Showing papers on "Health care published in 1973"

Societal and Individual Determinants of Medical Care Utilization in the United States

Abstract: A theoretical framework for viewing health services utilization is presented, emphasizing the importance of the (1) characteristics of the health services delivery system, (2) changes in medical technology and social norms relating to the definition and treatment of illness, and (3) individual determinants of utilization. These three factors are specified within the context of their impact on the health care system. Empirical findings are discussed which demonstrate how the framework might be employed to explain some key patterns and trends in utilization. In addition, a method is suggested for evaluating the utility of various individual determinants of health services utilization used in the framework for achieving a situation of equitable distribution of health services in the United States.

Small Area Variations in Health Care Delivery

Abstract: Health information about total populations is a prerequisite for sound decision-making and planning in the health care field. Experience with a population-based health data system in Vermont reveals that there are wide variations in resource input, utilization of services, and expenditures among neighboring communities. Results show prima facie inequalities in the input of resources that are associated with income transfer from areas of lower expenditure to areas of higher expenditure. Variations in utilization indicate that there is considerable uncertainty about the effectiveness of different levels of aggregate, as well as specific kinds of, health services. Informed choices in the public regulation of the health care sector require knowledge of the relation between medical care systems and the population groups being served, and they should take into account the effect of regulation on equality and effectiveness. When population-based data on small areas are available, decisions to expand hospitals, currently based on institutional pressures, can take into account a community's regional ranking in regard to bed input and utilization rates. Proposals by hospitals for unit price increases and the regulation of the actuarial rate of insurance programs can be evaluated in terms of per capita expenditures and income transfer between geographically defined populations. The PSRO's can evaluate the wide variations in level of services among residents of different communities. Coordinated exercise of the authority vested in these regulatory programs may lead to explicit strategies to deal directly with inequality and uncertainty concerning the effectiveness of health care delivery. Population-based health information systems, because they can provide information on the performance of health care systems and regulatory agencies, are an important step in the development of rational public policy for health.

The Welfare Loss of Excess Health Insurance

Abstract: American families are in general overinsured against health expenses. If insurance coverage were reduced, the utility loss from increased risk would be more than outweighted by the gain due to lower prices and the reduced purchase of excess care. The first part of the paper develops and estimates a structural equation for the demand for health care and then examines the dynamic interaction between the purchase of insurance and the demand and supply for health care. The second part estimates the welfare gains that would result from decreasing insurance by raising the average coinsurance rate from 0.33 to 0.50 and 0.67 percent. The most likely values imply net gains in excess of $4 billion.

Location of health care facilities: An analytical approach

Abstract: The problem of health facilities location is explored under a mathematical optimization approach. Several models are developed for the location of a generalized health facility system in a region in a manner that the selected criteria are optimized. Locational criteria are structured as a hierarchy of social, economic and political attributes and defined analytically using economic and utility theory. A planning framework, based on the models developed, is presented to aid the health planner in the formulation of health facility location decisions.

Cyclical scheduling and allocation of nursing staff

Abstract: Nursing salaries make up the largest single element in hospital costs. Thus, the effective allocation of available nursing staff to patient care requirements is an important tool in controlling the cost of health care. This paper describes an allocation procedure consisting of two parts: 1. A cyclical scheduling procedure designed to meet average staffing requirements in a manner consistent with hospital personnel policies and employees' preferences. 2. A procedure for adjustment of staffing twice daily in accordance with an index of the latest patient care requirements. The procedure is now in use in a major hospital where it has demonstrably improved nursing staff allocations.

The national ambulatory medical care survey.

Abstract: THE NATIONAL CENTER for Health Statistics (NCHS) of the Department of Health, Education, and Welfare is responsible for developing and producing on a continuing basis a body of balanced and relevant statistics for planning, legislation, administration, program evaluation, and research in the health field. In addition to collecting and disseminating reports and analyses of vital statistics, the health status of the population, and the characteristics of health resources, the Center recognizes the need for developing statistical systems that describe health care arrangements and the use of health manpower and facilities. To meet these needs, the Center has developed a series of health information systems collectively known as the National Health Survey. One of the components directly concerned with medical care is the Hospital Discharge Survey, which provides a comprehensive set of basic statistics on inpatient care derived from a continuing survey of discharges from the nation's short-stay hospitals. The Resident Places Survey provides, on a periodic basis, information on patients in long-stay hospitals, nursing homes, and custodial care institutions. Complementary information on admissions to short-stay hospitals and on visits to physicians' offices is obtained periodically from household respondents through the Center's Health Interview Survey. A series of ad hoc manpower surveys conducted by NCHS has provided limited

