[Preparations for personal capital financing--4: Is your marketing fit for a rating?].
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Capital Financing↗
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Results for “Financing, Personal”
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Healthcare finance is personal for HFMA's new chairman, David Canfield.
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Career Mobility↗
Organization and financing of personal health services today.
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Humans↗
Consumer-directed models of personal care: lessons from Medicaid.
"Consumer-directed" models of financing and services delivery are compared with models that emphasize professional control and accountability within the context of Medicaid-financed personal care services (PCS). The Medicaid PCS benefit finances aide or attendant services for low-income persons with functional disabilities to assist them with daily living tasks. Consumer-directed modes of service provision permit service recipients themselves to have greater choice and control over all aspects of service provision. Client surveys in three states found that clients were most satisfied with the program elements of Medicaid PCS services that gave them more choice and control. Case studies of how Medicaid PCS programs in particular states are administered indicate that the use of aides who are independent providers, unattached to a home health or home care agency, is a critical aspect of consumer direction. By itself, however, this factor does not guarantee consumer direction because other Medicaid PCS rules and regulations may restrict client choice and control.
Aged↗
Personal income and finances: regional comparisons.
As the "baby boom" generation moves closer to retirement and Social Security and Medicare face potential problems, the financial condition of U.S. households and families has become a much discussed topic. The personal saving habits, wealth and debt burden of society have been intensely analyzed in order to gauge the future impacts on the economy. This article views personal income growth from a regional perspective, pointing to the vastly differing outcomes of total and per capita data. The importance of regional differences in cost of living and taxation and the possible impacts on personal finances are highlighted. A review and debate on the broad brush approach of many federal programs is suggested.
Economics↗
Canada's disabled population in institutions.
One percent of Canada's population are long-term residents of health care institutions. Of this group an estimated 97% have a disabling condition. This article profiles disabled people living in institutions using data from the Health and Activity Limitation Survey (HALS) undertaken by Statistics Canada. HALS collected data on: the nature, number and severity of disabilities; the underlying causes of the disabilities; and the degree of assistance required for daily activities. For the institutional component of HALS, a sample of 19,000 disabled individuals from 1,100 institutions was used. The institutional survey indicated that almost 80% of the disabled population in institutions were aged 65 or older, while about 90% had mobility and/or agility-related disabilities. The most frequently cited underlying cause of disability for respondents living in both institutions and households was disease or illness. Among young adults in institutions, mental retardation was the main disabling condition. Among the elderly, diseases of the musculoskeletal system and connective tissue (including arthritis) were most common. Most respondents in institutions required daily help with personal care, shopping and personal finances.
Activities of Daily Living↗
Follow the money: funding streams and public health nursing.
The increasing reliance of health departments on income generated by billing for individual clinical services impacts the role and outlook of public health nurses. This commentary discusses some of the reasons for the emergency of that finance trend and the current shifts in financing personal care, with observations on the challenges facing nurses in public health agencies today.
Community Health Services↗
Factors influencing students' borrowing that may affect their specialty choices and other after-graduation behaviors.
PURPOSE: To assess the factors that influence medical students' borrowing and how these factors may affect access to the profession, specialty choice, and medical graduates' repayment behaviors. METHOD: The borrowing patterns of the 3,495 indebted students enrolled at Jefferson Medical College of Thomas Jefferson University between 1989-90 and 1994-95 were analyzed. (Debt included both subsidized and unsubsidized debt.) These borrowing patterns were assessed in relation to changes in the cost of education, family (i.e., parents') income, availability of grant funding, legislative changes to loan-eligibility criteria (specifically, the Higher Education Amendments of 1992), and average interest rates on federal unsubsidized loans. RESULTS: The annual changes in average debt levels suggest that while cost of education, family resources, and availability of grant funding may be significant factors, changes in loan eligibility and prevailing interest rates on unsubsidized loan source also influence medical students' borrowing. A comparison of the borrowing patterns for three income groups (low, middle, high) further demonstrated that while overall fluctuations for low-income group mirrored changes in the cost and resource variables, annual borrowing fluctuations for the middle- and high-income groups were more reflective of the expansion of loan eligibility and reduced interest rates on unsubsidized loans. From 1989-90 to 1994-95 the average cost of education increased by $2,368. Average unsubsidized debt increased by $1,544 for the low-income group, $3,960 for the middle-income group, and $4,439 for the high-income group. The percentage of unsubsidized funding included in the borrowers' financing packages increased by just under 6% for the low-income group but almost 10% and 11% for the middle- and high-income groups, respectively. CONCLUSION: The results suggest that medical students borrow for a variety of reasons, ranging from financial need to personal financing or lifestyle choices. These reasons should be considered in relation to institutional and governmental financial aid policies and future research on the relationship between debt and speciality choice.
