摘要:

Recent trends in access to and utilization of health services by children living in poverty, near poverty, and higher income households in the Flint, Michigan, metropolitan area are examined. During the period under study (1973-1977), there were substantial increases in the percentage of poor children enrolled in Medicaid. By 1977, however, 15 per cent of children in poverty in the city of Flint were still not enrolled; in suburban areas, this estimate was 30 per cent. Some correlates of non-enrollment are identified. These changes in Medicaid enrollment were accompanied by an attenuation of differences in the utilization of ambulatory medical services among income groups, although children on Medicaid in 1977 were still less likely to have a regular source of care, and less likely to have a pediatrician as a regular physician. Although dental visits were covered by Medicaid beginning in 1975, economic differentials in dental utilization appear to have widened over the period under study. A variety of barriers to the delivery of services under Medicaid in this community are noted, and the generalizability of these findings discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Many sources of data confirm that utilization of health services by poor children has increased since the advent of Medicaid in 1966. Poor children make approximately the same number of visits to medical providers each year as do non-poor children. Considering the greater need for services among poor children, few suggest that their full need is met. Available data are not entirely adequate to document how or where the increased utilization has occurred. The Medicaid legislation appeared to presume that poor children would be “mainstreamed” into the same provider systems that are used by the non-poor. Data from national and local surveys are cited in support of the possibility that Medicaid has in fact had a paradoxical effect, proportionately increasing publicly sponsored provider systems, and proportionately decreasing poor children's utilization of private medical providers.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Patterns of primary health care utilization for a random sample of urban elementary school children in three ethnic groups are described. Visit type, reasons for visit, and frequency of visits remained stable from year to year. More than 50 per cent of the children were non-visitors each year; 72 per cent of those not visiting the first year also did not visit the second year. Anglo-Americans were more likely to be non-visitors. Enrollment in a children and youth project is examined as a system factor that enabled limited-income families to seek comprehensive medical services. Analysis of the lowest two social classes indicated that significantly fewer Anglos than Mexican-Americans and blacks were enrolled in the Children and Youth Project The proportion of Anglo nonvisitors in the enrolled group was higher than the proportion of enrolled nonvisitors in the Mexican-American and black population. Each year, significantly more children in the non-visitor category were in the non-enrolled group regardless of ethnicity.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The relative impact of a patient's sex and expressivity (expression of a personal problem) on attitudes of physicians toward patients was assessed using case simulations and questionnaires. Eight simulated cases were used that varied by presenting complaint, patient sex, and inclusion or exclusion of a personal problem. Two non-identical cases were read by each of 253 primary-care physicians, yielding 506 questionnaires for analysis. Of the physicians, 25 per cent believed women were likely to make excessive demands on physician time, although only 14 per cent believed this likely of men (p < 0.01); women's complaints were judged more likely to be influenced by emotional factors (65 per cent versus 51 per cent in men, p < 0.01), and were identified as psychosomatic more frequently than were men's (21 per cent versus 9 per cent, p < 0.01). No sex differences were observed for tranquilizer prescriptions. Sex differences persisted when complaint and expressiveness were controlled; however, physicians' reactions to expressivity were strong enough to equalize male-female differences in some items. Although non-expressive women were more likely to receive a psychosomatic diagnosis than non-expressive men (14 per cent versus 2 per cent, p < 0.01), expressive men and women were almost equally likely to receive psychosomatic diagnoses. Thus, differences in labeling occurred as a function of the patient's sex and expressivity. The effects of these differences on quality of care remain to be determined.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

