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At least 19 recordsLinked to original sources
PubMed1992

Local advocacy for the medically indigent: strategies and accomplishments in one county.

Access to health care for the medically indigent has emerged as a major policy issue throughout the United States. Because no national health program assures entitlement to basic services, practitioners and patients must cope with barriers to access on the local level. The authors report several separate but integrated strategies that a community-based coalition has used to achieve improvements in indigent care within a single county. Research strategies have involved short-term investigations of barriers to needed services, so that local awareness of the problem would increase rapidly. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor, to modify the practices of local health care institutions, and to influence statewide and national policies affecting local conditions. Legal strategies have involved the participation of attorneys who represent clients unable to receive care and who could initiate litigation as appropriate. Each of these strategies contains weaknesses as well as strengths. Although such advocacy efforts do not achieve a coherent system guaranteeing access, they can substantially improve the availability of local services.

California↗
PubMedDate not supplied

Medically indigent women seeking abortion prior to legalization: New York City, 1969-1970.

If the efforts now underway to limit access to abortion services in the United States are successful, their greatest impact will be on women who lack the funds to obtain abortions elsewhere. There is little published information, however, about the experience of medically indigent women who sought abortions under the old, restrictive state laws. This article details the psychiatric evaluation of 199 women requesting a therapeutic abortion at a large municipal hospital in New York City under a restrictive abortion law. Thirty-nine percent had tried to abort the pregnancy. Fifty-seven percent had concrete evidence of serious psychiatric disorder. Forty-eight percent had been traumatized by severe family disruption, gross emotional deprivation or abuse during childhood. Seventy-nine percent lacked emotional support from the man responsible for the pregnancy, and the majority were experiencing overwhelming stress from the interplay of multiple problems exacerbated by their unwanted pregnancy.

Abortion, Legal↗
PubMed1992

Health care consortia: a mechanism for increasing access for the medically indigent.

In response to poor coordination among health and social service providers, health care consortia have emerged in many areas of the United States. Consortia link multiple providers in a common structure to create comprehensive systems of care. They can be formally structured or informal combinations of providers that engage in coordination but otherwise do not comprise an independent organization. The functions most common among all types of consortia are shared services and service coordination; however, a number of consortia also operate outreach/education programs. Consortia represent an innovative response to the need both for vertical integration--case management of all levels of care--and horizontal integration to prevent duplication among primary care providers. We outline the history of consortia in which federally-funded community health centers have participated. We also suggest an analytical framework for the various types of consortia; discuss lessons learned about building and maintaining consortia; and provide preliminary outcome data.

Community Health Centers↗
PubMed1978

The effect of outreach workers' services on the medical care utilization of a disadvantaged population.

An original goal of the Kaiser-Permanente Neighborhood Health Center Project was to organize the project so that a medically indigent population would be able to utilize fully and appropriately the services of a complex medical care program. A special program of outreach services was designed as the principal means to achieve this goal. This study was made to determine the effects of these outreach services on (1) the use of or nonuse of ambulatory care services; (2) the volume and type of services used; (3) the patterns of use; and (4) the appointment-keeping behavior of the project population for a 12-month period. Outreach and medical care services were provided to an average of 7,000 persons in 1,500 low-income families who were enrolled as health plan members in the Kaiser-Permanente Medical Care Program. Project participants were randomly divided into two groups, one with and one without services, and utilization data were collected from their medical and administrative records. The findings suggest that outreach intervention had a positive effect on access to care. Persons who received outreach services were more likely to contact the medical care system; these persons also showed a substantial difference in the volume of services they used, when compared to those without outreach services. Outreach workers were less successful in changing utilization patterns, although slight differences were found in the direction of more appropriate use. Persons with outreach services were more likely to have made contacts with their regular physician, to have made a smaller proportion of walk-in contacts, to have had a higher proportion of regularly scheduled contacts, and to have made a higher proportion of continuing visits. Outreach workers also had little or no effect on appointment-keeping behavior.

Adolescent↗
PubMed1976

Studying the impact of patient drug profiles in an HMO.

The objectives of the study were to determine if a drug profile quantitatively and qualitatively influenced various aspects of drug utilization. A group of 1,632 medically indigent persons enrolled in the Kaiser Health Plan constituted the study population. This population received completely prepaid medical care including drug services from the Kaiser Medical Care Program. A computer-based chronological and monthly updated listing of drugs ordered and prescriptions received was provided as the front page of the centralized outpatient medical chart for a randomly selected half of the study population for a full year. Duplicate and bound copies of these patient drug profiles were also provided each outpatient pharmacy. The findings indicated the presence of the drug profile did not quantitatively or qualitatively affect prescription receipt of the group with the profile. Although the findings must be viewed in the contexts of the population served and the medical care setting, the findings strongly indicate the need for additional research to assess additional forms of drug profiles and under conditions not addressed by this study.