Academic Medical Centers↗
Surgical residents in the 1990s. Issues and concerns for men and women.
OBJECTIVE: To survey the concerns of surgical residents in New England and to determine whether similarities or differences exist based on gender. DESIGN/SETTING: A survey was distributed to all 21 surgical residency programs. The survey consisted of six demographic questions and 23 items, which the residents coded on a Likert-type scale. PARTICIPANTS: Surgical residents enrolled in a general surgical residency or specialty residents completing general surgery requirements. INTERVENTION: Distribution and completion of the survey. MAIN OUTCOME MEASURE: Prominent concerns among residents during training years and gender differences based on these concerns. RESULTS: All programs responded. A completed survey was returned by 501 residents (73%), 378 (75%) of whom were male and 123 (25%) of whom were female. On a scale of 1 to 5 (from no concern to major concern), the five most important issues were work hours (mean, 3.4), personal finances (mean, 3.1), quantity and quality of formal education (mean, 3.0 each), and postponement of family plans (mean, 2.9). Six items surveyed were of more concern to women than men; availability of role models, mentors, or both; comfort in expressing emotions at work; initiating and maintaining personal relationships; having children during residency; and postponing family plans. CONCLUSIONS: Three of the highest-reported concerns for the entire group are issues that could conceivably be controlled by surgical chairpersons and program directors. In contrast, only one of the six concerns that differed for men and women is directly program related. The remaining five issues require changes in societal values for these differences to dissolve.
Adult↗
Assistance arrangements and use of services among persons with multiple sclerosis and their caregivers.
A large population-based survey of persons with multiple sclerosis (MS) and their caregivers was conducted in Ontario using self-completed mailed questionnaires. The objectives included describing assistance arrangements, needs, and use of and satisfaction with services, and comparing perceptions of persons with MS and their caregivers. Response rates were 83% and 72% for those with MS and caregivers, respectively. Based on 697 respondents with MS whose mean age is 48 years, 70% are female, and 75% are married. While 24% experience no mobility restrictions, the majority require some type of aid or a wheelchair for getting around. Among 345 caregivers, who have been providing care for 9 years on average, the majority are spouses. Caregivers report providing more frequent care than do persons with MS report receiving it, particularly for the following activities of daily living: eating, meal preparation, and help with personal finances. Caregivers also report assistance of longer duration per day than do care recipients with MS. Frequency and duration of assistance are positively associated with increased MS symptom severity and reduced mobility. Generally there is no rural-urban disparity in service provision, utilization or satisfaction, and although there is a wide range of service utilization, satisfaction is consistently high. Respite care is rarely used by caregivers. Use of several services is positively associated with increased severity of MS symptoms and reduced mobility. Assistance arrangements and use of services, each from the point of view of persons with MS and their caregivers, must be taken into account in efforts to prolong home care and to postpone early institutionalization of persons with MS.
Activities of Daily Living↗
Correlates of early disability in Huntington's disease.
Functional disability in Huntington's disease usually results from a combination of the movement disorder, intellectual decline, and psychopathological changes, but the unique contribution of each element has never been investigated. The Shoulson-Fahn functional capacity rating scale measures independence in such daily activities as eating, dressing, and managing personal finances, and is used to stage the illness and follow its progression. To determine which problems contribute most to reduced functional capacity as the disease evolves, we reviewed the records of 48 consecutive patients who were evaluated for intellectual and emotional status and motor disability. Each patient was staged and rated for functional capacity at the time of the examinations. Thirty-three of these patients were followed over several years with repeat evaluations at 6-month intervals. Intellectual impairment and depression correlated significantly with reduced functional capacity. However, when the somatic symptoms of depression were eliminated from the analysis, its relationship to functional capacity was no longer significant. Duration of illness, motor disability, and age at onset also had little impact. Neuropsychological test performance and functional capacity deteriorated over time. Our data suggest that intellectual impairment is a major factor in reducing functional capacity in the early stages of Huntington's disease.
Activities of Daily Living↗
Health care utilization among persons who are unemployed or outside the labour force.
