Behaviorally caused loss of health and the use of medical care

This paper extends the analysis of the demand for medical care to an aspect which has previously been ignored: variations in expected, as opposed to experienced, cause of losses of health and the current use of medical care. Losses of health which cannot be prevented by the prior use of medical care are hypothesized to decrease the use of medical care by reducing the rate of return to investments in health, ceteris paribus. The reduction in the rate of return occurs both because these losses curtail the length of the stream of benefits to the use of medical care and because prior use of medical care is not effective in reducing the occurrence of these types of loss. Empirical findings support this hypothesis. Results suggest that differences in expected losses may account for some of the differences in utilization of medical care by sex.     

Medical tourism in the backcountry: alternative health and healing in the Arkansas Ozarks

Tourists travel to Arkansas' mountain regions to experience, appreciate, and consume multiple aspects of otherness, including sacred sites and pristine and authentic peoples and environments. A largely unexplored aspect of this consumption of authenticity is alternative medicine, provided to tourists and day travelers in search of physical and emotional restoration. Traditional forms of medicine are deeply rooted in women's social roles as community healers in the region and are perpetuated in part because of the lack of readily accessible forms of so-called modern medicine. Contemporary medical tourism in Arkansas has promoted access to folk health systems, preserving them by incorporating them into tourists' health care services, and also has attracted new and dynamic alternative medical practices while encouraging the transformation of existing forms of traditional medicine. Ultimately, the blend of alternative, folk, and conventional medicine in the Arkansas highlands is evidence of globalizing forces at work in a regional culture. It also serves to highlight a renewed appreciation for the historic continuity and the efficacy of traditional knowledge in the upper South.     

Health technology assessment between our health care system and our health

In this contribution, I wish to explore the potential of health technology assessment and ethics for increasing our capacity to pre-empt the shortcomings and undesired consequences of modern health care while maintaining its benefits. Central is the presumption that in case of some health problems this cannot be done unless we explicitly reconsider some features of the modern health care system, especially those related to its strong reliance on scientific rationality and the strong role played by medical professionals. So as to both maintain the benefits of advanced health care and ensure that it produces less reason for concern, we need to reconsider our approach to rationality—and maybe even the way in which we build our health care system around that rationality. That is, we need to introduce an element of reflexivity. Two types of circumstances are being explored in which such reflexivity may prove worthwhile: controversies on side effects, and persistent problems encountered in optimising health care. Drawing on brief discussions of typical cases, we explore the potential of reflexive HTA and its methodical prerequisites. We conclude that ethicists may contribute to reflexive HTA, if they combine a hermeneutic—and often also participative—methodology with a solid understanding of the relation between the health problem under scrutiny and more general critique of the health care system. Insights from the areas of science and technology studies, as well as from social philosophy may be critical items in their tool kit.     

Fuzzy modelling and efficiency in health care systems

American Medical Institute reports that each year, because of the medical error, minimum fifty thousand people are dead. For a safety and quality medical system, it is important that information systems are used in health care systems. Health information applications help us to reduce the human error and to support patient care systems. Recently, it is reported that medical information systems applications have also some negative effect on all medical integral elements. The cost of health care information systems is about 4.6% of the total cost. In this paper, it is tried a risk determination model according to principles of fuzzy logic. The improvement of health care systems has become a very popular topic in Turkey recent years. Using necessary information system; it became possible to care patients in a safer way. However, using the necessary HIS tools to manage of administrative and clinical processes at hospitals became more important than before. For example; clinical work flows and communication among pharmacists, nurses and physicians are still not enough investigated. We use fuzzy modeling as a research strategy and developed sum fuzzy membership functions to minimize human error. In application in Turkey the results are significantly related with each other. Besides, the sign differences in health care information systems strongly effects of risk magnitude. The obtained results are discussed and some comments are added.     

Access to health care in urban areas of developing societies

Emphasis on rural health problems has led to a relative neglect of urban health issues in developing societies. Yet the fact that a large proportion of the limited financial and human resources is allocated to urban health care makes it imperative for researchers and health planners to evaluate the effectiveness of the urban health care system. This paper examines data on health care utilization from a sample survey of 1500 households conducted in three areas of Accra, Ghana in 1982. The factors that influence the use of three types of health care services (clinics, drug vendors, and traditional healers) are examined. Suggestions are made for increasing the effectiveness of the health care system in Accra, with the aim of making medical care more accessible to all families.     

Inequities in health outcomes and access to health care in South Africa: a comparison between persons with and without disabilities

Health is a fundamental human right and if health care is to be universal and equitable it should not be less accessible to some sectors of society than to others. The objective of this study was to compare health outcomes and access to health care between persons living with disabilities and their non-disabled counterparts. The research was based on secondary data analysis of wave 1 of the National Income Dynamic Survey. Results from the study indicated that people with disabilities reported a higher incidence of communicable and non-communicable diseases, lower access to medical insurance and greater use of public health care than their non-disabled counterparts. In conclusion, the findings highlight the inequities in health outcomes and access to health services for people with disabilities and emphasise the need for disability-friendly health care policies that reduce barriers to accessing health care.     

Measuring the quality of health care

This Issue Brief examines some of the issues involved in defining and measuring the quality of health care and in implementing quality measures. It discusses the importance of measures of health care quality in the evolving health care delivery system, examines some of the conceptual issues involved in defining quality of care, and discusses some of the measures of health care quality and how these measures have been implemented in the health care delivery system. The major impetus for quality assurance programs is cost management: it is an attempt to allocate scarce health care resources efficiently. This requires making choices among alternatives, which may mean that maximizing quality of care for whole populations may not maximize the quality of care for individuals. Quality, in terms of any single good or service, has a number of dimensions. Health care is a complex bundle of services, and each component service within an episode of care affects the other components and the patients differently. Moreover, patients differ in numerous ways, which means that similar symptoms may require different services if care is to be effective. Measuring quality of health care services requires accounting for all of these factors. In attempting to manage health care costs, employers and other private health plans have begun to employ process measures of quality, i.e., evaluating caregivers' activities, the decisions made at each step in an episode of illness, and the appropriateness of the care provided. Process is an important component of quality measures because it focuses directly on the uncertainty in the efficacy of treatment. Given this uncertainty, the logic of medical decision making is an important determinant of quality and cost effectiveness. Examining the process of care involves assembling a panel of physicians who review medical records to determine the appropriateness of the care received. Providers have increasingly found that their medical decision making and practice styles are being monitored by purchasers as new health care delivery systems are being formed. The American Medical Association found that 39 percent of surveyed physicians were subject to clinical profiling.     

Critical Theory and Medical Care in America: Changing Doctor–Patient Dynamics

This paper examines the potential for theory to adapt to changing contexts of health in the western world. The commoditization of health and the ideology of biomedicine affects social life in creating dependency, social control, and vast inequalities. At the same time, increased access and diversity of consumer health knowledge as evidenced by the use of the Internet and the sharp rise in alternative medicine point to a different dialectic between doctor and patient and the potential for transforming diagnostic, treatment, and economic components of health care. Recent trends suggest increasing patient autonomy and the possibility of a re-emergence of medical pluralism. New theoretical directions should be considered by social scientists in order to more fully understand these changes.     

Mexican immigration and health care: a political economy perspective.

This paper examines the case of Mexican immigrants in the United States and their access to medical services within a political economy of health framework. Such an approach stresses that the provision of health care is independent of health factors per se and that access to health care is not equally distributed throughout a population. The first section reviews the three major concepts influencing medical anthropologists working within a political economy framework: the social origins of illness; the allocation of health resources; and fieldwork in Third World countries. The analysis then focuses upon the reasons for limiting immigrants' access to health care, followed by an examination of the socioeconomic characteristics of Mexican immigrants, including an undocumented immigration status, which limit their access to health care. Finally, the consequences of limited access to health services are suggested, including a low utilization of preventive health services resulting from the high cost of care combined with the immigrants' generally low income, lack of medical insurance and fear of using U.S. health services.     

Defined contribution health benefits

This Issue Brief discusses the emerging issue of "defined contribution" (DC) health benefits. The term "defined contribution" is used to describe a wide variety of approaches to the provision of health benefits, all of which have in common a shift in the responsibility for payment and selection of health care services from employers to employees. DC health benefits often are mentioned in the context of enabling employers to control their outlay for health benefits by avoiding increases in health care costs. DC health benefits may also shift responsibility for choosing a health plan and the associated risks of choosing a plan from employers to employees. There are three primary reasons why some employers currently are considering some sort of DC approach. First, they are once again looking for ways to keep their health care cost increases in line with overall inflation. Second, some employers are concerned that the public "backlash" against managed care will result in new legislation, regulations, and litigation that will further increase their health care costs if they do not distance themselves from health care decisions. Third, employers have modified not only most employee benefit plans, but labor market practices in general, by giving workers more choice, control, and flexibility. DC-type health benefits have existed as cafeteria plans since the 1980s. A cafeteria plan gives each employee the opportunity to determine the allocation of his or her total compensation (within employer-defined limits) among various employee benefits (primarily retirement or health). Most types of DC health benefits currently being discussed could be provided within the existing employment-based health insurance system, with or without the use of cafeteria plans. They could also allow employees to purchase health insurance directly from insurers, or they could drive new technologies and new forms of risk pooling through which health care services are provided and financed. DC health benefits differ from DC retirement plans. Under a DC health plan, employees may face different premiums based on their personal health risk and perhaps other factors such as age and geographic location. Their ability to afford health insurance may depend on how premiums are regulated by the state and how much money their employer provides. In contrast, under a DC retirement plan, employers' contributions are based on the same percentage of income for all employees, but employees are not subject to paying different prices for the same investment.     

A survey of Colorado's migrant farmworkers: access to health care

This report utilizes data collected in a 1986 sample survey of 329 adult (18 to 50 years old) migrant farmworkers in Colorado to determine their health needs, health services utilization, and overall access to care. Health needs include selected indices of medical, dental, nutrition, and reproductive health. About 1/4 of the population had no usual source of health care. Upstream states such as Colorado are responsible as the primary providers of health services for those who either have no source of health care at their home base or experience a variety of barriers in their attempts to access services. Women are most likely to have had a medical visit over the past 12 months and are more likely to have experienced hospitalization. Unfortunately, although their contact with medical professionals is more frequent, the family planning needs of women are not being met. A large disparity exists between ideal family size and number of pregnancies and live births. The findings of this survey document the inferior health status of the migrant farmworker population in Colorado. Hunger, poverty, and environmental hazards increase the risk of illness, while at the same time, barriers to care often prevent migrants from accessing needed health services. Recommendations include 1) promoting and funding family planning and reproductive health services for migrant farmworker women and their partners, 2) incorporating trained family planning promoters in the migrant health delivery system, 3) maintaining successful models of restorative dental care for adults, 4) increasing access to services in nontraditional settings, 5) increasing use of ancillary personnel to provide services, especially dental services, 6) maintaining outreach programs in the available food programs, and 7) encouraging migrant health programs to provide leadership in the development of alternative food sources.     

Health insurance coverage and routine health care use among children by family immigration status

This study utilizes Los Angeles Family and Neighborhood Survey data to investigate children's (17 years and younger) health insurance coverage and routine medical and dental care visits by family immigration status (N = 2846). We use a combination of nativity (U.S. and foreign born) and legal status (authorized and unauthorized) of mothers and their children to categorize family immigration status (citizen mother-citizen child; authorized mother-citizen/authorized child; unauthorized mother-citizen/authorized child; unauthorized mother-unauthorized child). Health care use is measured by routine medical visits and dental visits. We find that health insurance coverage and dental visits are lowest for the children of unauthorized mothers but gaps are most pronounced for unauthorized mother–unauthorized child pairs. Policy implications, in light of recent health and immigration-related legislation, are discussed.     

Troubled hearts,care pathways and hospital restructuring: Exploring health services research as active knowledge

This paper explores the socially active character of contemporary forms of expertise through an institutional ethnographic analysis of health services research. The paper draws primarily on interview research to investigate how health services research helps shape text-mediated relations linking government health-care policy with local reform initiatives. In the paper, I focus on the use of a particular research report by managers, physicians, and others at a community hospital in Toronto, Canada as part of their efforts to standardize and reduce the duration of care provided to heart attack patients. I discuss how, through its intertextual presence, health services research helps to co-ordinate medical and managerial practices and rationalities into medico-administrative relations. I offer two examples of this process. The first focuses on the relations co-ordinated through the textual observance of inefficiency. The second addresses how the report helped resolve the problem of physicians’ resistance to reforming cardiac care. My analysis contributes to current perspectives on the relationship between discourse and action.     

