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Biomedical subjects

F D Wolinsky

Publications and source records attributed to F D Wolinsky.

At least 109 records · Page 6Linked to original sources
PubMed1984

Measurement of the global and functional dimensions of health status in the elderly.

Data from a two-stage random sample of 401 noninstitutionalized elderly individuals residing in 18 census tracts in south-central metropolitan St. Louis were used to examine the relationships among seven measures of health status. Factor analyses revealed two pristine dimensions: (a) a global health status dimension, on which perceived health status, nutritional risk, perceived sensory functions, and mental health all load significantly; and, (b) a functional dimension on which the Activities of Daily Living, Instrumental Activities of Daily Living, and mental orientation measures all load significantly. These two factors explain 56% of the variance in the seven health status measures, and, using an oblique rotational procedure, they were found to be correlated only modestly (r = .37). The implications for the measurement of health status of elderly adults as well as the use of such measures in predicting health services utilization are discussed, and recommendations for the inclusion of items tapping both dimensions in future studies are presented.

Activities of Daily Living↗
PubMed1984

Physician and hospital utilization among noninstitutionalized elderly adults: an analysis of the Health Interview Survey.

Data on 15,899 noninstitutionalized, elderly adults taken from the 1978 Health Interview Survey were used to assess the effects of the predisposing, enabling, and need characteristics on the volume of physician and hospital utilization. These were measured three ways: the actual number of visits (nights), and truncated and logarithmic transformations of that actual volume. Multiple regression analyses explain 3.9% to 21.3% of the variance in physician utilization and 5.1% to 9.4% of the variance in hospital utilization. The unique contributions of the need characteristics account for 56.8% to 66.7% of the variance explained in physician utilization and 74.5% to 77.7% of the variance explained in hospital utilization, suggesting an apparently equitable system is operative in elderly adults' use of health services. The effects of the three methods of coding physician and hospital utilization on the significance of the regression coefficients and the magnitude of the R2 values were examined and their implications are discussed.

Aged↗
PubMed1983

Waiting to see the doctor. The impact of organizational structure on medical practice.

In this article it is assessed whether or not the scheduling and office visit queues a patient faces depend upon the organizational structure of the physician's practice (i.e., does the physician practice in the fee-for-service system or in a health maintenance organization [HMO], and if in an HMO, in what type of an HMO). Data pooled from two national studies (N = 2448) reveal two major findings. First, although scheduling queues may be predicted from the organizational structure of physicians' practices and other factors, office queues appear to be more of a random phenomenon. Second, a distinct pattern emerges among the effects of the organizational structure of physicians' practices on patient queues, including 1) physicians in solo practice offer their patients the shortest queues, 2) physicians in group model HMOs maximize scheduling queues but minimize waiting room queues, 3) patient queues for physicians practicing in IPAs are no different from those of their counterparts in group-practice fee-for-service settings, and 4) patient queues for salaried physicians practicing in a predominantly salaried environment are among the longest. The implications of these findings are discussed with special reference to extent and future studies of the effects of organizational structure on medical practice.

Appointments and Schedules↗
PubMed1983

The organization of medical practice and primary care physician income.

This study investigates the effect of the organization of medical practice, e.g., solo, fee-for-service group, or health maintenance organization (HMO) settings, on primary care physicians' net incomes. Using pooled data on 2,372 primary care physicians, multivariate regression analysis is used to adjust physicians' 1979 net incomes for differences in medical specialty, workload, sex, and experience before estimating the effects of the organization of medical practice. Among HMO physicians, only those in staff model HMOs were found to have significantly lower net incomes than their fee-for-service group practice counterparts. Accordingly, there is little evidence to support the popular belief that physicians practicing in HMOs consistently earn less than their fee-for-service counterparts. (Am J Public Health 1983; 73:379-383.)

Humans↗
PubMed1982

Racial differences in illness behavior.

Using data on 359 white and 126 black respondents who were interviewed in their home as part of an omnibus health care study in a rural southern county during 1978, the illness behavior (i.e., dentist, physician, and hospital utilization measures) of blacks and whites are compared and contrasted. Zero-order racial differences in illness behavior disappeared after controlling for the predisposing, enabling, and need characteristics identified in Andersen's generic access model. Further multivariate analysis, however indicates that while there are no racial differences in illness behavior after the predisposing, enabling, and need characteristics of the individual are taken into consideration, there are significant differences between blacks and whites in the effects of these characteristics, at least in terms of discretionary health services utilization. This provides some support for recent speculation that blacks might respond differently than whites regarding the use of and access to health services because of separate cultural traditions.

