ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00184.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.tb00185.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.tb00186.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:The purpose of this study was to explore how the primary care (PC) physician‐to‐population ratio changed from 1975 to 1985 in counties that were served by an Area Health Education Center (AHEC) in contrast to those counties that were not. The investigation attempted to determine whether any observed changes in this ratio were dependent upon either degree of urbanization or contiguity to a Standard Metropolitan Statistical Area (SMSA). The data source for this study was the Area Resource File. Results indicated that: (a) irrespective of AHEC status, increased degree of urbanization across counties was associated with relatively more PC physicians in both 1975 and 1985; (b) PC physician‐to‐population ratios increased from 1975 to 1985 for all American Medical Association (AMA) county code categories, regardless of AHEC versus non‐AHEC designation; (c) AHEC counties demonstrated greater (or equivalent) absolute improvement for all AMA county code categories except for several categories which represented more urbanized counties; (d) for the least urbanized counties in the AMA code, the percentage improvement in PC physician‐to‐population ratios for AHEC counties ranged from 3 to 5 percent higher than corresponding percentage improvement in ratios for non‐AHEC counties; and (e) AHEC counties showed greater absolute and percentage improvement in PC physician‐to‐population ratios than did non‐AHEC counties for counties no

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00187.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:This paper briefly describes a number of structural and economic changes in the profession of medicine and in the rural medical care delivery system that have occurred since about 1970. Changes in the national physician supply; in the training, work, and practice characteristics of physicians; in the demographic characteristics of physicians; in the medical resources available in rural communities; and in federal and state support for the provision of medical services are noted. Four conceptual models that underlie physician recruitment and retention programs for small towns and rural communities are described. These include affinity models, which attempt to recruit rural persons into training or foster interest in rural practice among trainees; economic incentive models, which address reimbursement or payment mechanisms to increase economic rewards for rural practice; practice characteristics models, which address technical, collegial, referral, and other structural barriers to rural practice; and indenture models, which recruit temporary providers in exchange for scholarship support, loan forgiveness, or licensure. Examples of applications of each model are provided and the effects of changes in the medical care system on the effectiveness of each model are assessed. Finally, it is argued that elements of an optimal model for the recruitment of physicians to rural practice include the promotion of medical careers among rural high school students, the provision of financial and cultural support for their training, the development of technical and collegial support systems, and the limited use of indenture mechanisms to meet the needs of the most impoverished or isolated rural settings.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00188.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:The demographic and health characteristics of metropolitan and nonmetropolitan adolescents are examined based on a nationally representative sample of 15,181 randomly selected adolescents from the 1984 National Health Interview Survey. One third of all adolescents reside in nonmetropolitan areas of the United States. Nonmetropolitan youth differed from their metropolitan counterparts in race, population concentration in the South, poverty status, family composition, education of household head, and marital status. While the health status of metropolitan and nonmetropolitan youth were similar, their patterns of health services utilization and health insurance coverage were not. Nonmetropolitan adolescents made fewer physician visits and were more apt to delay seeking physician care than metropolitan youth. Adolescents in nonmetropolitan areas were also 39percent more likely to be hospitalized and 30 percent more likely than metropolitan youth to be without any form of health insurance protection. Despite higher rates of poverty among nonmetropolitan adolescents, they were 20 percent less likely to be publicly insured. The delivery and financing implications of these distinct metropolitan and nonmetropolitan demographic and health characteristics are discussed.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00189.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:This research illustrates the importance of a hospital to the economic health of a community. A simulation model of a rural community in Oklahoma is used to demonstrate how the implementation of the DRG reimbursement policy has impacted a rural community, and to project how the closing of the hospital would impact the economy of the community. The results indicate that rural hospitals play a vital role in the economics of their communities. The closing of a rural hospital has a devastating impact on the community, while the DRG reimbursement policy has had a significant impact on the community.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00190.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Book Reviewed in this Article:WOLPER, LAWRENCE and PENA, JESUS J., Eds.Health Care Administration Principles and Practices.TINNING, FRED C., PhD.Characteristics of Primary Care Osteopathic Graduate Medical Education in the Ambulatory Setting.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1990.tb00191.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.tb00192.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY