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Illness Episodes, Physician Visits, and Depressive Symptoms

Journal of Aging and Health 1992年第3期4卷 331-348页

作者： Berkanovic, Emil Hurwicz, Margo-Lea University of California Los Angeles United States University of Missouri Saint Louis United States

Although there is a large literature examining the effects of distress on the demand for medical care, the data on which this literature is based are equivocal. Nonetheless, this literature is cited frequently by those who advocate a national mental health policy designed to produce a cost-effective “medical offset effect.” In this study, longitudinal data on illness episodes, physician visits, and depressive symptoms were collected from 940 Medicare recipients enrolled in a health maintenance organization (HMO) under a Tax Equity and Fiscal Responsibility Act (TEFRA) contract. Seven waves of interviews were conducted over a period of 1 year. This article presents two sets of analyses. In the first, controlling for chronic conditions and demographics reported at baseline, the relationships between depressive symptoms reported at baseline, and all illness episodes and physician visits that occurred over the subsequent year are examined. In the second, controlling for depressive symptoms and demographics reported at baseline, the relationships between illness episodes and physician visits over the study year, and depressive symptoms recorded at the final interview are examined. The data indicate that, whereas depressive symptoms at baseline are virtually unrelated to subsequent illness episodes and physician visits, illness episodes and physician visits are related to subsequent depressive symptoms. These data indicate, therefore, that policies aimed at diverting the distressed from seeking medical care may result in further inequities in the receipt of needed care. © 1992, SAGE Publications. All rights reserved.

关键词：加利福尼亚/流行病学抑郁/流行病学抑郁/病因学疾病/心理学治疗过程片断健康维护组织/利用卫生服务需求/统计学和数值数据健康状况纵向研究 Medicare/利用精神卫生服务/利用诊室就医/利用医师/利用回归分析美国老年人女(雌)性人类男(雄)性

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UNCERTAINTY AND THE DEMAND FOR MEDICAL-CARE

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JOURNAL OF HEALTH ECONOMICS 1990年第1期9卷 23-38页

作者： DARDANONI, V WAGSTAFF, A UNIV SUSSEX BRIGHTON BN1 9QNENGLAND

This paper provides an analysis of the effects of uncertainty on the demand for medical care using a simplified version of Grossman's human capital model of the demand for health. Two types of uncertainty are analysed: the uncertainty surrounding the incidence of illness and the uncertainty surrounding the effectiveness of medical care. In the first the consumer's basic level of health is assumed to be a random variable; in the second the effectiveness of medical care is assumed to be random. Comparative static results are reported indicating the effects on the demand for medical care of both increases in the means of these distributions and mean-preserving spreads of the distributions.

关键词：卫生服务/利用卫生服务需求/统计学和数值数据卫生服务研究/统计学和数值数据健康状况模型统计学结果与过程评价(卫生保健)/统计学和数值数据美国

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Differences in Need Among the Rural and Urban Aged: Statistical Versus Practical Significance

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The Journal of Rural Health 1988年第3期4卷 27-34页

作者： Leinbach, Raymond M. Director of The Center for Gerontology in the College of Health Sciences at Old Dominion University. He is the former Director of the State Office on Aging in West Virginia. His current research interest is in the role of aging advocacy groups in public policy development.

Needs assessment data from two states are analyzed to determine if there are differences between rural and urban older persons. Five different definitions of “rural” are utilized. A test of statistical significance is used to determine if differences exist and a measure of association is used to determine how strong the relationships are between residence and need. It is concluded that, with the exception of one rural definition within one state, there are residential differences in need. However, those differences are so small as to have limited practical significance in the public policy arena. Copyright © 1988, Wiley Blackwell. All rights reserved

关键词：人口统计学卫生服务需求/统计学和数值数据卫生服务研究/统计学和数值数据宾夕法尼亚概率农村人口市区人口威斯康星老年人人类

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Identifying health care needs of rural Ohio citizens: An evaluation of a two-stage methodology

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JOURNAL OF RURAL HEALTH 1996年第2期12卷 130-136页

作者： Birdwell, SW Calesaric, H OHIO STATE UNIV COLL PHARM 500 W 12TH AVE COLUMBUS OH 43210 USA

The purpose of this study was to determine the health care need of rural Ohio from the perspectives of health care providers and consumers using a two-stage methodology. In stage one, 12 focus groups were conducted in six rural areas: six groups of consumers and six groups of health care providers. A total of 53 consumers and 53 health care providers participated in the sessions. The participants identified 124 health care issues. In stage two, a questionnaire was developed to determine the importance of all issues identified in the focus group sessions. The questionnaire was mailed to all focus group participants and also to individuals invited to participate in the focus groups who were unable to attend. Individuals were asked to rate the importance of each health care issue in their community on an 11-point scale (0=not important, 10=extremely important. A total of 207 (56.9%) usable questionnaires were returned. Mean (+ S.D.) values were calculated for each health care issue, and the most important were (1) issues related to the financing and cost of health services and insurance, and (2) concerns associated with characteristics and behaviors of rural residents. The two-stage methodology provides a mechanism for identifying the concerns of providers and consumers and allows for these perspectives to be considered in the planning and development of strategies to address issues surrounding rural health care.