Adult↗
PubMed1992

Improving public health care: lessons on governance from five cities.

Policy-oriented investigations into public health care delivery have been limited, especially during the Reagan era of competition and profit-based health care, when the inner city was essentially forgotten. In this study, policymakers toured five urban public health care systems in different parts of the country to promote consideration of a new governance for Chicago and Cook County's complicated and uncoordinated care for the medically indigent. A comparison of patterns of governance revealed strengths and weaknesses of each model. Local leadership and the political will to evolve a system of care, with clear connections between the public and private sectors, account for each city's relative success in addressing mounting needs of inner-city populations.

Chicago↗
PubMed1978

Variations in state Medicaid programs.

Many federal laws permit the states considerable latitude in determining the important characteristics of programs created under them. Yet, frequently, this aspect is overlooked in the analyses of differences in state-level programs. The purpose of this paper is to present a measure to aid in the analysis of one such program, Medicaid, and to illustrate some of the ways it can be useful. The Medicaid Program Index (MPI) differentiates among state Medicaid programs according to four important characteristics: inclusion of the medically indigent, the optional services covered, limitations on the provision of the basic services, and arrangements for paying providers. Data are presented to show that, in fact, the states do vary considerably on these factors, which can be analyzed in the aggregate (i.e., as the MPI) or separately. In addition, several uses for the MPI are discussed. They include: (1) identifying variations in state programs; (2) accounting for those differences by comparing them to promising explanatory variables; (3) identifying trends in program characteristics over time: and (4) developing hypotheses to account for those trends. Finally, it was suggested that similar measures can be developed to facilitate analyses of other federal/state programs.

Humans↗
PubMed1992

Medical rehabilitation for the indigent in Louisiana: a primer for physicians.

The impact of a stroke, head injury, spinal cord injury, or other disabling condition can be especially devastating for individuals without health insurance. Fortunately, a comprehensive system has evolved to address the needs of the indigent for medical rehabilitation services in Louisiana. The purpose of this paper is to familiarize readers with this complex system, and thereby to assist practicing physicians and other health care providers in better serving this large and medically needy population. First, state and federal medical assistance programs which cover rehabilitation services are reviewed; next, services available through Louisiana Rehabilitation Services are discussed; and finally, services available through the Handicapped Children's Services Program and various voluntary organizations are described.

Persons with Disabilities↗
PubMedDate not supplied

The medical problems of homeless clinic patients: a comparative study.

OBJECTIVE: To compare the prevalence of major medical problems in homeless and nonhomeless patients. PATIENTS: All 475 persons seeking care at an ambulatory clinic serving the medically indigent for one calendar year. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Demographic and clinical data were collected by structured interviews and medical record reviews for all patients seeking care at the clinic between March 1989 and April 1990. Comparisons were made between homeless patients, those patients with unstable housing, and those with stable housing. There was no significant between-group difference in age, gender, ethnicity, and health insurance coverage. Homeless patients were more likely to be unemployed (p less than 0.001) and were found to have higher prevalence of alcohol abuse, injuries/fractures, and dental and gynecologic problems (p less than 0.05). CONCLUSIONS: There were more similarities than differences in the prevalences of major medical problems in homeless vs. nonhomeless community clinic patients. Where differences did exist, homeless persons consistently had a higher prevalence of illness than did the nonhomeless.

Adult↗
PubMedDate not supplied

Infant feeding practices of low-income mothers.

This study describes infant feeding practices over the first year of life for 294 medically indigent, inner city mothers. These findings highlight the need for interventions to improve infant feeding knowledge and practices throughout the first year of life. Nutritional problems identified included low rates of breast-feeding; early introduction of solid food, especially cereal in the bottle; and excessive use of foods that are high in sugar.

Adolescent↗
PubMed1976

Experience in mass Papanicolaou screening and cytologic observations of teen-age girls.

This report is based on a seven-year retrospective analysis of computerized data available from the Chicago Board of Health's Cancer Control Section and its Cytology Laboratory. All patients included were medically indigent. The cytologic specimens were obtained by the VCE technique; all Papanicolaou smears were classified with both the numerical and descriptive systems for abnormal cytology. The study cohort was composed of 33,641 teen-age patients through age 19; 58 (1.7/1,000) had abnormal cytology (Class III, IV, or V). In Chicago, from 1962 through 1969, approximately 25 per cent of the total patient load were teen-agers under the age of 19 with an extremely low yield of suspect cytology: Class III = 1.6 per month; Class IV = 0.1 per month; Class V = 0.0 per month. The Chicago Board of Health has reduced the number of Papanicolaou smears taken on young women under the age of 19; however, this conceptual approach does not exclude women under age 19 who epidemiologically and/or clinically warrant the implementation of a Papanicolaou smear with the use of Friedell's "biologic age of the cervix" formula.

Adolescent↗