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At least 217 records · Page 12Linked to original sources
PubMed1977

National health insurance policy in the United States: a case of non-decision-making.

Despite the vast range of commentaries and research on the current health care crisis, little research attention has been focused specifically on the lack of federal response to this crisis. As a way of focusing analysis on the specifics of Congressional inaction, it is suggested that both the range of health care proposals and the current debates in Congress may be seen as part of an ongoing bargaining process over legitimate alternatives for modication of health care delivery. It is argued that the lack of any new health care legislation may be seen as the result of a series of non-decision by conservative Congressional representatives of the dominant medical interest groups. These non-decisions have successfully excluded any challenges to those interests by reliance upon a predominant "mobilization of bias" to effectively define and/or divert these challenges as illegitimate attempts at change. The changes which eventually evolve from Congressional compromise may represent a modification of the prevailing bias concerning legitimate alternatives, but are unlikely to modify the relation of the controlling interests involved.

American Medical Association↗
PubMed1994

The relationship of prenatal care and pregnancy complications to birthweight in Winnipeg, Canada.

OBJECTIVES: Prenatal care is commonly understood to have a beneficial impact on birthweight. This study describes socioeconomic differences in utilization of prenatal medical care and birthweight in a population with universal health insurance. METHODS: Measures of prenatal care utilization, incidence of pregnancy complications, and birthweight were obtained from physician reimbursement claims and hospital separation abstracts for 12,646 pregnant women. Maternal socioeconomic status was derived from small-area census data. RESULTS: Infants born to women in the poorest income quintile had lower birthweights than infants born to wealthier women. Much of the difference was associated with a higher prevalence of complications, smoking, unmarried status, and inadequate prenatal care among low-income women. The difference in birthweight between adequate and less than adequate care groups was small, and the benefit associated with prenatal care was no greater among women with pregnancy complications. CONCLUSIONS: The lower utilization of prenatal care by poorer women accounted for a small proportion of the difference in birthweight. Socioeconomic differences in birthweight are primarily attributable to factors not directly influenced by early prenatal medical care.

Adolescent↗
PubMed1995

Naming notes: transitions from free text to structured entry.

To practice medicine in the near future, health care providers in the USA need an information infrastructure they do not yet have. We offer a contribution from social science research to discussions of current medical records practices and how health care activity systems may be transformed by the advent of electronic health records. The goal of the paper is to set forth a framework that connects over-arching questions concerning medical informatics systems development with the practical, cultural and conceptual issues involved in transitions from handwritten and other free text documentation to structured entry of medical records to build patient profiles. The research is broadly framed by an interest in how reciprocal modifications of the design and use of an electronic health record are negotiated in an iterative prototyping project. It is conducted as part of a complex multi-disciplinary research and development effort to create an electronic health record prototype for use in the integrated health care delivery environment of the Southern California Kaiser Permanente Medical Care Program.

Ambulatory Care↗
PubMed1976

The effect of prepaid group practice on physicians' utilization behavior.

The study is concerned with the practice of physicians in a prepaid group practice setting. Specifically, it is concerned 1) with investigating the extent of variation in physician behavior concerning use of clinical resources, that is, office visits and telephone calls, and technical resources, that is, x-rays and laboratory procedures, and 2) with determining the factors that account for such variation. The universe of this study consists of all internists practicing in 1970 in the prepaid group setting of Kaiser Permanente at Portland, Oregon, a total of 34. The overall framework for the study is based on the belief that medical training and the setting in which physicians work are significant determinants of their use of clinical and technical resources in different disease situations. Specifically, the framework posits that different sets of organizational variables are important in determining use of resources for acute and undiagnosed conditions. The findings reported in the study suggest that while the teaching environment in which a physician is trained is important in shaping his clinical personality, the setting in which he actually works contains its own source of influence over his professional activity. These results also provide supportive evidence for the widely held notion that prepaid group practice, through changing the nature of the incentives to physicians and introducing professional regulation, leads to a more efficient way of providing medical care by reducing the use of costly resources.

Consumer Behavior↗