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PubMed1992

The effect of health care coverage on medical cost, utilization, and well-being of the aged.

The relationship of medical insurance, utilization and health status indicators was examined for 463 elderly individuals. The uninsured were less well and tended to utilize the health care system more often than those with more types of coverage. Need was found to be the best predictor of utilization. A profile describing those with above average levels of well-being also was developed. Methodological issues and health care policy recommendations are discussed.

Aged↗
PubMed1999

Using the POPULIS framework for interprovincial comparisons of expenditures on health care. Population Health Information System.

OBJECTIVES: Motivated by Manitoba Health's desire to know how health spending in Manitoba compared with other provinces, this study is a descriptive project designed to inform the health policy process by comparing indicators of need and expenditure across Canada. RESEARCH DESIGN: Population characteristics that are known to influence the need for health care constitute the comparative data categories. FINDINGS: In terms of all five health status indicators and five of eight socioeconomic indicators, Manitoba ranked medium (fourth to seventh of 10 provinces) or average. Demographic characteristics placed Manitoba second to Saskatchewan in proportion of both elderly residents and Registered Indians. This is notable, because both groups traditionally have high health needs. With provincial characteristics established, the second part of the study compares provincial per capita health expenditure data with expected need for health care services. RESULTS: Overall, the study finds provincial health expenditures are not related to health care need indicators. Saskatchewan is a case in point; despite having similar population characteristics to Manitoba, Saskatchewan has a population with good health status and lower health care expenditures. This offers a model that invites further exploration. CONCLUSIONS: At the provincial level the amount of health care spending is not positively related to the need for health care.

Adolescent↗
PubMed1996

The relationships among gender, perceived financial barriers to care, and health status in a rural population.

This study examined the relationships among gender, perceived financial barriers to health care, and selected health status indicators in a randomly selected rural Appalachian sample. The data were gathered through the Johnson County Health Survey. The survey was conducted through personal interviews with 207 females and 178 males representing 197 households. The Duke Health Profile was used to measure the perceived health of the respondents. Analysis of variance, t tests, and descriptive statistics were used to analyze the data. Analysis of the data revealed that women perceive financial barriers to health care significantly more than men (P < 0.01), even when living in the same household; women had significantly poorer health than men (P < 0.01); and both women and men with perceived financial barriers experienced poorer health (P < 0.01) than those who did not perceive such barriers. Conclusions from the study suggest that in this rural sample women were the most compromised by both gender and health status, and that they perceived that their health care needs were not being adequately met.

Community Health Centers↗
PubMed1976

State level comprehensive health planning: a retrospect.

A questionnaire survey of the 50 state CHP agencies and a case study of a single state CHP agency were conducted to contrast the concept of comprehensive health planning with the practice of health planning at the state level. Both the survey and the case study evidenced a substantial disparity between concept and practice. For example, the survey indicated that the following tasks had not been completed by the following percentages of the responding agencies: defining the system of interest (64%), ranking problems (50%), setting targets (74%), thoroughly analyzing intervention alternatives (71%), selecting criteria and procedures for intervention evaluations (57%). The state CHP agencies were found to be lacking in the following areas: (a) technical analyses, (b) explicitness, (c) priority setting, (d) attention to health status indices and preventive interventions, and (e) integration of planning activities. The implications of these findings are discussed.

Evaluation Studies as Topic↗
PubMed1997

A comparison of the subjective oral health status of older adults from deprived and affluent communities.

A comparative study of the subjective oral health status of 60-65-year-old residents was undertaken in two Liverpool electoral wards, Vauxhall, the most deprived, and Woolton, the most affluent in the city. The measuring instrument used was the Subjective Oral Health Status Indicators (SOHSI) questionnaire devised by Locker. The questionnaire was administered by post to random samples of 250 residents from each ward. The main aim of the study was to compare the reported impact of oral conditions on the lives of individuals living in deprived and affluent communities. Responses of 59.6% for the deprived ward and 77.7% for the affluent ward were achieved. The literature suggested that significant differences could be expected between the wards in the reporting of subjective impact. However, significantly greater impact for only one functional sub-scale and one psycho-social sub-scale was reported by residents from the deprived ward. Further analysis of the relationship between impact and socio-demographic variables revealed a strong association between self-reported general health status and the subjective oral health indicators. Finally, a stepwise regression analysis found that pain and chewing problems were the only significant predictors of psycho-social impact. This finding confirms that the individual's socio-economic circumstances are of secondary importance to pain and functional problems in determining the psycho-social effects of oral conditions, as predicted by the conceptual model on which the measuring instrument is based.

Aged↗
PubMed2001

Psychiatric health service areas in the southeast.

