ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00675.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00676.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

The decade of the 1980s was a roller coaster ride for many rural Americans, rural health care providers, and scholars of rural life. The “rural renaissance” of the late 1970s and early 1980s was followed by the economic “farm crisis” of the mid‐1980s and, in the late 1980s, by a resurgence of interest and policy making related to small towns and rural communities. It was a tempestuous time. Perhaps such fluctuations in national attention and concern are characteristic of most 10‐year periods in history; however, the vacillations that occurred in the 1980s seemed, particularly, to have no f

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00677.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:A review of the literature of the 1980s reveals that women living in rural America are at risk for receiving inadequate prenatal and maternal care. Documented risk factors include poverty and concomitant lack of medical insurance, residence in the most restrictive Medicaid states, and loss of local services including the closure of obstetric units of rural hospitals and the decision by local physicians to discontinue obstetrics. A prominent factor in a physician's decision to stop providing maternity care is the escalating cost of medical liability insurance; however, other forces are also at work, including interference with personal and family activities, disruption of other aspects of professional life (e.g., office schedule), inadequate reimbursement, and an inability to keep up with advancing technology. A research agenda for the 1990s should be consistent with previous recommendations and must stimulate the development of new programs that will induce the maximum number of providers to again offer high quality perinatal care to rural women. Other items on the 1990s research agenda include: (1) the clarification of the impact of lost perinatal services in rural areas, (2) the effects of travel time and distance on perinatal outcomes and cost of care, (3) the effect of loss of obstetric services on other health care services for women and children, and (4) comparisons of regionalized versus centralized systems for the provision of perinatal services.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00678.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:Research from the 1980s on several dimensions of health and health care among the rural elderly is reviewed. Following a brief discussion of the demographic patterns and life conditions of the rural elderly, the current state of knowledge regarding health status, health services utilization, and the potential for informal and familial care of the elderly is examined. The review concentrates on studies that include comparisons between rural and urban populations and/or control for additional variables that are known to covary with residence. Such analyses permit the documentation of the effects of residential location on health indicators net of other factors. The review concludes that the rural elderly are relatively disadvantaged in terms of both health status and access to health care services, and have little if any advantage over the urban elderly in their access to informal sources of care. Following the review, an agenda for future research is identified.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00679.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:More than 50 million Americans live in rural areas. These rural residents often work for small businesses or in the extraction industries (farming, mining, and logging). Because of the size of the businesses, the mandate of the Occupation Safety and Health Administration (OSHA) does not cover these workers and they are seldom afforded the same protection as urban workers. This review focuses on the special health problems facing farm workers, farmers, miners, and loggers. Farm workers are often ill and are affected by psychological illness, injuries, parasites, skin diseases, and the dangers of agrichemicals. Farm owners also face the hazards of stress and have very high rates of suicide. In addition, they are often injured on the job and suffer the highest rate of job related fatality of any work group. The complex farm environment presents a continuons threatto the lungs. This danger has worsened with the increased use of confinement buildings for poultry, hogs, and cattle. As farming has changea with increased mechanization, attendant medical problems have arisen. These “illnesses of innovation” are important. Mining and logging also are dangerous occupations with acute and chronic problems including respiratory illness, vascular problems, and malignancy. The decade of the 1990s must be one of increased attention to rural occupational health care and resea

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00680.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:A number of alternatives to the solo, fee‐for‐service physician model have been pursued in an attempt to alleviate some of the specific problems associated with the delivery of primary care in rural areas. This article reviews and critiques the literature published in the 1980s for four alternative models: organized group practices, community health centers, community‐oriented primary care and managed care systems. The review examines the strengths and shortcomings of the existing literature, and identifies high‐priority research areas for each model. These four alternative models were introduced and promoted during the 1970s with little in the way of research evidence to support them. The subsequent literature pertaining to their performance was primarily descriptive. Of the quantitative studies, many utilized 1970s data. Therefore, the effects of the many environmental changes in rural areas during the 1980s on the viability of these models is unknown. In addition, little, if anything, is known about the life cycle of these models. While longitudinal, cross‐organizational studies present several logistic difficulties and require considerable resources for data collection, they hold the promise of extending the existing knowledge concerning alternative models beyond its pres

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00681.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:We review 1980s research on American rural hospitals within the context of a decade of increasing restrictiveness in the reimbursement and operating environments. Areas addressed include rural hospital definitions, organizational and financial performance, and strategic management activities. The latter category consists of hospital closure, diversification and vertical integration, swing‐bed conversion, sole community provider designation, horizontal integration and multihospital system affiliation, marketing, and patient retention. The review suggests several research needs, including: developing more meaningful definitions of rural hospitals, engaging in methodologically sound work on the effects of innovative programs and strategic management activities—including conversion of the facility itself—on rural hospital performance, and completing studies of the effects of rural hospital closure or conversion on the health of the communities s

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00682.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:The provision and utilization of health care services in rural areas are tied directly to the structure of financing. The model of rural health care shaped by federal policies over three decades was significantly altered by changes during the 1980s. With reactions of third‐party payers to health care costs rising faster than inflation, the difficulty of accommodating access to care and cost efficiency in provision became evident. This review begins with the literature on patient services and capital financing of rural hospitals, then continues with the financing of clinics, community centers, and other supply forms. Research during the 1980s provides insight into the effects of various financing policies on the supply of services. The demand for health care in rural areas is characterized by less generous third‐party coverage, leaving residents paying a larger share of their incomes for care than do urban residents. As a consequence, access to care is especially difficult for low‐income and elderly people, heavily dependent upon government financing. Third‐party payers have severely reduced cost shifting as a mechanism for taking care of the health care needs of a sizable share of the population, thereby placing providers in an uncomfortable position. Several potential and more formalized financing options for replacing cost shifting are discussed. Several important changes will take place with rural‐focused legislation enacted in the late 1980s. These are used to present a rural financing research agenda for

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00683.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:The 1980s saw a retrenchment of the ideology that government intervention could solve the problems of inadequate access to health services in rural areas. Increased emphasis was placed on an ideology that promoted deregulation and competitive market solutions. During the 1980s, the gap in the availability of physicians in metropolitan versus nonmetropolitan areas widened. Also during that time period, the gap between metropolitan and nonmetropolitan populations' utilization of physician services widened. In addition, many indicators of the health status of nonmetropolitan residents versus metropolitan residents worsened during the 1980s. As we enter the 1990s, concern about equitable access to needed health care services and for the vulnerability and fragility of rural health systems has resurfaced. A number of national policies and a research agenda to improve accessibility and availability of health services in rural areas are being considered.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00684.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY