In some situations, the hospitals were billing physician office visits as outpatient department visits in the hospital, even though the practices in some cases were far removed from the hospital that owned the office. The response of the Inspector General's Office has been to rule that hospitals that own practices must, except under rare conditions, bill all physician practices they own as separate entities. The care is available on a non-referral basis. The increase in activity and interest in vaccine-related issues has resulted in a need for additional donations to meet the additional demand. It is unusual in that it enters the discussion about the utility of vaccination in the larger context.
Credit is given to diet, sanitation and living conditions for the decline.
The article concludes with the discussion of adverse reactions and the National Vaccine Injury Compensation Program. This article is an important sign in the changing nature of the argument and the reintroduction of data that questions the underlying nature of the changes in rates of infectious disease following vaccination. In addition, self-reliance was promoted and victimization was discouraged. Atopy is of a complex origins, but the recent rise in atopic disease in westernized communities points to the action of important environmental effects. One candidate mechanism is the changing pattern of microbial exposure in childhood.