Analysis of small areas in psychiatric health services research is sensitive to the choice of geographic units. To partially overcome the arbitrary aspects of political boundaries, service areas can be synthesized from empirical data on consumer migration patterns. Using patient flow data from 1991 Medicare discharges, we completed an agglomerative cluster analysis to generate psychiatric health service areas (PHSAs) and found that the optimal solution contained 75 PHSAs. Solutions greater than 75 clusters had high rates of area fragmentation and small single-county clusters. Psychiatric resource supply and health status indicators should be analyzed using expanded geographic units.

Catchment Area, Health↗
PubMed2004

[Influence of patient's social and demographic characteristics on patient's expectations for medical consultation].

UNLABELLED: Most of the patients, coming to see their primary care physician, have explicit expectations and priorities for the medical consultation. Recognition of these expectations is an important step in organizing patient-oriented health care services. Patient expectations depend on a number of factors: health problem and its severity, as well as social and demographic characteristics of patient and physician. Objective of this survey was to evaluate influence of patient's socio-demographic characteristics and some health status indicators on expectations for primary care consultation. MATERIAL AND METHODS: During the study 403 patients and 162 physicians were surveyed. Pre-visit expectations of patients coming to see their primary care physician for health problem were investigated using self-addressed original questionnaire. RESULTS: Factor analysis revealed three main factors: biomedical expectations, emotional support expectations and expectations for partnership. Analysis of influence of socio-demographic characteristics on patient expectations showed that statistically significant differences in different age groups were found only for emotional support factor. Patients' desire for emotional support from doctor increased with age. Relationship was observed between expectations for emotional support and health status as perceived by patient. Patients evaluating their health problem as not serious had mean score of expectations for emotional support 3.4, patients with moderate health problem--3.5, patients with serious health problem--4.0 out of 5. CONCLUSIONS: Patient's need for emotional support from physician depends on his age, marital status, frequency of his visits to physician during the year, self-perception of the health status and course of disease. Analysis of relationship between patient's expectations and his sex, education, physician's sex or type of practice did not show statistically significant differences between groups. No influence of analyzed social and demographic characteristics or perceived health status on biomedical expectations (laboratory tests, specialist consultations, and hospital treatment) was found during our study.

Age Factors↗
PubMed1976

Constructing social metrics for health status indexes.

Health status indexes used to make collective decisions satisfying the principles of equality and social minimum must incorporate a social metric for health. Any index or indicator applied to populations for determining health status or to health programs for evaluating outcome must confront the question of who prefers which states of health under which circumstances? Utility models, psychometric scaling, and empirical social decision valuation have been used to measure preferences for states of health. Efforts should be directed toward constructing social metrics for health that are prospective, context-independent, relevant, community-wide, ratio scalled, sensitive, empirically validated, and applicable to program evaluation. These efforts represent the application of normative social theory to research, an important advance in uncovering the mysteries of social action and its consequences.

Attitude to Health↗
PubMed2000

Income, occupational position, qualification and health inequalities--competing risks? (comparing indicators of social status).

STUDY OBJECTIVE: The debate on health inequalities has shifted from the consequences of occupational position, as expressed in the Registrar General's classification, to consequences of material living conditions. This change in interest occurred without comparative analyses of different sources of health inequalities. Thus this study investigated the relative contribution of "material resources" (income), "qualification" and "occupational position" for explaining social differentials in mortality. DESIGN AND SETTING: Analyses were performed with records from a statutory health insurance in West Germany. The analyses were performed with data of 84,814 employed men and women between 25 and 65 years of age who were insured between 1987 and 1995 for at least 150 days. RESULTS: The three indicators were statistically associated, but not strong enough to warrant the conclusion that they share the same empirical content. The relative risk (hazard rate) for income by controlling for occupational position and gender for the highest as compared with the lowest category was 1.99 (95% CI 1.66, 2.39). The corresponding relative risk for income by controlling for qualification and gender was 2.03 (95% CI 1.68, 2.46). In both multivariate analyses, the effects of occupational position and qualification were no longer interpretable because of large confidence intervals. In sum, income related relative mortality risks were the comparably highest, while qualification and occupational position were no longer substantial. CONCLUSIONS: The results emphasise the present discussion on the consequences of material living conditions. Income on the one hand and qualification and occupational position on the other are largely independent. Mortality related effects of income override those of the other socioeconomic status indicators. However, seen in a time perspective, qualification may still have a placement function at least for the first occupational position.

Adult↗
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↗
PubMed1998

Building public health goals into the purchasing process: the Missouri Medicaid agency as purchaser.