Daily Stress, Illness, and Use of Health Services in Young Families

Abstract: Extract: Family life crises have been suggested as etiologic factors in common illness and in precipitating the use of health services. In this study both relations were studied by means of a daily diary kept by 512 families. Comparison of the observed onset of illness in mothers on the first day of a stress episode with the expected onset revealed that illness was 2.5 times more likely than expected by chance. If no illness was present, stress increased utilization of medical services. If there was illness, it decreased utilization for mothers and increased it for young children. The site of care was an important variable. The probability of telephone calls, visits to the outpatient department (OPD) and emergency department (ED) was doubled in “stress-combined illnesses,” although there was little change in the probability of office visits or visits to other clinics at these times. Length of illness was also relevant. One-day-illness episodes have lower chances of medical contact with stress than without, for both mother (1.5% with stress and 2.1% without) and child (4.0% with stress and 6.4% without). For longer illness episodes (2–5 days) the probability of utilization increases for the child when stress is present (from 0.9% to 15.5%), but decreases for the mother (from 10.4% to 8.4%). Speculation: The greatest future challenge lies in controlled trials of methods to reduce internal stress and the resultant perceived illness. This would reduce acute illnesses and place fewer and more rational demands on the health care system. Finally, we have to face the question of whether we should work towards reducing the external stresses of life or limit ourselves to “immunizing” people against inevitable life crises by strengthening their ability to handle stress without becoming physically or mentally ill and without making undue demands on the health care system.

Causal models and social indicators: toward the development of social systems models.

Abstract: To be meaningful social indicators must be components of some social systems model so that changes in the values of these social statistics over time tell us something about the functionimg of the social system. A necessary next step in developing social indicators is constructing models involving interrelated sets of social indicators in each major institutional area of society. This paper reports an initial effort to derive a set of social indicators for the area of health care. A structural equation model has been constructed fox the health care system serving the state of New Mexico. The model includes a network that specifies the causal relationships hypothesized as existing among a set of social, demographic, and economic variables related to the availability and use of health services and to health status; a set of structural equations that indicate the direct effect of variables in the model on each endogenous variable; a set of reduced form equations that indicate the combined direct and indirect effect of each predetermined variable on each endogenous variable included in the model. The model can be used to provide monitoring information pertaining to the effect of a change in a particular variable on all other variables comprising the health care system. Also it provides explanatory information regarding the differences in the availability of health care services, their use, and the health-status of the population in various counties. Finally, predictions of the effects of alternative health care policies that would affect the supply, the organization of care, or patterns of use of health services can be made based on the model.

A new programme of sex education and counselling for spinal cord injured adults and health care professionals.

Abstract: A new programme in sex education and counselling for spinal cord injured adults and health care professionals has been described. The format of the 2-day desensitising-resensitising programme included exposure to a programmed assortment of explicit slides and films of sexual activity. Periodic small group discussions led by trained group leaders constituted the most important part. The results suggest that continued sexual interest, activity and satisfaction can be anticipated for many paraplegics and quadriplegics. An accepting, experimental attitude toward sexual activity promotes satisfaction with an interested and caring partner. However, many health professionals deliver inadequate sexual counselling to patients with spinal cord injury. This may add to the sum of the disabilities carried by the paraplegic and quadriplegic adult.

Determinants of medical care utilization: the role of the telephone in total medical care.

Abstract: The importance of the telephone in the American medical care system is only beginning to receive appropriate attention. Fast studies indicate that a significant proportion of new diseases and a significant proportion of all medical care contacts take place by phone. A study of telephone use in a pre

Child rearing methods and children's health behavior.

Abstract: A developmental pattern of child rearing was found to be associated with better health care practices by children than a disciplinary pattern of child rearing. The developmental methods included substantial use of reasons and information, rewards, and granting of autonomy. Based on these findings and a review of previous research, the higher level of health practices of children reared by developmental than of those reared by disciplinary methods is interpreted as an expression of the differential effectiveness of these contrasting child rearing approaches in developing the child's resources and capacities for coping and taking care of himself. THIS paper examines the relationship between methods of child rearing used by parents and their children's personal health care practices. The child rearing methods to be examined are the tendency to grant autonomy or to control, the extent to which reasons and information are supplied, and the tendency to reward good behavior or to punish misbehavior. It was hypothesized that children whose parents encouraged autonomy and responsibility, supplied reasons and information, and rewarded good behavior to a greater extent than they punished misbehavior would have better health practices than children whose parents made little attempt to develop informed, independent performance by the child, and who emphasized punishment to enforce behavior standards. The first group of methods are consistent with a "developmental" approach to child rearing in that they focus on developing in the child the capacities needed to care for himself. The second group are labelled here "disciplinary" methods because they focus on obtaining unquestioning obedience to the parents' specifications. The distinction made here is rooted in that made by Duvall (1946) between the "developmental" approach to motherhood that

Doctors in Crisis: A Study of the Use of Medical Education Reform to Establish Modern Professional Elitism in Medicine

Abstract: conservatism of the medical profession in general, and most particularly, the American Medical Association. Critics charge that doctors have been an elite who have been primarily and excessively interested in increasing their status and achieving a large income commensurate with a high social standing. Furthermore, it is asserted, physicians blocked reforms and innovations designed to improve health care for a majority of Americans, especially if such reforms (such as more doctors or national health insurance) could result in hurting the doctors' financial interests. Historians have also started to take note of this conception of physicians. They assert that a shift occurred in the medical profession's ideology and public positions after World War I when organized medicine began its active campaign against any government involvement in medical care or financing. Prior to 1917, it is held, the AMA, and the profession in general, supported national health legislation and therefore it represented a liberal or progressive force in America.

Time and distance: the journey for medical care.

Abstract: Time and distance, the two common measures of travel, are examined as they relate to the use of various types of medical service facilities, using correlation and regression analysis. Different conclusions about the relative accessibility of health care facilities for selected sub-population groups result from the use of each measure separately. Differences in travel patterns to hospitals and those to physicians and dentists are observed when measured by time alone or by linear distance alone. Methodologic and health care implications are discussed.

Medical Sociology: A Brief Review

Abstract: stitutes of Health and the interest of private foundations in interdisciplinary research stimulated and supported the growth of medical sociology as an area of research and teaching. During the 1950s, the field developed in two directions: sociology of medicine, centered in departments of sociology in universities, and sociology in medicine, concentrated in schools of medicine and health care facilities. As training programs proliferated through the 1960s, the market for books on the subject grew quickly. Five textbooks on medical sociology are reviewed, and some suggestions are made about issues in need of study for

Medical communication in Alaska by satellite.

Abstract: An experimental communication satellite has been used since late summer of 1971 to provide daily two way radio contact between native health aides in remote Alaska communities and a Public Health Service doctor. Health aides, who after 16 weeks of training provide all the primary health care in their communities, are now able to consult with a doctor concerning treatment of most of their cases where formerly radio contact was impossible six days out of seven. Doctors and health aides have accepted the experimental communication service as an integral part of the Alaska health-care delivery system. The Public Health Service now has the problem of how to terminate or replace the experimental service without lowering the quality of health care that the native people have learned to expect. (N Engl J Med 289:1351–1356, 1973)

A short textbook of preventive medicine for the tropics

Abstract: The tropical environment health statistics epidemiology infections through the gastro-intestinal tract infections through the skin infections through the respiratory tract arthropod-borne infections nutritional disorders occupation - health and disease genetics and health heat disorders the organization of health services family health mental health environmental health - sanitation health education international health planning.

Proposed changes in the organization of health-care delivery: an overview and critique.

Abstract: Students of the American health-care delivery system are generally agreed that, under its present organization, the system will be unable to accommodate any of the more ambitious national health-insurance schemes now before Congress It is argued that the current system is actually a fragmented "nonsystem" that fails to deliver the right mix of care to the right people and at the right time As a result, it is argued, the health-maintenance services received by the average American tend to be of dubious overall quality and are unnecessarily costly To eliminate these shortcomings, a great number of reforms have been proposed, the bulk of which, however, fall into one of the following major types: (a) a shift away from the fee-for-service mode of paying for health services and toward prepayment of comprehensive health care, (b) the substitution of paramedical for medical manpower and of capital for all types of manpower, (c) the consolidation of small provider facilities (especially solo medical practices) into larger production units, and (d) the integration of provider facilities in centrally directed regional systems In this essay, the various reform proposals that have been proposed at one time or another are explored against the backdrop of pertinent empirical research available at this time This exploration leads to the disappointing conclusion that far too many of the proposed reorganization schemesparticularly the much touted idea of a nationwide network of presumably competitive Health Maintenance Organizations-appear to have been proffered more on the basis of intuition or faith than on the basis of convincing empirical evidence At the risk of appearing timid and of exasperating the impatient reformer, the author concludes that a great deal more empirical information needs to be gathered on the behavior of the participants in the health-care sector and on the technical constraints under which that sector operates before one can confidently develop and follow a coherent blueprint for a reorganization of the American health-care system

Some social and attitudinal correlates of health care among Mexican Americans

Abstract: A sample of Mexican Americans was interviewed to ascertain their attitudes toward medical care and doctors and to determine what kinds of medical care they are receiving. Social characteristics of the respondents are examined to explain differences in "folk" medical beliefs. Beliefs are most strongly related to the size of the Mexican-American community the respondent lives in, but are not highly correlated with any characteristic. Finally, an attempt is made to explain variance in the utilization of medical services by both social and attitudinal variables. Utilization of medical services is found to be related more to class and age than either to attitudes toward modern medicine or to respondent's closeness to "Mexican culture."

An aggregative resource allocation model for hospital administration

Abstract: One of the most pressing social problems in the United States today is the delivery of adequate health care services to every American Despite the phenomenal rate of increase in hospital costs, the quality and depth of hospital service have been far from satisfactory Yet, systematic analysis of hospital administration has been generally neglected by decision scientists, hospital administrators, and economists This paper presents a methodology for an aggregative resource allocation in hospital administration More specifically, it applies goal programming to design a general model and demonstrates its practical application for an optimum resource allocation in hospital administration through an empirical study