Showing papers on "Health care published in 1974"

A framework for the study of access to medical care.

Abstract: Definitions and aspects of the concept of access to medical care are reviewed and integrated into a framework that views health policy as designed to affect characteristics of the health care delivery system and of the population at risk in order to bring about changes in the utilization of health care services and in the satisfaction of consumers with those services. Indicators are suggested for the measurement of the various relevant aspects of access, with the system and population descriptors seen as process indicators and utilization and satisfaction as outcome indicators in a theoretical model of the access concept.

Consumer Assessments of the Quality of Medical Care

Abstract: Studies using consumer evaluations of the quality of medical care are reviewed. Important methodological issues in studies using this approach are discussed and future paths for research are presented.

What Kind of Geography for What Kind of Public Policy

Abstract: Before geographers commit themselves to public policy, they need to pose two questions: what kind of geography and what kind of public policy. The evolution of the discipline, in terms both of its aims and its professional organization, must be seen as an adaptation to external conditions, particularly to the development of the corporate state with its emphasis on the 'national interest'. The corporate state forces education to be seen purely as investment in manpower and academic research becomes subservient to the state and is used to preserve and strengthen the status quo. There is here a potential conflict with the academic's sense of moral obligation, but in practice the conflict is resolved by the parochialism and elitism of the humanistic tradition. To help to move away from the corporate state and towards the 'incorporated state' in which men can control the social conditions of their own existence, geographers need to address their efforts towards understanding the tension between the humanistic tradition and the pervasive needs of the corporate state and thereby to learn how to exploit the contradictions within the corporate state itself. CAN geographers contribute successfully, meaningfully and effectively to the formation of public policy ? General Pinochet is a geographer by training, and by all accounts he is successfully putting geography into public policy. As President of the military Junta that overthrew the elected government of Salvador Allende in Chile on I September I973, General Pinochet does not approve of 'subversive' academic disciplines such as sociology, politics and even philosophy. He has asked that 'lessons in patriotism' be taught in all Chilean schools and universities and he is known to look with great favour upon the teaching of geography-such a subject is, he says, ideally suited to instruct the Chilean people in the virtues of patriotism and to convey to the people a sense of their true historic destiny. Since the military have taken full command of the universities and frequently supervise instruction in the schools, it appears that geography will become a very significant discipline in the Chilean educational system. General Pinochet is also actively changing the human geography of Chile. An example is here in order. The health care system of Chile has, for some time, comprised three distinct components: the rich paid for services on a 'free-market' basis; the middle classes made use of hospital-based medicine financed by private insurance schemes; while the lower classes and poor (some 60 per cent of the population) received free medical care in community-based health centres paid for out of a National Health Service.1 Under Allende, resources were switched from the first two sectors into the community health services which had previously been poorly financed and largely ignored. The geography of the health care system began to be transformed from a centralized, provider-controlled, hospital-centred system catering exclusively to the middle and upper classes, to a decentralized, community-controlled, free health care system primarily catering to the needs of the lower classes and the poor. This transformation did not occur without resistance-the providers of hospital-based medicine organized strikes to preserve the old social geography of health care against the emergence of the new. But during the Allende years the community health centres grew and flourished. Also, community control through the creation of Community Health Councils had a profound political impact and many aspects of life began to be organized around the community health centres. The emphasis also shifted from curative medicine (with all of its glamour and expensive paraphernalia) to preventive medicine which sought to treat medical care as something integral to a wide range of environmental issues (water supply, sewage disposal, and the like). The human geography of social contact, political power and distribution changed as hitherto never before, as the lower classes and poor people began to realize the potential for controlling the social conditions of their own existence.

The Sickle Cell Diseases: Clinical Manifestations Including the Sickle Crisis

Abstract: Working definitions of "sickle cell disease," "sickle-cell trait," and "the sickle crisis" are given. The pathogenesis of the crisis is explained and the complications of the disease are presented in a quantitative manner. The need to look at the patient as a whole and to assess the natural history of the disease against the background of an often prevalent social and environmental pathologic condition is stressed. A call for effective public health measures, including raising of living standards and providing comprehensive health care facilities for sickle cell disease patients is made.

Innovation of health services: a comparative study of hospitals and health departments.

Abstract: This paper investigates the differential contribution of various organizational variables affecting the innovation of high-risk versus low-risk health service programs in two types of health care organizations: hospitals and health departments. It was found that variables are differentially related to both the type of program and the type of organization. Organizational size was a critical factor in program innovation as it relates to high-risk services in hospitals and low-risk services in health departments. Excluding size, characteristics of the staff, such as cosmopolitan orientation and training, were prime predictors for both highand low-risk programs in health departments and low-risk programs in hospitals. The degree of formalization was the primary predictor of innovation of high-risk programs in hospitals. Cosmpolitan orientation of the administrator was a critical factor in the innovation of high-risk programs in both hospitals and health departments.

Measurement of Outcome: A Proposed Scheme

Abstract: The need to demonstrate that health care has an influence on health status is increasingly pressing. Such demonstrations require tools of measurement which are unfortunately not available. Development of instruments has been hampered by a lack of consensus on appropriate frames of reference, and there appears to be little agreement on what should be measured and what relative importance should be ascribed to different dimensions of health status. An approach that does not require the assignment of numerical values or weights to various aspects of health status and is applicable to all age groups within the population and to the whole spectrum of health problems rather than to specific medical diagnoses would seem desirable. A scheme that is based upon the development of a “profile” rather than a single “index” for describing health status is proposed in this paper. The model is a conceptual framework whose usefulness will depend upon efforts of a large number of researchers from many disciplines to develop instruments which can be incorporated in it. Although the problems in development of the scheme are complex, I hope that it will focus attention on the relevant dimensions and facilitate improved coordination of efforts to produce ways to demonstrate what health care contributes to health.

Social justice and equal access to health care.

Abstract: A societal goal to which more and more people in the United States appear to be committedat least officiallyis the assurance of comprehensive health services for every person irrespective of income or geographic location. This paper offers one possible moral justification of the goal. It does so by attempting to apply various standard conceptions of social justice to considerations about health care and to reflect about the reasons why some of the conceptions seem more relevant than others. Several institutional implications are also

Social class variations in health care and in the nature of general practitioner consultations.

Abstract: O of the fundamental principals of the National Health Service was 'to divorce the care of health from questions of personal means or other factors irrelevant to it' (H.M.S.a. 1944). The extent to which this has been achieved is still debated nearly thirty years later. In this paper we take a critical look at the data and arguments used by some of the people who have taken part in this debate, and examine further data which are relevant to it. We discuss some of the mechanisms which can affect the distribution of care and incidentally present some new data about social class variations in the nature of general practitioner consultations.

Some aspects of childhood malnutrition as a public health problem.

Abstract: much concern to medical politics. The village worker sug gested above is still unacceptable to many doctors and their professional organizations. In rural Punjab research has shown that three-quarters of the health care is provided through local people who have learnt to give injections and practise traditional medicine in response to the people's need. A proposal by the Indian Government to recognize and pro vide training for these people in such subjects as nutrition was defeated (by the medical ldbby. Other countries have medical professions no more liberal than India. Effective ser vices in rural areas continue to be blocked by city-based doctors and nurses striving after and passing laws to main tain and improve training of personnel and standards of health care for the elite who live in their cities-standards of care and qualifications which are out of the reach of the rural people both now and i the foreseeable future.

Areas of responsibility in the health care of multiply handicapped children.

Abstract: To clarify the roles of primary and consultant physicians in the health care of children with chronic disabilities, 44 mothers of children with spina bifida were interviewed to determine whether a primary physician, a specialist or another source had taken the responsibility for providing the following areas of health care: evaluation and treatment of the chronic disease, advice, future planning, genetic counseling, coordination, emotional support, education, acute illness care, and well-child care. Specialists provided evaluation and treatment of the chronic disease for all children, while about three fourths of the children received acute illness and well-child care from their primary physicians. The patterns of responsibility for the other areas of health care were less clearly defined. Primary physicians were perceived as contributing little to the rehabilitative and coordinative care for these children; most mothers felt there was no physician responsible for providing overall direction to their children9s care. To provide complete and effective health care to children with chronic disabilities, parents and physicians must clearly understand who is to be responsible for both the specific health services as well as the overall direction of care. A primary physician, a specialty clinic or a "coordinating pediatrician" might effectively play this role.

Psychosocial effects of sickle cell disease.

Abstract: The psychosocial adaptation of an individual with sickle cell anemia is dependent on a number of variables, including the personality structure, family attitudes and behavior, and community responses and resources. Interactions of the individual, family, and community, and areas of stress and crises are analyzed by means of a developmental-maturational approach. Accurate knowledge of the disease, anticipatory guidance and continued (intermittent) counseling by trained health professionals, encourage and facilitate positive adaptations. Unfortunately, in current sickle cell programming, there are features that can have a negative psychosocial impact on individuals with sickle cell trait and anemia, the black population and society at large. These features include inaccurate communication materials; inaccurate diagnosis by physicians; lack of or improper counseling; unproved, unrealistic health care recommendations; and mandatory testing laws.

An Exploration of the Path-Goal Theory of Leadership in a Health Care Environment

Abstract: Relationships between leader behavior and subordinate satisfaction and performance, unmoderated and moderated by a subordinate's role ambiguity, were studied at multiple occupational skill levels i...

Health and Labor Force Participation.

Abstract: Models are estimated to analyze the influence of health on labor force participation. It was found that the participation of blacks is more likely to be reduced by health factors than that of whites; that the primary importance of education derives from its association with skills and ability rather than health. Public transfer payments influence but do not control participation of nonseverely disabled workers. Including health measures can increase the explanatory power of labor force models. Better information on health of workers would allow separation of the cost of disability into those reducible through delivery of health care and those more appropriately dealt with through labor market policies.

Improving patient care

Abstract: The “Bicycle Process” is a systematic approach that requires health care providers to establish their own minimal standards of patient care. Any performance below their minimally accepted level is called a performance deficit. Educational programs are instituted for each performance deficit after which their performance is remeasured. To be successful the process requires at least the cooperation of physicians, administrators, boards of trustees and medical record analysts. At one children's hospital attempting to institute the “Bicycle Process”, the staff created 54 standards of care for 3 commonly encountered conditions (meningitis, asthma and pneumonitis). Performance deficits were shown for 34 standards before and 29 standards after the educational programs. Of the 29 remaining deficits, 20 showed improvement, 6 worsened and 3 remained unchanged. Thus, the “Bicycle Process” can lead to significant improvements in patient care and warrants close inspection by all who render patient care.

The Cress Theory of Color-Confrontation

Abstract: (1974). The Cress Theory of Color-Confrontation. The Black Scholar: Vol. 5, Black Health, pp. 32-40.

The quality of physicians' health-care performance. A comparison against optimal criteria for treatment of the elderly and younger adults in community hospitals.

Abstract: Comparisons of the quality of physicians' performances against optimal criteria of care were made within 15 diagnostic categories for 808 patients over 64 years old and for 1,243 younger adult patients hospitalized in 22 short-term, community hospitals in Hawaii during 1968. There was no overall consistent evidence that hospitalized elderly patients were treated by their physicians with a different level of personal medical care than were younger adult patients.