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At least 613 records · Page 34Linked to original sources
PubMed2005

Predictors of elderly mortality: health status, socioeconomic characteristics and social determinants of health.

This paper uses longitudinal survey data from Taiwan to investigate the predictors of elderly mortality. The empirical analysis confirms a relationship between socioeconomic characteristics and mortality, but this relationship weakens considerably when estimates are conditional on the health status at the time of the first wave survey. In terms of predictive power, the models with an activities of daily living index fare better (as opposed to models with self-evaluated health or self-reported illnesses). Having said that there is a payoff to the consideration of self-evaluated health jointly with other 'objective' health indicators. Other findings include a strong association between life satisfaction and survival, which prevails even after controlling for other explanatory variables.

Activities of Daily Living↗
PubMedDate not supplied

Distribution of patients between faculty and residents in a teaching hospital clinic.

The authors tried to determine whether housestaff are systematically assigned clinic patients who are more "difficult": the elderly, the poor, those with many problems, and those who cannot speak English. This cross-sectional study was carried out in the outpatient department of a university health care insurance. A systematic sample of 1,870 patient visits to the medical clinic from 1980 to 1986 was studied. Housestaff were more likely to see patients who did not speak English, who had four or more medical problems, who had visited the clinic five or more times, who had been admitted to the hospital or emergency ward, or who had a skin problem. Multivariate analysis of these individual factors, allowing for the effect of each upon the others, showed that only previous hospital or emergency ward admission, native language, and skin disease retained a significant association with housestaff physicians. None of these factors was strongly associated with physician status, as shown by poor predictive accuracy when the multivariate models were used to predict accuracy when the multivariate models were used to predict physician status in 105 patient visits in 1987. While some factors were statistically associated with physician status, the magnitude of the effect of each was small. An explantation, other than bias in patient assignment, was usually apparent. It is possible to organize an outpatient clinic where housestaff care for patients who are similar to those seen by faculty.

Appointments and Schedules↗
PubMed1984

Structural interests and Australian health policy.

Health policy has been a matter of public discussion in Australia since the late 1960s. Mirroring the United States experience, much of the debate initially centred around the introduction of a universal national health insurance scheme but since the mid 1970s economic conditions have changed and contemporary decisions are often accompanied by rhetoric about the need to constrain costs which are portrayed as increasing out of control. These changes have been associated with changes in the relative influence of the dominant and challenging structural interests within the health sector. This article analyses the influence of those interests in Australian health policy since the mid 1960s.

Australia↗
PubMed1996

Health care reforms in Bulgaria: an initial appraisal.

Bulgaria is in the process of re-structuring its health care system from one based on command and control to one founded on pluralism. This paper explores the way this transformation is taking place from the comparative perspective of the health care reforms being implemented in Britain and elsewhere. It draws out the lessons that there may be for Bulgaria based on western European experience and concludes with an assessment of the applicability and desirability of relying on the experience of other countries as a precursor for policy development and formulation in another.

Bulgaria↗
PubMed1996

Market-oriented health care reforms: trends and future options.

In many (predominantly) publicly financed health care systems market-oriented health care reforms are being implemented or have been proposed. The purpose of these reforms is to make resource allocation in health care more efficient, more innovative and more responsive to consumers preferences while maintaining equity. At the same time, the advances in technology result in a divergence of consumers' preferences with respect to health care and urge society to (re)think about the meaning of the solidarity principle in health care. In this paper we indicate some international trends in health care reforms and explore some potential future options. From an international perspective we can observe a trend towards universal mandatory health insurance, contracts between third-party purchasers and the providers of care, competition among providers of care and a strengthening of primary care. These trends can be expected to continue. A more controversial issue is whether there should also be competition among the third-party purchasers and whether in the long run there will occur a convergence towards some "ideal" model. Although regulated competition in health care can be expected to yield more value for money, it might yield both more efficiency and higher total costs. It has been argued that equity can be maintained in a competitive health care system if we interpret equity as "equal access to cost-effective care within a reasonable period of time". Because the effectiveness of care has to be considered in relation to the medical indication and the condition of the patient, the responsibility for cost-effective care rests primarily with the providers of care. Guidelines and protocols should be developed by the profession and sustained by financial incentives embedded in contracts. It has been argued that the third-party purchasers could start to concentrate on the contracts with the primary care physicians. Contracts with other providers could then be a natural complement to these contracts. Coordinated-care contracts between the third-party purchasers and the consumer of care could provide the consumer with monetary incentives to go to efficient providers. A consumer choice of insurance contract could give the consumer an opportunity to make important choices in health care. However, each society has to make its own choices about what care should be available to everybody independent of an individual's purchasing power.

Community Participation↗
PubMed2006

Racial/ethnic differences in influenza vaccination in the Veterans Affairs Healthcare System.

BACKGROUND: Racial/ethnic differences in influenza vaccination exist among elderly adults despite nearly universal Medicare health insurance coverage. Overall influenza vaccination prevalence in the Veterans Affairs (VA) Healthcare System is higher than in the general population; however, it is not known whether racial/ethnic differences exist among older adults receiving VA healthcare. Racial/ethnic differences in influenza vaccination in VA were assessed, and barriers to and facilitators of influenza vaccination were examined among veteran outpatients aged 50 years and older. METHODS: A random sample of 121,738 veterans receiving care at VA outpatient clinics during the 2003-2004 influenza season completed the mailed Survey of Health Experiences of Patients (77% response rate). Multivariate logistic regression was used to examine associations among race/ethnicity and influenza vaccination prevalence, barriers, and facilitators. Analyses were conducted during 2005 and 2006. RESULTS: Based on unadjusted prevalences, non-Hispanic blacks, Hispanics, and American Indian/Alaskan Natives were significantly less likely to be vaccinated for influenza compared to non-Hispanic whites (71%, 79%, and 74%, respectively, vs 82%). After adjustment for age, gender, marital status, education level, employment, having a primary care provider, confidence and/trust in provider, and health status, only non-Hispanic blacks remained significantly less likely to be vaccinated compared to non-Hispanic whites (75% vs 81%). Influenza vaccination barriers and facilitators varied by race/ethnic group. CONCLUSIONS: Compared to non-Hispanic whites, non-Hispanic blacks were less likely to receive influenza vaccination in the VA healthcare system during the 2003-2004 influenza season. Although these differences were small, results suggest the need for further study and culturally informed interventions.

Black or African American↗
PubMed2005

Associations between ambient air pollution and daily mortality among persons with diabetes and cardiovascular disease.

BACKGROUND: Recent studies suggest that persons with diabetes and with cardiovascular disease may be at higher risk for the short-term effects of air pollution. We carried out this mortality time series study in Montreal, Quebec, Canada to confirm these observations and to determine whether diabetics who had other health conditions were also at higher risk of dying when air pollution increases. METHODS AND RESULTS: In one analysis, we related daily deaths from diabetes (using the underlying cause) to daily concentrations of particles and gaseous pollutants. In another analysis, we created subgroups by identifying subjects diagnosed 1 year before death with diabetes and other major health conditions from billing and prescription data from the universal Quebec Health Insurance Plan. The analysis made use of parametric log-linear Poisson models that were adjusted for long-term temporal trends and daily weather conditions. We found positive associations between most air pollutants and daily mortality from diabetes as well as among subjects diagnosed with diabetes 1 year before death. In the latter group of subjects, greater effects were found generally in the warm season and especially among subjects who had diabetes and who also had any cardiovascular disease, chronic coronary disease, and atherosclerosis. We did not find evidence of associations among persons who only had diabetes (i.e., did not also have cancer, cardiovascular disease, or lower respiratory disease). CONCLUSIONS: These data indicate that individuals with diabetes who also have cardiovascular disease may be susceptible to the short-term effects of air pollution.

Aged↗
PubMed2004

Medical savings accounts in a universal system: wishful thinking meets evidence.

Medical savings accounts (MSAs) and similar approaches based on flowing reimbursements through individuals/consumers rather than providers are unsuited for systems with universal coverage. Data from Manitoba, Canada reveal that, because expenditures for physician and hospital services are highly skewed in all age groups, MSAs would substantially increase both public expenditures and out-of-pocket costs for the most ill. The empirical distribution of health expenditures limits the potential impact of many current 'demand-based' approaches to cost control. Because most of the population is relatively healthy and uses few hospital and physician services, inducing the general population to spend less will not yield substantial savings.

Cost Control↗
PubMed2004

Medical savings accounts and the Canada Health Act: complimentary or contradictory.

The publicly funded health system in Canada, almost since inception, has been the focus of numerous critiques, matched only by the solutions offered, and the secondary problems generated. One of the proposed solutions is the use of medical savings accounts (MSAs). It is reasoned that MSAs will make Canadians more accountable for the health services they utilize, yield cost containment, and potential savings. However, before a nation-wide, public MSA can be considered further, there is need to reconcile the following: (a) empirical evidence in support of MSAs that is not as compelling as some of its proponents argue; (b) the scale and complexity of a MSA if integrated into a publicly funded, nation-wide health system in a country the size of Canada; (c) whether the cost to formulate, implement, and operate a nation-wide Canadian MSA would yield the net gains to warrant such an expenditure; (d) the fact that implementation of a nation-wide MSA potentially may contravene the Canada Health Act.

Canada↗
PubMed2006

Obstetrics and perinatal outcomes of Thai pregnant adolescents: a retrospective study.

BACKGROUND: Adolescent pregnancy is considered a high risk pregnancy. OBJECTIVES: The purpose of this study was to compare pregnancy outcomes in adolescent females aged 19 and younger with those of adult women aged 20-34 years. DESIGN: A retrospective case control study was designed to address the purpose of the study. PARTICIPANTS: Participants of this study consisted of 401 randomly selected adolescent females and 815 adult mothers who gave birth at a regional hospital in Bangkok from 2001 to 2003. METHODS: Two domains of pregnancy outcomes; maternal and infant outcomes were collected from participants' medical and prenatal records by trained observers. RESULTS: The study revealed that, compared to the adult mothers, teenage mothers were less likely to make the first prenatal visit in their first trimester (16% and 38.9%, p<.001), to have adequate prenatal care (83% and 91%, p<.01), and cesarean sections (odds ratio (OR) 2.05, confidence interval (CI) 1.44, 2.92). They had higher rates of anemia (OR 0.44, CI 0.26, 0.75), preterm deliveries (OR 1.21, CI 1.01, 1.75), and lower mean birth weight babies (2931 g and 3077 g, p<.001). CONCLUSION: This study demonstrates that, while teenage pregnancy outcomes have improved in recent years due to medical accessibility, pregnant adolescents continue to be complicated requiring clinical interventions from the health care providers.

Adolescent↗