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Microsoft word - 21 spgpps news issue 22 & 23 sep 2005.doc
Substance Use Disorders and the Private Hospital Role Assessment of Models of Funding Service Delivery for Private Psychiatric Services Pilot of a Consumer Perceptions of Care Measure Our Apollo 13 - Exploring Collaboration between SPGPPS and Universities How to Contact Your Representatives SPGPPS News provides a brief summary of some of the issues being progressed by our Private Mental Health Alliance. As such it is intended to stimulate discussion and debate concerning the delivery of mental health services in the private sector. SPGPPS News does not, therefore, necessarily represent the views of participating organisations, unless otherwise stated. Further information can be obtained from the SPGPPS Website at www.spgpps.com.au, or by contacting the Secretariat on 02 6270 5438. Page 2 SPGPPS News Editor’s Desk Dr Bill Pring SPGPPS Substance Abuse and Dependency Working Group (SDWG)
his Edition of SPGPPS News focuses on our SPGPPS working groups, which largely oversee
Drug and alcohol abuse is a major issue for the mental
Tthe work of the SPGPPS. In addition, we have health sector. At the same time, good data on best
an update on SPGPPS involvement with the various
practice in dealing with the problem is sparse. To
government inquiries into mental health and Dr help remediate this situation, the SPGPPS invited Andrew Page elaborates on how our sector can work
Professor John Saunders from the Centre for Drug and
collaboratively on making the best use of outcomes
Alcohol Studies, Department of Psychiatry, School of
Medicine, University of Queensland, to address the
Government Inquiries into Mental Health.
The SPGPPS has considered the issues raised by
SPGPPS representatives recently appeared before the
Professor Saunders and reconvened its SDWG to
Parliamentary Inquiry into Health Funding. The undertake the following, under the Chairmanship of
public hearing focused on the private health sector with
Mr Maurie O’Connor from the Department of
particular regard to one of the Committee’s terms of
• Promote the best practice scenarios outlined in
How best to ensure to ensure that a strong private sector can be sustained into the future, based on positive relationships between private health funds,
• Develop a Position Paper on the Diagnosis and private and public hospitals, medical practitioners, Treatment of Substance Abuse and Dependency for other health professionals and agencies in the various
• Develop a subsection for the Guidelines for Innovative Models Working Group (IMWG) Determining Benefits for Health Insurance
From February to August this year, IMWG, held a
Purposes for Private Patient Hospital-based
series of meetings to draft an Interim Draft Discussion
Mental Health Care on best practice in the
Paper titled The Assessment of Models of Funding
diagnosis and treatment of people with substance
Service Delivery for Private Psychiatric Services. As
the title suggests, the paper is not so much a blueprint
• Disseminate the information from Professor
for the sector as a stimulus to discussion about
Saunders presentation, with consideration of the
funding reform and the best way to provide the care
reality that many practitioners have little
that consumers and their carers want. The Chair of
exposure to information about drug and alcohol
the IMWG, Mr Phillip Taylor, gives a brief overview
An overview of Professor Saunder’s impressive
Information Strategy Working Group (ISWG)
Does the mental health sector need to measure National Network
consumer satisfaction with the care they receive? The National Mental Health Information Priorities Our National Network held it’s second face-to-face Workshop, held in February 2004, thought it was a
meeting for the year on 15/16 August 2005 at
RANZCP Headquarters. Our thanks go to RANZCP for their generous support of the Network in hosting
In late 2004, ISWG began to examine the feasibility
of using the US devised NRI/MHSIP Consumer In-patient Survey instrument as a consumer perception of
The National Network hosted a booth at the recent
care (CPoC) measure in the private sector.
TheMHS conference in Adelaide to promote a wider recognition of the Network, its aims and activities.
With input from the National Network of Private Reception was very positive. Psychiatric Sector Consumers and Carers (National Network), the CPoC Project has reached a stage of
Attendees commented that the Network was fulfilling
coming to an agreement between the Australian a real need for advocacy on issues peculiar to the Medical Association, the Australian Government private mental health sector, as well as those affecting Department of Health and Ageing, and Queensland
all mental health consumers and their carers.
Health to pilot the measure. For more detail, read the article in this Edition.Dr Bill Pring is the Editor of SPGPPS News, the official AMA observer on the SPGPPS, and Chair of the ISWG. Page 3 SPGPPS News Substance Use Disorders and the Private Hospital Role Professor John Saunders
and sometimes withdrawal symptoms. The criteria are set out below.
rofessor John Saunders from the Centre for Drug and Alcohol Studies, Department of
Three of the following elements occurring
P Psychiatry, School of Medicine, University repeatedly for one year are necessary for the
of Queensland, and the Alcohol and Drug Service,
diagnosis according to International Classification
Royal Brisbane and Women’s Hospital gave a
presentation to the 40th SPGPPS Meeting on
• Impaired control over substance use.
Substance Use Disorders and the Private Hospital
A strong desire to take the particular substance.
Overview of the problem – a shifting landscape
• Preoccupation with substance use (given
greater priority than other activities).
Substance Use in the Australian General Population: Findings from the recent National Drug Strategy Household Surveys Use in Past Year % Change 1998 - Substance 1993 1995 1998 2001 2001 Alcohol 73.0 78.3 80.7 82.4 +2%
• Continuation of use despite harmful effects.
Tobacco Developments in Neuro-scientific Knowledge Cannabis 12.7 13.2 17.9 12.9 -28%
Over the last fifteen to twenty years there has been a major investment in neuro-scientific research into
Heroin 0.2 0.4 0.8 0.2 -75%
substance abuse. Arising from this research it is now known that substance dependence syndromes
Amphetamines 2.0 2.1 3.7 3.4 -8%
have profound biological underpinnings. What
Cocaine 0.5 1.0 1.4 1.3 -7%
happens is a resetting of the dopamine reward pathways in the midbrain as depicted in the
Any illicit drug 14.0 17.0 22.0 16.9 -23% Injected illicit 0.5 0.6 0.8 0.6 -25% drugs
As the table shows, use of drugs is not static. Over
Repeated use of:
the 1990’s there was an epidemic of heroin related
• alcohol
problems including overdose and dependency.
• certain medications Re-setting of dopamine
complications associated with amphetamine usage.
• drugs reward centres
Over the last century there has been an array of diverse opinion about what constitutes substance abuse disorder. It is now recognised that there is a spectrum of substance use and misuse of all
Substance
psycho-active substances. For most substances
dependence syndrome
most of the population will be absent. A number,
using some substances like alcohol, will be in the
low risk category. A smaller number will use
dependence identified are nuclei in the mid-brain
certain substances in ways that are known to have
concerned with reward and reinforcement,
negative consequences. A smaller number still are
including the: ventral tegmental nucleus and
those with a definable clinical syndrome of
dependency, which acts in many ways like a disease process.
The changes in neurotransmission are multiple,
The Dependence Syndrome
deep-seated and lingering. Some of these changes last for as long as the lifespan of the individual.
Dependence syndrome is essentially a condition
The Syndromes can be chronic and quickly re-
that occurs as the result of an initial period of
activated upon further exposure to the substance,
repeated substance use. It is associated with
which does not represent a relapse due to choice,
neurochemical changes, which sets up a syndrome
but as a consequence of biological drives. Genetic
with a life of its own. It is a psychobiological
factors account for around 50% of the reason why
syndrome, which comprises an inner drive to take
some people develop substance abuse disorder.
consequences, preoccupation with substance use,
Page 4 SPGPPS News
Treatments for Alcohol Dependence Syndrome Treatments for Other Substance Misuse: What is
There is a major disjunction between what is shown by the research to be best practice and what is done
Cannabis Dependence
‘in practice’ as shown by the table below.
