Showing papers on "Health care published in 1981"

The concept of access: definition and relationship to consumer satisfaction.

Abstract: Access is an important concept in health policy and health services research, yet it is one which has not been defined or employed precisely. To some authors "access" refers to entry into or use of the health care system, while to others it characterizes factors influencing entry or use. The purpose of this article is to propose a taxonomic definition of "access." Access is presented here as a general concept that summarizes a set of more specific dimensions describing the fit between the patient and the health care system. The specific dimensions are availability, accessibility, accommodation, affordability and acceptability. Using interview data on patient satisfaction, the discriminant validity of these dimensions is investigated. Results provide strong support for the view that differentiation does exist among the five areas and that the measures do relate to the phenomena with which they are identified.

Sex Bias in the Family Allocation of Food and Health Care in Rural Bangladesh

Abstract: Conclusive evidence was provided in an earlier study by the authors of higher female than male mortality from shortly after birth through the childbearing ages in a rural area of Bangladesh.' Male mortality exceeded female mortality in the neonatal period, but this differential was reversed in the postneonatal period. Higher female than male mortality continued through childhood into adolescence and extended through the reproductive ages. The most marked differences were observed in the 1-4-year age group, where female mortality exceeded male mortality by as much as 50 percent. The higher male mortality rate during the neonatal period is consistent with evidence from many societies that the biological risk of death is higher among male children than among female children.2 The reversal of the sex differential of mortality, markedly so during childhood and persisting through adolescence, was postulated to be reflective of sex-biased health- and nutritionrelated behavior favoring male children. Son preference in parental care, intrafamily food distribution, feeding practices, and utilization of health services are some of the behavioral mechanisms by which sex-biased attitudes may have led to the observed mortality pattern. The purpose of this study is to examine the validity of this hypothesis. To do so, a framework is presented in which the mechanisms through which sex-biased attitudes and practices might operate to affect health, nutrition, and mortality are postulated. In-depth empirical data are presented from rural Bangladesh to examine the validity of the hypothesis that sex-biased health and nutrition behavior discriminates against female children, thereby causing an aberrant female predominance in the childhood mortality rate. The paper concludes by discussing policy and program implications associated with these findings.

Epidemiology of head injury.

Abstract: To find the incidence of the various types of head injury that occur in the community separate yearly rates (per 10(5) population in Scotland) for deaths, admissions to hospital, and attendance at accident and emergency departments were estimated and compared (when possible) with rates in England and Wales and the United States. Hospital admissions provide the best data for comparing incidences in different geographical areas and rates of attendance at accident and emergency departments the most reliable guide to incidences in the community. Admission rates, however, vary with local facilities and policies, and these also determine the proportion of patients referred to regional neurosurgical units. Such epidemiological data must be sought both for planning health care for head injury and for monitoring the effectiveness of services.

Equity of access to medical care: a conceptual and empirical overview

Abstract: This paper summarizes the major ethical considerations in the conceptualization and measurement of the equity of access concept, presents national and community data on the most current profile of access in the United States, and discusses the implications of these conceptual and empirical issues. Changes in health care policy and the future of the "equity of access" objective in the U.S. are also discussed. THE ETHICAL considerations in the conceptualization and measurement of equity of access to medical care, the current empirical profile of equity in the United States, and the implications of these conceptual and empirical issues for future health policy dealing with the "equity of access" objective are the focus points of this report. Implicit in this objective of equity are three assumptions that serve as a starting point for examining the ethics of equity: 1) Health care is a right; 2) The resources for allocating health care are finite; 3) Health policy should be concerned with the design of "just" mechanisms for allocating

A Prison Environment's Effect on Health Care Service Demands

Abstract: This study looks at the impact of a corrections environment upon prisoners through a process of monitoring inmate attendance at sick call clinic. Contrasting cell block designs and characteristics are compared on the basis of significant differential demands for health care services emanating from specific areas. Known psychological and physiological responses to situations perceived to be threatening provide the theory that health behavior may be used as one indirect measure of environmentally induced stress. Findings suggest there are architectural design features of the prison environment that provide basis of perceived threats to inmate safety and survival. Loss of privacy on several dimensions appears to be a critical environmental characteristic. Research has established that abnormally high utilization of health care services occurs in total institutions. This raises several questions. Do people who find themselves in total institutions have characteristics which are predominantly unique to their population but at variance from the general population? If so, would such variation influence the differences in utilization of health care? Are there common characteristics of total institution environments that would cause the high rates of health care utilization? Studies of Navy ship crews by Doll et al., 1969 [1] ; Gunderson et al., 1970 [2] ; and a prison study by Andrew Twaddle, 1976 [3], revealed health care utilization patterns which were similar to each other. Here two different total institutions with different subject profiles produced similar patterns. This suggests the possibility that characteristics of total institutions are causal rather than characteristics of the subjects.

