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Biomedical subjects

D Mechanic

Publications and source records attributed to D Mechanic.

At least 145 records · Page 8Linked to original sources
PubMed1980

A model of rural health care. Consumer response among users of the Marshfield Clinic.

Comparisons of prepaid, Medicaid and fee-for-service patients using the Marshfield Clinic and affiliated non-Clinic physicians indicate that a well-organized multispecialty group can successfully provide accessible and responsive care to rural populations and integrate varying types of payment systems. Most patients were highly satisfied, but differences in satisfaction among varying subgroups were substantially attributable to access barriers. Patients in the Greater Marshfield Community Health Plan (prepaied patients) were most generally satisfied, but patients using non-Clinic affiliates were higher on socioemotional satisfaction, reflecting certain barriers to personal care in complex organizational settings.

Community Health Services↗
PubMed1980

Ambulatory medical care in the People's Republic of China: an exploratory study.

One hundred thirty-eight persons in varying outpatient settings in the People's Republic of China were interviewed briefly. Hospital outpatient utilization appeared to reflect not only severity of illness, but also patients' attitudes and beliefs, illness behavior patterns, and convenience, modifying the formal system of care to some extent. Traditional clinics in commune and county hospitals were typically used to treat psychiatric disorders (defined as physical conditions), chronic illness, and other conditions for which Western medicine offers only symptomatic treatment.

Adult↗
PubMed1980

Rationing of medical care and the preservation of clinical judgment.

It is inevitable that efforts to contain medical care costs will increase. Approaches to cost containment vary substantially and have different effects on access, equity, and professional performance. Cost sharing primarily affects the behavior of patients, while other types of regulation are intended to influence how physicians practice. While some types of physician regulation such as prospective budgeting are intended to constrain physician decision making without dictating clinical judgment, other approaches are more intrusive on physician autonomy. Physicians should contribute to the development of regulatory approaches consistent with the responsible exercise of clinical judgment and professional autonomy.

Cost Control↗
PubMed1979

Development of psychological distress among young adults.

Persons with high scores on psychiatric screening scales appear frequently in general medical settings, psychiatric outpatient clinics, and other agencies providing assistance, but there is considerable controversy concerning the appropriate interpretation of high scores on such scales obtained in community epidemiological studies. Data are presented from a 16-year follow-up study of children, first studied in 1961, examining developmental aspects of achieving high scores on such scales. Data come from the children themselves, their mothers, teachers, and school records. The findings are consistent with the hypothesis that such generalized distress reports are in part a learned pattern of illness behavior involving a focus on internal feeling states, careful monitoring of body sensations, and a high level of self-awareness.

Adolescent↗
PubMed1979

Some observations of mental illness and its treatment in the People's Republic of China.

A visit to the People's Republic of China provided impressions of the use of psychiatric concepts and the organization of mental health services. The Chinese report of low rates of mental illness appears to reflect narrow definitions of disorder and somatic expressions of personal and social distress which are viewed by health personnel as physical conditions. Acute mental health services are provided at commune and county hospitals, and special psychiatric hospitals are maintained for more intractable patients. Chronically disturbed patients may receive long term care in sanatoriums associated with large industries or may be maintained in home beds in their production brigades assisted by family and barefoot doctors. Psychiatric practice in teaching hospitals is similar to psychiatric practice in the West, although little attention is devoted in general medical care to psychosocial problems. Question for future visits and possible collaborative research are suggested.

Adult↗
PubMed1979

The stability of health and illness behavior: results from a 16-year follow-up.

In 1977, 302 young adults who were among 350 children first studied in 1961 responded to a questionnaire related to their health and illness behavior. Ten types of adult health and illness behaviors and orientations are examined including seat belt use, smoking, exercise, drinking, and risk taking. These patterns are associated only to a modest degree, and patterns of health and illness behavior appear to have low levels of continuity over a 16-year period (correlations varying from .02 to .20).

Adolescent↗
PubMed1978

Approaches to controlling the costs of medical care: short-range and long-range alternatives.

Cost containment requires changes either in patterns of consumption or in the way services are provided. Although the former includes prevention, changing social expectations and finding suitable substitutes for some types of care, the latter involves mix of personnel technologic inputs, auspices of care and the content of encounters. Ultimately, the future of medical care and cost containment depends on advances in biomedical and health-services research. In the short run, costs will be contained increasingly by rationing mechanisms. Whereas cost sharing is intended to affect consumer behavior, implicit rationing, as through capitation and prospective budgeting, is intended to encourage physicians to make tougher allocation decisions. Explicit rationing, in contrast, depends more on administrative decisions that limit physician discretion. A better understanding of the effects of different rationing technics on patient and physician behavior and the quality of care, as well as on cost, is required.

Attitude↗
PubMed1978

Effects of psychological distress on perceptions of physical health and use of medical and psychiatric facilities.

Psychological distress not only contributes to bodily symptoms but also affects the way people perceive their physical health status and their use of medical care. Reporting on a program of research, this paper reviews evidence that psychological distress is an important component of illness behavior and response and must be taken into account in the appropriate organization of medical services.

Attitude to Health↗
PubMed1978

Factors affecting children's use of physician services in a prepaid group practice.

This paper examines factors affecting children's use of physician services in a prepaid group practice. The independent measures come from questions asked of mothers in a survey interview, while the utilization data come from their children's medical records. All independent variables were measured prior to the period of utilization studied. The results provide some evidence in support of the view that physician utilization for children is affected by characteristics of the mother, as well as the child's age and health status. Somewhat different variables were related to whether health services were used at all as compared with magnitude of use. Special consideration is given to the effect of the mother's level of psychological distress on her propensity to use medical services for children. The results suggest that distress was relevant, but only for the white families included in the sample. Also, distress was more important in explaining extent of use than accounting for whether utilization occurred at all. Various hypotheses are examined to explore white-nonwhite differences.

Adult↗
PubMed1978

Considerations in the design of mental health benefits under National Health Insurance.

The existing insurance coverage for mental health benefits provides incentives for hospital as compared with community care and reinforces a medical approach to psychological disability. Moreover, the structure of benefits favors the affluent as compared with the disadvantaged and provides little assistance for the community integration of the chronic mental patient. In considering mental health benefits under National Health Insurance we must be careful to avoid reinforcing these patterns. It is suggested that NHI include a mental health resource development fund intended for building a stronger network of community mental health care and that the pattern of insurance benefits under NHI be consistent with developing psychiatric services on a capitation basis.

Community Mental Health Services↗