DETERMINANTS OF WELFARE POLICY ATTITUDES: A CONTEXTUAL LEVEL ANALYSIS

Using the 2008 Chicago Area Study, this article tests how residential context plays a role in welfare policy attitudes, controlling for individual level characteristics. The contextual level variables of household public assistance use and minority concentration in respondents' neighborhoods are tested using multinomial logistic regression analysis. When including controls for education, income, political party, age, employment status, gender, and race, respondents residing in neighborhoods with a higher concentration of African Americans are more likely to endorse positive attitudes toward welfare policy. Additionally, an interaction effect is found between individual level income and household public assistance use in the ZIP code when predicting welfare policy attitudes. Lower income respondents residing in neighborhoods with higher household public assistance use are more likely to endorse positive attitudes toward welfare than their higher income neighbors. Given the exploratory nature of this study, the author concludes with implications for such findings and proposes future research.     

Variations in Provider Capacity to Offer Accessible Health Care for People with Disabilities

Abstract

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

Environmental Concern and Personal Health Behaviors in Women

Abstract

Effective efforts to shift attitudes and behaviors impacting the health of the ecological environment may be found to be similar to those efforts that are effective for changing personal health behaviors. This investigation examines the relationship between environmental attitudes and self-care behaviors in a sample of twenty-seven women in their forties. Environmental concern, as measured by an updated version of Weigel and Weigel's (1978) Environmental Concern Scale, was significantly correlated with self-reported personal health care behaviors as measured by a new self-report Health Questionnaire. Implications for social work practice and future research are discussed.     

Trust and Health Care

Trust is believed to be particularly salient to the provision of health care, and since the establishment of the National Health Service (NHS) in the UK, trust has played an important role in the relationships between its three key actors: the state, healthcare practitioners, and patients and the public. Service users trusted the judgement, knowledge and expertise of health professionals to provide a competent service that met their needs, and they trusted the state to ensure equity in the allocation of public goods and services. These implicit or taken-for-granted trust relationships have, it is claimed, been challenged as a result of the introduction of changes in the organisation and funding for the health service, in the regulation and performance assessment of health professionals, and in public attitudes to health care and scientific medicine. This paper considers the influences of social changes and recent policy and professional initiatives in health care on the structure of trust relations in health care in the UK. It presents a theoretical framework for examining trust relations using the NHS as a case study and concludes with an agenda for future research.     

Social Context and Personal Expenditures for Health Care: Federal Policy and the Experience of Older Adults in the 1970s

The relationship between the intent and the outcome of legislated social policy is discussed. Specifically, this study documents some effects of federal health reimbursement and income policy in the late 1960s and early 1970s on health care behavior and expenditures in the decade 1970-1980. The Longitudinal Retirement History Study (LRHS), containing information on a panel of 6,270 men and unmarried women aged 58 to 63 in 1969, was used to provide information on the personal health expenditures in this decade. Medicare and Medicaid and the indexing of Social Security became operational at the beginning of the study, which permitted the exploration of intended and observed effects of legislation designed to make health care more accessible and affordable for older adults. As policy intended, utilization increased over the decade as indicated by both increases in the number of panelists with health care bills and increases in the size of total bills (constant dollars). Consistent with federal policy to reduce personal costs, out-of-pocket expenditures and the proportion of total bills paid out of pocket decreased. However, the effects of these federal policy initiatives were constrained by reimbursement rules and the social location of users. For instance, even at the end of the 1970s, out-of-pocket health care expenditures across subpopulations persisted. The 1980s and early 1990s have brought increased concern over the cost of health care and renewed concern over access. Data suggest that future proposals aimed at providing universal coverage along with high out-of-pocket costs may not result in equitable programs, and are likely to have a limited impact on constraining health care costs. The LRHS data indicate that utilization increased despite continued high out-of-pocket costs for all except the lower-income groups, who may be limited in their ability to purchase increasingly costly care.     

Health Care Professionals' Experience,Knowledge, and Attitudes Concerning Homosexuality

The purpose of this study was to examine the experience with attitudes towards, and knowledge about homosexuality of three groups of health care professionals. Subjects were 97 registeres nurses, social workers, and psychologists who responded to a six-page mailed questionnaire. Professional discipline of the subject, gender of the client, and gender of the client's lover in a fictitious scenario did not significantly affect ratings or suggested diagnoses of the client. Most subjects felt that they needed moer training in working with homosexual clients, which was consistent with their high but not perfect scores on a knowledge test. Subject's mean scores of the Attitudes Toward Lesbians (ATL) and Gay Men (ATGM) scales of Herek (1998) reflected significantly less prejudice than his college samples. More knowledgeable respondents were less prejudiced and had more positive attitudes about working with gay and lesbian clients; those with more positive attitudes toward clients also showed less prejudice on the ATL and ATGM scales. The authors argue that training health care professionals to be more knowledgeable about gay and lesbian issues would lead to more positive attitudes and better services for gay and lesbian clients.     

Health Maintenance Organizations

Health maintenance organizations and similar pre-paid health plans are an alternative form of health care available to Medicare beneficiaries in some areas of the country. While proponents of HMOs have argued that these plans may be better suited than fee-for-service medicine to provide care to an older population, HMOs have played a relatively small role in health care of the elderly. This paper traces federal health policy relating to HMOs and Medicare and describes obstacles to HMO Medicare programs stemming from those policies. It then examines the Massachusetts experience in HMO program development as a case study of how state policy can play a critical role in implementation of policy objectives at a local level. The paper demonstrates how an active state policy involving the executive and legislative branches, elder advocacy groups, and the private sector created a public-private partnership to develop HMO programs for the Medicare population. When this paper was completed, however, Medicare HMO development in Massachusetts was at a standstill, waiting for several critical problems of federal policy to be resolved.     

Variations in provider capacity to offer accessible health care for people with disabilities

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

Adolescent attitudes toward random drug testing in schools

The current research examined students' perceptions of random drug testing for students participating in after-school activities. Results found students were more likely to endorse drug testing at their school if they are already engaged in after-school activities and not currently using drugs and/or alcohol. While middle and high school students' scores fell within the median, most reported if drug testing were implemented in their school they believed it would not deter continued participation in after-school activities. However, if drug testing were a prerequisite for participating in after-school activities, high school students were more apprehensive about getting tested than middle school students. Student respondents were more likely to endorse drug testing, if all members of the school system (i.e., teachers, coaches and staff) participated in drug testing. High school students' believed they had enough knowledge about drug abuse and were less likely to endorse drug testing because they believed it would violate their personal privacy compared to grade school students. Results also differed as a function of gender and self-reported drug and alcohol use.     

The effect of self-care information on health-related attitudes and beliefs of college students

We conducted a study to determine whether an intervention using self-care information would change college students' attitudes and beliefs concerning personal responsibility and involvement in their own health care. Individuals entering a student health service were randomly assigned to a treatment or control group. Members of the treatment group (n = 187) received the intervention and completed the survey instrument. Members of the control group (n = 204) completed the survey instrument only. The intervention consisted of one page of general information about the benefits to individuals of taking responsibility for their own health and a booklet containing excerpts from a consumer-oriented health care book. The survey instrument was composed of a measure of attitudes toward information and behavioral involvement in health care and a measure of beliefs regarding control over one's health. Results indicated that the intervention was able to change the treatment group's attitudes regarding active participation in health care. The treatment group's responses also reflected less belief that health was outside of the individual's control. The study showed that a positive change in health-related attitudes and beliefs can result from a relatively uncomplicated informational intervention.     

Expanding the Focus of Health Insurance Education for Medicare Beneficiaries

Health insurance education plays an important role in helping consumers make informed decisions about their need for supplemental coverage. This article reviews findings on the knowledge of Medicare beneficiaries about their health insurance coverage. Then, current health insurance education programs are examined with regard to their ability to meet the needs of a competition-based public policy. Barriers outside the control of individuals that impede the growth of the long-term care insurance market are identified and the need for an alternative, broader form of health insurance education is suggested. Changes in the scope and content of health insurance education are proposed that would educate the elderly to their own needs as well as the larger policy issues. An expanded model of education based on the concept of the Swedish study circle is discussed to illustrate the possibility of combining individual knowledge and public debate about complex social issues.     

Health care proxies: whom do young old adults choose and why?

Dying persons are encouraged to name as durable power of attorney for health care (DPAHC) someone who will thus be empowered to make end-of-life treatment decisions for them in the event that they become incapacitated. We use data from the Wisconsin Longitudinal Study to investigate whether and whom older adults designate as their DPAHC. DPAHC appointments are affected by recent hospitalizations, personal beliefs (including religion, fear of death, and the belief that doctors rather than patients should control health care decisions), and personal experience with the recent painful death of a loved one. The selections of DPAHC designees are generally consistent with the hierarchical compensatory model: Married persons overwhelmingly name their spouses, while unmarried parents appoint their children. Women are more likely than men to rely on children. Parents of one or two children tend to bypass their children for another relative. Unmarried, childless persons show considerable heterogeneity in their choices. We discuss implications of these findings for health care policy and practice.     