The Relevance of social science for medicine

Abstract: 1. Clinical Social Science.- Section 1: How Academic Physicians View the Social Sciences.- 2. An Informal Appraisal of the Current Status of 'Medical Sociology'.- Section 2: Social Supports: Influences on Health and Illness.- 3. Physical Health and the Social Environment: A Social Epidemiological Perspective.- 4. Social Network Influences on Morbid Episodes and the Career of Help Seeking.- Section 3: Illness Behavior.- 5. Sickness and the Sickness Career: Some Implications.- 6. The Sickness Impact Profile: The Relevance of Social Science to Medicine.- 7. Cultural Influences on Illness Behavior: A Medical Anthropological Approach.- Section 4: Culture, Meaning, and Negotiation.- 8. The Meaning of Symptoms : A Cultural Hermeneutic Model for Clinical Practice.- 9. A Cultural Prescription for Medicocentrism.- 10. Attributions: Uses of Social Science Knowledge in the 'Doctoring' of Primary Care.- 11. Structural Constraints in the Doctor-Patient Relationship: The Case of Non-Compliance.- 12. Doctor-Patient Negotiation and Other Social Science Strategies in Patient Care.- Section 5: Social Labeling and Other Patterns of Social Communication.- 13. The Social Labeling Perspective on Illness and Medical Practice.- 14. The Double-Bind Between Dialysis Patients and Their Health Practitioners.- Section 6: Sociopolitical and Socioeconomic Analyses.- 15. A Marxist Analysis of the Health Care Systems of Advanced Capitalist Societies.- 16. Importance of the Economy to the Nation's Health.- List of Contributors.- Name Index.

Ethnicity and Medical Care

Abstract: Ethnicity and Medical Care equips health professionals with the ethnographic data they need to deliver better health care within American communities of urban blacks, Chinese, Haitians, Italians, Mexicans, Navajos, and Puerto Ricans. Each chapter, dealing in turn with one of these seven American subcultures, reviews the available demographic and epidemiological data and examines sociocultural influences on each major phase of illness. Topics range from culture-specific syndromes such as susto or ?evil eye,? to concepts of disease based on blood perturbations or God's punishment, to lay-referral networks, consultation of mainstream and non-mainstream sources of medical care, and adherence to treatment regimens. But ethnic behavior often entails general styles of interaction?attitudes toward authority figures, sex-role allocations, and ways of expressing emotion and asking for help?that are carried over into the healthcare setting. Accordingly, Ethnicity and Medical Care also offers general guidelines for providing more personalized, culturally relevant care for any ethnically affiliated patient.

The Duke-UNC Health Profile: an adult health status instrument for primary care.

Abstract: The Duke--UNC Health Profile (DUHP) was developed as a brief 63-item instrument designed to measure adult health status in the primary care setting along four dimensions: symptom status, physical function, emotional function and social function. Reliability and validity were tested on a group of 395 ambulatory patients in a family medicine center. Temporal stability Spearman correlations ranged from 0.52 to 0.82 for the four dimensions. Cronbach's alpha for internal consistency was 0.85 for emotional function. Guttman's reproducibility coefficients were 0.98 for physical function and 0.93 for social function, and the scalability coefficients were 0.89 for physical and 0.71 for social. Observed relationships between DUHP scores and demographic characteristics of the respondents correlated well with those predicted by the investigators (overall Spearman correlation 0.79). Convergent and discriminant validity was supported by strong associations between components of DUHP and those on the Sickness Impact Profile (SIP), the Tennessee Self-Concept Scale (Tennessee), and the Zung Self-Rating Depression Scale (Zung). DUHP with SIP monocomponent-heteromethod Spearman correlations ranged from 0.34 to 0.45, and those for DUHP with Tennessee ranged from 0.68 to 0.81. DUHP with Zung monoitem--heteromethod correlations ranged from 0.54 to 0.57. It is concluded that this evidence supports the reliability and validity of the DUHP as an instrument suitable for studying the impact of primary health care on the health outcomes of patients.