INTRODUCTION: As managed care radically changes the medical care environment, public health leaders are under increasing pressure to focus more on core public health functions and less on personal health services. As public health re-evaluates its key strategies, it can take advantage of its strategic role in purchasing medical care to forge new partnerships that benefit its constituents. METHODS: Specific roles for public health in medical care purchasing are discussed. The state of Missouri is used as an example of successful strategies for positioning public health as a leader in the managed care environment. Key strategies include increasing influence in contracting; selecting and reporting of key health status indicators; promoting use of population-based data files; taking leadership roles in government-sponsored insurance programs; and assuring stability of critical health conditions during managed care transitions. CONCLUSION: Public health has unprecedented opportunities to develop new methods for improving health status. Public health's well-developed scientific principles and methods, combined with strategic leadership, will position the discipline in the forefront of the dialogue about our nation's health system into the next century.

Contract Services↗
PubMed2002

The GAIN (Geriatric Anorexia Nutrition) registry: the impact of appetite and weight on mortality in a long-term care population.

PURPOSE: To investigate nursing home residents at high nutritional risk to determine: 1) which baseline nutrition or health status indicators correlated with subsequent weight gain or appetite improvement; and, 2) whether a continued weight loss correlated with higher mortality. METHODS: At study entry, nutritional, health status, and demographic data were extracted from the nursing home chart or the MDS. Each subject was tracked for 6 months with survival, weight gain of 5%, and appetite improvement the primary outcome measures. RESULTS: During the 6-month study, younger age was the strongest correlate of appetite improvement. The odds of gaining weight were negatively correlated with BMI, age, and feeding dependency. Subjects who were receiving appetite stimulants (orexigenics) at study entry had a 70% greater probability of gaining weight than those who were not. A weight loss during the 6-month period was associated with a nearly two-fold increase in the likelihood of dying (adjusted RR: 1.95, 95% CI 1.43 to 2.66). CONCLUSION: The course of nutritional problems within nursing homes is highly variable. Continued weight loss, however, appears to have ominous implications for mortality. Younger residents who are not dependent on others for feeding assistance, and who receive orexigenics tend to experience weight gain.

Age Factors↗
PubMed1994

Public health in the next century.

The over-reliance of our health care system on treatment of disease rather than prevention of disease has brought it to the point of near financial collapse. Although improvements in longevity and in key health status indicators have occurred, to some extent from advances in medical care, many of the gains in healthy living have come from basic population-based interventions known as public health. This article describes the role and function of public health, describes the public health system in Missouri, and recommends the reinventing of public health for the next century.

Forecasting↗
PubMedDate not supplied

Baccalaureate educator use of environment-based strategies to teach diagnostic patterns.

Baccalaureate nurse educators reported that their use of 10 environment-based strategies in the classroom or clinical setting may foster recognition of diagnostic patterns likely to be encountered in clinical practice. Environment-based strategies are verbal or print materials that draw attention to a particular aspect of what is being taught and that draw attention to important information. A national sample of 255 full-time baccalaureate educators (56 per cent return rate) from 28 randomly selected programs completed a questionnaire. The reliability estimate related to the 10 items was 0.70. Most respondents reported use of all 10 environment-based strategies with a minimum reported use of 60 per cent for each strategy on at least a "sometimes" basis. The most frequently reported use of a strategy on a "greater than sometimes" basis was the transparency (75 per cent). Color and print differences were the most infrequently used at 40 per cent and 37 per cent, respectively. The results of this study show that faculty, either consciously or unconsciously, use the environment-based strategies to facilitate student selection of key diagnostic indicators. Increasing educators' awareness of such benefits to students may stimulate further research in this area. Methods to help students decipher significant health status indicators from associated ones are clearly needed so that timely intervention can be used to prevent harm to patients.

Attention↗
PubMed1983

[Work environment and health status of agricultural aviation personnel].

The morbidity rate and present health status of flying agricultural aviation personnel under health care of the Main Military Medical Committee for aviation workers were analysed and compared with another group of helicopter pilots. A detailed clinical examination of 77 "Agro" pilots indicated more trauma cases than idiopathic diseases cases, some of those trauma cases were due to professional work. Analysis of the present health status indicated the predominance of pilots with just one health disturbance, pilots with no health disturbances taking the second position in the comparison. The health deviations did not differ from those in other populations, as classified by pilots' age. On the other hand, their percentage was higher than in helicopters pilots control group. Average age of "Agro" pilots was relatively high and number of hours spent in air considerable, too.

Accidents, Aviation↗
PubMed2006

Do psychological characteristics explain socioeconomic stratification of self-rated health?

This study evaluated whether negative emotions explain socioeconomic status (SES) stratification of self-rated health (SRH) and whether this putative relation is independent of established SRH determinants. Mood disorders, trait negative affect and health status indices were assessed in a representative cross-sectional survey of 3032 adults in the National Survey of Midlife Development in the United States (MIDUS). Adjustment for health behaviors and health status appreciably reduced SES influence on SRH, but adjustment for negative emotions did not. However, both psychological resources (e.g. social support, extraversion) and negative emotions independently predicted SRH. Detection of SRH determinants was sensitive to binary versus ordinal SRH definitions.

Adult↗