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Biomedical subjects

D Mechanic

Publications and source records attributed to D Mechanic.

At least 91 records · Page 5Linked to original sources
PubMed1991

Strategies for integrating public mental health services.

Practical solutions to the issues troubling public mental health systems must be developed within the constraints of existing political structures. A key enabling factor is the inclusion of a broad range of reimbursable mental health benefits within health insurance. However, services cannot be improved without the development of viable frameworks for organizing effective service delivery; such strategies include assertive community treatment, capitation approaches, strong local mental health authorities, and reimbursement structures that achieve key objectives. The author discusses examples of the four strategies and argues for their better integration.

Capitation Fee↗
PubMed1991

Sources of countervailing power in medicine.

In recent years a substantial literature has emerged on the alleged deprofessionalization and proletarianization of physicians. The contention is that corporatization is transforming the practice of medicine, divesting physicians of control over many features of their work, consistent with the needs of advanced capitalism. I examine the hypothesis skeptically, differentiating between the cultural role of medicine, the political and social legitimacy of medical concepts, and the personal autonomy of the individual physician. I suggest that while physicians are less autonomous than they used to be, the constraints imposed on them fall within a medical paradigm. From a cultural or social perspective, medicine is more central to the economy and more powerful than ever before. As its centrality and importance increase, there is more at stake, and interests compete more aggressively. I conclude that there is little evidence in support of the hypothesis.

Attitude of Health Personnel↗
PubMed1991

Changing perspectives in the study of the social role of medicine.

The Milbank Quarterly over the past 14 years took the lead in examining inequalities (and their policy implications) arising from stigma and devaluation because of age, disability, mental impairment, and lifestyle as well as socioeconomic disadvantage. It sought to examine alternative models in a context sensitive to the inextricable connections between health and society, their persistence through time, and their link to demographic changes. In focusing on concepts of disease, disability, cultural responses, and ideas of personhood, it brought to health policy considerations a depth of discussion that was visibly absent as our society increasingly became obsessed with containing health care costs. Throughout the years of David Willis's editorship, the Quarterly conveyed a vision of a more equitable health care system sensitive to practical realities but dedicated to moral objectives.

Activities of Daily Living↗
PubMed1991

Risk and selection processes between the general and the specialty mental health sectors.

This paper examines risk, defined as the threat of danger or disruption, as a contextual concept important for understanding patterns of patient selection and referral. We explore the hypothesis that risks associated with mental disorder, as represented by factors such as thoughts about suicide or problems associated with drinking, increase the probability of referral of patients receiving mental health care from general medical practitioners to the specialty mental health sector. Interview and claims data from the RAND Health Insurance Experiment, a large experimental study of coinsurance, are used to examine referral processes over a five-year period. Risk, and especially a measure of suicide thoughts, increase the probability of referral to specialty care. Women and persons with higher education are more likely to use specialty services; older persons are less likely to use such services. Understanding referral requires attention to the behavioral contingencies and illness behavior surrounding the presentation of mental disorder.

Educational Status↗
PubMed1990

Patterns of care in general hospitals for patients with psychiatric diagnoses. Some findings and some cautions.

Patients with psychiatric diagnoses in general hospitals in New Jersey in 1985 with and without dedicated psychiatric units are compared. Unit and nonunit bed occupants are compared also in hospitals having dedicated units. Types of referral, case-mix, length of stay, co-morbidity, transfer to other settings, and social characteristics of patients vary by type of bed. Patients in scatter beds have relatively low lengths of stay, rarely are attended by a psychiatrist and have more CAT scans and EEGs for almost every diagnostic group. These data suggest the critical need for clinical studies of quality of care in varying psychiatric inpatient settings.

Affective Disorders, Psychotic↗
PubMed1990

Choosing among health insurance options: a study of new employees.

This study examines how 296 new university employees selected among alternative health care options. Those selecting a traditional Blue Cross and Blue Shield (BC&BS) plan attributed greater importance to freedom of choice of physician, while those selecting an HMO were more likely to give priority to cost considerations in seeing a doctor and to having services at a single location. Better educated respondents and those with more recent experience with the medical care system were more accurate in objectively appraising alternative choices. Respondents, whether choosing a BC&BS plan or an HMO, tended to deny the gatekeeper roles of physicians in HMOs, although the BC&BS plan enrollees were somewhat better informed.

Attitude↗
PubMed1989

Health care and the elderly.

Western values have long emphasized an interventionist approach to problems of health and health care. Yet, as medical technology becomes increasingly expensive and as the number of older people grows, proposed changes often are now governed more by considerations of cost than by quality of services. This tension between cost and quality also affects public willingness to invest in social components of health care despite their importance in enhancing quality of life. The tension emerges in sharpest contrast as scarce resources are allocated by gatekeepers in health maintenance organizations and in the arrangements for long-term care. With respect to financing, what seems to be needed is a creative mix of voluntary inputs from the community, private initiatives, and new programs of public entitlements. With respect to quality of care, what has often been overlooked is the recognition that gains in the quality of life require programs that encourage older people's continued involvement and participation in social life and in active and healthy life-styles. This article discusses the evolving balance between these two types of interventions: the medical and the social.

Aged↗
PubMed1989

Medical sociology: some tensions among theory, method, and substance.

Why is it that quantitative and qualitative researchers on health issues often have divergent findings and conclusions? Exploration of such differences can be a useful way of bringing separate intellectual enclaves in medical sociology together and also can stimulate future inquiries. Some differences can be resolved by more precise definitions, by comparable frequency and timing of measurement, and by careful evaluation of meaning contexts. The triangulation of methods, using diaries as a bridge between surveys and qualitative measurement, offers particular promise. Improved theory on the relationships of method to data, and more attention to behavioral sequences and the social context of measurement, can serve as a stimulant to innovative solutions.

Data Collection↗
PubMed1989

Divorce, family conflict, and adolescents' well-being.

The relative effects of family conflict and divorce on the well-being of adolescents were examined in a longitudinal study of a heterogeneous community sample. Higher levels of family conflict were associated with increases in adolescents' depressed mood, anxiety, and physical symptoms over time. In contrast, neither recent divorce nor earlier divorce was associated with longitudinal changes in any health outcomes. Also, adolescents living in intact families with high conflict had significantly poorer well-being than those living in families of divorce with low conflict. Finally, the longitudinal effects of divorce and family conflict did not differ by age and sex, but Hispanic adolescents experienced more negative effects of family conflict than non-Hispanic whites, and the well-being of Asian adolescents was influenced more strongly by recent divorce.

Adolescent↗