Hospitals are seeing a raft of mental health complications associated with cannabis use. CBT
Treatments for Alcohol Misuse
is promising but there is limited evidence.
Cannabinoid antagonists are currently being
Best practice Poor Evidence Available Just say no! interventions Heroin Dependence (limited) Substitution treatment - There is solid evidence for (limited) the effectiveness of methadone and buprenorphine approaches approaches Antagonist pharmacological treatments - There is
Acamprosate Acamprosate
some evidence for the effectiveness of naltrexone
(limited, if at all)
for highly motivated clients with good social
Naltrexone Naltrexone (limited) Rehabilitation and supportive approaches - There
Analytic Analytic
are good individual outcomes, but the attrition rate
psychotherapy psychotherapy
is high and the approach is unpopular with many.
Confrontation Confrontation Psycho-stimulant Dependence Supportive Supportive
Modest benefits can be gained from cognitive-
counselling counselling
behaviour therapy (4 sessions plus). There is a
Benzodiazepines Benzodiazepines
clear benefit from twelve-step facilitation, but it is
(post-detox) (post-detox) Anti-depressants Anti-depressants
There is no established pharmacotherapy for
Aversion
psychostimulant amphetamine dependence, but there are some trials attesting to the moderate
Hypnosis
effectiveness of disulfiram and medafinil.
Residential
Dexamphetamine substitution is also a useful
treatment
Serotonin reuptake inhibitors relieve depression in
It is very difficult to arrange for cognitive-
the first 4-6 weeks, but have no long-term benefit
behaviour therapy (CBT) or motivational enhancement therapy (MET), unless the patient is
The Reach of Treatment
privately insured and the health insurance carried
There is massive under-availability of treatment
covers for psychologist fees. There is massive
and the treatment that is offered is often
under-access of pharmacological approaches,
inappropriate. Out patient treatments are well
whereas a range of bad practices is readily
supported by the evidence base. However, the
available in the current treatment system. Some of
average number of therapy sessions attended in
ambulatory services is 2.2. This amounts to
Use of Pharmacotherapies for Alcohol Dependence
roughly an assessmentsession followed by one
Though pharmacotherapies for alcohol dependence
A private hospital program is a delivery
represent a very important component of best
mechanism, not a treatment modality where, in
practice, the rate of pharmacological intervention
engaging the person in treatment, in a structured
by GPs is around 3%. By contrast, currently, at the
program in an in-patient setting, the provision of
Alcohol and Drug Service at the Royal Brisbane
evidence-based therapy is achieved in a way that is
and Women’s Hospital, 80-90% of inpatients with
difficult to achieve in ambulatory settings.
alcohol dependence are discharged on acamprosate or naltrexone, and 80% of outpatients at Biala Alcohol and Drug Service, at The Prince Charles Hospital are treated with acamprosate or naltrexone.
Professor John Saunders may be contacted at: [email protected] Page 5 SPGPPS News Assessing Models of Funding Service Delivery for Private Psychiatric Services Mr Phillip Taylor
must be judged on their capacity to meet the fundamental expectations of consumers and their
n 2003, the SPGPPS established an Innovative
Models Working Group (IMWG) to encourage
Ithe uptake of innovative models mental health • facilitate continuous and coordinated high
care and funding in the private sector. To achieve
quality care that is delivered by a range of
that goal, the IMWG developed a set of General Principles and Recommendations, which supported
• provide access to a range of specialist
the substitution of overnight admitted patient care
with less restrictive models of care. In progressing these it became clear that markedly different views
• respond to the needs of consumers and their
were held in the private sector concerning the
carers in a timely and efficient manner that
practicality, efficacy and feasibility of such models.
promotes recovery and support gains made;
In response, the SPGPPS significantly broadened
• provide a choice of treatment programs;
the IMWG Terms of Reference in 2004 to increase the focus on the merits, or otherwise, of different
• provide the most facilitative environment for
models of care and funding and the barriers to their
• prevent co-payments and out-of-pocket
The IMWG subsequently invited providers,
funders, and consumers and their carers, to put their case on alternative models of mental health care
• protect patient privacy and confidentiality.
and funding to the SPGPPS Between February and August 2005, the IMWG met on several occasions
Psychiatrist’s Perspective
to analyse these different perspectives. From these
Psychiatrists believe that the private mental health
discussions, the IMWG agreed to prepare a
system is a complex system, which is balanced in a
discussion paper, for the SPGPPS that identifies
particular way at present, which has led to high
and discusses funding arrangements that can:
effectiveness and high cost-efficiency. Any
changes to the homeostasis of the system at present may lead to cost inefficiencies and poor outcomes,
increase incentives for alternative models to
and so psychiatrists are advocating for evolutionary
change, not revolutionary change. In the
provide training in best practice alternatives;
Discussion Paper, psychiatrists present the
meet the desired needs of consumers and their
Option 1: Improve Remuneration for Consultations with Carers Interim Discussion Paper
Review the two item numbers, which are available under the Medicare Benefits Schedule (MBS), for
The IMWG’s Interim Discussion Paper titled, The
services to carers of patients being treated under
Assessment of Funding Service Delivery for
that schedule for mental illnesses. Those items are
Private Psychiatric Services, firstly identifies what
used occasionally, but not used a great deal.
are the agreed fundamental expectations of
Option 2: New Item Numbers for Allied Health
consumers, and their carers. It then goes on to
Professionals Under Medicare Funding
discuss some of the options available for the funding of comprehensive models of service
Make MBS item numbers available under limited
delivery that would enable the needs of consumers
circumstances, for consultations provided by allied
and carers to be most effectively met. Certain of
health professionals under the supervision of
the options could be implemented or at least trialled
psychiatrists. Such professionals might include
in the short term whilst the remainder will most
clinical psychologists, psychiatric nurses, social
likely require further consideration and debate.
Any legislative or regulatory constraints, and how
Option 3: Health Insurance Fund Financed Allied
they might be addressed, are also discussed.
Health Initiative Expectations of Consumers and Carers
Include referral to psychologists as part of medical
Consumers know what does, and what does not,
and hospital products in the private health
work for them. Therefore, models of service
delivery and their associated funding mechanisms
Page 6 SPGPPS News Option 4: Psycho-social Rehabilitation Projects Prospective Case Payment Model
Initiate psychosocial rehabilitation projects in the
Under this model, hospitals are paid a fixed sum for
private sector that not only cater for the private
the provision of care to the patient for an identified
hospital insured group, but also allow for some
period, most probably the twelve months following
involvement of non-insured patients. This
their initial admission to the hospital. The amount
initiative would be slightly more complicated, but
of the payment would depend on the initial
assignment of the patient to one or other case classification. The prospective payment would be
Option 5 - Increase Private Psychiatrist Rebates
expected to cover all aspects of the patient’s care as
MBS rebates for private psychiatrists have declined
determined by the hospital in consultation with the
in real terms over the last 20 years. There has been
patient’s treating psychiatrist. Within that context
a conscious policy of limiting the increase of
of joint responsibility with the treating psychiatrist
rebates for specialists other than GP specialists,
for the patient’s care, the hospital is free to allocate
Alternative Models For Funding Hospital-Based Bundled Prospective Payment Model Psychiatric Care
In this model, Health Funds and Hospitals would
The Interim Discussion Paper acknowledges that
negotiate a bundled payment, which would then be
the current per–diem based funding models provide
used by the hospital to provide care to all of the
strong financial disincentives for hospitals to
Health Fund’s members who might require care in
change from the delivery of services principally
the period covered by the payment. The quantum
within the overnight inpatient service setting, to
of the payment would be based on an analysis of
alternative settings, including sameday and
the historical service needs of the Health Fund’s
outreach. The Paper identifies five alternative
members at that hospital in an agreed period
models of funding of hospital-based psychiatric
The Interim Discussion Paper suggests that these
Programme–based Per–diem Payment Model
models of service delivery and their associated funding arrangements should be judged on the
With some variation across Health Funds and
Hospitals, the most common payment model at present is one in which benefits for both overnight
1. The effectiveness with which the needs of
inpatient and ambulatory care are stratified by
program and paid on a per–diem basis with step
2. The efficiency with which the required
down points set on the basis of length of stay
Casemix–based Per–diem Payment Model
3. The extent to which financial risk is equitably
shared between providers and payers, or is
Under this model patients are classified under an
agreed casemix classification system, for example, the Australian Refined Diagnosis Related Groups
The Discussion Paper acknowledges that health
funds and other payers are not able to fund all the
schedule is agreed for each casemix group. Based
services that it may be desirable to have available.
