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At least 433 records · Page 24Linked to original sources

Class differences in the social consequences of illness?

STUDY OBJECTIVE: To investigate adverse social consequences of limiting longstanding illness and the modifying effect of socioeconomic position on these consequences. DESIGN: Cohort study on the panel within the annual Swedish Survey of Living Conditions where participants were interviewed twice with eight years interval 1979-89 and 1986-97. Sociodemographic characteristics, self reported longstanding illness, employment situation and financial conditions were measured at baseline. Social consequences (economic inactivity, unemployment, financial difficulties) of limiting longstanding illness were measured at follow up eight years later. SETTING: National sample for Sweden during a period that partly was characterised by high unemployment and reduction in insurance benefits. PARTICIPANTS: PARTICIPANTS were 13 855 men and women, economically active, not unemployed, without financial difficulties at the first interview and aged 25-64 years at the follow up. MAIN RESULTS: Persons with limiting longstanding illness had a higher risk of adverse social consequences than persons without illness. The effect was modified by socioeconomic position only for labour market exclusion while the effects on unemployment and financial difficulties were equal across socioeconomic groups. CONCLUSIONS: Labour market policies as well as income maintenance policies that deal with social and economical consequences of longstanding illness are important elements of programmes to tackle inequalities in health. Rehabilitation within health care has a similar important part to play in this.

Activities of Daily Living↗

Substance use and assignment of representative payees.

Recent legislation prohibiting the awarding of Social Security Disability Insurance benefits to people whose disability is based on drug and alcohol abuse has effectively eliminated the Social Security Administration's practice of assigning representative payees to such persons. Currently no regulations exist for assigning representative payees to substance users who receive benefits based on non-substance-use disabilities. The authors suggest guidelines for determining when recipients with comorbid substance use disorders are incapable of managing their benefit funds. Representative payeeship is recommended for recipients who meet three criteria within the last 12 months: a maladaptive pattern of substance use; mismanagement of funds due to substance use, causing substantial harm to the recipient, unavailability of sufficient funds to meet basic needs, or victimization of the recipient; and availability of a representative payee whose efforts would increase the likelihood that the beneficiary's mismanagement of funds will be curtailed.

Alcoholism↗

Treatment choices by seriously ill patients: the Health Stock Risk Adjustment model.

Anecdotal evidence suggests that patients who have life-threatening conditions often choose to undergo high-cost, high-risk treatments for them. This kind of risk-seeking behavior seems irrational because most patients are risk-averse. The Health Stock Risk Adjustment (HSRA) model seeks to explain this phenomenon. The model is based on the concept of relative health stock--the ratio of patients' expected quality-adjusted life years (QALYs) after a diagnosis to their expected QALYs before the diagnosis. The model predicts risk-averse patients will behave in a risk-seeking manner as their relative health stocks deteriorate. The HSRA model can help physicians better understand why some seriously ill patients seek high-risk treatments while others elect to forgo treatment. State legislatures and insurers are attempting to appropriately design insurance benefits for patients with life-threatening conditions. The HSRA model can help predict which patients will most likely take advantage of these benefits.

Aged↗

Choices in health care: what are they and what are they worth?

This overview article provides a conceptual introduction to this special issue on health care choices, containing four main papers originally commissioned in 1997 for a conference titled "The Power of Choice in the Health Care Marketplace and Its Consequences," sponsored by the Robert Wood Johnson Foundation under its Changes in Health Care Financing and Organization (HCFO) program and conducted by the Alpha Center on November 19, 1997. Drawing on information from these four papers, the authors discuss what factors affect the different choices we face, highlighting the fact that different players in the health care system face diverse and often conflicting choices and trade-offs. The authors then examine the consumer choice model and its premise that when consumers are presented with adequate information about these different choices, they will make selections about plans, providers, and health insurance that will move the health care system toward a higher quality/lower cost equilibrium.

Attitude to Health↗

General Practitioners' views on the provision of nicotine replacement therapy and bupropion.

BACKGROUND: Nicotine replacement therapies (NRT) and a new drug, bupropion, are licensed in several countries as aids to smoking cessation. General practitioners (GPs) play a crucial role in recommending or prescribing these medications. In the UK there has been discussion about whether the medications should be reimbursable by the National Health Service (NHS). This study assessed English GPs' attitudes towards reimbursement of NRT and bupropion. METHODS: Postal survey of a randomly selected national sample of GPs; 376 GPs completed the questionnaire after one reminder; effective response rate: 53%. There was no difference between the responses of GPs who responded to the initial request and those who responded only after a reminder suggesting minimal bias due to non-response. RESULTS: Attitudes of GPs were remarkably divided on most issues relating to the medications. Forty-three percent thought that bupropion should not be on NHS prescription while 42% thought that it should be (15% did not know); Fifty percent thought that NRT should not be on NHS prescription while 42% thought it should be (8% did not know). Requiring that smokers attend behavioural support programmes to be eligible to receive the medications on NHS prescription made no appreciable difference to the GPs' views. GPs were similarly divided on whether having the medications reimbursable would add unacceptably to their workload or offer a welcome opportunity to discuss smoking with their patients. A principal components analysis of responses to the individual questions on NRT and bupropion revealed that GPs' attitudes could be understood in terms of a single 'pro-con' dimension accounting for 53% of the total variance which made no distinction between the two medications. CONCLUSIONS: GPs in England appear to be divided in their attitudes to medications to aid smoking cessation and appear not to discriminate in their views between different types of medication or different aspects of their use. This suggests that their attitudes are generated by quite fundamental values. Addressing these values may be important in encouraging GPs to adhere more closely to national and international guidelines.

Antidepressive Agents, Second-Generation↗