Showing papers on "Health care published in 1982"

Cost-of-illness methodology: a guide to current practices and procedures

Abstract: illness and disease have been on a dramatic upward trend that is projected to continue. The most recent estimates of national health expenditures indicate a 400 percent increase since 1965 (Freeland and Schendler, 1981). As a proportion of the Gross National Product (GNP), the costs associated with illness and disease are projected to reach nearly 11 percent by the year 1990 (Freeland and Schendler, 1981) compared to 9.4 percent in 1980 and 6 percent in 1965 (Gibson and Waldo, 1981). It should not be surprising that the analytic literature on these costs has also grown rapidly. Medical journals, in particular, contributed to this growth as the medical profession has become increasingly involved with economists, sociologists, public health specialists, and others in scrutinizing the cost of modern health care (Warner and Hutton, 1980). Estimates of the costs of illness and disease are produced and used in cost-benefit and cost-effectiveness analyses and in other modes to set priorities and make government policy decisions, to prepare and deliver congressional testimony, and to support agency budgets. The application of the techniques of cost-benefit and cost-effectiveness analysis to health care, in particular, has been the subject of several

Health-Related Quality of Life Measurement for Evaluation Research and Policy Analysis

Abstract: The present article describes a unit of health status, the "Well-Year," which expresses the output of health programs in terms of the number of years and the health-related "quality of life" produced by a treatment or program. Dividing the cost of the program by the number of Well-Years that it produces gives the cost-utility of the program. This cost-utility ratio can be used in a general health policy model to compare the efficiency of different programs or to assess the relative contribution of different programs and providers in the health care system. A comprehensive standardized measure of health status has many advantages for health planning, decision analysis, and program evaluation. An example demonstrates how the relative production of WellYears by psychologists might be compared to the contribution of other health care services.

Research Protocol for Measuring the Prevalence of Neurologic Disorders in Developing Countries

Abstract: Because of the scarcity of trained personnel in neurology in developing countries, we designed a protocol utilizing, in large part, non-doctor primary health care personnel for collecting data in a do

Who Should Decide?: Paternalism in Health Care

Abstract: "A very good book indeed: there is scarcely an issue anyone has thought to raise about the topic which Childress fails to treat with sensitivity and good judgement....Future discussions of paternalism in health care will have to come to terms with the contentions of this book, which must be reckoned the best existing treatment of its subject."--Ethics. "A clear, scholarly and balanced analysis....This is a book I can recommend to physicians, ethicists, students of both fields, and to those most affected--the patients themselves."--Edmund D. Pellegrino, John Carroll Professor of Medicine and Medical Humanities, Georgetown University Medical Center.

How Physicians View the Process of Change in Their Practice Behavior.

Abstract: The changes all physicians make in their treatment of patients constitute a neglected but key issue in the operation of the health care system. Identification of a model of this crucial change process was the purpose of this study. Interviews with a random sample of 66 physicians representing five specialties produced data on 182 changes. The fundamental stages in the change process were priming (coming to feel dissatisfaction with some aspect of practice behavior), focusing (learning of alternative practice behavior), and follow-up (obtaining further information or advice regarding the possible change). Any of a variety of information sources may focus a change, but follow-up is overridingly dependent on colleague communication (representing local professional opinion) and journals (representing an authoritative professional perspective). This change process model provides a basis for orienting continuing medical education activities to the achievement of behavioral outcomes.

Equity of access to health care: some conceptual and ethical issues.

Abstract: Problems of defining equity and equality of access are not trivial; there are fundamental disagreements about the nature of health care as a social good and about other principles of distributive justice. Presuppositions about equity underlying several current proposals for reform of health care "markets" are considered. Issues of equity--and theories of justice--arise also in contexts other than disputes about access.

Not on our street : community attitudes to mental health care

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Interpersonal issues in health care

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The Foster Care System and Health Status of Foster Children

Abstract: The foster home care system is the most commonly used alternative for the care of dependent children in the United States. However, it often fails to achieve its objective of returning the child to his home or providing a permanent substitute family. Children entering foster care have frequently suffered social, emotional, and medical neglect, and physical abuse. They have a high rate of chronic medical problems, educational handicaps, and severe emotional impairment. In many cases the health care that foster children receive fails to recognize and/or adequately address their disabilities. In order for the pediatric practitioner to work successfully with a foster child, he must not only provide comprehensive health care, but also must be familiar with the social welfare system within which the child lives.

