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An evaluation of the Australian government's policy of access and equity strategy in selected localities

Journal of Health and Social Policy 1993年第2期5卷 15-34页

作者： Doyle, R. Department of Social Work Latrobe University Latrobe Australia

Australia is a country of 17 million people from diverse cultural and racial backgrounds. To respond to this diversity, the Australian Commonwealth Government in 1986 announced an Access and Equity Strategy as part of the Agenda for a Multicultural Australia. The Strategy was evaluated in 1991, and included five locality studies which assessed the implementation of the Strategy from the perspective of target groups of Aboriginal and non-English speaking people (NESB). This article describes this evaluation and the development of the Australian multicultural policy within which the Strategy is conceived. The findings and recommendations from the locality studies provide case examples of government wide policy development and implementation processes.

关键词：澳大利亚用户满意人种群政府机构/标准卫生政策/立法和法学卫生服务易得程度/标准卫生服务需求/标准国家卫生规划/标准方案评价地区卫生计划/标准社会正义

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Perceived benefits and barriers of prenatal care in low income women.

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Journal of the American Academy of Nurse Practitioners 1999年第12期11卷 527-532页

作者： Fuller, C.A. Gallagher, R. College Misericordia Department of Nursing Dallas 18509 PA United States

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ACCESS TO HEALTH-CARE - A CONCEPTUAL-FRAMEWORK AND ITS RELEVANCE TO HEALTH-CARE PLANNING

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EVALUATION & THE HEALTH PROFESSIONS 1994年第1期17卷 60-76页

作者： KHAN, AA BHARDWAJ, SM KENT STATE UNIV KENTOH 44242

Despite some serious past efforts to clarify its multiple dimensions and meanings, access to health care has remained a rather elusive concept, hampering the work of health care policymakers and professionals as they endeavor to effect meaningful health care reform. This article provides perhaps the most detailed clarification of the access concept, especially the crucial linkages among the various access dimensions, and presents a comprehensive conceptual framework for evaluation and planning activities as they relate to people's access to health care services. The proposed conceptual model recognizes access as the outcome of a process involving the interplay between the characteristics of the health care service system and of potential users in a specified area, and moderated by health care related public policy and planning efforts. An elaborate typology of access, incorporating four pairs of access dimensions, is also derived. This atomization of the concept allows us to focus on specific aspects of the access to health care problem, and to develop precise outcome indicators Of health System performance for evaluative purposes. Further, it enables the ''cess concept and its pertinent dimensions to be put into proper perspective when assessing the health care access situation in a specific national or regional context. The relevance of the proposed access model and the typology to health care planning in general, and to spatial planning of health care service systems in particular, is also discussed.

关键词：人口统计学地理学卫生保健改革/组织与管理卫生服务易得程度/组织与管理卫生服务易得程度/标准模型组织管理地区卫生计划/组织与管理美国

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Current Approaches to Shortage Area Designation

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The Journal of Rural Health 1991年第4期7卷 437-450页

作者： Lee, Richard C. Bureau of Health Care Delivery Health Resources and Services Administration United States

This paper reviews the various indicators and criteria that are in use to identify rural and urban areas with shortages of primary care physicians, dentists, psychiatrists, or nurses;areas with medically under served populations;high migrant impact areas;and areas of greatest need/shortage, leading to lists of designated shortage or underserved areas eligible for various federal and state programs;and to lists of areas with priority for resource placement. Presenting these shortage and under service criteria at a workshop dealing with adequacy was not meant to suggest an equivalency between the concepts of “shortage,”“underservice,” and “adequacy,” but the shortage and underservice criteria can be thought of as a floor on the definition of adequacy, and may contain elements of that definition. Refinements or revisions to the various criteria could probably better identify the needs in rural areas, or the kind of staffing mix needed in various types of areas, or improve priority setting among designated areas;but the existing criteria remain a good first screen to identify those areas with health services‐related needs that require further attention. Copyright © 1991, Wiley Blackwell. All rights reserved

关键词：卫生服务范围数据收集卫生人力/标准卫生人力/统计学和数值数据卫生服务易得程度/标准卫生服务易得程度/统计学和数值数据卫生服务研究/方法缺医地区农村卫生/标准小地区分析旅行美国

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Ethnicity, nationality and health care accessibility in Kuwait: A study of hospital emergency room users

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HEALTH POLICY AND PLANNING 1996年第3期11卷 319-328页

作者： Shah, NM Shah, MA Behbehani, J KUWAIT UNIV DEPT HLTH INFORMAT ADMSAFATKUWAIT

In mid-1994, non-Kuwaiti expatriates constituted 61.7% of the total population of Kuwait (1.75 million). Despite this numerical majority, non-Kuwaitis exist as a social minority. Non-Kuwaitis may be grouped into three broad categories along ethnic/nationality lines into Bidoon (without nationality), Arabs, and Asians. The objective of this paper was to compare the relative accessibility of the various groups to health care services in Kuwait. The study is based on data collected as part of a survey of 2184 Emergency Room (ER) users in January-February 1993. All patients attending the hospital ERs between 7:30 am and 9:00 pm were interviewed about their reasons for coming to the ER instead of going to the primary health care (PHC) centres, as required. The major reason given was the low accessibility of the PHCs. Compared to Kuwaiti nationals, 92% of whom were registered at the PHC centres, only 62% of the Arabs and 39% of the Asians were registered. Multiple logistic regression of the factors in registration indicated that nationality was the most important reason for lack of registration, with Asians only about one-quarter as likely to be registered as Kuwaitis. Also, people who had been in Kuwait for shorter durations (<5 years) were less likely to be registered than the Kuwaiti nationals or expatriates who had been here for 10 years or longer. in the absence of registration at the PHC centre, the civil identification card (ID) may be used as a valid means to enter the health system. Among the Arabs and Asians, 22% and 29% did not have a civil ID card. Thus, for many expatriates, the hospital ER, which does not provide the necessary follow-up care is often the only source of health care available.

关键词：阿拉伯人亚洲/人种学数据收集急诊室医院/统计学和数值数据急诊室医院/利用人种群/统计学和数值数据卫生服务易得程度/标准科威特/人种学线性模型人类

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Seeking and obtaining mental health services: What do parents expect?

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ARCHIVES OF PSYCHIATRIC NURSING 2001年第5期15卷 223-231页

作者： Richardson, LA Univ N Carolina Sch Nursing Greensboro NC 27402 USA

This study examined parents' expectations about seeking and obtaining mental health care. Using the Expectations of Mental Health Care survey, structured interviews were conducted with 235 parents with children between the ages of 5 and 19;most were African American. Expectations were assessed in four areas: treatment effectiveness, provider/client relationship, accessibility of mental health services, and social and cultural factors, e.g., stigma. Parents reported a number of negative expectations, and black parents had significantly more negative expectations than white parents. The findings suggest that attitudes and expectations may influence parents' decision to seek mental health care for their child. Copyright (C) 2001 by W.B. Saunders Company.

关键词：青少年保健服务/标准非洲裔美国人/心理学儿童保健服务/标准卫生服务易得程度/标准精神卫生服务/标准模型心理学双亲/心理学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/心理学问卷调查美国东南部治疗结果青少年成年人儿童儿童学龄前女(雌)性人类男(雄)性

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What happens when capitated behavioral health comes to town? The transition from the Fort Bragg demonstration to a capitated managed behavioral health contract

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JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 2000年第4期27卷 390-405页

作者： Heflinger, CA Northrup, DA Vanderbilt Ctr Mental Hlth Policy Nashville TN USA

Capitated managed care contracts for behavioral health services are becoming more prevalent across the country in both public and private sectors. This study followed the transition from a demonstration project for child mental health services to a capitated managed behavioral health care contract with a for-profit managed care company. The focus of the study was on the impact-at both the service system and the individual consumer level-pertaining to the start-up and maintenance of a capitated managed behavioral health program. A case study using multiple methods and multiple sources of information incorporated a program fidelity framework that examined micro to macro levels of program implementation. The findings of this study include the following: access to services decreased, the lengths of stay and average daily census in the more intensive levels of treatment declined, difficult-to-treat children were shifted to the public sector and ratings of service system performance and coordination fell.

关键词：青少年保健服务/统计学和数值数据按人收费费用分配/统计学和数值数据保健福利计划雇员卫生服务易得程度/标准卫生服务易得程度/统计学和数值数据管理医疗规划/经济学管理医疗规划/组织和管理管理医疗规划/标准管理医疗规划/统计学和数值数据精神卫生服务/经济学精神卫生服务/组织和管理精神卫生服务/标准精神卫生服务/统计学和数值数据北卡罗来纳卫生保健质量/标准卫生保健质量/统计学和数值数据回顾性研究利用情况审核/标准利用情况审核/统计学和数值数据青少年儿童人类

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Fairness, public expenditure and the cost of new treatments in the UK

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Journal of Health Services Research and Policy 1999年第1期4卷 58-60页

作者： West, P.A. Natl. Economic Research Associates London W1N 9AF 15 Stratford Place United Kingdom

Current differences in standards for allocating resources in the UK for, on the one hand, drugs and surgery, and on the other, chronic community and social care and social security lead to significant inequality. Using a case study of hypothetical patients, it can be shown that adoption of new treatments, at high cost, to make marginal improvements in well-being would lead to much greater spending on some patients than on others with similar problems from different causes. Inequality occurs because society tolerates tighter constraints on community and social care and social security than on acute care and drug budgets for new treatments. Resolution of the inequality would involve establishing fairly the resources to increase the welfare of patients with different chronic diseases to some target level of welfare. However, this would make overt the current rationing of community and social services and demonstrate the low levels of welfare of many with chronic diseases. Governments concerned with lower taxation might prefer to avoid exposing such issues.

关键词：慢性病/治疗大不列颠卫生保健费用卫生保健公平提供/标准卫生经费支出卫生服务易得程度/经济学卫生服务易得程度/标准社会正义社会支持人类

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Health promotion for older people: what are the opportunities?

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Promotion & education 1999年第4期6卷 4-7,41,51页

作者： Fletcher, A. Breeze, E. Walters, R. Department of Epidemiology and Population Health London School of Hygiene &amp Tropical Medicine.

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TO ANYONE MORALLY PERPLEXED ABOUT THE POLITICS OF UNITED-STATES HEALTH-CARE

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HEALTH CARE ANALYSIS 1995年第1期3卷 68-70页

作者： MENZEL, PT PACIFIC LUTHERAN UNIV TACOMAWA 98447 USA

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