on analyses of historical data, Health Funds and
The Paper suggests that the models of service
hospitals would, in the course of their normal
delivery that clearly require increased expenditure
commercial in confidence negotiations, agree the
by payers should also meet the following additional
positioning of step down points as well as the
quantum of benefits payable for each day.
4. The disease, syndrome or condition for which
Casemix–based Episodic Payment Model
services are to be delivered should be a recognised psychiatric condition.
Under this model patients are classified under an agreed casemix classifications system (e.g. AR–
5. The proposed model of service delivery and its
DRG’s). A specific per episode payment schedule
constituent therapeutic interventions should be
is agreed for each casemix group. Based on
based on evidence that they represent current
analyses of historical data, health funds and
hospitals would, in the course of normal commercial in confidence negotiations, agree the
Copies of the Interim Discussion Paper can be
quantum of benefits payable for each episode. The
principal feature of this model, and that which
http://www.spgpps.com.au/documents/spgpps/publi
distinguishes it from per–diem based funding
models is that hospitals share more equally in the
Mr Phillip Taylor is SPGPPS Executive Officer
financial risk associated with variations in patients’
and Chairs the IMWG. Page 7 SPGPPS News Pilot of a Consumer Perceptions of Care (CPoC) Measure Ms Janne McMahon
3. Is the measure sufficiently easy to complete?
n September 2004, consumers in the private
sector expressed the view that whilst satisfaction
appropriateness of this overseas measure for
I surveys were carried out by hospitals as part of
use in Australia and the appropriateness of this
their quality improvement processes, these seemed
measure, initially designed for public sector
to lack consistency across the private hospital
services and agencies, for the private hospital
sector in their design and collection. At the
National Mental Health Information Priorities
Utility of the measure and the measurement process
Workshop, held in February 2004, there was strong
from the service provider’s perspective
agreement among all participants that the development and implementation of a nationally
With service providers, the following issues are
agreed measure of Consumer Perceptions of Care
relevant in addition to those identified above.
5. Will the collection of these measures help
Project Development
providers to improve their services? In particular can summary scores be derived that
Following these two developments and to progress
are relevant to specific domains and is it
this issue, the SPGPPS Information Strategy
Working Group (ISWG) prepared a Project Brief in
Further, can the reporting process be made
late 2004 that set out a plan for the evaluation and
sufficiently quick and frequent that routine
possible trial of the NRI/MHSIP Inpatient
Consumer Survey, developed under the auspices of the Mental Health Statistics Improvement Program
6. How will the collection of the measures
(MHSIP) and the National Research Institute (NRI)
interact with other questionnaires currently in
of the National Association of State Mental Health
Program Directors. These measures are in the
7. Could the reporting process be integrated
within the existing CDMS or similar public
The NRI/MHSIP Inpatient Consumer Survey, was
referred by the ISWG to the National Network of
8. What would be the likely annual cost should
Private Psychiatric Sector Consumers and their
the collection and reporting process be fully
Psychiatric Sub-committee for consideration and
CPoC Ascertainment and Reporting Protocol
Following further consultation, a funding proposal
The pilot study will involve a test of a particular
was developed for a pilot study and evaluation of
methodology for the ascertainment and reporting of
the feasibility and utility of the routine
CPoC over a period of sixteen weeks, allowing for
ascertainment and reporting of information
three monthly reports, which will also enable the
regarding consumer perceptions of care in both
reporting framework to be refined during the
private hospital-based and public sector specialist
Participants Issues to be addressed by the Pilot and Evaluation
In the private sector, at least six private hospitals
with psychiatric beds have indicated that they wish to participate in the proposed study.
Validity and appropriateness of the measure from the consumer’s and service provider’s perspectives
In the public sector, the Mental Health Unit of Queensland Health has indicated that they have
1. Does it cover the domains of, for example, the
identified a number of integrated mental health
rating of consumers’ perceptions of the
services that wish to participate and have the
outcomes, quality of care provided the facility,
attitudes towards consumers displayed by the hospital’s or the service’s clinical staff, quality
Funding Agreement
and accessibility of the hospital or service
The Department of Health and Ageing (DoHA) and
environment and address the processes of care:
Queensland Health have given “in principle”
approval to the funding of the pilot, and an
Agreement is in the process of being drafted.
2. Are the various domains covered by the
Ms Janne McMahon is the Consumer representative
measure relevant to consumers and able to be
on the SPGPPS and Chair of the National Network of Private Psychiatric Sector Consumers and Carers Page 8 SPGPPS News Our Apollo 13 - Exploring Collaboration between SPGPPS and Universities Dr Andrew Page
source of information on the one hand, but it poses serious questions for each hospital on the other. For
n the film Apollo 13, the astronauts need to re-
instance, each hospital will be able to identify
enter the earth’s atmosphere without exhausting
strengths and weaknesses from the data, but this
I the remaining electrical power. The solution poses the question, “How best to capitalise on
requires NASA scientists to research ways to
address the problems so the astronauts can return
collaboration, we have been able to identify areas
safely. As such, the film is a testimony to
where new treatment strategies may be needed. This
collaboration has involved a link between academics
In a similar way, the Strategic Planning Group for
and postgraduate students in the university and clinic
Private Psychiatric Services (SPGPPS) was brought
staff. These collaborations have not only benefited
together to facilitate collaboration on issues relevant
hospitals and their patients, since data have been
to the provision of mental health care in the private
used for continuous quality improvement, but they
sector. Thus, there was an explicit recognition that
have been beneficial to the university, since
coordinated action between alliance partners could
outcomes have been published in peer-reviewed
journals (see below) and supported numerous postgraduate theses. In so doing, the bringing
Apollo 13 represents one model whereby universities
together of academic and hospital staff creates a
and groups like the SPGPPS can collaborate to
culture of excitement about a more research-
generate new knowledge. The astronauts were the
informed and research-informing clinical practice.
ones working on the job. They faced the problems and they needed the solution. The NASA
Thus, SPGPPS is in a strong position to develop
researchers were given the problem and asked to
links with the tertiary educational sector and derive
find an effective solution. Analogous to the
comparable benefits. The tertiary sector aims to
astronauts, the SPGPPS members face the problems.
generate new knowledge and can bring to bear the
Daily their members confront the difficult task of
resources it has to achieve this end. Likewise,
effectively and efficiently treating people with
generating new knowledge is part of the SPGPPS
mental health problems. Universities, however, are
strategic plan. Collaboration between the SPGPPS,
analogous to the NASA scientists. University staff
its member hospitals, and key staff within
are not responsible for health care, but they are
universities can serve to achieve outcomes that
charged with the responsibility of finding novel
solutions when the call goes out, “Houston, we’ve
Recent Collaborative UWA-Perth Clinic Research
got a problem”. Thus, collaboration between
Publications
universities and the SPGPPS can be mutually
Hooke, G. R., & Page, A. C. (2002). Predicting outcomes of group cognitive behaviour therapy for patients with
An example of one such partnership is between staff
affective and neurotic disorders. Behavior Modification,
at the University of Western Australia and Perth
Clinic. Clinic staff describe issues they face in their
Page, A. C., & Hooke, G. R. (2003). Outcomes for
work and solutions are explored within the
depressed and anxious inpatients discharged before or
framework of the academic collaboration. For
after group cognitive behaviour therapy: A naturalistic
instance, staff wondered if it was possible to identify
comparison. The Journal of Nervous and Mental Disease, 191, 653-659.
potential treatment drop-outs sufficiently early to implement a remedial program. We researched the
Page, A. C., Hooke, G. R. (2004). Failure to replicate
topic and found that drop-outs could be identified
effects of gender and season on length of hospitalisation in unipolar depressives. Journal of Affective Disorders, 81,
and implemented a program to try to address the
issues. Second, Perth Clinic and its benchmarking
Page, A. C., Hooke, G. R., & Rampono, J. (2005). A
hospitals wondered about the stresses and strains
methodology for timing reviews of inpatient hospital stay.
borne by the supporters of inpatients, therefore we
Australian and New Zealand Journal of Psychiatry, 39,
conducted an assessment of the extent of the burden
with a view to better targeting resources to address
Page, A. C., Hooke, G. R., & Rutherford, E. M. (2000).
the needs of supporters. Third, staff wondered when
Measuring mental health outcomes in a private
it would be best to time reviews of an inpatient’s
psychiatric clinic: Health of the Nation Outcome Scales
stay in hospital. It was possible to identify ways to
and Medical Outcomes Short Form SF-36. Australian and
schedule reviews so that they were most efficient
New Zealand Journal of Psychiatry, 35, 377-381.
with respect to the treating psychiatrists’ scarce
time. Finally, the data from the SPGPPS Centralised
Dr Andrew Page can be contacted at the University
Data Management Service (CDMS) provides a rich
of Western Australia at: [email protected] Page 9 SPGPPS News How to Contact Your Representatives National SPGPPS Secretariat Mr Phillip Taylor Australian Medical Association Dr Martin Nothling The Royal Australian and New Zealand College of Psychiatrists Dr Yvonne White (Chair SPGPPS) The Royal Australian College of General Practitioners Dr Brian Kable Australian Government Ms Suzy Saw
Health Priorities and Suicide Prevention Branch
Page 10 SPGPPS News
Acting Director Mental Health Policy section
Consumer Representative Ms Janne McMahon Carer Representative Mrs Ruth Carson Private Health Insurer Representatives Private Hospitals Representatives Ms Moira Munro (Deputy Chair SPGPPS)
Complete List of Patent and Publications: PATENTS: 1. A Novel Method for Production of Nanoparticles using Sub-critical Carbon Dioxide, Granted Indian Patent (Number 544/MUM/2004). 2. Protein Shelled Microbubbles for Intravenous Oxygen Delivery (US Patent Being Filed) PUBLICATIONS: 1. Sameer Dalvi, Mohammad A. Azad, Rajesh Dave, "Precipitation and Stabilization of Ultrafi
ASSURANCE ACCIDENTS CONDITIONS GÉNÉRALES D’ASSURANCE (CGA) TABLE DES MATIÈRES DISPOSITIONS COMMUNES ASSURANCE POUR ENFANTS ET JEUNES ASSURANCE POUR ADULTES ET SENIORS GENERALI Assurances Générales – Genève TABLE DES MATIÈRES 1. DISPOSITIONS COMMUNES H Assurance «allocation au décès » Objet du contrat H 1 Personnes assuréesH 2 Sommes assurées B Di