Passive Smoking and Health Care: Health Perceptions Myth vs. Health Care Reality

Individuals exhibit systematic tendencies to overstate the risks of unlikely lethal events. If the risks of passive smoking are overstated in this manner, and if passive smoking is not harmful to adult health, then passive smoking by adults should have a discernible effect on subjective evaluations of health status, but no corresponding effect on health. This idea is examined empirically below using data from the National Health Interview Surveys. The empirical results can be summarized as follows. Passive smoking is associated with assessments of significantly poorer health. Poorer health assessments are associated with significantly greater medical resource use. However, direct estimates of the effects of passive smoking on health care use indicate no statistical association whatsoever. These results are consistent with a model whereby individuals systematically overestimate the effects of passive smoking on their health and where the short-term effects of passive smoking on adult health care costs are negligible.     

European Health Care Costs

The rising cost of health care in Western European countries is now seen by many governments as a problem, and attempts are being made to find a solution by introducing cost-containment policies.
The author begins by reviewing trends in health care expenditures, and examines some of the underlying reasons for the upward trend.
He then considers some of the more important differences in the organization and financing of Western European health care systems, before surveying the different kinds of cost-containment policies which are being, and could be, pursued.
The conclusion is that present cost-containment policies do not take sufficiently into account the underlying reasons for rising costs, and that the criteria for evaluating the success of these policies are inadequate. To be successful, the policies will have to be altered, and the objectives and means of evaluation reconsidered.     

Delivering Health Care to Aborigines

The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.¹     

Integrating Health and Social Care at the Micro Level: Health Care Professionals as Care Managers for Older People

A common problem in the provision of coordinated long‐term care is the separation of health and social care. The present government has been increasingly concerned with promoting convenient, user‐centred services and improving integration of health and social care. One arrangement that could contribute to this for some older service users is for health care staff to act as care managers, coordinating the provision of both health and social care. This paper presents the findings of a survey of arrangements in place in local authorities for health staff to work as care managers for older people. This was designed to provide details about the range and scope of care management activities undertaken by health care professionals. Key areas of enquiry included: which kinds of health care staff undertook care management and in what settings; how long the arrangements had been in place and how widely available they were; whether there was a distinction between the types of cases and care management processes undertaken by health care staff compared with their social service department counterparts; and what management and training arrangements were in place for the health care staff.     

Health Care Utilization Among the Elderly

The present study represents and attempt to develop a conceptual framework which provides a theoretical linkage between predisposing, enabling, and need for care factors and the utilization of physicians' services within an elderly population. Multiple regression and path analytic techniques are used to access the relative importance of these factors in determining health care utilization. The findings indicate, among other things, that the measures of morbidity, or the need-for-care, are the most important variables determining use. The substantive findings and their implications for the development of health care policies and programs for future research are highlighted.     

From Hospital to Home Health Care

No abstract available for this article.     

An Analysis of Taiwanese Immigrants' Health Care Choice – Obamacare or Taiwan National Health Care

Due to recent policy changes in the USA and Taiwan, Taiwanese immigrants residing in the USA face a choice of continuing to receive health care in the USA or returning to Taiwan for treatment care. This study uses a quantitative survey to explore the association between recent health policy changes and the health care choice of Taiwanese immigrants residing in the USA. These findings indicate that there are statistically significant associations between a variety of factors and the Taiwanese immigrants' desire to return to Taiwan for health care under the new national health insurance plan (2nd NHIA). The variables positively associated with a desire to return to Taiwan for health care include the length of domicile and residence required to receive benefits, a nostalgic desire to return to Taiwan, the lower cost of health care in Taiwan, and if the respondents had come to the USA before 1996. The negatively associated variables include having a job in the USA, having a desire to return to Taiwan to live after retirement, the language preference in communications with a doctor, and a preference about the best place to receive dental treatment. The study reveals the dynamics behind the health care decision‐making of Taiwanese immigrants and particularly their choice of whether to seek care in the USA or in Taiwan.     

Comfort and Confidence Levels of Health Care Professionals Providing Pediatric Palliative Care in the Intensive Care Unit

ABSTRACT

Most childhood deaths that occur in the hospital happen in the pediatric intensive care unit. Providing pediatric palliative care in the intensive care unit comes with unique challenges due to the acute care, curative and often medically aggressive focus of these settings. In this study, 190 PICU health care professionals reported on their comfort and confidence in providing palliative care. Findings indicate that professionals report only a moderate level of comfort and confidence in this type of care in the pediatric ICU. For physicians and nurses, comfort and confidence was significantly higher for those who had practiced 8 years or more. Practitioners reported less comfort in providing psychosocial care. Implications for the social work role on the interdisciplinary team and suggestions for future research are discussed.     

Narrating Sustainability in Canadian Health Care Reform Discourse

In Canada, as in other industrialized welfare states, definitions of health system sustainability reflect different goals and correspondingly diverse ways of understanding exactly what is to be sustained and how. In this article, we report on results from a survey of documents and groups involved in and/or concerned about sustainability of the healthcare system. We identify four broad narratives of sustainability in Canadian healthcare reform discourse, and explore what these different sustainability narratives tell us about the character and contours of these often‐fractious debates. We argue that sustainability itself may not be a paradigm shift, as has been suggested, but a plot device that helps to steer the story in a particular direction, ‘black‐boxing’ certain aspects of context and emphasizing others.     

Primary Health Care Workers' Views about Social Work

Summary SUMMARY A comparison of the views about social work held by 188 primaryhealth care workers—118 GPs, 31 health visitors and 39district nurses—working in the same teams is presentedhere.^* The study focussed particularly on their perceptionsof social workers, their role and performance. The data indicatea general acceptance of the social work role, but a lack ofknowledge of or extensive criticism about, social work performance.Significant differences of view emerged about social work training,role and clients, indicating occupation is a significant factorin perceptions held. In particular, the client group predominantlydealt with appears to have had an impact on perceptions. However,views about social work performance did not differ greatly,suggesting the influence of occupation on perceptions shouldnot be overstated.     

Facilitators and Barriers to Implementing Transitional Care Managers Within a Public Health Care System

Transitional care is crucial to ensure quality of care and safety for elderly patients. In the context of health care reforms promoting a shift from a hospital-centered approach to a home care approach, transitional care becomes a vital component and social workers can play an important role in easing transitions. Most recent studies have focused on the development or improvement of transitional care intervention models or tools, but few have addressed implementation issues. In this study, the implementation process of an innovative intervention aiming to integrate transitional care managers (TCMs) from Health and Social Services Centres (HSSC) within two Canadian hospitals was evaluated. Data collection comprised focus groups (n = 8), direct observations, meeting minutes, activity grids and logbooks. To facilitate the implementation of TCMs, decisions were made to clearly indicate their involvement in patients’ files and concentrated their efforts on a restricted number of units. Barriers included confusion about target clientele, inequitable information exchange between partners, limited powers regarding coordination of care, and organizational constraints limiting additional measures to improve transitional care. Evaluating implementation processes is crucial to efficiently identify obstacles and apply additional implementation strategies to promote the integration of new practices within the health care system.     

Care Programming in Mental Health: assimilation and adaptation

Correspondence to Justine Schneider. PSSRU. University of Kent, Canterbury CT2 7NF. Summary Two years after the care programme approach in mental healthwas introduced there is still widespread confusion about itsmeaning and its relation to other changes in the arena of communitycare. This paper looks at how care programmes are being implementedand at whom they are being targeted. It also examines the relationbetween care management and care programming and raises somequestions about future developments in the light of communitycare reforms. It draws on data collected during 1992 from threecontrasting health districts, all of which had made considerableprogress in care programming. Sixty practitioners were interviewedabout the theory and practice of care programming. Their experienceis presented here in the context of a review of community careplans for 1992/93 which characterizes the responses of differentlocal authorities to the approach.     

五行学说与中国人生命保健的伦理观探析

五行学说是中国古人对自然万物本质的一种抽象概括。“五”是指金、木、水、火、土。“行”有两层涵义一指行列、次序;二指运动变化。五行学说以五行之间的互动性和统一性来揭示人与自然、人的身体内部各部分之间的有机联系,并以五行与人的道德的关系揭示人类社会发展和人的生命和谐成长的规律,提出了中国人生命保健的伦理观。对中国人的重生养生、对生命的唯物辩证的理解和认识、人与自然的和谐统一、人与群体的和谐统一的伦理观念产生了影响。并对中医学说中利用五行的相生相克,促进人体机能的健康发展,达到延年益寿的目的起到了重要作用。