摘要:

Passage of the 1973 Health Maintenance Organization Act (P.L. 93-222) represents a significant effort by the Federal government to experiment with organizational change in the structure of the health care delivery system. The history of the bill is briefly reviewed. The most important sections of the bill arc analyzed from the perspective of an existing prepaid group practice plan.The author concludes that the bill contains sufficiently stringent requirements that it will not result in a major increase in the number of Health Maintenance Organizations unless similar requirements are imposed on other private insurance carriers. Furthermore, significant allowance for “phasing in” will be required for the existing prepaid group practice prototype plans to qualify for Federal certification.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Over the past two decades, hundreds of articles, editorials, and commentaries have been published describing the considerable disruptive effects on quality of care of individual noncompliance with health and medical advice. While much research has been directed at determining factors responsible for poor compliance, past studies have tended to focus upon easily measured characteristics of the patient, regimen, or illness which, unfortunately, are usually neither predictive nor alterable. This paper systematically reviews the literature on patient acceptance of recommended health behaviors, attempting to find social-psychological and related variables which have proven to be consistent predictors of compliance. The review suggests that certain health beliefs (especially personal estimates of vulnerability to, and seriousness of, the disease, and faith in the efficacy of care), health-related motivations, perceptions of psychological and other costs of the recommended action, various aspects of the doctor-patient relationship, and social influence arc the most productive dimensions for present intervention and further exploration. Building upon an earlier formulation, an hypothesized model is presented which combines these elements for explaining and predicting compliance behavior. Further research should, with standardized questionnaires and analysts techniques, employ prospective, experimental designs for a variety of population groups, settings, and regimens, to evaluate the ability of practical attempts to modify the model variables and thus enhance compliance.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Health insurance plans are evaluated here in terms of ability to guarantee financial access to a set of basic fertility-related health services. Extent of coverage is determined by whether a service is a contract benefit, its market cost, and how often it is used in a given population in one year. Comprehensive coverage removes a deterrent to utilization of preventive care such as wellbaby visits, prenatal care, and family planning. In a total population of women of child-bearing age, each is likely to need some fertility-related care in a given year. The method of calculating adequacy involves using best available estimates of deliveries, abortions, etc. per 1,000 women, and, within each category, of components such as cesarean section. Local or national cost data can be used to derive an average cost per service and an aggregate for a group. The method of comparing this with plan benefits depends on the way benefits arc expressed. Jacksonville, Fla. medical market data were used in a trial of the method on a plan for Federal employees, which shows 70 per cent coverage of estimated expense.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Pharmacists arc thought to play a central role in providing information and advice on health to lower income and other socially disadvantaged groups. However, recent evidence suggests that social biases exist in the spatial distribution of urban pharmacies. Such biases would severely limit the accessibility of the poor and the nonwhite to pharmacy services. To test the general nature of this evidence, we used multiple regression techniques to assess the simultaneous influence of several ecological and socioeconomic variables on the location of pharmacies in Pittsburgh and Omaha. After controlling for the influence of physicians, hospitals, commercial activity, population, and other variables thought to affect pharmacy location, we were unable to detect any evidence of a direct association between pharmacy location and the socioeconomic or demographic (other than total population) characteristics of areas in either city.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The purpose of this paper is to present the results of a study on maintenance and nonmaintenance drugs written for outpatients not covered by prescription insurance. The average cost to the patient for a day's supply of drugs, as well as the average dosage, frequency of administration, and length of duration for maintenance and nonmaintenance drugs were examined. The objective of the study -was to present the economics and prescribing patterns for the two groups of drugs in order to provide data on the costs involved and the prescribing patterns of physicians.The results of comparing the various components of maintenance and nonmaintenance drugs revealed that significant differences exist in the dosage directions, frequency of administration, units prescribed per day, lengths of duration, costs per day, prescription prices, and quantities prescribed and dispensed. Maintenance drug prescriptions tend to have lower dosage directions, costs per day, and frequencies of administration and higher quantities prescribed and dispensed, prescription prices, and lengths of duration.Two variables, frequency of administration and quantity prescribed, were found to have the greatest influence on the cost per day and length of duration for maintenance drug prescriptions. It is the conclusion of this study that further examination into the factors which influence the physician when he specifies the frequency of administration and quantity to prescribe on maintenance drug prescriptions be conducted.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

In 1970, a private medical group practice serving a large rural area introduced psychiatric social workers in an integrated clinic to provide accessible mental health services to all economic levels in the community. Public acceptance confirmed the demand. The rapidity with which other community mental health needs were subsequently recognized in the area, service instituted, and community funds and manpower mobilized to develop new community programs documents the rising awareness of health care needs in traditionally conservative rural areas.The acceptance by community members and psychiatric of psychiatric social workers as members of the health care team suggests the desirability of the group practice clinic for the introduction of nonphysician mental health care professionals. The unique position of the medical group practice for innovation in community health care delivery in outlying areas is evident.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Medicaid programs which provide services for low-income persons who have high medical needs have been criticized for high costs and have raised questions about overuse of physician services. A Baltimore SMSA household interview of use of health services permitted comparison of use of physician and preventive services controlled for morbidity by Medicaid recipients and two other income groups. Medicaid recipients were sickest and had higher physician use. They were more likely to have visits suggested by a physician, to be asked to return, and to be given injections. Physician visit rates were higher for each morbidity category, particularly for Medicaid healthy, who also used more preventive services in two weeks. Higher use of services by Medicaid recipients is accounted for by higher morbidity and increased need and demand for preventive services. Constraints on the use of physician services now most directly affect use of preventive services by those of low income without Medicaid benefits in the Baltimore SMSA.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The unprecedented accomplishments reported from China and Cuba in providing health care to their populations question the assumption that economic development along the model of Western nations is a sine qua non for developing effective health care systems among nonaffluent developing nations. Equal distribution of resources, emphasis on preventive public health measures, and attention to improving overall quality of life have been concepts employed to great advantage by both countries. When it is realized that improved standards of living have far overshadowed modem medical technology in upgrading the health of populations, the policies employed in China and Cuba become especially relevant to other nations, both developed and developing.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Serendipitously occasioned, interim findings from an exploratory study “which—as Whitehead once said of William James's pragmatism—'chiefly starts a lot of hares for people to chase.' ”3The data, collected in a 1965 community survey of health, show that no indulgence in the sick role apparently entails greater mortality risk than docs a modicum of such indulgence.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID