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Mode of payment as a predictor of health status, use of health services and preventive health behavior: a report from the Los Angeles Health Survey.

Several issues relevant to Health Maintenance Organizations (HMOs) were examined in this article using data collected from the Los Angeles Health Survey. No support was found for the hypothesis that HMOs disproportionately attract people in poorer health. In fact, HMO members actually reported lower rates of acute or occasional illness and disability than fee-for-service subscribers (FFS). HMO members also reported lower total family incomes and educational status than FFS subscribers and they were less likely to report having a regular doctor. Few differences were found between the two groups in reports of using health services and practicing preventive health behavior. However, HMO members were more likely to report a recent physical examination--but only after taking into account the fact that they were less likely to have a regular doctor. It has been shown that these findings are consistent with recent evidence, and serve to amplify serveral key findings reported in other studies.

Adolescent↗

Evaluation of preventive health services for hospitalised children under a child health programme.

In the hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, the Child Health Programme (CHP) has been offering preventive health care services to about 60,000 patients per year. The patient populations are mostly children who stay with their mothers or other relatives. In this programme, health education, immunisation and nutrition rehabilitation services are offered. Health education is offered as group discussion and face-to-face interaction between the educator and the mother. Immunisation is offered daily from 0700h to 1900h to all children and women attending the hospital. Nutrition rehabilitation services, both inpatient and outpatient, are offered to severely undernourished children. These preventive services are implemented by health workers and health assistants. All attendants and adult patients participate in health education sessions. More than 80% of unimmunized children and 50% of unimmunized women receive immunisation. The experience of the CHP shows that it is possible to offer different preventive health care services to all attendants and patients attending a busy hospital.

Bangladesh↗

Self-reported utilization of preventive health services by retired employees age 65 and older.

OBJECTIVES: Increased utilization of preventive services among the aging has been associated with improved health status and decreased medical costs. We sought to examine the use of the Health Risk Appraisal (HRA) in benchmarking compliance and characterizing those retired employees who met preventive service guidelines. DESIGN: A retrospective cohort study of retired employees age 65 and older. SETTING: Nation-wide health promotion program offered by General Motors Corporation. PARTICIPANTS: 59,670 retired General Motors employees age 65 and older who participated in a nationwide mailed HRA health promotion program. MEASUREMENTS: Preventive health services compliance was measured using selected HRA questions. Gender, HRA participation patterns, overall health risk status, medical plan selection and disease status were examined as predictors of increased compliance. Multivariate logistic regression models were developed to test the relative contributions of participant characteristics to increased utilization. RESULTS: The self-reported HRA data indicated that compliance levels were higher than national averages. The Healthy People 2000 goals for the preventive services studied were met and exceeded (with the exception of tetanus immunization). Higher compliance was associated with being male, younger than 70 years, multiple-year HRA participation, overall low risk status and HMO insurance plan selection. CONCLUSION: The results from the HRA indicated that this population participated at a higher level than a comparable national sample exceeding goals set by Healthy People 2000.

Age Factors↗

Relationship between preventive health services and use of inpatient and outpatient care by residents aged 40 or older in 44 municipalities in Osaka Prefecture, Japan.

We examined the relationships between preventive health services provided under the Law for Health and Medical Services for the Elderly and the use of inpatient and outpatient care by insured residents aged 40 or older covered by the National Health Insurance in 44 municipalities in Osaka Prefecture. Factor analyses showed that hospital admission rate and inpatient days per 100 insured persons, bed days per insured person, inpatient days per case, mean bed days, the proportion of long-stay (180 days or more), and the rate of long-stay per 1,000 insured persons accounted for the first factors of inpatient care with factor loadings of more than 0.82. Outpatient utilization rate and outpatient days per 100 insured persons comprised the first factors of outpatient care with factor loadings of more than 0.80. Patient cost per case and the proportion of high patient cost (600,000 Yen or more for inpatient care and 60,000 Yen or more for outpatient care) made up the second factors of either type of patient care with factor loadings of more than 0.87. The frequency of use of health check-ups and the numbers of instruction classes and participants in health education and health counseling per 100 residents showed negative correlations with indices of inpatient and outpatient care, except for patient cost per day. The scores for the first and second factors of inpatient care and for the first factor of outpatient care correlated negatively with all indices of the use of preventive health services. More active provision of preventive health services may therefore contribute to reducing the subsequent use of inpatient and outpatient care among residents aged 40 or older.

Adult↗

The use of preventive health services by disabled children.

As a measure of the use of general pediatric health services we assessed disabled children's receipt of preventive health care in relation to a control group of nondisabled children, matched by age, family size, and region of residence. The study and control subjects were identified in a household survey conducted in Minnesota in 1976 and ranged in age from 1 to 18 years. The proportion who made a preventive health visit was nearly identical in both groups. Binary variable multiple regression showed that 9 percent of the variation in outcome was explained by the independent variables, which included demographic and socioeconomic characteristics and access to health care. Disability did not contribute significantly to the explained variation, but family structure, mother's education, and mother's use of preventive health services reached the 95 percent level of significance. The results suggest that children in a community who are identified as disabled are not at a disadvantage, in comparison with the nondisabled, in gaining access to preventive health services. The use of such services by all children appears to be low when information on using school health services is not available.

Adolescent↗

Maternal health locus of control beliefs, utilization of childhood preventive health services, and infant health.

This study examined the relationships among mothers' health locus of control beliefs concerning their children's health, utilization of childhood preventive health services, and child health status. Mothers' health beliefs were measured with the Parental Health Belief (PHB) scales developed to explore three factors: (1) mothers' degree of perceived control or internality with respect to their children's health, (2) the extent to which they believe that "chance" or (3) "powerful others" affected their children's health. Eighty-eight low- and middle-socioeconomic status black and Caucasian mothers and infants participated. Results indicate relationships among maternal health locus of control beliefs, utilization of preventive health services, and child health outcome, suggesting targeted ways in which utilization of childhood preventive health services and child health levels might be improved.

Adolescent↗

Utilization of preventive health services by HIV-seronegative injection drug users.

Little is known about the use of preventive health services by HIV-seronegative IDUs. This study examines screening and preventive health services use by two populations of HIV-seronegative IDUs recruited from a needle exchange program and methadone program. We found high rates of HIV and tuberculin skin testing in the past year as well as tetanus vaccination among both groups of IDUs. Hepatitis B and C testing was significantly higher in the methadone group than the needle exchange group. Syphilis testing and pneumovax administration was disappointingly low in both groups. Given the burden of disease among IDUs, our findings suggest the need for a distinct set of testing and vaccination guidelines for the HIV-seronegative IDU population.

AIDS Serodiagnosis↗

Assessment of delivery of preventive health services.

Our objective was to design and evaluate an instrument to assess the performance of a clinic in the delivery of preventive health services to a general medical clinic population. The patients were identified prospectively; data were obtained retrospectively with review of the charts. The study was conducted in a primary care clinic staffed primarily by internal medicine residents in an urban academic medical center. Patients who were receiving continuity care in the clinic and who were scheduled for an appointment during the 4-week study period were eligible for inclusion. Patients were identified by the appointment schedule. Charts were reviewed for the delivery of preventive health services. Data were abstracted utilizing a standard instrument. We found that the rate at which services were provided varied considerably by service and over time. The techniques used provided some insight into methods for the evaluation of the delivery of preventive services. It should be possible to assess a clinic's performance over a range of services over its entire population over time. An understanding of this more global performance may provide a better tool for managers and researchers addressing these issues. There may be legitimate reasons for services not being provided. These issues are complex and require sensitive, detailed investigation.

Delivery of Health Care↗

Acculturation, access to care and use preventive health services by Vietnamese women.

PURPOSE OF THE PAPER. The purposes of this study were to examine the relationships between acculturation and (1) access to health services and (2) use of preventive services among Vietnamese women in western Massachusetts. METHODS. The telephone survey method was conducted with 141 Vietnamese women ages 18 years or over. PRINCIPAL FINDINGS. Of the acculturation variables, language acculturation was significantly related to having a routine place for health care and a regular provider. Women tended to have better access to health service with an increase in the length of residence in the US. Length of residence in the US was an independent predictor of prior use of Pap test and clinical breast examination. CONCLUSIONS. Utilization level of preventive health services among study group participants was low. The findings indicate that length of residence and increase in language capacity (more English usage) lead to more adequate access to health care. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS. This study is particularly relevant to Vietnamese American women in the U.S. KEY WORDS. Vietnamese women; acculturation; preventive heaslth services; Massachusetts.

Journal Article↗

Preventive health services received by minority women aged 45-64 and the goals of healthy people 2000.

We attempted to evaluate the preventive health services received by minority women aged 45-64 in an underserved region of Boston. We compared two surveys of disease burden and preventive health services to national data sets and the goals of Healthy People 2000. We found that minority women seen both in community health centers and within the community had many cardiovascular risk factors (41-45% had hypertension, 24-29% had cholesterol > 200 mg/dL, and 49-56% had a body mass index of >27.3 kg/m(2)). Women reported that they received low rates of counseling on healthy behaviors but generally received breast and cervical cancer screening. Forty-three percent of women who were interviewed in the community had no health insurance and these women were less likely to have received a Papanicolaou test or mammogram than insured women. Lack of insurance did not predict cancer screening for women already being seen in the community health clinic.

Boston↗

Effects of preventive health services on survival of the elderly living in a community in Osaka, Japan.

STUDY OBJECTIVE: To examine the relationships between the use of preventive health services--such as health checks, basic health examination/cancer screening, and daily preventive health practices--and survival of elderly people living in the community. DESIGN AND SETTING: A cohort of elderly people aged 65 years and over living in Settsu City, Osaka was followed for 38 months. Data on the history of health management, disability scores, and psychosocial conditions were collected in October 1992 by interview during home visits. SUBJECTS: Of the 1491 people randomly selected from the computerised sex-age register at enrollment, 1473 were contacted and responses were obtained from 1405 (95.4%). They constituted the study cohort. Follow up was completed for 1325 (94.3%) (154 decreased and 1171 alive). MEASUREMENTS AND MAIN RESULTS: From the analysis using the Kaplan-Meier method and the log-rank test, female sex, younger age group (65-74 years), use of health checks, use of basic health examination and/or cancer screening, use of daily preventive health practices, less disability, taking part in social activity, and finding life worth living were univariately statistically significantly related to survival. The estimated survival rates were highest in those with regular health checks or daily preventive health practices before 59 years of age or both basic health examination and cancer screening. From the Cox proportional hazards model, use of health checks and use of daily preventive health practices remained as statistically significant factors associated with survival, controlling for other factors such as sex, age group, medical treatment, disability scores, and psycho-social conditions, and these hazard ratios (not used v starting at 59 years) were 0.41 (95% CI, 0.25, 0.66) and 0.52 (95% CI, 0.30, 0.88), respectively. CONCLUSIONS: Health management efforts such as health checks and daily preventive health practices may increase survival in the elderly.

Aged↗