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Transitions and inequalities in acute myocardial infarction mortality in New South Wales, 1969-94

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1999年第4期23卷 343-351页

作者： Burnley, IH Univ New S Wales Sch Geog Kensington NSW 2052 Australia

Objective: To chart the transition in myocardial infarction mortality in NSW between 1969 and 1994 and to determine whether spatial, marital and occupational status differentials increased over time, despite overall mortality decline. Method: The study was undertaken in NSW for the 25-year period from 1969 when mortality from ischaemic heart disease declined. The demographic and spatial analysis involved descriptive epidemiology and utilised the unit list mortality fifes of the Australian Bureau of Statistics which are based on detailed death certificate information. Results: Spatial, marital and occupational status differentials in myocardial infarction mortality increased over time, more especially variations by occupational status, inland/metropolitan differences, and married/divorced or widowed variation. Spatial variations in mortality were not simply the result of occupational status differences as mortality from white collar groups was also elevated in inland areas. Spatial variation in mortality was not diluted due to the impact of immigration. Conclusion: Particular subgroups of people remained at risk and it is likely that differential access to ambulance services and travel time contribute, more particularly in inland rural areas. Implications: Groups at risk need to be more precisely targeted for preventative measures and public health initiatives, with particular implications for groups in inland rural areas. the Hunter Region, and outer lower income areas of Sydney.

关键词：年龄分布卫生服务易得程度/标准婚姻状况/统计学和数值数据心肌梗死/死亡率新南威尔士/流行病学职业/统计学和数值数据人群监测居住特征/统计学和数值数据危险因素性别分布社会经济因素成年人老年人女(雌)性人类男(雄)性中年人

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Racial/ethnic disparities in admissions to public and private psychiatric inpatient settings: The effect of managed care

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ADMINISTRATION AND POLICY IN MENTAL HEALTH 1998年第2期26卷 101-109页

作者： Crawford, K Fisher, WH McDermeit, M Boston Univ Sch Med Div Psychiat Boston MA 02215 USA Univ Massachusetts Sch Med Dept Psychiat Amherst MA 01003 USA

This study investigates the effect of managed care on access patterns among people of color who are severely and persistently mentally ill. The distribution of admissions to public and private psychiatric hospitals was compared for African-American, Asian, Latino, and white case managed clients of the Massachusetts Department of Mental Health before and after implementation of Medicaid managed mental health care in October 1997. Managed care appears to have increased access to private services across all racial and ethnic groups, although admissions of non-white patients were still more likely to take place in publicly operated settings. These data suggest that equalizing access to putatively better inpatient treatment settings may be an externality of managed care.

关键词：大陆人口群人种群/统计学和数值数据卫生服务易得程度/标准卫生服务研究医院私立/利用医院精神病/利用医院公立/利用管理医疗规划/组织和管理马萨诸塞 Medicaid/组织和管理病人入院/统计学和数值数据美国成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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A provider assessment of the Massachusetts Medicaid Managed Behavioral Health Program: Year four

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ADMINISTRATION AND POLICY IN MENTAL HEALTH 1998年第4期25卷 411-426页

作者： Beinecke, RH Lockhart, A Suffolk Univ Dept Publ Management Boston MA 02108 USA

A stratified, random sample of 80 providers in the Massachusetts Medicaid Managed Mental Health/Substance Abuse Program were interviewed by phone to assess their views of the program in year four. Providers continued to believe that access and quality were the same or better than a year earlier, that client severity continued to increase while length of stay decreased, that readmissions and emergency room admissions were the same as a year earlier, and that aftercare was the same or better than a year earlier. Substantial problems were reported in the integration of services, in linkages with support services, and with administration of the program.

关键词：医务工作者的态度卫生保健提供联合/组织和管理卫生服务易得程度/标准住院时间/统计学和数值数据住院时间/发展趋势管理医疗规划/组织和管理马萨诸塞 Medicaid/组织和管理精神卫生服务/组织和管理方案评价卫生保健质量问卷调查州卫生计划/组织和管理物质滥用治疗中心/组织和管理美国成年人儿童人类

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A quantitative index of access to primary medical care for health planning

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Socio-Economic Planning Sciences 1978年第6期12卷 295-301页

作者： Chen, Martin K. National Center for Health Services Research Hyattsville MD 20782 United States

The emphasis of Public Law 93-641 on numerical goals of health care, as elaborated upon by the National Health Planning Council in its guidelines, foreshadows the emergence of quantitative indices in many areas of health resources utilization and health outcomes. In the area of access to primary medical care, the guidelines spell out in detail what is considered the reasonable waiting period for an appointment, travelling time to the source of care, and in-office waiting time for individuals seeking care. An index of access is developed on the basis of these reasonable limits of waiting for health services research and planning purposes. An example of hypothesis-testing with hypothetical data is given, along with a caveat in the interpretation of the results. © 1978.

关键词：病人预约和时间安排健康计划/标准卫生服务易得程度/标准模型理论初级卫生保健/组织和管理政府政策美国

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HHS secretary and Surgeon General launch Healthy People 2010

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 2000年第2期22卷 39-40页

作者： Pelletier, Luc R. Shalala, Donna E. Satcher, David U.S. Department of Health and Human Services United States

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Multi-method assessment of access to primary medical care in rural Colorado

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JOURNAL OF RURAL HEALTH 1999年第1期15卷 113-121页

作者： Fryer, GE Drisko, J Krugman, RD Vojir, CP Prochazka, A Miyoshi, TJ Miller, ME Univ Colorado Hlth Sci Ctr Denver CO 80220 USA

The objectives of this study include conducting an analysis of access to primary medical care in rural Colorado through simultaneous consideration of primary care physician-to-population and distance-to-nearest provider indices. Analyses examined the potential development and implications of excessively large, perhaps unmanageable patient caseloads that might result from every rural Coloradoan's exclusive use of the nearest generalist physician as a regular source of care. Using American Medical Association Physician Masterfile data for 1995 and coordinates for latitude and longitude from U.S. Census files (Census of Population and Housing, 1990), the authors calculated distance to the nearest primary care physician for residents of each of the 1,317 block groups in Colorado's 52 rural counties. Caseloads for each generalist physician were computed assuming the population used the nearest provider for care. Straight-line mileage to primary medical care was modest for rural Coloradoans-a median distance of 2.5 miles. Almost two-thirds (65 percent) of the population resided within 5 miles, and virtually all residents (99 percent) were within 30 miles of a generalist physician. However, had everyone traveled the shortest possible distance to care, demand for service from many of the 343 primary care doctors in rural regions of the state would have been overwhelming. The results of simultaneous application of distance-to-care and provider-to-population techniques unrestricted by geographic boundaries depict access to primary medical care and corresponding consumer difficulty more fully than in previous studies. Further combination of methods of needs assessment such as those used in this analysis may better inform the future efforts of organizations mandated to address health care underservice in rural areas.

关键词：科罗拉多数据说明统计卫生服务易得程度/标准卫生服务研究/方法医师家庭/供应和分配医师家庭/利用人口密度初级卫生保健/人力初级卫生保健/利用专业场所/统计学和数值数据乡村卫生服务/人力乡村卫生服务/利用旅行工作负荷量人类

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Utilization of health care services among adults attending a health fair in South Los Angeles County

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JOURNAL OF COMMUNITY HEALTH 2000年第1期25卷 35-46页

作者： Macias, EP Morales, LS Univ Calif Los Angeles Sch Med Los Angeles CA 90095 USA

A bilingual survey was developed to collect information regarding socio-demographics, access to medical and dental care, health insurance coverage, perceived health status, and use of folk medicine providers from 70 adults presenting to a health fair in South Los Angeles County. Ninety-seven percent of respondents were foreign-born, Seventy-nine percent reported having no health insurance during the year prior to survey. Of the uninsured, 61 percent lacked a doctor visit and 76 percent lacked a dental visit during the previous year. The high cost of care was the most frequently cited barrier to seeking medical(58 percent) and dental (67 percent) care even when respondents felt it was necessary. Respondents who felt they needed medical attention bur did not seek it had a lower perceived health status (7.0 +/- 2.2) than those who did (8.0 +/- 2.0), Among respondents perceiving themselves in poor health, only 17 percent were insured. Relatively few respondents (7.2 percent) reported seeing a folk healer during the past year. Our results support the argument that the medically indigent in some localities face serious financial, as well as less salient, barriers to access. These local conditions reflect inadequate enforcement by local governments in correcting the difficult problems indigent populations face in accessing medical and dental care.

关键词：移民(移出和移入)/统计学和数值数据卫生保健调查卫生展览会卫生服务/经济学卫生服务/利用卫生服务易得程度/经济学卫生服务易得程度/标准健康状况西班牙裔美国人/心理学西班牙裔美国人/统计学和数值数据洛杉矶医疗费用无力承担/心理学医疗费用无力承担/统计学和数值数据未参加医疗保险者/心理学未参加医疗保险者/统计学和数值数据医学传统病人接受卫生保健的程度/人种学病人接受卫生保健的程度/统计学和数值数据问卷调查社会经济因素青少年成年人女(雌)性人类男(雄)性中年人

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Capitation funding in Australia: Imperatives and impediments

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Health Care Management Science 2000年第2期3.0卷 77-88页

作者： Peacock, Stuart Segal, Leonie Health Economics Unit Centre for Health Program Evaluation Monash University West Heidelberg Vic. 3081 PO Box 477 Australia

Health service funding mechanisms are pivotal in the pursuit of health system objectives, as they provide strong financial incentives for actors in the system to achieve policy goals. Underpinning funding mechanisms is a set of key economic principles, or objectives, that should guide their design and use: efficiency, equity, and accountability. The Australian health system has historically performed relatively poorly in relation to these objectives, with evidence of inefficiencies, inequities, and poor accountability in many areas of health services. The primary cause of these shortcomings may lie in the complex set of funding and delivery arrangements at the State and Federal levels of government. Potentially significant improvements in the performance of the health system would be available from the integration of the funding and delivery of services within a single tier of government, coupled with the development of a national weighted capitation approach to funding. To develop a national capitation funding model a number of unique factors require consideration, including the current fragmentation of services, the role of the private sector, the needs of indigenous populations, and the effects of rurality. The data available to develop a capitation model is of a level of detail and quality not readily found elsewhere. If policy statements promoting efficiency, accountability, and particularly equity are to be actively pursued, a national capitation model based on robust methods should become a cornerstone of Australian health system reform. © Baltzer Science Publishers BV.

关键词：澳大利亚按人收费/组织和管理卫生保健提供联合/组织和管理效率组织筹资政府/组织和管理卫生保健改革/组织和管理卫生服务易得程度/标准管理医疗规划/组织和管理模型组织管理国家卫生规划/组织和管理需求估价/组织和管理全面质量管理/组织和管理人类

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INVOLVING CONSUMERS IN HEALTH-CARE DECISION-MAKING

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HEALTH CARE ANALYSIS 1995年第3期3卷 196-204页

作者： SHACKLEY, P RYAN, M UNIV ABERDEEN DEPT PUBL HLTHHLTH ECON RES UNITUNIV MED BLDGABERDEEN AB9 2ZDSCOTLAND

This paper considers ways of involving consumers in decisions regarding the allocation of scarce health service resources. Specifically, two levels of consumer participation are highlighted and discussed. These are: (1) at the level of deciding whether or not a particular service should be introduced or its scale changed;and (2) at the level of deciding how best to provide a service once it has been decided that the service will be provided. The limitations of the current methods of involving consumers are outlined and two alternative approaches discussed. These are willingness to pay and conjoint analysis.

关键词：用户参与/利用数据收集决策组织卫生保健公平提供/组织和管理卫生服务易得程度/标准组织改革病人满意度回归分析资源分配苏格兰社会价值公费医疗时间因素

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Consumer and provider evaluation of rural pharmacy services

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JOURNAL OF RURAL HEALTH 1999年第4期15卷 403-412页

作者： Straub, LA Straub, SA Western Illinois Univ Dept Econ Macomb IL 61455 USA

This paper compares consumer and provider perceptions regarding access to pharmacy services in rural Illinois, given a decrease in the number of pharmacies. Consumer data are from the Illinois Rural Life Panel in which more than 1,800 respondents answered questions about availability and use of pharmacy services and about insurance coverage and cost. A survey of all licensed retail pharmacies in 74 rural Illinois counties and in seven non rural counties provided pharmacy background information and was the source of data on changes in profitability and payment sources. The data provided insight on factors that affect access. Descriptive statistics were used to analyze data from both groups to compare perceptions about access. The objective was to evaluate current access to pharmacy services and implications for future access from the perspective of consumers and pharmacists. Results from rural consumers show access is currently good;77 percent have a local pharmacy, and 64 percent prefer this source. Future access is of more concern. Pharmacy survey results show 81.5 percent of rural pharmacies are experiencing declining profits from dr-tig sales. Restricted reimbursements from third-party payers, demands of managed care and expanded competition are seen as threats to retention of local pharmacies and continued good access. An important finding, especially given survey evidence of increased managed care penetration, is the difference in views of pharmacists and consumers regarding the effects of managed care on access. Pharmacy survey data also revealed differences between rural and non-rural pharmacies.

关键词：医务工作者的态度健康态度社区药房服务/标准经济竞争卫生服务易得程度/标准卫生服务研究伊利诺伊管理医疗规划药剂师/心理学问卷调查偿还途径乡村卫生服务/标准成年人老年人老年人 80以上人类中年人

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