A comparative study of health delivery systems of India and China

The medical systems which most of the developing countries have, are ad hoc adoptions inherited from their colonial masters and have met with little success in making health planning as part of their national planning. Very few countries have been able to overcome the resistance of the medical profession and the bureaucratic inertia which is a major obstacle in the transformation of this system to a broad based social service and integrating it with the process of socio-economic development planning. The adoption of this system by developing countries is a typical example of technological misfit. A cheap and labour intensive model for developing countries shall be a proper solution for the development of a health care delivery system for the masses. A solution to this problem is a mix or hybrid of the traditional and modern medicines which very recently have been exploited both in India and China. How far India and China have been successful and what is needed to be done is the subject matter of this paper.     

Neighborhood socioeconomic disadvantage and access to health care

Most research on access to health care focuses on individual-level determinants such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed care, however, has not received much attention. We address this gap in the literature by examining how neighborhood socioeconomic disadvantage is associated with access to health care. We find that living in disadvantaged neighborhoods reduces the likelihood of having a usual source of care and of obtaining recommended preventive services, while it increases the likelihood of having unmet medical need. These associations are not explained by the supply of health care providers. Furthermore, though controlling for individual-level characteristics reduces the association between neighborhood disadvantage and access to health care, a significant association remains. This suggests that when individuals who are disadvantaged are concentrated into specific areas, disadvantage becomes an "emergent characteristic " of those areas that predicts the ability of residents to obtain health care.     

Training for collaboration: collaborative practice skills for mental health professionals

The purpose of the study was to identify skills that mental health practitioners need for successful collaborative practice in medical settings. Known experts in the field of collaborative health care completed a survey designed to elicit their suggestions about what is needed for successful collaborative care practice. Through qualitative analysis, a set of 56 skills was developed. These skills are organized into three general categories of competency: (a) skills for working in a medical setting; (b) skills for working with patients; and (c) skills for collaborating with healthcare providers.     

Bringing social worlds together: computers as catalysts for new interactions in health care organizations.

In this case study, computer systems are explored as catalysts for new interactions between departments in health care organizations. Hypotheses investigated changes in the extent to which members of different departments (1) exchange information and (2) understand each other's work following implementation of an integrated medical information system. Analyses showed that communication-based forms of involvement in implementation (communicating with systems personnel and trainers, communicating about new ways to use the system, and receiving support from supervisors for doing so) were overwhelmingly more important than either general participation or computer use in predicting increases in interdepartmental interaction. Changes in tasks and roles also led to new, informal, face-to-face contacts to support computer system use, as well as greater administrative control over the organization as a whole. In addition, results of interviews and observations over the two-year study period illustrate the importance of work group identification in predicting changes accompanying computerization.     

Explanatory models for disability: perspectives of health providers working in Malawi

Health providers’ understanding of disability determines how disabled people are treated, and hence it is imperative to address conceptualisations of disability, as this will contribute to better opportunities and realisation of human rights for disabled people. This article will use data from a qualitative study exploring conceptualisations of disability by 22 health service providers from the total health care system in Malawi, including the professional sector (e.g. medical doctors and nurses) and the folk sector (healers and indigenous practices). We will discuss how these perceptions influence the lives of disabled people, using the case of a health service user with physical and speech impairment as an example. Our data show that health providers largely conceptualise disability according to the medical model for disability, contributing to the exclusion of disabled people. The bio-psycho-social model for disability, largely absent as an explanatory model for disability among our informants, is the most inclusive and rights based.     

Another face of health care disparity: stigma of mental illness

In many everyday situations, individuals with mental illness face stigma that leads to discrimination. A growing body of evidence suggests that those with mental illness experience disparities in health care and that their medical needs are often overlooked. The purpose of this article is to increase awareness to this problem. Fictional vignettes in which individuals with mental illness seek medical care are presented, followed by discussion on the role discrimination may play in the level of care these patients received. To help alleviate disparities, nurses are encouraged to advocate and speak out when they suspect discrimination is affecting the quality of care of those with mental illness.