关键词：用户参与评价研究集中研讨小组卫生保健费用健康教育卫生服务需求/统计学和数值数据卫生服务研究/方法职业病/流行病学俄亥俄/流行病学问卷调查乡村卫生服务/经济学乡村卫生服务/供应和分配乡村卫生服务/利用农村人口人类

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Rural Youth Disability Prevention Project Survey: Results from 169 Iowa Farm Families

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The Journal of Rural Health 1991年第2期7卷 170-179页

作者： Hawk, Cheryl Gay, Jane Donham, Kelley J. Department of Preventive Medicine and Environmental Health AMRF-Oakdale College of Medicine University of Iowa Iowa City 52240 United States

ABSTRACT: Agriculture is now the most hazardous occupation in the United States and it is the only one in which children not only comprise a significant part of the work force, but also live and play at the work site. Annually, 23,500 pediatric agricultural injuries are reported, with nearly 300 fatalities (Rivara, 1985). The Rural Youth Disability Prevention Project was designed to use innovative, community‐oriented methods to address the unique problems of child safety in agriculture. Toward this end, a survey instrument was designed to gather data both to assist in program development and to serve as a pretest for the subsequent evaluation. Analysis of these data indicated several issues to target for intervention efforts. One is lack of supervision—more than 40 percent of children who operate equipment do so unsupervised. Approximately 30 percent of children more than 3 years old play alone in work areas, and 80 percent of these children play near machinery in operation. Another issue is operation of farm machinery by very young children—respondents' children began operating equipment at an average age of 12 years. Coupling this with the finding that the parents believe their children are not capable of operating equipment until age 15 exemplifies the most important issue, the disparity between parents' levels of safety knowledge and safety behavior. Using the survey data to increase local involvement, efforts are being directed toward facilitating an ongoing, community‐sponsored intervention program to empower farm families to effect their own solutions. Copyright © 1991, Wiley Blackwell. All rights reserved

关键词：事故预防青少年保健服务/统计学和数值数据农业/统计学和数值数据评价研究家庭卫生健康知识态度实践卫生服务需求/统计学和数值数据衣阿华/流行病学试点项目预防卫生服务/组织和管理问卷调查安全青少年儿童人类

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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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Informing prescribing allocations at district level in England

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Journal of Health Services Research and Policy 1997年第3期2卷 154-159页

作者： Rice, N. Carr-Hill, R. Roberts, D. Lloyd, D. Resource Allocat Deployment Skillmix Centre for Health Economics University of York York YO1 5DD United Kingdom

Objectives: To derive a predictive model based on the morbidity, demographic and socio-economic characteristics of district populations to explain variations in prescribing costs in England. Method: Inter-relations between morbidity, demographic, socio-economic, general practice supply characteristics and net ingredient cost per age, sex and temporary resident originated prescribing unit (ASTRO-PU) were explored statistically for 90 districts in England using 1994 cost data. The possibility of mutual inter-relationship between 'supply' and 'demand' was examined;then the associations between a range of factors and prescribing costs were estimated using ordinary least squares regression and the predictive power of the possible models was systematically examined. Results: Whilst there was a relatively weak relationship between the supply factors that were measured, there did not appear to be any reciprocal relationship. Three parsimonious models estimated using ordinary least squares multiple regression techniques based on combinations of permanent sickness, low birth weight and the proportion of general practitioners registered for postgraduate certificate of education were identified. The models explained up to 61% of variation between districts in prescribing costs. Conclusions: 'Need' and 'supply' characteristics are independently associated with variations in prescribing costs at district level. The negative association between the proportion of general practitioners eligible for postgraduate education allowance and prescribing costs may reflect 'better' prescribing but could not be introduced into a resource allocation formula without introducing perverse incentives. The combination of permanent sickness and low birth weight complement each other by providing a proxy measure of morbidity mostly applicable to adult males (permanent sickness) and mothers (low birth weight being a measure of maternal health). These variables should be considered further for use in t

关键词：费用分配药费支出/统计学和数值数据英格兰/流行病学家庭医学卫生服务需求/统计学和数值数据健康状况指标模型统计学处方药物/经济学回归分析社会经济因素女(雌)性人类男(雄)性

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Residence Differences in the Health Status of Elders

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The Journal of Rural Health 1988年第3期4卷 11-26页

