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PubMedDate not supplied

The relationship between modifiable health risks and group-level health care expenditures. Health Enhancement Research Organization (HERO) Research Committee.

PURPOSE: To assess the relationship between modifiable health risks and total health care expenditures for a large employee group. DESIGN: Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data from employers' fee-for-service plans over the 6-year study period. SETTING: The setting was worksite health promotion programs sponsored by six large private-sector and public-sector employers. SUBJECTS: Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis. MEASURES: Eleven risk factors (exercise, alcohol use, eating, current and former tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimate group-level impact of risks on expenditures. RESULTS: Risk factors were associated with 25% of total expenditures. Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures. CONCLUSIONS: Modifiable risk factors contribute substantially to overall health care expenditures. Health promotion programs that reduce these risks may be beneficial for employers in controlling health care costs.

Adult↗
PubMed1987

The role of health practices, health status, and prior health care claims in HMO selection bias.

To examine selection bias in terms of demographics, self-reported health practices, professionally evaluated health status, and prior health care utilization by employees and dependents, we examined health insurance choice between traditional insurance and a health maintenance organization (HMO) by central office employees of a large southwestern utility company. The HMO attracted a relatively younger and female population compared with the traditional plan. We found no difference in health practices and health status measures between the two groups. Consistent with recent studies, the HMO group experienced lower health claims cost the year prior to enrollment compared with persons who remained in the traditional plan. This difference was largely due to dependents' utilization-a factor that should be examined in future studies and considered by those structuring insurance premiums for HMOs and traditional plans.

Adult↗
PubMed1993

Health status, health perceptions, and health behaviors of young adult women.

A descriptive, exploratory study of 76 young adult women enrolled in a women's health course at a large, midwestern university was undertaken to identify their current health status, health perceptions, and general health behaviors. Two groups of young adult females participated, nursing students (n = 38) and non-nursing students (n = 38). The panel of young adult women in this study reported their health as good or excellent, viewed health as very important and generally used positive health practices. However, data revealed that the lifestyles of many respondents were not conducive to promoting or maintaining health. Negative health practices identified were drinking and driving, non-performance of self breast examinations, ineffective stress management strategies and poor dietary and exercise habits. No significant differences were noted between nursing and non-nursing students.

Adult↗
PubMed2005

What factors induce health care decision-makers to use clinical guidelines? Evidence from provincial health ministries, regional health authorities and hospitals in Canada.

This paper addresses three questions: What is the extent of clinical guideline utilization by decision-makers in provincial health ministries, regional health authorities and hospitals in Canada? Are there differences between these work settings in regard to the extent of clinical guideline utilization? What are the determinants of clinical guidelines utilization in health ministries, regional health authorities and hospitals? Based on a survey of 899 decision-makers from Canadian provincial health ministries, regional health authorities and hospitals, the results indicate that there are large differences between work settings in regard to clinical guideline utilization. Not surprisingly, work settings like hospitals rely more intensively on clinical guidelines than the other work settings (health ministries or agencies and regional health authorities). The results of the regression models indicate that cognitive factors, social factors, technological factors, organizational factors and individual attributes significantly predict the utilization of clinical practice guidelines by decision-makers. However, the results of the regression models also indicate that some factors that predict clinical guideline utilization by decision-makers in hospitals do not predict clinical guidelines utilization by decision-makers working in ministries or in regional health authorities. Therefore, these results suggest that customized interventions would be appropriate in order to efficiently increase the utilization of clinical practice guidelines in different work settings. The paper concludes with suggestions for future research.

Canada↗
PubMed1997

Self-rated health status as a health measure: the predictive value of self-reported health status on the use of physician services and on mortality in the working-age population.

The validity of various self-reported health assessments in predicting physician contracts and all-cause mortality was investigated in a prospective study in Finland. The follow-up periods were one year for the use of physician services and ten years ten months for the mortality. The study cohort comprised 1340 men and 1500 women, 35-63 years of age at the beginning of the study. The initial health assessments were derived from postal questionnaires in 1980 (response rate 77.5%). The survey was repeated one year later to verify the stability of the respondents' perceived health status. The data on the physician contacts and mortality were registered independently. The stability of perceived health status was relatively good and the perceived health was inversely associated with the number of physician contacts per year. A consistent inverse association, standardized by age, sex and social status, was observed between perceived health status and perceived physical fitness and mortality, while the predictive value of self-reported chronic diseases was low. The results suggest that the subjective health assessments are valid health status indicator in middle-aged populations, and they can be used in cohort studies and population health monitoring.

Adult↗
PubMedDate not supplied

The influence of mothers' health beliefs on use of preventive child health care services and mothers' perception of children's health status.

During the first three years of life, many health problems are preventable, and health maintenance visits present an excellent opportunity to prevent disease and disability. Unfortunately, preventive child health care services are underutilized. Children who do not adequately use preventive health care services are often seen late in the course of an illness. Thus, they do not receive the continuing care that could eliminate the onset of preventable health problems. In our research, we sought to determine whether mothers' health beliefs influence their use of preventive child health care services and whether their use of preventive child health care services influence their perceptions of the child's health status. The sample was composed of low-income mothers living in an urban environment. No significant relationships were found between the variables. These results indicate the need to develop more sensitive tools to measure these variables in a similar sample.

Adult↗
PubMed2002

Measuring the health burden of chronic disease and injury using health adjusted life expectancy and the Health Utilities Index.

OBJECTIVES: To estimate the burden of illness from chronic disease and injury using a population based health survey, which contains both measures of chronic disease and a utility based health related quality of life (HRQOL) measure. DESIGN: An adapted Sullivan method was used to calculate cause deleted health adjusted life expectancies for chronic conditions. SETTING: Ontario, Canada, 1996/97. SUBJECTS: The 1996/97 Ontario Health Survey (n=35 527) was used to estimate the prevalence of chronic conditions. A cause deleted approach was used to estimate the impact of these conditions on the Health Utilities Index (HUI). Cause deleted probabilities of dying were derived with the cause eliminated life table technique and death data from vital statistics for Ontario 1996/97 (n=156 610). RESULTS: Eliminating cardiovascular disease and cancer will cause an "expansion of morbidity", while eliminating mental conditions and musculosketal disorders will result in a "contraction of morbidity". The HUI score varies depending on chronic condition, age, and sex-most of which were assumed not to vary in previous summary measures of population health. CONCLUSIONS: Health adjusted life expectancy estimated for chronic conditions using a utility based measure of health related quality of life from population health surveys addresses several limitations of previous studies that estimate the burden of disease using either a categorical measure of disability or expert opinion and related epidemiological evidence.

Adolescent↗
PubMed1997

Integrated primary health care. Opportunities for psychiatric-mental health nurses in a reforming health care system.

As changes in our health care system evolve, making the transition to greater parity of mental and physical health is paramount to move health care in the direction of prevention and health promotion. Although parity is the goal, the most feasible path to reaching it may lie in relinking mental health to physical health in managed care models of primary health care. This article identifies emerging directions in the mental health field and points to new opportunities for advancing the practice of psychiatric-mental health nurses.

Health Care Reform↗
PubMed1990

[Health promotion in the framework of the health reform legislation--current perspectives for health insurance and municipalities].

This paper describes the perspectives of health promotion within the framework of the basic laws promulgated as of January 1989 in the Federal Republic of Germany. The initial situation, the intentions of the legislator, the performance criteria and the types of organised health promotion on a regional or county (community) basis are described. The new legislation on health promotion opens up new perspectives for compulsory health insurance bodies and regional (community) bodies. The advantages offered thereby must be made use of. The health insurance bodies can revive the principles of self-administration by taking full advantage of all possibilities of creating health promotion facilities. Community bodies must not only bear costs, they are also centrally responsible for health promotion policies to be enforced in their respective regions by organising cooperation between the individual persons and institutions who can regionally act as health policy promoters, and they are expected to bring about a general consensus on health promotion procedures.

Germany, West↗
PubMed1990

Do health service organizations and community health centres have higher disease prevention and health promotion levels than fee-for-service practices?

We interviewed health care providers representing 23 fee-for-service (FFS) practices, 19 health service organizations (HSOs) and 11 community health centres (CHCs) in Ontario to compare self-reported approaches to disease prevention and health promotion. Few significant differences were found across practice types in the presence of recall systems for screening or in knowledge of, compliance with or estimated coverage for selected preventive maneuvers recommended by the Canadian Task Force on the Periodic Health Examination. CHCs reported a significantly greater variety of formal health promotion programs and a greater tendency to use nonphysician health care personnel to carry out both prevention and health promotion activities. The results must be interpreted with caution because of the use of self-reported data, the low response rate for FFS practices and the use of a restrictive definition of disease prevention tied to evidence from the reports of the task force. Thus, the results cast some doubt on the common assumption that increasing the population served by alternative modes of delivery such as HSOs and CHCs necessarily increases the level of disease prevention and health promotion activity.

Aged↗
PubMed1986

Health policy implications of health promotion and disease prevention for allied health.

Regardless of the direction health policies in this country may take, allied health professionals seem uniquely positioned to meet the health promotion needs of a variety of clients, such as patients, families, other providers, employees, and members of communities. If allied health professionals choose to respond to health promotion as an area of clinical expertise, they will have to accept the challenge presented by the numerous complex issues associated with implementing a new discipline. However, the successful application of energy and resources to resolving these problems would allow allied health professionals to provide significant interventions in meeting national health goals. This article reviews the history of health promotion in the United States, discusses current practices in health promotion, and suggests some future trends.