Adolescent↗
PubMed1982

Salient issues in choosing a new doctor.

In this paper we argue that selecting a new doctor is one of three phases in the overall, iterative process of patient-practitioner encounters. Further, we assume that the factors which impact on individuals' decisions to seek and to use health services should also influence their choices of new physicians. Accordingly, we assess the extent to which traditional predictors of health services utilization (i.e. the predisposing, enabling, illness-morbidity, and consumer satisfaction characteristics) are directly associated with individuals' identifications of the important factors in their choices of new doctors. Discriminant function and multivariate contingency analyses of data from a national survey of 1530 adults reveal five major patterns of typical behavior. First, individuals with lower socioeconomic status and poorer access to medical care choose the psychosocial aspects of the patient-practitioner relationship as most important in selecting a new doctor. Second, individuals with lower socioeconomic status but better access to medical care focus on the cost of an office visit. Third, individuals with higher socioeconomic status but poorer access to medical care focus on the hospital affiliation of the physician. Fourth, individuals with higher socioeconomic status and better access to medical care focus on the physician's affiliation with a medical group. Fifth, individuals with higher socioeconomic status and moderate access to medical care focus on the recommendation of friends. Finally, we discuss the implications of these behavioral patterns for models of health services utilization, consumer satisfaction, the sick role, and medical school curricula and recruitment policies.

Adult↗
PubMed1982

Spending time with patients: the impact of organizational structure on medical practice.

This article assesses whether the amount of time that physicians spend overall, in the office, and in the hospital per patient visit depends upon the organizational structure of the physician's practice (i.e., does the physician practice in the fee-for-service system or in an HMO, and if in an HMO, in what type of an HMO). Data pooled from two national studies (N = 2.521) reveal several interesting patterns, including: 1) on all measures, solo physicians spend more time per patient visit than physicians in group practice; 2) overall and in the office, internists spend more time per patient visit than general practitioners; 3) overall and in the hospital, obstetricians-gynecologists spend more time per patient visit than general practitioners; 4) overall and in the office, physicians in prepaid group practices spend less time per patient visit than physicians in fee-for-service group practices; 5) overall and in the office, physicians reimbursed on a straight salary basis spend more time per patient visit than nonsalaried physicians; and, 6) in the hospital, physicians in staff model HMOs spend more time per patient visit than physicians in fee-for-service group practice. The implications of these findings for future studies of the effects of organizational structure on medical practice are discussed.

Health Maintenance Organizations↗
PubMed1982

Why physicians choose different types of practice settings.

This paper presents an extension of Freidson's typology concerning the four medical practice settings which physicians may enter. First, Freidson's typology is modified to contain only three medical practice settings: 1) solo practices; 2) small group practices (partnerships or associations consisting of two to seven physicians); and, 3) large group practices (having eight or more physicians). Then, it is argued that the most interesting sociological difference between these three medical practice settings is the differential probability for effective peer regulation, with that probability lowest in solo practices, highest in large group practices, and lying somewhere between these extremes in small group practices. Finally, it is argued that because physicians recognize these differential probabilities for peer regulation, they seek out those niches (i.e., medical practice settings) which most closely reflect their preferences. This extended version of Freidsonian theory is then incorporated into an analytic model using the sociodemographic, environmental, and attitudinal characteristics of physicians to predict their practice choices. Data from a 1979 national survey of approximately 4,500 physicians are used to assess the model empirically. The results obtained from these analyses conform quite well with both our general and specific expectations. The implications of these findings for the future configuration of the American health care delivery system are discussed with special reference to health maintenance organizations.

Career Choice↗
PubMed1980

The performance of Health Maintenance Organizations: an analytic review.

An analytic review of the literature on HMO performance reveals common limitations that make available evidence inconclusive, at best. Most studies have been more descriptive than analytic; others are characterized by serious deficiencies in methodology. Although several observations about the effects of HMOs appear frequently, the causes are not known. Four hypotheses concerning performance are advanced for further exploration.

Capitation Fee↗