ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00333.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACT:The introduction of Medicare's Prospective Payment System (PPS) has disproportionately increased financial pressures on rural hospitals and posed challenges to the survival of these institutions. Increasingly, rural hospitals are seeking strategies that can enhance their chances for survival in a turbulent and hostile environment. This study examined the survival effects of one such strategy, multihospital system affiliation. Specifically, we assessed: (1) whether and how different types of system affiliation in the post‐PPS era affect the likelihood of rural hospital survival; (2) whether particular structural, environmental and hospital performance characteristics moderate the effects of system affiliation on rural hospital survival; and (3) whether systematic selection by rural hospitals into multihospital systems potentially accounts for observed relationships between system affiliation and survival.Proportional hazards analyses indicate that system affiliation with investor‐owned systems significantly reduces survival probabilities of rural hospitals. Affiliation with not‐for‐profit systems or system affiliation under contract management arrangements does not affect survival probabilities of rural hospitals.These general findings are moderated by the effects of hospital ownership and size at the time of affiliation. Finally, study findings indicated that systematic selection by poor performing rural hospitals into investor‐owned systems has occurred in the post‐PPS era. No evidence of selection into not‐for‐profit systems

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00334.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACT:Despite substantial recent increases in the number of rural physicians, it is unknown whether rural children still face significant barriers to medical care. To address this question, we determined travel times in 1980 and in 1989 to child health services for the rural pediatric population of northern New England–the area with the highest per‐capita primary care physician supply of any non‐metropolitan region in the United States. The study population in 1989 included 363,443 children living in 936 nonmetropolitan towns. The study revealed important spatial relationships in health service supply and demand not identified using other methods of assessing physician availability. Although travel times to physicians decreased slightly during the decade, we found that 15.5 percent of the children in our population were more than 30 minutes from pediatricians in 1989, and travel time to emergency rooms was more than 30 minutes for 9.9 percent of the children. In contrast, only 1.8 percent of children faced excessive travel times to family/general practitioners. While towns with pediatricians were likely to also have a family physician or an emergency room, the majority of towns with family physicians had neither a pediatrician nor an emergency room. Towns with poor geographic access to pediatricians and emergency rooms had low population densities and were distant from metropolitan areas. The analysis indicates that even in rural areas of high physician supply, access to pediatricians and emergency rooms for many children remains limited, and family physicians are the dominant medical providers for children. Future work using travel time variables will clarify the relative importance of travel to medical care as a factor in rural health out

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00335.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACT:In Alabama between 1985 and 1989, a total of 94 physicians outside of the four largest cities in the state dropped the obstetrics portion of their practices or left practice in their communities altogether. During the same period 82 physicians entered obstetrics pratice in this area. The study presented here used survey and archival data to compare pratice characteristics of generalists and specialists in rural and town counties who made different decisions about providing obstetrics care. More generalists left and more specialists entered practice both in town and in rural counties. Rural counties lost more obstetrics providers becasue more generalists provided the obstetrics care in these areas. Across both speciality and county categories, physicians in group practice who accepted Medicaid and had local access to larger numbers of patients were more likely to remain or begin new obstetric practices. During this period, some obstetrics specialists moved into rural communities that had previously supported only generalist physicians.These findings suggest that the options for organizing successful obstetrics practices have narrowed, putting solo and generalist physicians who operate small‐scale obstetrics practices at a disadvantage. These physicians also face competition from obstetrics specialists who are beginning to enter practice in the rural areas of the state.Designing policies that effectively improve geographic access to care requires a realistic understanding of the practice constraints faced by obstetrics providers. For example, as centralized specialist group practices serve residents from surrounding rural areas, programs that facilitate linkages, such as satellite clinics and use of mid‐level practitioners, can be promoted. The challenge for policy‐makers and advocates is to understand and take advantage of changes in the organization of obstetrics practice to improve the availability and the quality of obstetrics care in rural Am

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00336.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACT:Rural hospitals were under tremendous stress in the 1980s, as evidenced by decreasing use and closures. Rural populations increased in the two proportions of people older than 65 years relative to urban areas. Rural communities had more chronically ill residents than urban areas. Population aging and hospital stress have opened an option for small rural hospitals to develop long‐term care units. Analysis of a national cohort of 750 small rural hospitals was undertaken in 1983,1985, and 1987 to identify the characteristics of these hospitals, their communities, and the relative contribution of the small rural hospital to long‐term care bed supply. Hospitals more likely to have long‐term care during this period of time had lower occupancy rates and higher expenses per admission both prior to and after developing long‐term care. While only 14 percent of the 750 hospitals studied had long‐term care, they contributed nearly 30 percent of the total long‐term care bed supply in their counties. Population‐based need and bed supply measures were not significantly different in counties having a small rural hospital with long‐term care. Areas of further analysis of the small rural hospital as a resource for long‐term care are suggested. The implications for the health care system of small rural hospitals with long‐term

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00337.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACT:Nearly three fourths of the migrant farmworkers in the U.S. are Hispanic. Cultural and social barriers, along with constant travel, make coordination of care a significant concern for migrant health centers providing perinatal services to female farmworkers. As part of a demonstration project, a migrant‐specific maternal care coordination program was developed that used bilingual staff, outreach services, lay health advisers, and a multistate tracking system. Following the initiation of the project, first‐trimester entry into prenatal care and number of prenatal visits increased over a five‐year period among the target population. Successful tracking methods provided outcome data on more than 80 percent of participants during the project period.The results of this study suggest that migrant health centers should focus on employing public health‐oriented bilingual or bicultural health professionals and that an outreach strategy must be an integral part of a health care delivery system serving migrant farmworkers. Without these key ingredients, health care services will not be accessible or acceptable for this hard‐to‐reach population. Collaboration among the National Migrant Resource Program, the Migrant Clinicians Network, and the National Perinatal Association can facilitate development of a regionwide perinatal service system for female migrant

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00338.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACT:Proper nutrition during pregnancy has a major effect on a mother's health, as well as that of her baby. This paper examines the adequacy of diet among low‐income, black, pregnant women residing in rural areas of west central Alabama. The factors associated with diet adequacy in this population are also examined. Data for this study were collected from 186 women who provided 24‐hour dietary recalls. The data indicate that these women have major deficiencies in their diets, particularly in terms of milk and milk products. Most women are receiving only about 60 percent of the number of servings of the four basic food groups recommended for a pregnant woman. Women younger than 20, unmarried or not heading their own household, receiving no post‐high school education, unemployed, experiencing an unplanned pregnancy, and not having a home visitor had less adequate diets than their counterparts. Diet adequacy had a low (r = .16) but statistically significant correlation with birthw

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00339.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACT:Suicide rates among farm populations have been reported to be higher than among other populations. Overall economic stressors and exposure to hazardous work conditions have been reported to be associated with the increased rates of suicide. The purpose of this paper is to examine the pattern of suicide among white men in Colorado, contrasting the rates of on‐farm suicides with those of other nonmetropolitan and metropolitan residents. The analysis indicated a high suicide rate in Colorado compared to white males in the United States; however, the farm suicide rate was similar to the U.S. rate. On‐farm suicide rates in Colorado were lower than suicide rates for the metropolitan and nonmetropolitan males. Prior to targeting all farm populations as at high risk for suicide, more work needs to be done assessing actual risk and considering potential differences in agricultural populations across the coun

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00340.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACT:Farm tractor rollovers account for one quarter of all fatal farm injuries, but their economic impact has not been studied previously. This study surveyed surviving family members of people killed between 1985 and 1987 in New York farm tractor rollovers and found the average expected income lost by each death was $243,615 (response rate=46%, N=12). Fatal farm tractor rollovers may cost New York more than $2 million a year in lost income. Nonfarmers account for 33 percent of these rollover deaths. These nonfarmers were not on a farm and were not doing farm work at the time of the fatal injury. Policy responses to the dangers of farm tractors should consider the risks to nonfarmers and should be cognizant of the costs that could be averted.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00341.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1992.tb00342.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY