Health service utilization and attitudes toward Health Maintenance Organizations: a theoretical and methodological discussion.
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Consumer Behavior↗
Biomedical subjects
F D Wolinsky
Publications and source records attributed to F D Wolinsky.
HMO: the concept, new evidence, implications.
HMOs have been the most controversial alternative healthcare delivery system in the US. As a first step towards understanding the concept and state of HMOs, a description is offered, including a review of basic characteristics, types, and general financial incentives and disincentives. Although the performance of HMOs has also been the subject of recent debate, there is evidence that studies of performance have been inconclusive, and while observations about the effects of HMOs appear frequently in the literature, the causes are not actually known. To provide more conclusive information on the performance of HMOs, the American Medical Association conducted several related studies during the tenure of the authors. Results and implications of these studies are presented.
Evaluation Studies as Topic↗
How the public chooses and views hospitals.
This article examines factors people consider important in choosing a hospital, as well as their feelings toward hospitals. It begins with a brief discussion and overview of the literature on how people choose doctors and hospitals. The literature on factors involved in people's choices of new physicians is discussed primarily because of the lack of data in this area. After reviewing the issues, we describe the data used in this study and the context in which they were gathered. The analysis is divided into two sections: the first examines the salient issues in choosing a hospital, while the second examines the public's attitudes toward hospitals. Finally, we present a summary of the results and conclusions.
Data Collection↗
Who picks the hospital: practitioner or patient?
This article presents the findings of a survey on consumer versus physician selection of a hospital. Forty-one percent of respondents reported that they or the affected household member selected the hospital. In addition, the perception of who chose the hospital was related to: 1) demographic (age and marital status); sociocultural (number of times moved in the past five years), and psychological (willingness to change physicians) factors which predispose hospital selection; 2) differences in individual resources (type of insurance coverage) which influence decision making; and 3) medical conditions (inpatient vs. outpatient status and the reason for the hospital utilization) which imply specific needs. Knowledge of these factors permits the correct classification of 70.2% of the cases, as opposed to 59.5% without such knowledge. The implications of these findings for healthcare marketing are discussed.
Adult↗
A preliminary validation of a nutritional risk measure for the elderly.
We used data from a two-stage random sample of 401 noninstitutionalized elderly individuals residing in 18 census tracts in south-central metropolitan St. Louis to establish the reliability and validity of a 16-item nutritional risk measure. Reliability analysis yielded a Cronbach's alpha of 0.603. Concurrent predictive validity was demonstrated by the prediction of physician, emergency room, and hospital use. Individuals with high scores displayed a consistent pattern of higher rates of known nutrition-related problems and their sequelae than did those with low scores, providing evidence of known groups validity. Statistical correlations with components of an established theoretical model of the elderly's health and illness behavior demonstrate preliminary support for construct validity. The advantages of our nutritional risk measure include its ease of administration and telephone portability.
Aged↗