Allied Health Personnel↗
PubMed1989

Health care utilization and attitudes to health care before and after development work in a health centre. Results from two independent postal surveys.

In development work at the Vännäs Primary Health Care Centre (VPHCC) in northern Sweden, attitudes towards and the use of health care were studied from 1977 to 1979. Mail questionnaires were sent to random and independent samples of Vännäs inhabitants to collect data. A relative increase in the health centre physician consultancy rate was found when it was compared to other health care facilities. No change was seen in hospital utilization. Attitudes towards health information and health care accessibility were more positive after the development work. No change in attitudes to quality of health care as such was seen. The changes implemented at the VPHCC seemed to be a major cause for the results obtained as no such change was seen in the catchment area of the reference health centre.

Adolescent↗
PubMedDate not supplied

Occupational mental health promotion: a prevention agenda based on education and treatment. The American Psychological Association/National Institute for Occupational Safety and Health, Health Promotion Panel, 1990 Work and Well-Being Conference.

PURPOSE OF THE REVIEW. Psychological disorders are one of the 10 leading work-related diseases and injuries in the United States according to the National Institute for Occupational Safety and Health. This article addresses occupational metal health and preventive stress management in the workplace. The individual and organizational costs are briefly considered with concern for reducing the burden of suffering associated with these problems. SEARCH METHOD. As an American Psychological Association interdisciplinary panel, we searched the psychological, medical, public health, and organizational literature. We selected articles relevant to the problem of psychological disorders in the workplace and to enhancing occupational mental health and preventive stress management. IMPORTANT FINDINGS. The panel proposed a national agenda of education and treatment, combined with a program of evaluation research, for addressing these issues. Target populations are identified, and the need for collaboration among a variety of national constituencies is considered. Advancing occupational mental health and promoting skills in preventive stress management is considered in the context of comprehensive health promotion. MAJOR CONCLUSIONS. The panel concluded that there is a pressing need to: 1) set a 'gold' standard concerning the current state of knowledge in the domains of occupational mental health and stress management; 2) identify Diagnostically Related Groups (DRGs) which are stress-related; 3) establish assessment standards for stress and mental health; 4) set guidelines for reasonable interventions; and 5) establish acceptable post-outcome criteria.

Health Education↗
PubMedDate not supplied

[Health education and people's participation in health in Nicaragua: research on the profile, role and function of the "brigadistas populares" in health].

The Nicaraguan democratic government has been building, since the defeat of somozism in 1979, a very extensive and uniform health system in the whole country, giving special attention to the problems of prevention and health education, promoting and utilizing a wide participation of the population. The most emblematic representative of the Nicaraguan model of participation is the Brigadista Popular en Salud, a voluntary figure in urban and rural areas, working along side the Sole National Health System. The work and role of the Brigadista is integrated in a health education action defined "Educaciòn Popular en Salud", intended as a dialogue through which the educator and educated, beginning with the specific political and economical social reality, accomplish work of observation, analysis and syntesis of the different phenomena that deal with health-sickness. The Brigadista is a member of the community that works voluntarily for the community to carry out health actions, in coordination with the "Puesto de Salud" of the community. The authors refer to a research study done in the field in 1987, geared to study the profile, role and activities of the Brigadista. The research was done in the "Las Segovias" Region, in the Northern part of the country, in two Health Areas, involving three urban centers and six rural communities: 73 Brigadistas were interviewed, of which 50 (predetermined) of urban centers and 23 (total population) in rural communities. The article represents in a comparative manner the operative Brigadista respectively, in urban areas on the one hand and in rural areas on the other. The article examines: sex; age; schooling; work activity; social-cultural background; collective systems background; participation in Literacy Campaigns; motivation; length and continuity of activities; relationship with the territory; activities done. The Brigadista that works in rural areas seems actually to be more attached, even to the formal image of his role, that the urban Brigadista. This is shown by the reduced turn-over, the wider span of functions, the closer relationship with collective systems that represent categories, a more intense relationship with colleagues of the health system as well as with other Brigadistas, the operative reference to specificity defined territories, more continuity in the functions of the Brigadista Popular en Salud.

Adult↗
PubMedDate not supplied

Health practices and health status: evidence from the Canada Health Survey.

Data from the Canada Health Survey were analyzed for the interrelationships of health practices and for the association of health practices with health status. Moderate alcohol use, not smoking, and seat belt use formed a cluster representing passive avoidance of direct risks; exercise and immunization made up another component, identified as active avoidance of abstract risks. These six practices clustered in the same fashion for both sexes; but for women, there was an additional factor, the avoidance of sex-specific risks. Separate health practice indices were created for men and women based on these behaviors. Index scores were shown to be significantly associated with four measures of health status. The association was particularly strong for the two indicators of emotional health for both sexes and for all four indicators for women. This study confirms the conclusions of earlier reports based on regional or highly selected samples and extends them to emotional health status; it is the first study to publish comprehensive data on this question from a sample survey representative of an entire national population.

Age Factors↗
PubMedDate not supplied

Health insurance and health status: implications for financing health care reform.

Self-reported health status measures from the 1987 National Medical Expenditure Survey indicate significant differences among each of five population groups defined by current health insurance coverage. These differences in health status imply that the groups are likely to exhibit different patterns of expenditures, even if enrolled in the same health insurance after health care reform. The healthiest group along most dimensions is the population covered by employer-sponsored insurance, followed in order by the population with nongroup private insurance, the uninsured population, the population that qualifies for public coverage based on income, and the population that qualifies for public coverage based on medical need. While the general health and mental health of the uninsured are slightly worse in comparison to the privately insured, the uninsured have fewer chronic health problems. The uninsured who recently lost private insurance or who live in working families are significantly healthier than the long-term or low-income and nonworking uninsured.

Adolescent↗
PubMed2000

The interdependence of mental health service systems: the effects of VA mental health funding on veterans' use of state mental health inpatient facilities.

BACKGROUND: There are relatively few published data on how the financial structures of different health systems affect each other. With increasing financial restrictions in both public and private healthcare systems, it is important to understand how changes in one system (e.g. VA mental healthcare) affect utilization of other systems (e.g. state hospitals). AIMS OF THE STUDY: This study utilizes data from state hospitals in eight states to examine the relationship of VA per capita mental health funding and state per capita mental health expenditures to veterans' use of state hospitals, adjusting for other determinants of utilization. METHODS: This study utilized a large database that included records from all male inpatient admissions to state hospitals between 1984 and 1989 in eight states (n = 152541). Funding levels for state hospitals and VA mental health systems were examined as alternative enabling factors for veterans' use of state hospital care. Logistic regression models were adjusted for other determinants of utilization such as socio-economic status, diagnosis, travel distances to VA and non-VA facilities and the proportion of veterans in the population. RESULTS: The single strongest predictor of whether a state hospital patient would be a veteran was the level of VA mental healthcare funding (OR = 0.81 per $10 of funding per veteran in the population, p = 0.0001), with higher VA funding associated with less use of state hospitals by veterans. Higher per capita state funding, reciprocally, increased veterans' use of state hospitals. We also calculated elasticities for state hospital use with respect to VA mental healthcare funding and with respect to state hospital per capita funding. A 50% increase in VA per capita mental health spending was associated with a 30% decrease in veterans' use of state hospitals (elasticity of -0.6). Conversely, a 50% increase in state hospital per capita funding was associated with only an 11% increase in veterans' use of state hospitals (elasticity of 0.06). IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: These data indicate that per capita funding for state hospitals and VA mental health systems exerts a significant influence on service use, apparently mediated by the effect on supply of mental health services. Veterans are likely to substitute state hospital care for VA care when funding restrictions limit the availability of VA mental health services. However, due to the relative sizes of the two systems, VA funding has a larger effect than state hospital funding upon state hospital use by veterans. IMPLICATIONS FOR HEALTH POLICIES: These data indicate that changes in the organizational and/or financial structure of any given healthcare system have the potential to affect surrounding systems, possibly quite substantially. Policy makers should take this into account when making decisions, instead of approaching systems as independent, as has been traditional. IMPLICATIONS FOR FURTHER RESEARCH: Further research is needed in two areas. First, these results should be replicated in other systems of care using more recent data. Second, these results are difficult to generalize to individual behavior. Future research should examine the extent and individual determinants of cross-system use.

Journal Article↗
PubMed1998

Mental health expectancy: an indicator to bridge the gap between clinical and public health perspectives of population mental health.

Mental health indicators generally used in public health are derived from mortality statistics, but they do not reflect the impact that disability due to mental disorders has on population health. The present study proposes a global indicator of population mental health which combines both mortality and morbidity data. The data used were the results of a Health Interview Survey, including the 12-item version of the General Health Questionnaire, mortality life-tables for the general population, and data from a two-step epidemiological study used to assign the probability of case status. The results are calculated for the Catalonia region in north-east Spain. Life expectancy and mental health expectancies at all ages were found to be higher for women than for men. Men were found to have a higher total life expectancy in good mental health. The feasibility and potential areas of application of this generic mental health index are discussed.

Adolescent↗