This paper considers medical care given by physicians to men and women in the United States. It asks how often significant sex differences in care occur, and if these differences are attributable to medically relevant factors or not. Sex differences in diagnostic services, therapeutic services, and dispositions for follow-up are studied for All Visits, 15 major groups of complaints, and 5 specific complaints (fatigue, headache, vertigo/dizziness, chest pain, and back pain). Data are from the 1975 National Ambulatory Medical Care Survey (NAMCS). The analysis reveals that medical care is often similar for men and women, but a sizable number of significant sex differences occur (about 30 to 40 per cent of the services and dispositions studied), and they tend to show more medical care for women. Most of the differences persist even after controlling for medically relevant factors (patient age, seriousness of problem, diagnosis, prior visit status, and reasons for visit). Notably, women still receive more total and extensive services, and more laboratory tests, blood pressure checks, drug prescriptions, and return appointments for many complaint groups. They receive more services for back pain and headaches and more follow-up plans for vertigo/dizziness and back pain. Remaining sex differences may be due to missing medical factors, patient requests for care, patient distress and needs for nurturance, and physician sex bias. In contrast to a recent San Diego study,1national data show few significant sex differences in the extent and content of diagnostic services given for five common complaints.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

This paper projects the use of medical care forward and backward, from 1950 to 2050, to show the importance of the changing age structure of the population for this sector of the economy. The results indicate that institutional care will consume a growing share of the medical care budget in the next century. If rates of use by age and sex remain at current levels, the aging of the population will push days of hospital care to 1621 per 1000 population in 2040, the peak year for hospital use, compared with 1241 per 1000 in 1975. Residents in nursing homes are projected to number 12.8 per 1000 population in 2050, almost two-andone-half times the 5.4 per 1000 of 1975. Outpatient visits to doctors and visits to dentists are largely unaffected by age Structure.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

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 care system. Instead, a small proportion of those age 65 and older account for a disproportionately large share of service utilization. The study also identifies several predictors of high health-care use and discusses the implications of its findings for health care policy, practice, and research.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

This study sought to determine the completeness and congruence of records for drugs ordered and received by outpatients. The setting was a large outpatient medical facility that was part of a large multispecialty hospital. It was found that a listing of current drug orders (prepared by physicians) and a listing of current prescription drugs consumed (prepared from pharmacy drug profiles) each agreed 73 per cent of the time with a list of 107 prescription drugs actually consumed by 26 study patients. Lists were compared based on drug name, strength and directions for use. Further, the physician and pharmacy lists correlated with one another 70 per cent of the time, indicating a substantial degree of inconsistent as well as incomplete drug records within the same setting. In another comparison involving medical chart drug notations and pharmacy drug profiles, a complete match or drug name, strengthanddirections for use occurred in 39 per cent of the cases, while a match on drug name only occurred 64 per cent of the time. The highest degree of congruence occurred between hospital discharge medication notes and outpatient drug profile records. Based on the results of this study, the common assumption that drug records in such settings are congruent and complete appears unwarranted.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A medically referred treatment group (N = 17) exposed to a brief directive psychological intervention and a comparison group (N = 17) matched on age, sex, marital status, general medical symptomatology and initial frequency of outpatient visits over a 6-month period were compared as to the frequency of their outpatient visits in the 6-months following the presence or absence of the invervention in a small overseas military health care setting. Adequate controls of out-of-plan utilization as well as for the effect of a medical referral visit were achieved. Results indicated that a significant reduction in medical utilization occurred only for the treated group. This effect was not replaced with the mere number of psychological treatment sessions. Discussion of the treatment effect centered around the relative symptom specificity of the groups and the possibly limited treatment alternatives available. Results seemed to warrant further investigations in uniformed services health care facilities.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Utilization of medical services in Group Health Association of Washington, D.C., was analyzed for patients referred in 1970 for short-term psychiatric therapy under benefits but who had no therapy or referral for at least the 12 preceding months. A matched comparison group and family members were also studied. Medical visits were analyzed in three time periods: the 12 months preceding referral, the next 4 months when therapy was likely to be received, and a final 12 months. Compared with controls, the Index Cases did not show a significant reduction of “offset” in utilization of outpatient medical services after referral, but they did decrease days of medical hospitalization significantly. When Index Cases were divided into low and high users of psychiatric therapy, the former showed a decline, the latter an increase in medical visits, and the difference between them was significant. The before-after change in utilization among other family members was similar to that for index and control subjects. The findings suggest the need to identify the types of patient and the clinical settings which are most likely to maximize the offset effect of brief psychotherapy. Medical care programs should be tailored to meet the different psychiatric needs of these and other patients in an effective and efficient manner.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID