Dental caries treatment in Third World populations: a review.

THE PROBLEM OF MEDICAL SERVICES IN DEVELOPED AND DEVELOPING POPULATIONS USA expenditure on health care in the current year is esti­ mated to be 660 billion dollars (Smith, 1990). This figure is equivalent to the current total Gross National Product (GNP) of Britain. Health care expenditure in the USA expressed as a percentage of GNP, is almost double that of most other western countries. Yet the irony of the situation is that vital statistics in USA are not superior, but inferior to those of many developed populations. In the USA there are extremes of expenditure. On the one hand 1 American in 6 has no health insurance whatever. On the other hand, in one hospital in Los Angeles, a coronary artery by-pass operation costs about 60 000 dollars. Of considerable concern is a statement that only a half of such by-pass grafts are done on patients likely to benefit from the procedure (Smith, 1990). Frequency of caesarian section rises in proportion to socio-economic status, and does not seem to be related to maternal age, parity, birth weight, ethnicity, or complications of pregnancy (Gould, Davey and Stafford, 1989). These examples illustrate the dichotomy of treatment, health care being both deficient and excessive. Criticism of the inefficiency, bureaucracy and short-sightedness of administrators of health care abounds (Smith, 1990).