作者： Cutler, Stephen J. Coward, Raymond T. Professor of Sociology and the Bishop Robert F. Joyce Distinguished University Professor of Gerontology at The University of Vermont. He has been Chair of the Behavioral and Social Sciences Section of the Gerontological Society of America. Dr. Cutler is coauthor of Middle Start: An Experiment in the Educational Enrichment of Young Adolescents and coeditor of Major Social Issues: A Multidisciplinary Perspective. His research on cohort changes in social and political attitudes and on age and residence differences in household composition is supported by grants from the National Institute on Aging. Research Professor in the Center for Rural Studies and Professor of Social Work at The University of Vermont. He is a frequent contributor to journals in social work gerontology and health and is the author or editor of eight books including five on rural themes: The Rural Elderly: Program Phnning Guidelines (1979) 7he Family in Rural Society (1981) Family vices: Issues and Opportunities in Contem.my Rural America (1983) Emerging Issues in the Delivery of Rural Health Seruices (1984) and 7he Elderly in Rural Society: Every Fourth Elder (1985). His primary research interests are in the development delivery and evaluation of heath and human services in small towns and rural America.

Using data from the 1984 Supplement on Aging to the National Health Interview Survey, this study examined residential differences on a selected group of health status measures among persons 65 years of age and older (N = 11,497). Mean values on indicators of health and impairment for each of the residence categories were examined before and after adjusting for distributional differences in background and demographic characteristics which are associated with both health and residence. Three important conclusions emerged from the analysis: (1) health status does not vary with residence in a unitary fashion;(2) the relationship between residence and health status does not appear to fall along a straightforward rural‐urban continuum;and (3) there is both diversity in, and a general patterning of, the significant relationships between health and residence with the extremes of health status located in the rural categories. Copyright © 1988, Wiley Blackwell. All rights reserved

关键词：日常生活活动方差分析卫生服务范围人口统计学卫生服务需求/统计学和数值数据卫生服务研究/统计学和数值数据健康状况指标健康调查农村人口社会经济因素郊区人口美国市区人口老年人女(雌)性人类男(雄)性

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A comparison of measures of access to child health clinics and the implications for modelling the location of new clinics

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AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1999年第2期23卷 189-195页

作者： Hyndman, JCG Holman, CDJ de Klerk, NH Department of Public Health The University of Western Australia [*] Honorary Research Fellow Department of Public Health The University of Western Australia Western Australia 6907. Fax (09) 9222 4236 Email: jilda.hyndman@health.wa.gov.au

Objective: To determine whether measurement of access to existing child health clinics, and modelled location of new clinics, was affected by the spatial definitions of the target population. Method: Populations requiring childhood screening services were defined as located at individual households, and at geographic and population-weighted centroids of small and large areas. Straight-line and network distances were measured and compared from these origins to varying numbers of existing clinics. The same origins were used to model sets of locations for new clinics, and access levels were again compared. Results: Travel distances for 82,499 annual baby-visits to 140 existing clinics were between 136,000 km and 84,000 km, depending on origin definition. An analysis based on small area centroid data was as accurate as one based on household data. Planning solutions for new clinics located on the basis of few large areas, with populations centred at spatially defined centroids, resulted in poorer access for the population (231,000 km of travel) than one based on many small areas with populations centred at population weighted centroids (194,000 km of travel). Implications: Public access to health facilities will be improved if decisions about their locations are aided by the application of spatial analysis techniques based on small area definitions.

关键词：门诊医疗设施儿童保健服务/组织和管理卫生设施计划/组织和管理卫生服务易得程度/组织和管理卫生服务需求/统计学和数值数据专业场所西澳大利亚儿童儿童学龄前女(雌)性人类婴儿男(雄)性

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Treatment on demand: An operational model

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Health Care Management Science 2000年第3期3卷 171-183页

作者： Kaplan, Edward H. Johri, Mira Yale School of Management Box 208200 New Haven CT 06520-8200 United States Yale School of Medicine Department of Epidemiology and Public Health Box 208034 New Haven CT 06520-8034 60 College St. United States

The goal of "treatment on demand" is to allow all those seeking substance abuse treatment immediate entry into a program. Surprisingly, little is understood regarding the relationship between the demand for treatment, queues, waiting times and treatment admission rates, and treatment capacity. Nor has the increase in treatment capacity required to eliminate drug treatment queues, along with the expected benefits and costs of such an expansion, been studied carefully. In this paper, we present a mathematical model of drug treatment flows for systems where the demand for treatment greatly exceeds available supply. The model produces estimates of queue lengths, waiting times and treatment admission probabilities for any given treatment capacity, and suggests the capacity needed to achieve treatment on demand. The model also enables one to contrast the likely costs and benefits of changes in treatment capacity. We illustrate the model using San Francisco as a case study. © Baltzer Science Publishers BV.

关键词：门诊医疗效率组织卫生服务易得程度卫生服务需求/统计学和数值数据模型理论组织状况研究旧金山/流行病学物质滥用治疗中心/利用物质相关性障碍/经济学物质相关性障碍/流行病学物质相关性障碍/治疗预约名单人类

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