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The Effect of Social Support on Prenatal Care

The Journal of Applied Behavioral Science 1989年第1期25卷 79-98页

作者： John, Craig St. Winston, Terry J. Department of Sociology University of Oklahoma Norman OK 73019 United States Department of Corrections Oklahoma City OK 73136 3400 Martin Luther King Blvd United States

This article examines the effects of social support on the receipt of adequate prenatal care. A study was conducted to test the hypotheses that social support helps women overcome obstacles to obtaining such care, and that social support has greater effects on women facing the most obstacles. Survey data were gathered for more than 90% of the women who gave birth in Oklahoma hospitals during specific periods in the summer of 1986. The authors found only weak support for the first hypothesis, and for the second hypothesis found only support that must be qualified according to the measure of social support. Strong evidence indicates, however, that difficulty in paying for prenatal care, personal inconveniences, and unwanted pregnancies are obstacles to obtaining such care. The findings account for some of the frequently observed demographic differences associated with receipt of adequate prenatal care, although such differences persisted even after the obstacles were considered. The authors present implications for policy makers seeking to improve women's receipt of adequate prenatal care. © 1989, Sage Publications. All rights reserved.

关键词：年龄因素评价研究卫生服务易得程度/经济学俄克拉何马病人接受卫生保健的程度产前保健/利用问卷调查回归分析社会环境社会支持社会经济因素应激心理学女(雌)性人类妊娠

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Indigent health care plan for Tennessee.

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Journal of health & social policy 1990年第1期2卷 71-77页

作者： Light, R.T. Tennessee Department of Health & Environment Nashville 37219.

The author describes the development of an Indigent Health Care Program for the State of Tennessee from the campaign pledge of the Governor, through the development of an Indigent Care Cabinet Council, to the development and enactment of appropriate legislation required to implement this program. The program deals with availability of health care services, accessibility to health care services and funding mechanisms. The backbone of the program is the involvement of the local community and the coordinating and networking of the existing private, community and state health care providers.

关键词：社区卫生中心/经济学社区卫生中心/立法和法学卫生服务易得程度/经济学卫生服务易得程度/立法和法学 Medicaid/立法和法学医疗补助/立法和法学医疗费用无力承担/经济学医疗费用无力承担/立法和法学缺医地区医师/经济学医师/立法和法学医师/供应和分配规划制订/方法公共卫生管理州卫生计划/立法和法学田纳西美国人类

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PROTECTING THE POOR UNDER COST RECOVERY - THE ROLE OF MEANS TESTING

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HEALTH POLICY AND PLANNING 1995年第3期10卷 241-256页

作者： WILLIS, CY LEIGHTON, C ABT ASSOCIATES INC 4800 MONTGOMERY LANESUITE 600BETHESDAMD 20814 USA

In African health sectors, the importance of protecting the very poor has been underscored by increased reliance on user fees to help finance services. This paper presents a conceptual framework for understanding the role means testing can play in promoting equity under health care cost recovery. Means testing is placed in the broader context of targeting and contrasted with other mechanisms. Criteria for evaluating outcomes are established and used to analyze previous means testing experience in Africa. A survey of experience finds a general pattern of informal, low-accuracy, low-cost means testing in Africa. Detailed household data from a recent cost recovery experiment in Niger, West Africa, provides an unusual opportunity to observe outcomes of a characteristically informal means testing system. Findings from Niger suggest that achieving both the revenue raising and equity potential of cost recovery in sub-Saharan Africa will require finding ways to improve informal means testing processes.