The Ability of Primary Care Physicians to Recognize the Common Dermatoses

Abstract: • Although the balance between the number of primary care physicians and the number of specialists has been the subject of much attention, there has been little investigation of the quality and cost-effectiveness of various provider groups. To a large extent, dermatologic care is rendered by primary care physicians. In this study, the ability of primary care physicians to recognize the 20 most frequently encountered dermatoses was examined. Results indicate that, in comparison to dermatologists, primary care physicians are deficient in their ability to recognize common dermatoses. This study emphasizes the need for reevaluation of the training and, possibly, manner in which health care is delegated to personnel who deal with cutaneous disease. ( Arch Dermatol 1981;117:620-622)

Health for all by the year 2000.

Abstract: The World Health Assembly in launching the movement for health for all by the year 2000 has identified health for all as the attainment by all the people of the world of a level of health that will allow them to lead socially and economically productive lives. The definition implies that the level of health of all individuals should be such that they are capable of working productively and of actively participation in the social life of the community in which they live. To bring this about will necessitate reforms in the health sector as well as reforms of a political social and economic nature. A more equitable distribution of resources for health can be the 1st of several of such reforms in all sectors. The health infrastructure needs to be reorganized in order to play a leading role in forging together the different health programs into a single unified system. The International Conference of Primary Health Care held in Almata of the Union of Soviet Socialist Republics in 1978 issued a Declaration. This Declaration stated that primary health care is the key to realizing health for all by the year 2000. Also identified were 8 essential elements of primary health care. These include the following: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; and maternal and child health care including family planning and immunization against the major infectious diseases.

Access to medical care among the Hispanic population of the southwestern United States.

Abstract: This paper considers the meaning of minority group status for the Hispanic population of the United States regarding access to medical care. A review of the relevant literature raises a number of questions concerning determinants of medical care utilization for Hispanics. They are explored using data from a national survey of health care utilization that oversampled the Hispanic population of the southwestern United States. Some indicators suggest that limited access to medical care for Hispanics in this region is associated with low levels of income, education, and health insurance coverage. Some implications of the findings for future research on Hispanics' access to medical care are presented.

Childhood mental disorders in primary health care: results of observations in four developing countries. A report from the WHO collaborative Study on Strategies for Extending Mental Health Care.

Abstract: To ascertain the frequency of mental disorders in Sudan, Philippines, India, and Columbia, 925 children attending primary health care facilities were studied. Rates of between 12% and 29% were found in the four study areas. The range of mental disorders diagnosed was similar to the encountered in industrialized countries. The research procedure involved a two-stage screening in which a ten-item "reporting questionnaire" constituted the first stage. The study has shown that mental disorders are common among children attending primary health care facilities in four developing countries and that accompanying adults (usually the mothers) readily recognize and report common psychologic and behavioral symptoms when these are solicited by means of a simple set of questions. Despite this, the primary health workers themselves recognized only between 10% and 22% of the cases of mental disorder. The result have been used to design appropriate brief training courses in childhood mental disorders for primary health workers in the countries participating in the study.

Toward understanding elders' health service utilization

Abstract: Providing appropriate health services to the elderly is emerging as one of the major challenges of this decade. Using the theoretical framework developed by Andersen and Aday, this study attempts to improve our understanding of those factors which inhibit or facilitate elders' use of health services. The data come from a 1974 statewide random probability sample of 1,625 noninstitutionalized elders 65 years of age or older living in Massachusetts. Regression analysis is used to study the effects of predisposing, enabling, and need characteristics on the use of five health services: hospitals, physicians, dentists, home care, and ambulatory care. The model explains from 5% to 27% of the variance in health service utilization. Need characteristics, in general, account for most of the explained variance.

The Manitoba longitudinal study on aging: preliminary findings on health care utilization by the elderly.

