摘要:

This paper introduces an index of access to medical care that describes the use of services relative to the actual need for care. Findings on this particular measure suggest that, contrary to the implications of much of the existing literature, the poor continue to use fewer services–relative to the disability they experience–than do the nonpoor. Further, despite the advent of publicly financed economic solutions to these access differentials–Medicaid and Medicare, in particular–organizational barriers to entry, such as the long queues to obtain service and long travel times to care in some areas, still exist. The implications of these findings for the evaluation of existing and proposed national health policy efforts are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The California “copayment experiment” imposed a charge of $1 on certain Medicaid beneficiaries for the first two visits to a doctor and 50 cents for the first two drug prescriptions each month, effective January 1, 1972. Data on utilization rates were gathered for six months before this date and for 12 months after it. While other administrative requirements, like prior authorization of certain services, doubtless also played a part, it was found that, following the start of copayment, utilization of ambulatory doctor's office visits and other services associated with them showed a decline, relative to that of the non-copayment cohort. After a brief lag, however, hospitalization rates in the copay cohort rose to levels higher than those of the non-copayment cohort—more than offsetting the savings to the state from the reduction of ambulatory service use rates. Due presumably to the neglect of early medical care because of the inhibiting effect of the copayments, these higher use rates of costly hospitalizations suggest that financial deterrents on access to ambulatory service by poor people are penny-wise and pound-foolish, not to mention their effects on health and well-being.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

A method that can be used to classify the severity of health problems and measure change in health status is described. The “staging” concept provides a system which classifies patients with similar medical conditions into clusters useful for patient care evaluation. The method defines different levels of severity: Stage I—disease with no complications or problem of minimal severity; Stage II—disease with local complications or problem of moderate severity; and Stage III—disease with systemic complications or a problem of a serious nature. Examples of the method are given and the value of the approach is described for the evaluation of the hospitalized and ambulatory patient.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Utilization review has heretofore emphasized “length of stay” as the criterion for deciding when the patient is ready to leave the hospital. We suggest that “level of care” (the type, number, and/or intensity of a combination of physician, skilled nursing, and ancillary services) received by the patient should replace length of stay as the major “decision” criterion for deciding on continued hospitalization: “appropriate hospital placement” means the patient is currently receiving a level of care available only in the hospital. Length of stay should be the criterion for signaling intervals when patients are (re)reviewed to determine the currently needed level of care.Explicit criteria for determining when a patient is receiving a hospital level of care should be developed. Explicit criteria will increase objectivity, provide guidance to utilization review coordinators, and assist the hospital in defending its utilization review decisions to an intermediary or Professional Standards Review Organization (PSRO).Level of care will be reflected in a patient's “services profile,” a listing of all the services being received by the patient on any given day of hospitalization. The services profile varies throughout hospitalization; hospitalization is appropriate when a patient's current services profile constitutes a level of care available only in the hospital.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Community pharmacists, by virtue of their location, are thought to be among the most accessible health care workers in the delivery system. To estimate the importance of this assertion it is necessary to understand the communication habits of pharmacists, especially their interactions with patients.Since verbal communication is the most frequent form of patient interaction, this study attempts to specify the type and amount of all pharmacist communication with emphasis on the pharmacist-patient process. Using a modified work sampling technique, communication data were collected on community pharmacists practicing in chain pharmacies. Data are presented in the context of a causal model The strongest pathway in the model is found to be the inverse relationship of prescription department staffing to the percentage of time pharmacists devote to communication with patients. Prescription volume is seen to have a moderately positive effect on the level of communication. However, further analysis reveals staffing to be the limiting factor. The findings suggest that changes in the environment of the community pharmacists studied would do much to increase pharmacist-patient contact. An educational effort also is indicated to assure that patients receive quality communication.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

This study analyzes five variables related to quality and utilization of optometric prescribing of eyeglasses. The practices of optometrists participating in the New York City Medicaid Program were compared with those not participating. The variables chosen for this study can be analyzed by computer and seem to have wide applicability for monitoring of optometry services. Significant differences were found in four of the five variables under review. Overali, non-Medicaid patients appear to be receiving higher quality optometric care and less unnecessary care. Many of these differences, however, depend on the setting of the practice—whether solo, group, or corporate. Of additional note, wide variations occurred in the patterns of practice for non-Medicaid, as well as Medicaid, optometrists.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Projection of the probable demand for health services over time is one of the most important–and difficult–aspects of the health planning process. Not only must the planner contend with many variables external to the health sector, but also with the difficult to predict correlations between the supply of health services and the resultant demand. This article briefly reviews some of the principal demand projection methods in use and then describes in detail the one adopted in the Chilean health manpower study. The demand portion of the study in Chile involved three main elements: 1) a sample survey which measured the met and unmet demand for medical, dental, and hospital services as a function of six population variables (age, sex, location, income, educational level, and medical insurance status); 2) a baseline demand projection which takes into account the probable effects of changes in these six variables over ten and 20 years on the utilization of services; and 3) an alternative projection which postulates the fulfillment of certain targets for the improvement of health care. The approach offers the planner a number of important analytical and programmatic advantages compared with other methods now available and are discussed along with their limitations.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID