ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00500.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:This study uses data from the 1988 National Survey of Families and Households conducted by the University of Wisconsin to examine spatial variations in physical, mental, and social well‐being among young, middle aged, and elderly American adults. Rural residents of all ages were found to consistently rate their physical health more poorly than nonrural residents. Both young and old rural adults also rated themselves less happy than nonrural residents. However, middle‐aged and elderly rural residents appear better off on the majority of six other indicators of well‐being, and this group reports the highest proportion of adults with no health impairments. Finally, rural residents of all ages possess distinct advantages in terms of several measures of social

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00501.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:This study examines both the magnitude of and factors influencing the adoption of 13 horizontal and vertical integration and diversification strategies in a national sample of 797 U.S. rural hospitals during the period 1983–1988. Using organization theory, hypotheses were posed relating environmental and market factors, geographic location, and hospital characteristics to the adoption of horizontal and vertical integration and diversification. Results indicate that only one of 13 strategies was adopted by more than 50 percent of all rural hospitals during the study period, and that most of the directional hypotheses were not confirmed using Cox's proportional hazards models. In particular, environmental and market factors were unrelated to the strategies studied. Issues of methodology and theory are discussed; however, during an historically turbulent period, both relatively low levels of rural hospital strategic activities and lack of predictive power of the theory suggest caution in relying heavily on a policy for rural hospital survival that is dependent on individual market‐oriented strategic behav

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00502.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Reimbursement changes during the 1980s, particularly Medicare diagnosis‐related group (DRG) reform and the growth of managed care, have squeezed hospital revenues available for cross‐subsidizing care for uninsured patients and patients for whom marginal costs exceed marginal revenues. This study uses logistic regression with time and residence interactions to explore the impact of payment changes on rural versus urban patients' admission status (urgent versus nonurgent). Findings show that uninsured rural patients had a significantly higher probability in 1987 than they did in 1983 of being admitted to hospitals in an urgent/emergent condition. Findings also show incrementally higher probabilities for Medicare and Medicaid rural patients in 1987. Results are consistent with the view that cross‐subsidization is no longer effective for covering uninsured rural care and that more direct subsidies may be nece

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00503.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:During the 1980s a rapid rise in the costs of malpractice coverage for obstetrical services caused many practitioners to stop delivering babies. Other factors also influenced the decision by physicians to exclude obstetrics from their practices, including: increases in malpractice claims made against obstetrical providers and the subsequent fear of being sued; closures of hospital obstetrics units; issues involving Medicaid; and the daily stresses inherent in providing obstetrical care. Rural areas were particularly vulnerable to these factors.North Carolina was not unlike other states in recognizing a severe drop in access to obstetrical services in many communities, and policies were proposed to address this problem through tort reform, malpractice subsidies, and Medicaid program expansion. The exodus of obstetrical providers seemed especially critical in rural areas, and this article presents a metro‐politan‐nonmetropolitan analysis of the results of a survey of all obstetricians and gynecologists active and licensed to practice in North Carolina.The analysis is focused on provider responses to proposed policies and also examines the clinical support networks for these physicians to determine if this might also be an area for future policy activity. Important differences were found between rural and urban providers in terms of intensity of obstetrical practice, adequacy of backup, Medicaid participation and caseload, ideas about tort reform, and recent changes in obstetrical practice. The results indicate that policies to increase demand or income can help solve the rural obstetrical access problem but that states should pay equal attention to the clinical support system for practition

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00504.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Migrant farm workers play an essential role in the planting and harvesting of crops in our agricultural production system. In the United States today, about 6 percent of the paid farm labor force “follow the crops” across the nation. This article reports on the economic and health care needs of migrant farm workers who travel from the border areas of Texas to Wisconsin each year. Surveys conducted in 1978 and 1989 show that this population remains in serious need of health care and access to financial assistance programs.During the 11‐year interval between surveys, little change occurred in the health care status or use patterns of Wisconsin migrant workers, although housing and sanitary conditions in the work environment improved somewhat due to the passage of new federal regulations. This article discusses the problems and barriers that migrants continue to face and offers recommendations for government a

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00505.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:A cross‐sectional survey using a convenience sample of 157 Missouri rural and urban children (ages 8–13 years) yielded no significant differences in perceptions of stressors or use of coping strategies for dealing with those stressors between rural and urban children. The Feel Bad Scale and the Schoolagers' Coping Strategies Inventory measured the children's perceptions of stressors and use of coping strategies.Rural children experienced stressor levels equivalent to urban children, yet they were underserved in mental and physical health needs. The children studied reported self‐care through coping strategies for management of their stressors. Longitudinal research is needed to identify the impact of stress and interventions on the health and behavior of children in rural set

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00506.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

This section ofThe Journal of Rural Healthis intended to assist readers in their efforts to keep current in the research literature that is relevant to rural health. In monitoring the journals from neighboring disciplines, the journal attempts to alert readers to new research and scholarly debate. The scope of this section is, for the most part, limited to publications from the United States. Inclusion of a publication does not represent an endorsement of the research or the validity of the conclusions reported. As research reviews editor, I invite comments on this section. I am particularly interested in innovative ways the section might be used to ensure that the journal's readers are the most erudite professionals involved in rural health.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00507.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Book reviewed in this article:The Strategies and Environments of America's Small, Rural Hospitals: John W. Seavey, David E. Berry, and Richard J. Bogue (Editors).No Benefit: Crisis in America's Health Insurance Industry: Lawrence D. Weiss.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00508.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00509.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY