Satisfaction with Health Care and Community Esteem Among Rural Women

The present study examines the ways in which satisfaction with health care may be associated with the lives of rural women. One hundred thirty one rural women between the ages of 45 and 70 years completed measures of community esteem, life satisfaction, satisfaction with health care, health status, and mood. The results showed that rural women's satisfaction with their health care was associated with the extent to which they hold their community in esteem and their degree of life satisfaction. Moreover, women who had poor health were less satisfied with the available health care than were healthier women. These findings are discussed in terms of their implications for the well-being of rural communities in general.     

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.     

Smoking Risks in Spain: Part III—Determinants of Smoking Behavior

Using original survey data from Spain, this paper assesses the determinants of smoking behavior. This study examines the effect on smoking of the most diverse set of risk measures ever considered: lung cancer, relative lung cancer risks, lung disease, heart disease, relative heart disease risks, lost life expectancy to smokers, and various risk measures for passive smoking. Smoking measures include cigarette smoking, the number of cigarettes smoked, and pipe and cigar smoking. Primary smoking risks have a more consistent negative effect on smoking than perceived passive smoking risks.     

Child Health in Rural Mexico: Has Progresa Reduced Children's Morbidity Risks?

It is well known that ill health during early childhood can have deleterious consequences for future developmental outcomes. Furthermore, children growing up in poverty are at risk of experiencing frequent and severe episodes of illness because they are highly exposed to the risk factors associated with catching infectious diseases. Progresa, Mexico's main anti‐poverty programme, aims to support and promote parents living in rural areas to invest in children's education, health and nutrition. Poorer unhealthy children in remote rural areas have limited access to health care. This paper investigates whether this rural intervention improved children's health status during its first three years of operation. We examine whether Progresa reduces children's morbidity risks by looking at the changes over time in the incidence of diarrhoea and acute respiratory infections. Additionally, we assess whether there are differential treatment effects according to households’ severity of poverty. The analyses of this study have been carried out using longitudinal data from a randomized treatment and control survey. Our results indicate that there is some evidence that Progresa contributes to reducing morbidity rates. We find that for both diseases under study, the Programme effect is mainly due to a decrease in the morbidity risks of children aged between 24 and 59 months. However, the evidence of a Programme effect is stronger for diarrhoea than for respiratory infections.     

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.     

Gender in/and/of Health Inequalities

The relationship between gender and health inequalities is potentially complicated, raising questions for health and social research, practice and policy. In this paper, I use two population health case studies – obesity and smoking – to explore the interplay between gender and socioeconomic position. The cases show that, on its own, neither dimension of inequality affords a comprehensive picture of these significant risks to public health. Furthermore, historical change in the socioeconomic and gendered distribution of these health risks suggests that gender is best considered as a dynamic and layered form of differentiation, rather than as a simple or stable dichotomy. A more nuanced approach to the analysis of gender and health has the potential to generate both more fruitful research and more effective health and social policy.     

Health and Medical Services Use: A Matched Case Comparison Between CCRC Residents and National Health and Retirement Study Samples

Little is known about the health status of adults living in continuing care retirement communities (CCRC). Using matched-case control, 458 adults from the Health and Retirement Study (HRS) or a CCRC-based sample were compared on total comorbidity, self-rated health, home health services use, and hospitalizations. At year 2, the CCRC sample reported more comorbidities (96%) but significantly better self-rated health (96% good/excellent) than the HRS sample (93% comorbidity, 73% good/excellent; p < .01). There were no significant differences in frequency of home health use or hospitalization. Living in a CCRC appears to be associated with higher self-ratings of health in this sample.     

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.     

Two Decades of Research Comparing For‐Profit and Nonprofit Health Provider Performance in the United States*

Objective. This article reports on a systematic review of data‐based, peer‐reviewed scientific assessments of performance differences between private for‐profit and private nonprofit U.S. health care providers published since 1980. Methods. Computerized bibliographic searches of all relevant databases yielded 149 studies (179 assessments) that compared the performance of for‐profit and nonprofit health care providers on four performance criteria (access, quality, cost/efficiency, and/or amount of charity care). Reported findings on performance were coded in one of three ways: for‐profit superiority, nonprofit superiority, or no difference/mixed results. Results. Overall, the nonprofits were judged superior 59 percent of the time, the for‐profits superior only 12 percent of the time, and for the rest (29 percent), no difference was found or results were mixed. Conclusions. Caution is warranted on policies that encourage private for‐profit entities to replace private nonprofit providers of health care services in the United States.     

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.     

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.     

The Importance of Feeling Understood in Marital Conversations about End-of-Life Health Care

This study investigates processes within marital discussions about end-of-life medical treatment preferences. The associations among marital quality, the perception of having been understood following discussion, and intentions for whom to appoint as a health care surrogate are addressed. Data from 2,969 white married couples in their mid-60s are analyzed. Four-fifths of primary respondents reported that their partners understood their preferences extremely well. Primary respondents' perceptions of high marital quality were associated with feeling extremely well understood. In turn, feeling understood partially mediated the relationship between perceptions of marital quality and the intention to appoint the partner as durable power of attorney for health care (DPAHC). Implications for research on marital communication and quality end-of-life health care are discussed.     

Forecasting the cost of U.S. Health Care in 2040

One of the most important debates among health economists in rich nations is whether advances in biotechnology will spare their health care systems from a financial crisis. We must consider that prevalence rates of chronic diseases declined during the twentieth century and that this rate of decline has accelerated. However, health care costs may continue to increase even as the age of onset of chronic diseases is delayed, because the proportion of a cohort living to late ages will increase. The accelerating decline in the prevalence of chronic diseases during the course of the twentieth century supports the proposition that increases in life expectancy during the twenty-first century will be fairly large, but the effect on health care in the U.S. will be modest. The income elasticity for health services is calculated at 1.6, meaning that income expenditures on health care in the U.S. are likely to rise from a current level of about 15 percent to about 29 percent of GDP in 2040.     

Impact of Childhood Socioeconomic Position on Self‐Rated Health Trajectories of South Korean Adults

The aim of this study was to examine the impact of childhood socioeconomic position (SEP) on adult health trajectory in South Korea. Seven waves of data from the Korea Welfare Panel Study (KOWEPS, 2007–2012; Korea Institute for Health and Social Affairs, 2014 ) were analyzed using latent growth curve analysis. Health condition was measured by self‐assessment. The major independent variables were indicators of childhood and adult SEP. The findings suggest that those who perceive their childhood economic condition to be more affluent are more likely to assess their health to be better at the intercept. The insignificant effect of childhood economic condition on the slope and the quadratic term suggest that the initial gap remains over time. On the other hand, a disruption in education as a result of poverty was significantly associated with the intercept, slope, and quadratic term. The results suggest that although the large gap at wave 1 somewhat decreases, the gap in health remains because of the significant quadratic term. Childhood SEP has a a lasting effect on adult health trajectories, after controlling for adult SEP. Significant findings support policies and programs that are targeted to reduce socioeconomic disparities in childhood to enhance equality and public health.     

Racial/Ethnic Disparities in Access to Medicare Home Health Care: The Disparate Impact of Policy

The Balanced Budget Act of 1997 dramatically decreased reimbursements for traditional Medicare home health patients. A multivariate analysis of Medicare Current Beneficiary Survey data showed that African American and “other” users experienced greater decreases in home care between 1996 and 1998 than did White users. These results suggest (a) race/ethnicity is an independent factor in determining service use post-BBA and (b) health policy has a disparate impact on minority older adults. Capitated payment systems must be pursued cautiously to avoid negative effects on vulnerable populations. The potential for current and future Medicare policy changes to negatively affect vulnerable populations is also discussed.     

An Introduction to the Controversy Over Tobacco

The tobacco industry has a long history of denying any harmful effects produced by its products. This strategy was first developed to deny any health risks associated with smoking, and has recently been extended to the denial of the risks of environmental tobacco smoke (ETS), the addictive nature of nicotine, and the targeting of adolescents by tobacco advertisements. This has served to divert discussion of how society should address the risks of tobacco use to whether society should address tobacco use at all. If we move past these diversions and consider how society should address tobacco risks, the social sciences in general and psychology in particular have a number of insights regarding how to answer the question. The purpose of this issue of JSI is to examine some of these perspectives in an attempt to suggest how we should approach the important question of how to deal with tobacco use in our society.     

Health and medical services use: a matched case comparison between CCRC residents and national health and retirement study samples

Little is known about the health status of adults living in continuing care retirement communities (CCRC). Using matched-case control, 458 adults from the Health and Retirement Study (HRS) or a CCRC-based sample were compared on total comorbidity, self-rated health, home health services use, and hospitalizations. At year 2, the CCRC sample reported more comorbidities (96%) but significantly better self-rated health (96% good/excellent) than the HRS sample (93% comorbidity, 73% good/excellent; p < .01). There were no significant differences in frequency of home health use or hospitalization. Living in a CCRC appears to be associated with higher self-ratings of health in this sample.     

Health Care Fraud and Industry Structure in the United States

The cost of health care fraud and abuse is enormous. Not only is it costing us a lot of money but one wonders how many more people could afford and receive medical insurance if fraud and abuse were significantly lower. This paper will show that the problem is embedded in the way America does health business. The problem needs to be better addressed by both the criminal justice community and the health care industry. Most importantly, those making the health care industry policy decisions need to make a paradigm shift. The system is out of balance because of past policies and decisions that have given excessive power and liberty to the medical services community and insurance providers. Using O’Toole's Compass Card of the four major ideas that have influenced political decision‐making as a guide, this paper recommends that current decision‐making needs to strengthen the equality and community poles and restrict the liberty and efficiency poles so that more balance might exist within the American health care system. Talcott Parsons saw the dangers of commercializing health care over half a century ago. The health care scene of today shows that he was correct in his appraisal.     

Analysis and Advocacy in Home- and Community-Based Care: An Approach in Three Parts

A new chapter in health policy presents both challenges and opportunities for aging policy analysts and advocates concerned with long-term care. Millions of long-term care recipients and providers live today in a pubic policy netherworld, one principally associated with Medicaid. I suggest here that moving policy forward will entail three key steps: (a) to overcome structural lag in key home and community-based care (HCBC) policy arenas; (b) to reverse a contemporary pattern of risk-shifting from institutions to individuals; and (c) to inform and empower caregivers to have their own pressing needs recognized. Recent developments in Washington provide new optimism on these fronts. Voluntary long-term care and community-based care (LTC/HCBC) proposals are on the table within the broad context of health care reform. Whether they remain will be, in large, part a function of how far we have moved along the fronts described: modernizing policies, recognizing risks, and activating neglected policy constituencies.