摘要:

The authors studied the health care access and utilization patterns for a stratified random sample of 1,726 special education students in five large metropolitan school systems. Overall, 7% of the special education students had no regular source of care, 26% had no regular physician, and 38% had not visited a physician in the previous year; 13% had no health insurance. Each of these measures was worse for nonwhite and poorer children as well as for those whose mothers who had less formal education. Insurance coverage was associated with physician visits, with 45% of the uninsured children visiting a physician compared with 63% of those with public insurance and 66% of those with private insurance. Odds ratios for all health care access and use measures showed striking geographic variations. Thus, even for children identified as handicapped by their communities, barriers to health care are evident and are significantly greater for groups traditionally at risk.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A decreasing neonatal mortality rate has increased the number of infants who survive their stay in a neonatal intensive care unit only to need continued medical care. Medical services utilization by families with high-risk infants has been widely studied, but research is sparse on high-risk infants who do not receive follow-up care through medical specialists' services or speciality clinics. After dividing medical services utilization into four patterns, ranging from use of only primary care to use of three kinds of medical services, the authors analyzed a set of predictors of utilization. The factors most likely to affect pattern of utilization significantly are related to health need and illness level. The infants with more serious medical conditions diagnosed at birth were found to use the most follow-up services. No effects of location of residence or social class were found, which suggests that families had no significant problems of access to medical care services for their infants in the defined region of the study.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

National health care systems of Latin America have long consisted of a mixture of several subsystems, principally (1) traditional healing; (2) religious charity; (3) Ministries of Health; (4) social security organizations; (5) other government agencies; (6) voluntary agencies; (7) enterprises; and (8) a modern private market. Observations in Brazil and Peru in 1984, compared with 1962, show great changes in the proportions and character of all of these subsystems, particularly an expanding impact of the social security programs, in terms of people covered and the financial support of health services.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Using data from the National Health Interview Survey on approximately 30,000 children, maternal and child ambulatory care utilization patterns are compared. The results indicate that maternal physician utilization is closely associated with child utilization, as measured by presence or absence of a physician visit over the course of a year as well as annual volume of use. Maternal use appears to be a more powerful predictor of child use than several other family and maternal variables. These results confirm and expand on those of previous localized population-based studies and suggest that interventions directed at the mother may be effective in ensuring equitable and efficient use of ambulatory services by children.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

This study analyzes the health plan selection history of approximately 30,000 employees of a large aerospace corporation. The data show that families selecting HMOs were younger, had lower income, and had less time on the job. HMOs attracted families with lower annual claimed expenditures, and these families' claimed expenses were lower still in the year immediately prior to switching into the HMO. Lower costs among families switching into the HMOs are partly explained by the composition of these families compared with families who stayed in the FFS plan. However, the selection pattern persisted even after adjusting for the size of the family, the age and sex of family members, and other family characteristics, such as race and income. Families switching out of HMOs had higher total annual claims during their first year back in the FFS sector compared with families about to switch into HMOs. However, recent HMO exiters did not always differ from families who never left the FFS plan.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The goal of this study was to determine the factors that are related to utilization rates among older compared with younger enrollees in a health maintenance organization (HMO). Andersen's behavioral model was used as the conceptual framework for examining utilization rates. The approach was to determine the relative importance of predisposing, enabling, and medical need factors in explaining utilization rates among younger and older enrollees of an HMO. The study population included 2,603 adults enrolled in a large HMO. Three years of medical record data were linked with survey data for the analysis. The findings suggest that while the model as a whole explains about the same amount of variation in total doctor office visits for both age groups, the actual predictor variables are not the same. Predisposing factors are more important in explaining variation in utilization among the younger than the older enrollees. Enabling factors are more important in explaining variation in utilization among the older than the younger enrollees. Medical need factors explain about the same amount of variation in total doctor office visits for both age groups. Theoretic and practical implications are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structured four-item self-reported adherence measure (alpha reliability = 0.61), which can be easily integrated into the medical visit. Items in the scale address barriers to medication-taking and permit the health care provider to reinforce positive adherence behaviors. Data on patient adherence to the medical regimen were collected at the end of a formalized 18-month educational program. Blood pressure measurements were recorded throughout a 3-year follow-up period. Results showed the scale to demonstrate both concurrent and predictive validity with regard to blood pressure control at 2 years and 5 years, respectively. Seventy-five percent of the patients who scored high on the four-item scale at year 2 had their blood pressure under adequate control at year 5, compared with 47% under control at year 5 for those patients scoring low (P< 0.01).

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

What are the effects of sociodemographic factors on the use of outpatient mental health services when different demographic groups have identical health insurance coverage? The authors answer this question using data from the Rand Health Insurance Experiment. Health insurance was randomly assigned to families representative of the nonaged, noninstitutionalized civilian population in six U.S. sites. Income has no significant total effect on use when all income groups have the same coverage. When the effects of variables correlated with socioeconomic status are removed, users with higher socioeconomic status are significantly more likely to choose a mental health specialist rather than only general medical providers for their mental health care (P< 0.05); among those who visit mental health specialists, those with higher socioeconomic status incur significantly greater expenses (P< 0.10). Women use significantly more mental health services than men (P< 0.05), who in turn use significantly more mental health services than children (P< 0.05), even after controlling for demographic factors, health status, and insurance coverage. Similarly, there are large differences (roughly sixfold) by site in outpatient mental health expenses even when all sites have identical coverage.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID