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Biomedical subjects

S Woolhandler

Publications and source records attributed to S Woolhandler.

At least 73 records · Page 4Linked to original sources
PubMed1988

Reverse targeting of preventive care due to lack of health insurance.

We analyzed patterns of receipt of preventive services among middle-aged women, with particular attention to health insurance coverage, based on data from the National Health Interview Survey. Lack of insurance was most prevalent among socioeconomically disadvantaged women at high risk for disease and was the strongest predictor of failure to receive screening tests. The relative risk of inadequate screening for uninsured compared with insured women was 1.60 (95% confidence interval [Cl], 1.40 to 1.83) for blood pressure checkups, 1.55 (95% Cl, 1.43 to 1.68) for cervical smears, 1.52 (95% Cl, 1.41 to 1.63) for glaucoma testing, and 1.42 (95% Cl, 1.33 to 1.51) for clinical breast examination. Controlling for demographic and health status variables did not diminish the effect of insurance coverage. We conclude that inadequate insurance coverage leads to "reverse targeting" of preventive care--that is, populations at highest risk are least likely to be screened. This compromises both the effectiveness and the cost-effectiveness of screening.

Black or African American↗
PubMed1988

Free care: a quantitative analysis of health and cost effects of a national health program for the United States.

We estimate the health and cost effects of instituting a National Health Program (NHP) in the United States that would provide universal, comprehensive free care. Based on empiric studies of the relationship of health service use to cost and health outcomes, we estimate that an NHP would increase use of health services by 14.6 percent and save between 47,000 and 106,000 lives annually. Because the United States faces a growing surplus of hospital beds and physicians, additional services could be provided at low cost. Simplifying the health bureaucracy that currently enforces unequal access to care would also result in substantial savings. Consequently, an NHP would actually decrease costs 2.4 percent, $10.2 billion annually, since the $35.7 billion spent for additional services would be offset by $45.9 billion saved on bureaucracy.

Comprehensive Health Care↗
PubMed1988

Will cost effectiveness analysis worsen the cost effectiveness of health care?

Cost effectiveness analysis is increasingly advocated as a basis for health policy. Analysts often compare expensive interventions with highly cost-effective programs such as hypertension screening, implying that if the former were curtailed resources would be reallocated to the latter and the efficiency of health care would improve. However, in practice, savings are unlikely to be targeted in this way. We present refined policy models that take into account actual patterns of resource allocation in the United States, and provide more realistic estimates of the likely uses of savings. We illustrate the implications of these models in an analysis of the effects of diverting funds from an expensive but effective practice. Eliminating such a practice would actually worsen the overall cost-effectiveness of U.S. health care unless there are radical changes in health policy. Cost effectiveness analysis incorrectly predicts health and cost outcomes of policy initiatives because it ignores the political constraints to health care decision-making.

Cost Control↗
PubMed1987

Physicians for a National Health Program.

A new organization called Physician's for a National Health Program (PNHP) is mobilizing physician support for a universal, comprehensive public system of health care for the United States. Recent changes in power relations within medicine (the so-called proletarianization of physicians) are prodding many physicians to abandon their traditional reactionary role in health policy. PNHP is working with elderly, labor, community, and health care activist groups to put a national health program (NHP) back on the U.S. health policy agenda. In this article, five key features of an NHP needed to simultaneously assure access, control costs, and minimize bureaucracy are noted.

Cost-Benefit Analysis↗
PubMed1986

Socialized medicine: a solution to the cost crisis in health care in the United States.

Despite growing concern with cost containment, most health policy analysts have ignored vast potential savings on medically irrelevant spending for excess administration, profits, high physician incomes, marketing, and legal involvement in medicine. Indeed, many recent reforms encourage administrative hypertrophy, entrepreneurialism and litigation. A universal national health program could abolish billing and consequently the need for much of the administrative apparatus of health care, and decrease spending for profits and marketing. In this article we analyze the administrative savings that could be realized from instituting a Canadian-style national health insurance program or a national health service similar to that in Britain, and the potential savings from additional reforms to curtail profits, marketing and litigation. Our calculations based on 1983 data suggest that national health insurance would save $42.6 billion annually: $29.2 billion on health administration and insurance overhead, $4.9 billion on profits, $3.9 billion on marketing, and $4.6 billion on physician's incomes. A national health service would save $65.8 billion: $38.4 billion on health administration and insurance overhead, $4.9 billion on profits, $3.9 billion on marketing, and $18.6 billion on physician's incomes. Complete nationalization of all health related industries and reform of the malpractice system would save at least $87.2 billion per year. We conclude that a national health program, in addition to improving access to health care for the oppressed, could achieve cost containment without rationing of care.

Canada↗
PubMed1985

Militarism and mortality. An international analysis of arms spending and infant death rates.

Examination of data from 141 countries showed that infant mortality rates for 1979 were positively correlated with the proportion of gross national product devoted to military spending (r = 0.23, p less than 0.01) and negatively correlated with indicators of economic development, health resources, and social spending. In a multivariate analysis controlling for per caput gross national product, arms spending remained a significant positive predictor of infant mortality rate (p less than 0.0001), while the proportion of the population with access to clean water, the number of teachers per head, and caloric consumption per head were negative predictors. The multivariate model accounted for much of the observed variance in infant mortality rate (R2 = 0.78, p less than 0.0001), and showed good fit to similar data for the year 1972 (R2 = 0.80, p less than 0.0001). The model was also predictive of infant mortality rates in subgroup analysis of underdeveloped, middle developed, and developed nations. Analysis of time trends confirmed that an increase in military spending presages a poor record of improvement in infant mortality rate. These findings support the hypothesis that arms spending is causally related to infant mortality.

Capital Expenditures↗
PubMed1985

Medical care and mortality: racial differences in preventable deaths.

We analyzed deaths of blacks and whites in Alameda County, California where previous studies have documented consistent racial inequalities in health services. We classified each death during 1978 as due to preventable and manageable conditions or as "non-preventable" according to lists compiled by the Working Group on Preventable and Manageable Diseases chaired by Dr. David Rutstein. The total death rate for blacks 0-65 years of age exceeded that of whites by 58 percent (p less than .01). Rates of death due to preventable and manageable conditions for persons aged 0-65 years were 77 percent higher for blacks than for whites (p less than .01). More than one-third of the excess total death rate of blacks relative to whites could be explained by the excess of potentially preventable deaths. Our findings suggest that inequalities in health services reinforce broader social inequalities and are in part responsible for disparities in health status. Improvements in the health and longevity of blacks and other oppressed groups might be achieved by improved access to existing medical, public health, and other preventive measures.

Adolescent↗
PubMed1984

Patient transfers: medical practice as social triage.

We studied 458 consecutive patient transfers from 14 private hospitals to a public hospital emergency room during a six-month period. The transferred patients were predominantly male, young, and uninsured, and included large numbers of minority group members. We established criteria to identify patients at high risk for adverse effects of transfer and reviewed the clinical records of the 103 patients meeting these criteria. We judged that transfer resulted in substandard care for 33 of these patients, either because they were at risk for life-threatening complications in transit or because urgently needed diagnosis or therapy was delayed. In the community studied, transfer is a common and potentially dangerous medical intervention which appears to reinforce racial and class inequalities of access to medical care.

Adult↗
PubMed1983

Hypernatremic dehydration in nursing home patients: an indicator of neglect.

In order to determine the antecedents of hypernatremic dehydration the authors reviewed the records of 56 patients with this condition at two public hospitals, one of which includes a large chronic care facility. Twenty-nine patients developed hypernatremic dehydration while at nursing homes. All cases came from proprietary nursing homes, although proprietaries account for only 88 per cent of nursing home beds in the community studied (P less than 0.05). There was a cluster of patients from two nursing homes. Sixteen patients admitted from home all showed evidence of inadequate care prior to admission. Eleven patients became hypernatremic while in acute care hospitals. No patient in the public chronic care facility developed hypernatremic dehydration during the period studied. The average serum sodium concentration of patients transferred from nursing homes was significantly higher than that of patients who developed hypernatremic dehydration at home or in acute care hospitals. It is concluded that hypernatremic dehydration in an institutionalized patient may be an indicator of inadequate care, which should prompt further investigation of the living conditions of the patient.

Adult↗