Japan's Financing Systems for Health Care of the Elderly

The multiplicity of Japan's health insurance system fails to achieve equality among the different insurance groups of the sharing of the financial burden. This "horizontal" inequality is effectively offset by a unique redistribution mechanism established in 1982. However, there is no reserve fund so that savings can be accumulated for the greater financial need in the future. This will inevitably lead to a heavier financial burden for the future working generation or more utilization of the personal assets of the elderly. How to achieve "vertical" or intergenerational equality in financing the cost of health care for the elderly is the biggest social policy challenge for Japan.     

Variables Affecting Patient Satisfaction with Health Care Services in the College Health Setting

Abstract

Patient satisfaction with health care services is an important factor in health care delivery. It will significantly influence whether or not a patient seeks medical care, complies with prescribed treatment, and/or maintains a continuing relationship with a medical practitioner.

A survey questionnaire, relating patient satisfaction with a number of variables identified through a literature review, was mailed to a random sample of 500 students utilizing Student Health Service (SHS) at Kent State University (KSU) during the five week study period. The data obtained would be utilized to help with planning future health care services and staff inservice education programs.

The findings of this survey indicate that patient satisfaction has a statistically significant correlation with perceived technical competence of the practitioner and perceived adequacy of the interpersonal aspects of the practitioner-patient relationship. A significant relationship did not exist between satisfaction and expectations the patient holds of the practitioner's role performance. A statistically significant relationship was found to exist between receiving health information/education related to diagnosis, prognosis, and treatment plan and satisfaction with health care services. This relationship did not hold for health information/education related to activity restrictions or preventive measures. The study also revealed that time waited during the medical care encounter was inversely related to satisfaction. Last, stepwise regression found that perceived technical competence of the practitioner was the most important variable influencing patient satisfaction with health care services.

This study provides data about factors important to personal satisfaction with health care services for a selected group of college students.     

Health Care for Older Women:

The issue of health care for older women as it relates to their financial resources and health care reimbursement is the focus of this paper. Federal regulations that affect older women and also the role of the medical establishment are examined. Suggestions are given for policy changes on the federal and local levels and for a redirection of the women's health movement. It is suggested that women tend to be seen as burdens to the health care system and face both age and sex discrimination from many health care providers. This is the disease that needs to be cured.     

Attitudes toward homosexuality among U.S. residents of Mexican descent

This study examined attitudes toward lesbians and gay men in a sample of northern California residents of Mexican descent (N = 616), using 3-item versions of the Attitudes Toward Gay Men (ATG) and Attitudes Toward Lesbians (ATL) scales presented simultaneously in Spanish and English. Males attitudes toward homosexual men were significantly more negative than females attitudes, whereas females expressed relatively negative attitudes toward lesbians. Overall, respondents expressing negative attitudes endorsed more traditional gender attitudes than respondents with positive attitudes, tended to be older and less educated, had more children, were more likely to belong to a fundamentalist religious denomination and to attend religious services frequently, were more conservative politically, and were less likely to have personal contact with gay people. Further analyses revealed that associations between attitudes and education, number of children, personal contact, and religious attendance occurred mainly among respondents who spoke and read English (rather than Spanish) or identified with U.S. culture (rather than Mexican culture).     

Attitudes toward homosexuality among U.S. residents of Mexican descent

This study examined attitudes toward lesbians and gay men in a sample of northern California residents of Mexican descent (N = 616), using 3‐item versions of the Attitudes Toward Gay Men (ATG) and Attitudes Toward Lesbians (ATL) scales presented simultaneously in Spanish and English. Males’ attitudes toward homosexual men were significantly more negative than females’ attitudes, whereas females expressed relatively negative attitudes toward lesbians. Overall, respondents expressing negative attitudes endorsed more traditional gender attitudes than respondents with positive attitudes, tended to be older and less educated, had more children, were more likely to belong to a fundamentalist religious denomination and to attend religious services frequently, were more conservative politically, and were less likely to have personal contact with gay people. Further analyses revealed that associations between attitudes and education, number of children, personal contact, and religious attendance occurred mainly among respondents who spoke and read English (rather than Spanish) or identified with U.S. culture (rather than Mexican culture).