Abstract: This research links survey data from a large probability sample of the elderly population of one Canadian province with provincial insurance data documenting all their health care use during the years before and after the interview. The data show that “the elderly” are not high users of the health c

Social validation and training of emergency fire safety skills for potential injury prevention and life saving

Abstract: A multifaceted behavioral program designed to teach emergency fire escape procedures to children was evaluated in a multiple-baseline design. Five children were trained to respond correctly to nine home emergency fire situations under simulated conditions. The situations and responses focused upon in training were identified by a social validation procedure involving consultation with several safety agencies, including the direct input of firefighters. Training, carried out in simulated bedrooms at school, resulted in significant improvements in both overt behavior and self-report of fire safety skills. The gains were maintained at a post-check assessment 2 weeks after training had been terminated. The results are discussed in relation both to the importance of social validation of targets and outcomes and the implications for further research in assessing and developing emergency response skills.

National health expenditures, 1980.

Abstract: The United States spent an estimated $247 billion for health care in 1980 (Figure 1), an amount equal to 9.4 percent of the Gross National Product (GNP). Highlights of the figures that underlie this estimate include the following: Health care expenditures in 1980 accelerated at a time when the economy as a whole exhibited sluggish growth. The 9.4 percent share of the GNP was a dramatic increase from the 8.9 percent share in 1979. Health care expenditures amounted to $1,067 per person in 1980 (Table 1). Of that amount, $450, or 42.2 percent, came from public funds. Expenditures for health care included $64.9 billion in premiums to private health insurance, $70.9 billion in Federal payments, and $33.3 billion in State and local government funds (Table 2). Hospital care accounted for 40.3 percent of total health care spending in 1980 (Table 3). These expenditures increased 16.2 percent between 1979 and 1980, to a level of $99.6 billion. Spending for the services of physicians increased 14.5 percent to $46.6 billion, 18.9 percent of all health care spending. All third parties combined--private health insurers, governments, philanthropists, and industry--financed 67.6 percent of the $217.9 billion spent for personal health care in 1980 (Table 4), ranging from 90.9 percent of hospital care services to 62.7 percent of physicians' services and 38.5 percent of the remainder (Table 5). Direct payments by consumers reached $70.6 billion in 1980 (Table 6). This accounted for 32.4 percent of all personal health care expenses. Outlays for health care benefits by the Medicare and Medicaid programs totaled $60.6 billion, including $35.8 billion for hospital care. The two programs combined to pay for 27.8 percent of all personal health care in the nation (Table 7).

Shattuck Lecture--health care in the developing world: problems of scarcity and choice.

Abstract: The problems of putting the objective of health for all through primary health care into practice is described along with what may be feasible on the very limited budget available in most developing countries. Attention is directed to stages in the evolution of health systems obstacles to progress (uneven distribution of health services lack of appropriate technology pharmaceutical policies management of health resources poverty and financing of health services); efficiency and effectiveness of the use of resources; and financial feasibility of primary health care. The pattern of diseases in industrial countries has evolved through three stages over the course of more than 100 years: major and minor infectious diseases linked to poverty malnutrition and poor personal hygiene; chronic diseases; and health hazards arising from environmental exposure to an increasing number of chemicals drugs and other toxic substances and from changes in the social conditions. Developing countries face the challenge of coping with all 3 stages simultaneously and they have just a fraction of the financial and human resources that were availble to their industrialized counterparts. The greatest improvement in life expectancy from health investments can be expected in the rural and peri-urban poor through a program that provides maternal and child health services including control of the major infectious and parasitic diseases of children under 5. Effective technology for such a program is currently available and affordable in developing countries. 2 major problems persist: political will to allocate the needed resources for the program; and the management capability to organize and operate a system of services for the rural and peri-urban populations that use multi-purpose community health workers. No satisfactory strategy has been developed to meet the health needs of older children and adults within the financial resources of most developing countries. The search for health technology appropriate to the financial resources of most developing countries. The search for health technology appropriate to the financial and organizational circumstances of developing countries must be viewed as a high priority for the research and development community throughout the world. Financial constraints will continue to be an overriding consideration in the development of the health sector for the foreseeable future.

Access to Health Care for the Poor: Does the Gap Remain?