BACKGROUND: In Sweden, equity in health is a central aim of public health policy. To this end, the health care system is obligated to offer equal access to health care according to need. However, unemployment may hinder the fulfillment of this goal. The aim of the present study was to assess self-reported health care needs and service utilization with respect to employment status. METHODS: A questionnaire was sent to 4000 randomly chosen individuals 20-64 years of age living in different counties in Sweden (response rate 66.2%). Logistic regression analyses were carried out to estimate the influence of employment status, socio-demographic variables and health indicators on the need for and use of health care services. RESULTS: In total, 42.2% (n=35) among the unemployed, 37.4% (n=55) among persons who were on long-term sick leave (LTSD), and 22.3% (n=467) of the employed persons, abstained from consulting a physician despite reporting a perceived need to do so. The results persisted after adjusting for socio-demographic variables, social support and personal finances (unemployed: OR=1.91; LTSD: OR=1.62). The risk of foregoing care remained higher among the unemployed, but not the LTSD-group, after adjusting for long-standing illness (OR=1.94). The unemployed were more likely than the employed to perceive a need to seek care for psychological problems. The risk of abstaining from consulting a physician was related to symptoms of depression. CONCLUSIONS: Lack of employment may be related to unmet care needs, especially among unemployed who are experiencing psychological symptoms. To deal with the needs of the unemployed it may be useful to develop interventions within the health care system that focus more on psychological problems.
Adult↗
Perceptions of recent ophthalmology residency graduates regarding preparation for practice.
OBJECTIVE: To evaluate young ophthalmologists' perceptions of how well residency training prepared them for various aspects of their clinical practice. DESIGN: Self-administered survey. PARTICIPANTS: Two hundred sixty-nine United States ophthalmologists who have been in practice for < or =5 years. METHODS: A 4-page questionnaire was mailed to a randomly selected sample of 900 U.S. members and fellows of the American Academy of Ophthalmology who had been in practice for < or =5 years. MAIN OUTCOME MEASURES: Comparison of perceived preparedness in clinical and nonclinical areas of ophthalmology practice. RESULTS: Two hundred sixty-nine surveys were completed and returned (margin of error, +/-5%). Analysis of tabulated results indicated that 86% said they were extremely or very well prepared to practice comprehensive ophthalmology after residency training. Even so, about half of those respondents also desired some additional clinical training, and two thirds felt the need for some additional training in surgical areas (refractive, oculoplastics/orbital, glaucoma, retina, and pediatric ophthalmic surgery). At least 60% reported being not very or not at all well prepared in 6 of the nonclinical areas explored (business operations and finance, personal financial management, practice management skills, coding and reimbursement, political advocacy, and exposure to practice setting models). With the exception of personal financial management, most ophthalmologists thought training in all of these nonclinical areas was the responsibility of the residency training program. CONCLUSION: The transition from residency training to successful, efficient, ethical, high-quality ophthalmic practice demands a number of skills in addition to diagnostic acumen and surgical ability. In general, the U.S. residency program graduates surveyed are comfortable with their clinical training, but less so with their training in nonclinical areas. Opportunities to help ophthalmologists prepare better for the transition to clinical practice after training appear to exist and might be addressed by training programs, professional organizations, informal physician networks, and other stakeholders.
Adult↗
Adequacy of dialysis: the patient's role and patient concerns.
The patient's role in adequacy of hemodialysis is demanding and complex. It requires meticulous attention to initiating, accepting, and maintaining extraordinary behavioral change. This includes the following: (1) major alteration of dietary habits, often contrary to a patient's familial and cultural customs; (2) compliance with a new, voluminous medication routine, often straining personal finances; (3) reallocation of time for transportation, treatment, and partial recovery, frequently consuming a minimum of 6 to 8 hours 3 days each week; (4) psychologic adjustment to unaccustomed chronic dependency on, and accountability to, an array of variably experienced and competent renal care staff; (5) skills, seldom taught, required to communicate clearly and regularly with overworked medical professionals who are often much younger with less life experience; and (6) additional commitment to compensating for the physical fatigue that routinely accompanies hemodialysis. Reasonable behavioral modification in these 6 categories is likely to increase the chances of a patient fulfilling his role in adequacy of dialysis. Some patients, however committed the staff have been in assisting them, may show little interest in dialysis adequacy and the patient's role. Other patients periodically may fail in their role unless the renal care team recognizes the patient as an individual who is included as an important team member. The patient requires consistent and repeated education about their disease, treatment, and risks and benefits of adherence. The unique, unnatural requirements of adequate chronic hemodialysis require this patient support from the renal staff, enhanced by continuous sensitive attention, empathy, and persuasion. This will help the patient achieve success in their role.
Attitude to Health↗
Patient charges--a hindrance to financially and psychosocially disadvantage groups seeking care.
This study examines the extent to which people forego seeking primary health care due to the cost and to investigate the associated demographic, physical, psychological and social factors. In 1995, questionnaires were sent to a random sample of the population in two healthcare regions in the Stockholm area in Sweden covering a total of about 400,000 inhabitants. Among the sample of 8200 people over the age of 17 yr, 69% replied to the questionnaire. About 22% stated that on one or more occasions during the past year they had foregone seeking care due to the cost. About 30% stated that they had foregone or hesitated seeking medical help due to the cost during the past year. This applied to women to a greater extent than men. Not seeking medical care was strongly correlated to a self-assessment of personal finances. Among those who described their financial situation as poor, more than half stated that, on at least one occasion, they had foregone seeking medical care due to the cost. As a consequence, weaker groups in society such as the unemployed, students, foreign nationals and single mothers were overrepresented in this group. Those who had foregone care perceive their health as worse and they had a greater degree of general pains and a higher occurrence of chronic disease/disability compared to those who had not foregone care. Between 1970 and 1995, patient charges for consulting a general practitioner within Stockholm County have increased more than three times faster than the consumer price index. The results suggest that the rapidly increasing patient charges particularly affect the weaker social groups and thus pose a threat to the aim of Swedish healthcare legislation--that good care should be available to everyone on equal terms.
Adolescent↗
A comparison of inpatient and outpatient ASCT.
Outpatient high-dose chemotherapy and autologous stem cell transplantation (ASCT) has been shown to be feasible in terms of physical morbidity and mortality outcomes, but few data exist on the psychosocial impact of delivering such aggressive therapy in this manner. The purpose of this observational study was to compare effects of inpatient (n = 20) and outpatient (n = 21) modes of care on physical status, psychological well-being, quality of life, personal finances and caregiver burden. Most patients were treated according to their preference for inpatient or outpatient care. Those choosing outpatient care were screened for eligibility according to established criteria for ambulatory management. Measures were taken at baseline, then at days 4-6, 12-16 and 30 post ASCT. Results showed that overall, the psychological, physical, social and financial outcomes of the outpatient ASCT group were comparable, to or better than inpatients. Factors that seem to be important for successful outpatient management are previous experience with cancer treatment, a satisfying quality of life, physical well-being, patient's preference for a particular mode of care and physical proximity to the treatment centre. The study results suggest that outpatient ASCT is an efficient, effective and acceptable form of care for motivated patients and caregivers who have the physical and psychological capability and desire to receive cancer treatment in this manner.
Adult↗
Alcohol-related brain damage--the concerns of the Mental Welfare Commission.
Scottish mental health legislation permits 'guardianship' for certain mentally impaired individuals, which imposes a requirement on place of residence, access and attendance at specified services for treatment and rehabilitation. The use of guardianship for alcohol-related brain damage increased steeply in the years 1993-1998. Possible explanations include: (1) increased prevalence or diagnosis of these conditions; (2) reduction of hospital beds; (3) a trend towards diminishing family and social support; (4) increased social work involvement in caring for such individuals; (5) increased consideration of the use of guardianship; (6) new private residential services; (7) lack of interest in the condition by existing services. There have been legal and clinical concerns about such individuals under guardianship relating to quality of ongoing clinical assessment, need for specific treatment and for the management of associated psychiatric illness, issues over control of drinking and control of personal finances, uncertainty over the use of restraint, and need for programmes helping the individual's progress towards independent living.
Activities of Daily Living↗
How stressful is retirement? Findings from the Normative Aging Study.
The stressfulness of retirement both as a transitional event experienced during the past year and as a life stage was investigated. Transitional stress was assessed using a life events approach, and stage stress using a "hassles" approach. Respondents were 1,516 male participants in the Normative Aging Study, 45% of whom were retired. Among those retiring in the past year, respondents' own and spouse's retirement were rated the least stressful from a list of 31 possible events. Only 30% found retirement stressful. Retirement hassles were also less frequently reported and were rated less stressful than the work hassles of men still in the labor force. The only consistent predictors of both transitional and stage retirement stress were poor health and family finances; personality did not predict retirement stress.
Adult↗