than $3000. Some have cash, some own homes. Some live with children, and their expenses are probably small. But not many are on Easy Street.

This is a difficult situation that many people would be happy to turn over to the government. Some of the public opponents of governmental health insurance for the aged, in fact, privately support it, and with reason. While the voluntary health insurance organizations are pointing with pride to the progress they have made in enrolling the aged, progress has brought them problems. The Blue Cross organizations have repeatedly raised premiums to keep pace with hospital charges and increased hospital use; the public complains, and there are threats of investigation. Successfully insuring the sick old people would be a Pyrrhic victory. Commercial insurance is based upon “experience ratings”—the likelihoods that the insured will have to make claims—and the experience of the aged is such that the companies probably are not eager to compete for their premiums.

Even so, almost 45 per cent of our older citizens have some health insurance now. Does this mean protection against the costs of illness? A publication of the Health Insurance Institute points out that the hospital benefits which older persons receive may range from $5 to $25 per day. Most hospital charges run $25 per day and up. The person over sixty-five who goes to the hospital will stay there an average of almost fifteen days, compared with just under eight days for the general population. An average old person going to the hospital can thus expect a bill of about $375. Some of those who are “insured” will get back as little as $75. Medical costs are therefore a common cause of indigence in this age group.

Somewhere between organized labor, picturing the aged as victims of universally besetting misery, and organized conservatism, dwelling glowingly on the joys of the sunset years, is the uncomfortable liberal. He appreciates that the problem is real and that political action is almost certain. Why, then, is he concerned? Because the Forand Bill was not very good, and its rivals are no better. These bills assume that paying the medical expense is the only issue—in short, that this is just another welfare problem—when actually the problem deeply involves the practice of medicine, the quality of care, and the organization of medical care services. Inevitably, any legislation providing government health insurance will have consequences in these areas, too. There has been a great deal of experience with government support of medical care, much of it in Europe, which should help us to understand why this is so.

For example, a great weakness of the Forand Bill was that it provided only for hospitalization and medical care in the hospitals. People who have health insurance are hospitalized more than noninsured persons, in part, at least, because they know that their hospital care will be paid for. The demand that would have been created by the Forand Bill would have been even more serious. Old people tend to live alone or in easily broken homes, and once hospitalized they might have nowhere else to go. This is particularly true when there is some residual disability.

In England, where virtually all medical services are now provided through the National Health Service, this problem was pressing during the early years of the service. There was much “silting up” of the hospital beds by old patients with chronic diseases. The Forand Bill could not have been better designed to silt up our hospital beds and to keep them silted up.

Later bills have included provision for payment for home care and nursing-home care, which are cheaper and often more appropriate for the patient. Care in a doctor’s office is the most economical and sometimes the best form of treatment, but it was conspicuously absent from most of the proposals advanced earlier. Thus, a patient who has to pay for an X ray in the doctor’s office, but who is insured against the cost of that X ray in the hospital, has a good chance of ending up in the hospital.

A second frequently overlooked consideration in the Forand debate was the fact that a payment mechanism alone may have inflationary effects. Since the aged have low incomes and much illness, the advent of social security or other payments for their medical care would probably produce a sharp rise in the amount of medical care they receive, and therefore in the total cost. The history of fees and charges, furthermore, shows that they rise more easily when paid by insurance than when they have to be pried out of individual pockets. However, any attempt to control the cost and use of health service by fiscal means alone will not he more than partly successful. This would be like trying to control automobile accidents by manipulation of insurance premiums, when we are well aware that safe driving is a function of road construction, traffic cops, stop-and-go lights, licensing practices, driver training, and many other things. The problem of controlling the cost of health services is one of the considerations that will inevitably push the government more deeply into the field of medical services, once it has entered. It is equally certain that before long the government would become preoccupied with the problems of the quality and distribution of the care it purchases. We have already seen this in the Hill-Burton Bill. The government granted money for hospital construction only after each state had formulated a regional hospital plan. A plan was essential, the Public Health Service knew, simply to make sure that the government dollars would build the right kind of hospital in the right place. Pleasant Farm County needs general medical and surgical beds; the city can use one specialized neurosurgical ward that may serve patients from most of the state. Without a plan, hospitals might build the medical equivalent of a Yankee Stadium in Cokato, Minnesota.

A third consideration is quality, in the United States, the most enthusiastic backers of voluntary health insurance and government medical care have coupled their hopes for a solution to economic problems with brave talk of comprehensive medicine, high quality of medical care, primary and secondary disease prevention, and other wishful arguments. Instituting some form of prepayment for medical care does not solve the problem of poor or unskilled care. When the British Health Services were nationalized in 1948, there was widespread expectation that general practitioners would practice better preventive medicine in their own interests. Since they were paid according to the number of patients on their lists, whether they saw each patient a dozen times, once, or not at all, it was reasoned that the doctors would try to reduce their work by preventing disease. The new health service had not been functioning long before it was generally realized that the good doctors remained good and the others plodded along in their characteristic ruts.

If the government pays the piper, it is likely to demand that the musicians be qualified. Government support of health services has been undertaken primarily to eliminate financial barriers between patients and medical care, but attempts to set standards usually follow. For example, in our own country, much surgery is done by doctors with minimal training. It is most unlikely that the government would pay the well-trained and the partly trained doctor the same amount for an operation. Indeed, government subsidies of medical care would probably result in the limiting of surgical privileges to the fully trained and certified specialists.

It is often said that the United States has the best medical care in the world. Some aspects of American medicine are indeed outstanding, but the Scot or the Norwegian who enters a hospital in his country can do so with the assurance that the surgeon or physician who cares for him is well trained and well selected for his post. The American who enters a hospital must depend upon his own imperfect judgment of a doctor’s qualifications.

The editor of the British medical journal Lancet, Dr. T. F. Fox, commented recently: “The lack of fully specialized staff means that at present one’s chances of dying quietly in a hospital bed with a wrong diagnosis are higher in America than in Britain.” For this and other reasons, the government, when it loots the bill, may set standards of training for the doctor who gives the service. The sharpness of Dr. Fox’s comment is a case of tit for tat; the British have smarted under our criticism of their National Health Service.

The government may be forced to dabble with the quality of medical care for another reason: the need to have a brake on the use of hospitals. The practice of medicine presents many situations in which choices between action and inaction, surgery or medical treatment, hospital or ambulatory care must be made. The pressure is usually on the doctor to “do something.” The decision runs the risk of being biased when “doing something,” such as surgery, means a larger fee.

The very acrimonious fight between the United Mine Workers Welfare and Retirement Fund and the medical profession in the coal mine areas arose over this issue. The fund at first paid fees to local doctors. This question of unnecessary and incompetent surgery was soon raised publicly, and it was not long before the fund decided to build its own hospitals and staff them with salaried specialists. Dr. Warren F. Draper, the fund’s medical director, says bluntly; “We will never return to free choice of physicians; we have found that as long as the fund would pay any physician for any service which he saw fit to render, surgical diagnoses were often poor and the amount of surgery in beneficiaries was far in excess of that performed in others.” The government is not likely to be as cantankerous as labor about paying medical bills, but it is likely to scrutinize them carefully.

It is an oversimplification to equate unnecessary surgery with a fee. The fact that the largely discredited operation of tonsillectomy is still being done does not necessarily mean that it is performed because of the fee it brings. The doctor may decide on this operation because of his frustration in dealing with a child’s repeated respiratory infections. In Europe, the family doctor may send the child to a hospital, but it is the specialist who decides whether he is admitted for surgery or not. Checks and balances of this type are becoming increasingly familiar in this country, and governmental subsidies of health insurance will almost certainly extend them. But the exclusion of the general practitioners from hospitals is not without serious hazards. It divides the profession into an elite and “the others.” This division has the effect of removing some doctors from the one institution which gives promise of providing them with knowledge of the rapidly accelerating advances in medical diagnosis and treatment. It is for this reason that the real bedrock opposition to government health insurance is found among general practitioners rather than among specialists. Our country might well pioneer a new approach in which family physicians are permitted to use the hospitals under the direction or well-trained and well-selected chiefs of staff, the pattern that is now followed chiefly in our university hospitals.

The unavoidable issue of quality control has concerned physicians, and they are quite right in recognizing that the Forand Bill really involved it. These deeply conservative physicians also recognize that medical care for old people is only the beginning. They are right, because government-supported medicine for one problem group will be extended and broadened to include others—ultimately, all of us.

The Health Insurance Institute estimates that “getting sick and getting well” will cost the average American $105 in 1960. This sum will be distributed about as follows: $34 for the hospital, $26 for the doctor, $28 for medicines, $11.50 for the dentist, and $5.50 for other costs. The average United States family in 1957-1958 spent a little over $300 for medical care. These averages are influenced by many factors. Those with hospital insurance received more care than those without, and families with higher incomes spent more than those with smaller ones.

Medical costs also vary with age, sex, and amount of sickness. Persons or families alike in other respects often have different habits of use of doctors and hospitals. Medical bills are not constant, as rent is. In any given year, about two thirds of the population will visit a doctor, while the other one third will not. Admission to hospitals is even more skewed: about one in eight persons suffers this misfortune. The child who has a tonsillectomy usually is in a hospital for twenty-four to thirty-six hours, and the whole bill may be $75 to $150, depending upon the institution and the surgeon. The average hospital bill, which is somewhat more than $200, is compounded of many tonsillectomies and a very few operations on the heart. A typical example of the latter was a New England lady of about sixty years who entered a hospital on November 5 for heart surgery. She was discharged thirty-six days later. The bill, exclusive of surgical fee, was $1734.41.

Hospital charges, which usually produce the catastrophic bill, are increasing more rapidly than the cost of other types of medical care. Although the hospital bill is the most dramatic example of the unequal distribution of the sickness costs, there are diseases that push other charges into the catastrophic class. A few patients must make very frequent visits to their family doctor, and the total cost may be great. The unfortunate parents who have a child with cystic fibrotic disease may find that they are spending $40 or more a month on essential medications, as well as paying for frequent hospitalizations and visits to the doctor. Since the disease is familial, more than one member may be affected. Again, when the breadwinner of a family is ill, hospital or medical bills are often compounded by loss of pay. In any case, it is clear that the elderly are not the only ones with medical care problems and that the problems of the whole population differ in degree but not in kind from those of people over sixty-five.

If Congress passes a law to help old people pay their hospital bills, it had better prepare for another to pay for the doctors’ services. Some of the later bills have included this. The doctors can be bulldozed into a new system of medical care, but the bulldozer cannot make them like it. A exact survey published in Medical Economics indicated that doctors were more worried about what they called “socialistic trends in the United States” than about their personal finances or their children. It would be dangerous and unjust to think that the doctor’s opposition is based merely upon fear for his income or his right to charge whatever he pleases, as opposed to a fixed fee. Experiments such as prohibition should warn us that it is important that the solution to any problem should have the respect of those whom it will affect. Like justice, any provision of medical care must not only be well done but must appear to be well done in the eyes of both the doctors and the patients.

The respect and satisfaction with which different peoples view their government-supported health services vary. After long and thoughtful trial and error, the Scandinavians evolved a system which they feel has the proper mixture of state support and individual responsibility. Though the individual purchases state-subsidized health insurance, he must also pay part of the costs of each visit to his doctor out of his own pocket, and he must make a small payment for each day of hospitalization. To both patient and doctor, this fee appears to represent an assurance that the problem of the moment is an important one. This dual system of government and personal payment is more complicated and costly, but the Scandinavians seem to think it is worth the extra cost.

In contrast, when the British made the great leap into a national health service in 1948 under the optimistic banner of “fair shares for all,” the Socialist government hewed to the ideological line by deciding to pick up the whole tab, leaving nothing for the individual to pay. Rather than rejoicing, many of the British were subject to fears that the free care might be abused. Reimposition of charges for drugs, appliances, and false teeth met with some political but no popular opposition.

The British general practitioner also has complaints. Since he is not paid anything by the patient himself or paid for each visit, he is prone to feel put upon by patients who need much care, forgetting that his list of patients—which is the basis of his pay—also includes many whom he does not see from one year to the next.

The opinions which patients and doctor hold about their system of medical care may be wrong or right, but they are very human. They do demonstrate that what people think is true may he just as important as the objective truth. The British knew that, administratively, it was simpler and cheaper to collect money by taxation than through an insurance premium. Their logical decision to let the National Exchequer pay the bill was their most serious mistake. This centralization of the bill has produced a preoccupation with cost and cost alone that has hampered many needed developments. The moral: In problems as personal as the provision of health services, the logical and most efficient administrative device is not always the best. The task is to make good administration a means, not an end.

In most countries government health insurance has been financed through insurance mechanisms: partial payment for care, taxes, and voluntary effort. With funds coming from so many pockets, or from the same pocket at different times, the costs do not become the primary issue. In this respect the Administration’s proposal to provide health insurance for the aged is better than the Forand Bill, because it would distribute the cost between the federal and state governments and the consumer. But it looks as though the Administration’s proposal would pay only about $600 of a bill amounting to $1000, leaving the patient to find $400. Since, as we have seen, most old people are living on cash incomes of less than $1000 yearly, a $400 bill may be just as overwhelming as the full amount.

The first tentative government steps into medical care will uncover a chain of problems. The European experiences may have only limited applications, but ignorance of these experiences will condemn us to repeating errors. The liberal is worried because the debate has concentrated on financial problems. The American Medical Association has been a conspicuous exception; it has seen clearly that the Forand Bill involved more than the use of social security to pay medical bills. Paradoxically, its opposition is so complete that it is fair to question if its membership will lead when leadership is needed. The British Medical Association made the same mistake; it continued to resist even when the issue had been decided.

There is a peculiar assumption in the intense focus of the health bill debate on the question of how to pay for medical care. The assumption is that the only question in the minds of our sick old people, their families, and the doctors who will care for them is where and how to find the money. This attitude is dangerous because it obscures the crucial fact that we are struggling not with a fiscal problem but with a human problem; in fact, with a whole range of very human needs and problems. We had better make our plans accordingly.

What are these human expectations? First, the patient’s need for an interested doctor and the kindly care that has always been the hallmark of the good private practitioner. Second, good care, in the sense of competent care. Third, the desire to be treated with dignity as a respected individual, not as a casually handled body on a hospital assembly line.

But there is more to it than this. We need not only to take care of sick patients but to do this in such a way that we meet the needs of their families. The children of chronically ill or senile parents, or the parents of a child with cystic fibrosis or a congenital defect, are often squeezed between the almost insupportable emotional and physical burdens of their care and the fear that any alternative really will mean dumping them into the hands of a second-rate, and indifferent, outside authority.

The needs of the physician must not be overlooked. He wants to feel responsible for his patients to the limits of his competence. He wants freedom to be the boss of his own office or at the operating table and to practice as best he can. He wants to be paid a reasonable amount as reward for long and difficult training and a rigorous life. However he is paid, he should feel that he is being rewarded because of his individual skills and efforts and not merely as an entry on a payroll.

It is clear that paying for medical care for old people involves much more than paying a few hills. The legislation now under consideration touches on only part of the problem and is only a beginning. Major changes are ahead, and rational answers will not come from hastily considered legislation in an election year, though that is the way the process usually begins. If the liberal is a man who dislikes change but recognizes its necessity, then he and his legislators will need the time to plan what must be changed, the courage to leave some things unchanged, and the wisdom to tell the difference.

Tue, 24 Jan 2017 01:15:00 -0600 en text/html
Madras High Court orders incentive marks for PG medical students on COVID duty No result found, try new keyword!Ordering the award of incentive marks to the petitioners and PG medicos who have rendered the service, the bench directed the authorities to provide them COVID duty certificate Madras High Court has ... Thu, 16 Nov 2023 14:31:00 -0600 en-us text/html Happy grads

More than 30 people received their high school equivalency certificate at a graduation ceremony Oct. 16 hosted by the Intermediate Unit 1 at California High School. The event was moved to the high school due to the growth in enrollment, reflecting the increasing commitment to adult education within the community. The keynote address was delivered by Steven Foos, who, like the adult education program graduates, embarked on a similar path to success by earning his GED. The ceremony also featured additional speakers, including members of the IU1 administration, supervisors of the adult education program, and a graduate who shared their personal success story.

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PG docs can be given special marks for Covid duty in govt hospitals: Madras HC No result found, try new keyword!Even though the services of PG medicos during Covid pandemic is considered part of their 36 month training period ... the duties rendered by the PG medicos have been held equivalent to regular medical ... Thu, 16 Nov 2023 12:10:00 -0600 en-us text/html

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