Abstract: In the last 15 years several federal programs were established to improve access to health care for disadvantaged groups. Although numerous studies have been conducted examining trends in access to health care, considerable controversy remains. Nearly all authors concur that important progress has been made, and that gaps in access to care have narrowed considerably. Some, however, go further and conclude that the evidence indicates that all significant gaps have been eliminated and access to health care is universally shared. Evidence on access to health care has important health policy implica­ tions. If the task of assuring access to health care has been largely accom­ plished, further expansion of federal health care programs to promote access would be unwarranted. If selected population groups lag behind others in access to care, targeted policies to close remaining gaps may be warranted for these groups. The reasons for any remaining gaps also have significant policy implica­ tions. If the major barriers to access are financial, expansion of eligibility for existing financing programs such as Medicaid or a new national health insurance plan may be needed to bring all poor persons into the health care system. If the major barriers are related to race or limited resources, a services or manpower strategy for underserved areas may be called for. If the remaining barriers are racial or limited knowledge about the importance of using the health care system, still other strategies may be appropriate.

Ethical dimensions in the health professions

Abstract: I. Introduction to Ethical Dimensions in the Health Professions 1. Morality and Ethics: What Are They and Why Do They Matter? 2. The Ethical Goal of Professional Practice and Prototypes of Ethical Problems 3. Ethics Theories and Approaches: All You Need to Know 4. A Six-Step Process of Ethical Decision Making in Arriving at a Caring Response II. Ethical Dimensions of Professional Roles 5. Surviving Student Life Ethically 6. Surviving Professional Life Ethically 7. Living Ethically within Health Care Organizations 8. Living Ethically as a Member of the Health Care Team III. Ethical Dimensions of the Professional-Patient Relationship 9. Why Honor Confidentiality? 10. Why So Much Emphasis on Truth Telling? 11. Why Care About Informed Consent? IV. Ethical Dimensions of Chronic and End-of-Life Care 12. The Growing Ethical Challenges of Chronic and Long Term Care 13. Ethical Issues in End-of-Life Care V. Ethical Dimensions of the Social Context of Health Care 14. Distributive Justice: Clinical Sources of Claims for Health Care 15. Compensatory Justice: Social Sources of Claims for Health Care 16. Good Citizenship and Your Professional Role: Life As Opportunity

Use of ambulatory medical care by the poor: another look at equity.

Abstract: Access to health services by the poor and other disadvantaged groups has improved considerably over the past 15 years. These circumstances have led some to question whether the poor now have equal access to health care. This article presents recent evidence from the 1976-78 National Health Interview Surveys (NHIS) comparing utilization among age, race, and income groups. Without adjustment for health status, the poor have more physician visits than those with higher incomes. After adjusting for age and health status, however, these differences are reversed. Depending on which measure is used, the poor have between 7 per cent and 44 per cent fewer visits than those with income above twice the poverty level. Furthermore, the age- and health-adjusted data show blacks have significantly fewer visits than their white counterparts. In addition, there are large differences among race and income groups in the characteristics of the ambulatory care obtained. Blacks and the poor are much more likely to use hospital clinics and less likely to use private physician offices or telephone consultations. The poor also receive less preventive care. It would appear from the present evidence that still further progress is required to achieve the goal of equity in the distribution of medical care services.

Factors Affecting the Use of Social and Health Services Among the Elderly

Abstract: This study has systematically examined the use of health and social services among non-institutionalized elderly people according to the Andersen model which groups factors influencing use into predisposing, enabling and need variables. Need for service as evidenced by physical and psychological functioning was the most important predictor of use of physician services and hospitalization. Predisposing factors had the most effect on use of dental services. On the other hand, knowledge of services, an enabling factor, was most relevant to use of social services. Since this factor is manipulable to planned change, several program strategies were suggested for increasing awareness of social services particularly among the impaired elderly.

Does attitude toward psychosis relate to outcome

Abstract: In a previous follow-up of recovered schizophrenic patients, it was found that a positive, integrating attitude toward illness correlated with good outcome. In similar research at NIH, the authors of this study obtained partial replication of these findings. Specifically, the less negative patients were about their illness and future, the better their outcome. A very positive attitude was not associated with good outcome. Hence, the absence of a negative attitude appears critical. The authors failed to find a relationship between integration or isolation of the psychotic experience and outcome, which suggests the incidence of this (unconscious) psychological coping style from a conscious attitude and opinion about illness and the future.

Implementation of computer simulation projects in health care.

Abstract: In a survey of computer simulation in health care, few projects were found which reported any success in implementing their results. These few studies have been examined in detail to evaluate the success of their implementation and extract possible reasons for it by comparing these studies with the many unsuccessful ones. Discussion includes the criteria for selecting potentially successful projects before they are started and the reasons why health care is a particularly difficult area for implementation.