关键词：非洲费用分担发展中国家按诊疗收费计划卫生服务易得程度/经济学收入/分类尼日尔试点项目贫困/分类公共卫生管理/经济学卫生保健质量/经济学

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Barriers to preventive health services for minority households in the rural South

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JOURNAL OF RURAL HEALTH 1996年第3期12卷 206-217页

作者： Strickland, J Strickland, DL GEORGIA SO UNIV COLL HLTH & PROFESS STUDIES CTR RURAL HLTH & RES STATESBORO GA 30460 USA

Health values, behaviors, and status are shaped by place of residence, region, race, and socio-economic status, among other social factors. Consequently, this article examines barriers to preventive health services for lower-income blacks in five rural counties in Georgia. Qualitative and quantitative data were collected through 281 household, 51 community leader, and six focus group interviews. Female respondents who had been pregnant were most likely to have received pregnancy-related services and all respondents least likely to have received vision and dental screenings. Six of the seven types of services inquired about were most likely to have been received in a private practice setting. Primary barriers to preventive service utilization included ability to pay, perception of need, service availability, accessibility of services, and the perception of racism. The relationship between structural and nonstructural barriers, their impact on preventive service utilization, and research recommendations also were developed and presented.

关键词：适应心理学非洲裔美国人/统计学和数值数据集中研讨小组佐治亚卫生保健调查卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据卫生服务需求/统计学和数值数据少数民族/统计学和数值数据贫困/统计学和数值数据偏见产前保健/经济学产前保健/利用预防卫生服务/经济学预防卫生服务/利用乡村卫生服务/经济学乡村卫生服务/利用女(雌)性人类妊娠

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Economic and Health Needs of Wisconsin Migrant Farm Workers

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The Journal of Rural Health 1993年第2期9卷 138-148页

作者： Slesinger, Doris P. Department of Rural Sociology University of Wisconsin-Madison Madison Wisconsin 53706 313 Agriculture Hall 2450 Linden Drive United States

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 action. Copyright © 1993, Wiley Blackwell. All rights reserved

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Selected comparisons and implications of a national rural and urban survey on health care access, demographics, and policy issues

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JOURNAL OF RURAL HEALTH 1996年第3期12卷 197-205页

作者： Edelman, MA Menz, BL IOWA STATE UNIV SCI & TECHNOL DEPT ECONHEADY HALLAMESIA 50011 USA

As the national health debate evolved over the past two years, a need to better understand the differential constraints of rural health delivery and popular attitudes toward policy initiatives became apparent. Selected 1994 and 1995 results of two national surveys designed to compare rural and urban household responses are reported. The average distance those living in rural households must travel to access medical providers and emergency care is nearly double that of urban household residents. Rural household resident responses show a higher level of acceptance of nonphysician health care providers such as physicians assistants and registered nurses. Means testing of Medicare programs and use of special indicators for providing more Medicaid funds to states with medically underserved and sparsely populated areas are examples of two policy initiatives that receive favorable responses from both urban and rural household residents, but would disproportionately benefit rural areas.

关键词：卫生保健调查卫生政策卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据 Medicaid/立法和法学 Medicaid/利用缺医地区 Medicare/立法和法学 Medicare/利用病人接受卫生保健的程度/统计学和数值数据乡村卫生服务/经济学乡村卫生服务/利用农村人口/统计学和数值数据社会经济因素美国市区卫生服务/经济学市区卫生服务/利用市区人口/统计学和数值数据

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ECONOMIC INCENTIVES, HEALTH-STATUS AND HEALTH-SERVICES UTILIZATION

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JOURNAL OF HEALTH ECONOMICS 1993年第2期12卷 151-169页

作者： NOLAN, B ECON & SOCIAL RES INST 4 BURLINGTON RDDUBLIN 4IRELAND

The impact on utilisation of differential public entitlements to free health services is analysed, using data for a large sample of Irish households. GP visiting rates are seen to be significantly higher for those on low incomes whose costs are covered by the State than for those who pay for such care, having controlled for other characteristics including health status. The importance of taking differences in health status into account in attempting to distinguish the effects of economic incentives is shown both for GP visits and hospital stays.

关键词：青少年成年人老年人数据收集女(雌)性卫生保健费用/统计学和数值数据卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据健康状况住院/统计学和数值数据人类收入/统计学和数值数据保险健康/立法和法学保险健康/利用爱尔兰最小二乘法分析 Logistic模型男(雄)性医疗补助/立法和法学医疗补助/利用中年人动机国家卫生规划/经济学国家卫生规划/利用诊室就医/统计学和数值数据医师家庭/经济学医师家庭/利用

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Access to healthcare and the long-stay patient: A case study

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Hospital Topics 1995年第1期73.0卷 28-34页

作者： Wallace, Paul E. Department of Health Services Administration School of Business Howard University Washington DC United States

The delivery and financing of healthcare services continue to be two of this nation's most debated issues. This case study found that long-stay patients could spend up to 37 percent of their hospital stay waiting for discharge to postacute care services. Because acute care costs more than postacute care, increasing access to pastacute care facilities for long-stay patients could substantially decrease overall medical costs for the United States. © 1995 Taylor & Francis Group, LLC.

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User fees and patient behaviour: Evidence from Niamey National Hospital

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HEALTH POLICY AND PLANNING 1995年第4期10卷 350-361页

作者： Weaver, M WASHINGTON UNIV DEPT HLTH SERVSEATTLEWA

Evidence is presented on the effects of price changes on the delay before seeking care and on referral status in a sample of hospital patients in Niger. Price changes are measured as differences across patients at one hospital in whether or not they pay for care, rather than as differences in prices across several hospitals. User fees are charged, but the fee system allows exemptions for some payor categories such as government employees, students, and indigent patients. Evidence is also presented on the effect of income on the delay before seeking care and referral status. The analysis demonstrates a technical point on whether household consumption or current income is a more appropriate measure of income. The analysis shows that user fees affect patient behaviour, but the effects are not the same for outpatients and inpatients. Outpatients who pay for care wait longer before seeking care, but inpatients do not. Inpatients who pay for care are more likely to be referred, but outpatients are not. Patients with more income wait less time to seek care and are less likely to be referred than other patients. Further, household consumption explains patient behaviour better than current income.

关键词：数据收集发展中国家卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据卫生服务研究/方法医院收费/统计学和数值数据医院公立/经济学医院公立/统计学和数值数据医院公立/利用住院病人/统计学和数值数据最小二乘法分析尼日尔门诊病人/统计学和数值数据病人参与/经济学病人参与/统计学和数值数据转诊和会诊时间因素人类

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THE IMPACT OF ALTERNATIVE COST RECOVERY SCHEMES ON ACCESS AND EQUITY IN NIGER

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HEALTH POLICY AND PLANNING 1995年第3期10卷 223-240页

作者： DIOP, F YAZBECK, A BITRAN, R ABT ASSOCIATES INC 4800 MONTGOMERY LANESUITE 600BETHESDAMD 20814 USA

The authors examine accessibility and the sustainability of quality health care in a rural setting under two alternative cost recovery methods, a fee-for-service method and a type of social financing (risk-sharing) strategy based on an annual tax + fee-for-service. Both methods were accompanied by similar interventions aimed at improving the quality of primary health services. Based on pilot tests of cost recovery in the non-hospital sector in Niger, the article presents results from baseline and final survey data, as well as from facility utilization, cost, and revenue data collected in two test districts and a control district. Cost recovery accompanied by quality improvements increases equity and access to health care and the type of cost recovery method used can make a difference. In Niger, higher access for women, children, and the poor resulted from the tax + fee method, than from the pure fee-for-service method. Moreover, revenue generation per capita under the tax + fee method was two times higher than under the fee-for-service method, suggesting that the prospects of sustainability were better under the social financing strategy. However, sustainability under cost recovery and improved quality depends as much on policy measures aimed at cost containment, particularly for drugs, as on specific cost recovery methods.

关键词：费用分担数据收集按诊疗收费计划卫生保健改革/经济学卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据卫生服务研究医疗费用无力承担尼日尔试点项目回归分析乡村卫生服务/经济学税款

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