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Biomedical subjects

R Andersen

Publications and source records attributed to R Andersen.

At least 55 records · Page 3Linked to original sources
PubMed1978

Access to medical care in the U.S.: realized and potential.

This paper seeks to provide a framework for understanding differential access to medical care in the U.S. population and to suggest ways to achieve equity of access. The framework is provided by a behavioral model of health services utilization which suggests a sequence of predisposing, enabling and illness variables that determine the number of times people will visit a physician. The model is operationalized using a path analytic technique. The data come from a national survey of the noninstitutionalized U.S. population conducted in late 1975 and early 1976. The results suggest services are generally equitably distributed since age and level of illness are the main determinants of the number of services people receive. However, remaining inequities might be reduced by providing people who report no regular source of medical care with a familiar entry into the health service system.

Analysis of Variance↗
PubMed1978

Health status indices and access to medical care.

This paper examines the uses of some health status indices in measuring equity of access to medical care. Empirical examples are provided using data from national surveys of the U.S. population conducted from 1964 through 1976. A simple indicator, mean number of physician visits, suggests that between 1963 and 1976 the poor improved their position relative to the rest of the population and, indeed, currently enjoy the highest level of access. However, a second measure, the use-disability ratio indicates that the poor may still receive less care relative to their need. A third measure, the symptoms-response ratio suggests how norms of appropriate behavior might be incorporated into an access measure.

Disability Evaluation↗
PubMed1978

Insurance coverage and access: implications for health policy.

Data are presented from a recent survey of the United States population comparing the characteristics and levels of access to medical care of persons under 65 years who have group or individual private health insurance, public health insurance, or no third-party coverage. The uninsured group appeared to fall between the privately insured and publicly insured groups on measures of social and economic status. Persons with publicly subsidized forms of insurance coverage utilized services at the highest rates, and uninsured persons used them at the lowest rates. Neither of these groups was as satisfied with the convenience or the quality of the care it obtained as the privately insured group. Implications of these findings for national health insurance and other health policy initiatives are discussed.

Adolescent↗
PubMed1976

Pain as a major cause of postoperative nausea.

The incidence of nausea in relation to pain was recorded in 104 patients after abdominal operations. Ten per cent of the patients had episodes of nausea not related to pain. One hundred and fourteen episodes of concomitant pain and nausea were recorded in 61 patients (58.6 per cent). The intravenous injection of morphine or ketobemidone relieved nausea as well as pain in 80 per cent of the episodes. Relief of pain with persistence of nausea was uncommon and if pain relief was inadequate nausea was unabated. Nausea was provoked by 3.4 per cent of the morphine injections, but all patients tolerated similar doses of morphine on other occasions without nausea. Nausea often accompanies pain in the early postoperative period and can be relieved concomitant with the pain by the intravenous use of opiates in adequate doses in a high proportion of cases.

Adolescent↗
PubMed1976

The effect of measurement error on differences in hospital expenditures.

Differences in expenditures for medical care among various subgroups in the population according to age, income, residence, and ethnicity have important public policy implications. However, few efforts have been made to assess the extent to which these apparent differences among subgroups observed in social surveys may be influenced by measurement error. This paper provides a framework for examining the impact of various kinds of error including random error and biases. The framework is applied to data on hospital expenditures from a national survey of health services expenditure which includes in addition to consumer reports, verifying information from hospitals, physicians, and third-party payers who provided services to persons in the sample. Differential error according to demographic and social characteristics is estimated. The impact of such differential error on conclusions about the distribution of health resources is discussed.

Age Factors↗
PubMed1976

Postanaesthetic use of naloxone hydrochloride after moderate doses of fentanyl.

A consecutive series of 273 anaesthetics is presented. All patients were given moderate doses of droperidol and fentanyl intravenously to supplement nitrous oxide and oxygen anaesthesia. 28.6% of the patients needed reversal of the analgesic respiratory depressant effect at the end of anaesthesia to establish stable spontaneous respiration. The opiate antagonist, naloxone hydrochloride (Narcan), was found to give rapid and reliable reversal of the respiratory depression. A mean dose of 2 mug/kg body weight of naloxone was found adequate in that no patient required further doses in the post-operative period in order to maintain adequate ventilation. Neither does the dose seem to have been too large. Patients in the naloxone group had no need for additional analgesics during the first 5 3/4 hours postoperatively, as compared to the painfree interval of 3 1/4 hours in the control group.

Adolescent↗
PubMed1976

Rates and correlates of expenditure increases for personal health services: pre- and post-medicare and medicaid.

This investigation of the increases in expenditures for medical care of the noninstitutionalized population of the United States in two recent periods suggests the following: Price increases contributed substantially more to overall expenditure increases in both periods than did use increases. Hospital price increases contributed most to overall price increases in both periods. Drug use in the first period and hospital use in the second period contributed most to overall use increases. The so-called "free services" made a substantial contribution to increases in use between 1963 and 1970, while apparently making no contribution in the earlier period. In the pre-Medicare/Medicaid period, use increase were greatest among the working-age and male population. However, increases in use also seemed to be relatively high among the low-income group. In the most recent period, use increases shifted not only to the elderly and the very young, but also to the group 55-64. The relatively high rate of use increase for males and the low-income group continued. These findings, then, suggest that institution of the Medicare and Medicaid programs was accompanied by acceleration of some trends that were already taking place, i.e., relatively high rates of increase in the use of health services for the low-income population and the aged. Some groups not considered to be target populations for the programs, such as those 35-54, showed a reduction in their use rates; others those 55-64, increased their use. Finally, the non-white population showed no greater rate of increase in use of health services than the white population, even though the former would presumably be considered a target group.

Adolescent↗
PubMed1976

Determination of added blood in ground beef.

Blood added to ground beef is estimated from hemoglobin extracted with water. Since myoglobin is co-extracted with the hemoglobin, the 2 heme pigments are separated in one portion of the extract by precipitating the hemoglobin in an 85% (NH4)2SO4 solution. The myoglobin remaining in solution is used as the reference solution for determining the hemoglobin in another portion of the extract containing both pigments. The hemoglobin is converted to cyanomethemoglobin and quantitated by its absorbance at 422 nm.

Blood↗