Telemedicine in critical care: problems in design, implementation, and assessment.

Abstract: We introduced telemedicine, i.e., telecommunications for delivery of health services, to alleviate scarcity and maldistribution of critical care services. For 18 months, we used interactive television to provide consultation with university-based critical care physicians for patients in the ICU of a 100-bed hospital. Telemedicine "visits" (1548) were made to 395 patients. Television consultation had greater clinical and educational impact than consultation using the telephone. Equipment was expensive but proved to be reliable and easy to use. Interactive television extended the availability of specialist expertise, but full exploitation of this technology for delivery of critical care services was not achieved. Extensive background research, currently underway at the University of Pittsburgh, is necessary before the next telemedicine demonstration.

Nursing Management: A Systems Approach

Abstract: Material new to this edition includes: nursing research, motivation, overview of the US health care system, managed care, and risk management. This is a comprehensive text and aims to cover both theory and practice within a systems framework. It should be useful to BSN students on undergraduate and postgraduate programmes.

Clarifying autonomy and accountability in nursing service: part 2.

Abstract: How can a nursing service convincingly argue for autonomy and accountability without an understanding of the precise meanings of these terms? In this second of two articles exploring the meanings and implications of autonomy and accountability in nursing service, Lewis and Batey arrive at this and other provocative questions. They analyze the concept of accountability and provide selected definitions of the concept by directors of nursing. Their discussion provides insights into the presence or absence of true accountability in nursing organizations and presents issues for further study.

Specialist/Generalist Division of Responsibility for Patients With Mental Disorders

Abstract: • The division of responsibility between general medical staff and mental health specialists for care of persons with medical record diagnoses of mental disorders is documented in four organized health care settings. Rates of mental disorders identified in all departments ranged from 35.6 to 122.8 per 1,000 population. Specialty mental health departments treated most severe psychotic and personality disorders, plus transient situational disturbances, whereas neurotic, childhood behavior, and psychophysiological disorders received as much or greater attention in general medical departments. Mental disorder diagnoses were associated with greater patient use of general medical departments. However, joint specialty mental health/ general medical treatment of these patients was associated with lower general medical department visit rates in all settings. Such joint care was facilitated by the low average visit frequency use of mental health departments (2.2 to 8.9 visits per patient per year).

Politics and Health Care Organization: Hmos As Federal Policy

Abstract: Among various health cost containment strategies proposed during the 1970s, none has held more sustained fascination than the health maintenance organization (HMO). For many years, policy analysts in search of market- and incentive-based alternatives to command and control regulation have argued that medical groups combining prepayment and group practice, and offering comprehensive medical services within a fixed budget, would hold down costs both by their own efficient operations and by the competitive pressures they would apply to the conventional systems. During the 1970s, three presidents and five Congresses worked to formulate and implement legislation to increase the HMO presence nationwide, with very modest results. Some observers concluded that but for the well-intended but counterproductive efforts of the federal government, HMOs might thrive. Indeed, the Reagan administration has called for an end to direct federal financial involvement in building HMOsthough it has also promised legislation to promote HMOs and a newly competitive health care system based on revamped financial incentives and reinvigorated markets. In this book, Lawrence D. Brown, a senior fellow in the Brookings Governmental Studies program, examines the interplay between politics and policy in the federal HMO development effort between 1970 and 1980. He argues that the basic explanation for the disappointments of the policy analysts and federal supporters of HMOs lies not in a political miscarriage but in the overambitious promises of the policy strategy itself. Tracing the poor fit between policy and politics revealed by federal efforts to translate the attractive HMO idea into a workable strategy, Brown concludes that the episode augurs poorly for the competitive reforms frequently offered as a nonregulatory solution to rising health care costs in the 1980s."

School absence: A problem for the pediatrician

Abstract: Children who are frequently or persistently absent from school tend to perform poorly in school and are likely to drop out before graduation from high school. Excessive school absence was significant implications in terms of maladaptive behavior, wasted opportunities, and future unemployment and welfare costs. Epidemiologic information about this problem suggests that physical and mental health problems of students or their families are the sole or contributing cause of this behavior in more than 50% of cases. Excessive school absence may signal such health problems as poor coping with or management of chronic illness, masked depression, teenage pregnancy, substance abuse, inappropriate responses to minor illnesses, or severe family dysfunction. School absence patterns appear to be a readily available, easy-to-use marker of childhood dysfunction which lends itself to screening large numbers of children for unmet health needs. Attention to this area of child behavior as part of routine health care will frequently uncover previously unrecognized health problems in children and their families.

Compliance: an interactionist approach.

Abstract: Compliance is central to health care, but by its very nature it remains problematic to health care providers and health care receivers. In this article an interactional approach, the utilization of role theory, in the study of compliance is proposed. Rationale for the need for such a framework is provided through the presentation and critique of currently used models and theories, such as the medical model, the health belief model, control theory, and learning theory. Assumptions of the proposed framework are presented, and four components are identified when considering compliance enactment from an interactional perspective. These are: self-concept, role enactment, complementary roles, and periodic evaluation of role enactment by self and others. Several theoretical propositions evolve as central to the development of a unified framework for compliance. The propositions can be considered potential hypotheses. This article demonstrates one approach to theory development in nursing.

School absence; a problem for the pediatrician

Abstract: Children who are frequently or persistently absent from school tend to perform poorly in school and are likely to drop out before graduation from high school. Excessive school absence was significant implications in terms of maladaptive behavior, wasted opportunities, and future unemployment and welfare costs. Epidemiologic information about this problem suggests that physical and mental health problems of students or their families are the sole or contributing cause of this behavior in more than 50% of cases. Excessive school absence may signal such health problems as poor coping with or management of chronic illness, masked depression, teenage pregnancy, substance abuse, inappropriate responses to minor illnesses, or severe family dysfunction. School absence patterns appear to be a readily available, easy-to-use marker of childhood dysfunction which lends itself to screening large numbers of children for unmet health needs. Attention to this area of child behavior as part of routine health care will frequently uncover previously unrecognized health problems in children and their families.

Bitter pills: Medicines and the Third World poor

Abstract: Rich and poor could benefit from new drugs to treat incurable diseases. But only the poor are denied the life-saving drugs available to the rich. This report attempts to unravel the complexities of the medicines issue. The focus throughout is on the needs of the Third World poor. Chapter 1 assesses the role of medicines in creating better health. Chapters 2 to 6 highlight the special problems in the distribution, production and marketing of drugs in developing countries. Chapter 7 focuses on traditional medicine which remains the major source of health care for most of the world's population. Chapters 8 and 9 describe constructive initiatives to improve health and the supply and use of essential drugs both at project level and on a wider national and international scale. These and the following chapter are concerned both with attempts to rationalise drug policies to benefit the majority and with obstacles to change. Chapter 10 also examines attitudes and policies in the major drug producing nations and their impact on drug needs and policies in developing countries. Finally, in Chapter 11, we put forward Oxfam's suggestions on action that is urgently needed to benefit the Third World poor.

Factors related to utilization of dental services by the elderly.

Abstract: A household interview survey of 883 persons aged 62 and older residing in Seattle, Washington, asked about a broad range of health care and social service issues, including the need for and use of dental care. The Anderson model of health services utilization was used to identify predisposing, enabling, and need characteristics hypothesized to affect the use of dental services. A path analysis was conducted to distinguish the direct and indirect effects of the variables. The results showed that none of the predisposing variables, including age, was a significant factor in explaining the use of dental services. Education had both direct and indirect positive relationships to use. Having a regular sources of dental care was also an important factor affecting utilization. Neither income nor insurance variables were powerful factors. Need, measured by an index of dental problems and having dentures, was the stronger determinant of dental care use. In general, the model was better at predicting whether or not ...