Difficulty in seeking information about health care quality and costs: The field of dreams fallacy

While government agencies and health organizations have increased efforts to provide online information about health care quality and costs, we know little about whether individuals seek out or understand this information. Using results from a Louisiana telephone survey (N = 1030), we examine intent to use a website devoted to information about health care quality and costs and self-reported difficulty in finding this information. Intent to use a website is driven primarily by prior Internet use while difficulty in learning about health care quality is associated with greater choice in health care providers and dissatisfaction with current care.     

How do policy levers shape the quality of a national health system?

Poor quality of care may have a detrimental effect on access and take-up and can become a serious barrier to the universality of health services. This consideration is of particular interest in view of the fact that health systems in many countries must address a growing public-sector deficit and respond to increasing pressures due to COVID-19 and aging population, among other factors. In line with a rapidly emerging literature, we focus on patient satisfaction as a proxy for quality of health care. Drawing on rich longitudinal and cross-sectional data for Spain and multilevel estimation techniques, we show that in addition to individual level differences, policy levers (such as public health spending and the patient-doctor ratio, in particular) exert a considerable influence on the quality of a health care system. Our results suggest that policymakers seeking to enhance the quality of care should be cautious when compromising the level of health resources, and in particular, health personnel, as a response to economic downturns in a sector that traditionally had insufficient human resources in many countries, which have become even more evident in the light of the current health crisis. Additionally, we provide evidence that the increasing reliance on the private health sector may be indicative of inefficiencies in the public system and/or the existence of features of private insurance which are deemed important by patients.     

Young people leaving care: health, well-being and outcomes

This paper focuses on the health and well‐being of young people making the transition from care to independent adulthood. It draws on findings from a wider study of outcomes for young people leaving care in England. Notably, the study used, as its key outcome indicators, measures of general and mental well‐being. In doing so, it was able to explore the interrelationship between these areas and young people's overall progress after care. The paper explores the extent to which young people experience difficulties related to physical and mental health, disability and emotional and behavioural problems. It will show that such difficulties can impact upon and be influenced by overall well‐being and post‐care progress in more traditional outcome areas such accommodation and career, and will suggest that the transition from care itself can adversely affect health and well‐being. The paper considers these issues within the context of a changing policy framework which has given increased priority to the health and well‐being of young people in and leaving care, particularly in light of the Children (Leaving Care) Act 2000. It considers the ways that young people are supported to address health and well‐being and the implications for and impact on leaving care services.     

Three's a crowd? The Nader vote in the 2000 presidential, election in U.S. metropolitan areas

The 2000 U.S. presidential election resulted in one of the closest and most controversial outcomes in U.S. history. Green Party candidate Ralph Nader had little chance of winning, but nevertheless impacted the race in several close states and arguably swung the race from Al Gore to George W. Bush. This research examines Ralph Nader's “urban strategy” to win 5% of the vote for president and the bases of his electoral support. This study uses the METRO_2000 data set which contains a variety of publicly available variables for 276 U.S. metropolitan statistical areas (MSAs) in the year 2000. The analysis uses OLS regression to examine the determinants of the percentage of the vote for Nader in each MSA. The results indicate that the Nader vote was positively influenced by key electoral variables such as the level of electoral participation, whether Nader was on the ballot or could be written in, and the closeness of the race in state polls leading up to the election. The Nader vote was also higher in MSAs with high percentages of voters who supported Nader programs including environmentalists, those favoring universal health care and gay rights, union members, and MSAs that were college towns or with high percentages of college-educated voters. Ralph Nader's urban strategy effectively mobilized enough of his electoral base to impact the 2000 election, but electoral constraints and the closeness of the race prevented him from achieving his goal of attaining 5% of the vote. This case holds lessons about the limits and possibilities of third party campaigns in U.S. presidential elections.     

Mark Time: India's March to Universal Health Care Coverage

This article evaluates the efforts underway in India to achieve universal health care coverage and the conditions that fostered its contemporary evolution. It finds that India’s health system is characterized by private provision and financing, horizontal and vertical fragmentation, and weak governance arrangements. The article argues that these defining characteristics, which have solidified over time, account for poor health outcomes and make the system impervious to reforms as they deny the government levers to intervene and shape outcomes in the sector. While the government's recent efforts of increased public funding of national programmes have helped to reduce out of pocket spending, these are unlikely to work in the long run unless the government addresses the sources of the problems. The article argues that building health care governance, strengthening regulatory architecture, and stewardship over the system, in conjunction with increased public spending, are essential if the health care system is to provide affordable care to the entire population.     

Cancer and Health Policy: The Postcode Lottery of Care

Cancer is a major cause of death and ill health, accounting for roughly one in four deaths in the UK. Concern with cancer services was expressed in the 1990s when it was reported that the quality of cancer care was patchy and variable, and clinical outcomes varied in different parts of the country. The Calman‐Hine Report (1995) produced specific recommendations for the reorganizing and reconfiguring of cancer services, but although the Conservative government, which commissioned the report, endorsed its suggestions no additional funding was provided to implement the proposed changes, and consequently there remained variations in provision across geographical areas and between patients with different cancer types. However, since 1997 the Labour government has targeted cancer, appointing a Cancer Tsar, announcing a package of measures to “fight the war against cancer”, including the publication of a National Cancer Plan (2000 ) and with Tony Blair pledging to end the postcode lottery for cancer treatment. This paper explores the concept of the “postcode lottery of cancer care”, why it exists and whether measures taken since the Calman‐Hine Report and the Cancer Plan will address it.     

Part-time employment and worker health in the United States

A growing body of research has highlighted the consequences of part-time employment for workers’ health and well-being. However, these studies have yielded inconsistent results and relied on cross-sectional data. In addition, relatively little empirical research has explored whether the effect of working part-time on health varies by gender, particularly in the United States. Using longitudinal data from three waves of the General Social Survey panel (2010–2012–2014), our study examined the association between part-time employment and perceived health among U.S employees, and whether this association varied by gender. The results showed that part-time workers were less likely to report poor self-rated health than full-time workers, especially among males. The pattern of results was consistent across empirical approaches—including generalized estimating equations and random effects models, with an extensive set of covariates. Taken together, these findings suggest that for U.S. employees, working part-time appears to be beneficial or at least not detrimental to perceived health, which warrants further investigation.     

Physician behavior and conditional altruism: the effects of payment system and uncertain health benefit

This paper experimentally investigates the altruistic behavior of physicians and whether this behavior is affected by payment system and uncertainty in health outcome. Subjects in the experiment take on the role of physicians and decide on the provision of medical care for different types of patients, who are identical in all respects other than the degree to which a given level of medical treatment affects their health. We investigate physician altruism from the perspective of ethical principles, by categorizing physicians according to how well their treatment decisions align with different principles for priority setting. The experiment shows that many physicians are altruistic toward their patients but also that the degree of altruism varies across patients with different medical needs. We find a strong effect of payment system that is overall unaffected by the introduction of risk and ambiguity in patients’ health outcomes. There is, however, substantial heterogeneity across individuals, in particular under the capitation payment system where physicians’ responses to the introduction of uncertainty in patient health are modulated by their own generic risk and ambiguity preferences.

     

Health Care during Transition and Health Systems Reform: Evidence from the Poorest CIS Countries

The poorest seven countries of the former Soviet Union (CIS‐7) moved from a centralized system of health‐care funding and delivery to a range of institutional and financial arrangements. The different paths chosen have implied different results in terms of available resources, internal efficiency, health‐care inequality, and the corresponding incidence of public expenditures. This paper examines the level, composition and allocation of public spending on health, in light of the evolution of the health systems during the transition. The financial constraints experienced by CIS‐7 countries were reflected in the decrease of health‐care quality, the collapse of the already inefficient public health activities, and the increased incidence of out‐of‐pocket expenditures. These factors, alongside the increase in poverty, resulted in a decrease in health‐care utilization, suggesting that these countries may experience difficulties in achieving the health‐related Millennium Development Goals.     

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.     

Does what happens in group care stay in group care? The relationship between problem behaviour trajectories during care and post‐placement functioning

Residential programmes for youth may improve youth behaviour during placement, but it is not clear whether there is an association between a youth's behaviour pattern during placement and post‐placement outcomes. Life course perspective has been used to understand longitudinal patterns and pathways, and new statistical methods have been developed to identify latent trajectory groups. This study used administrative data from a family‐style group care programme to assess whether a youth's externalizing behaviour trajectory while in placement can significantly predict delinquency and adjustment outcomes at discharge and 6‐month follow‐up. Findings from multinomial logistic regression revealed a statistically significant relationship between a youth's behaviour trajectory class and outcomes. Behaviour pattern during care was a stronger predictor of outcome than cross‐sectional measures such as other demographic factors, placement history or mental‐health need indicators.     

The Organization of Health Policy Functions in the German Federal Government

This article gives an account of the organizational history of the German federal ministry of health (and its predecessors) since the beginnings of public policy intervention in health care. In doing so it analyses the role of ministerial organization and examines the functional and political rationale underlying acts of reorganizing the tasks and resources of federal ministries. This analysis has two sides: the first concerns the expressive function of organizational form, as revealing something about the scope and perceived importance of the policy field, while the second interrogates the policy‐shaping role of organization and the political influence of the federal health ministry in health policy‐making. The article thus considers the organizational location of health issues in the central executive from the perspective of what it reveals about government goals and priorities. Then it examines possible policy implications. It looks at resources and the size of the ministry as a first attempt to learn something about the ministry's political weight. The question of policy implications draws our attention away from organization and resource allocation and back to a focus on policy‐making and policy outcomes. The final section therefore examines substantive policy implications that might have emanated from the organizational consolidation of the federal health ministry. It concludes that one such policy implication might be the erosion of the social insurance model as a regulatory idea in health‐care services and financing.     

Relationships Among Caregiving,Income, Gender,and Health: A Cross-Sectional Examination of a Representative Sample of Older Americans

Although there is substantial evidence to support the effect of burden on caregivers, few studies have compared caregivers to their noncaregiving counterparts on the basis of health and well-being outcomes. This study examines the relationship between caregiving and health and whether other factors may have stronger influence on well-being measures. Using a nationally representative sample of older adults in the United States (N = 3,005), this study examines relationships between caregiving status, gender, and income, and 9 outcomes (self-rated physical and mental health, time since seeing a doctor, time since most recent pap smear or prostate-specific antigen [PSA] test, depression, loneliness, stress, anxiety), using logistic and linear regression models. Results support that paradoxically, caregiving was associated with increased likelihood of PSA test in male caregivers, although data also indicated higher levels of anxiety and stress, as might be expected. Income was associated with 8 of 9 outcomes, and gender predicted depression, anxiety, stress, and self-rated mental health. The study highlighted the importance of psychosocial stressors, such as income and gender, on the health outcomes of older adults who may be caregiving. Considering complexity of unique experience is necessary to accurately assess vulnerability to poor mental health or health-related outcomes.     

Religious affiliation and Hispanic health in Utah

Two research hypotheses are addressed in this study. (1) Do health trajectories of Hispanics in Utah differ from what has been documented in states with longstanding large Hispanic populations? (2) Do non-Mormon groups in Utah have less favorable health status than Mormons in Utah? This study employs three health outcome measures: activity limitations caused by emotional problems, activity limitations caused by physical problems, and self-rated health status using the 2001 Utah Health Status Survey. Comparisons of Hispanics in their traditional settings within the U.S. generally show more favorable health status for Hispanics than for whites. We find little difference in health status between Hispanics in Utah and their Anglo counterparts. Hispanics were more likely than Anglos to have “a little” activity limitation due to physical problems, but were not more likely to report “a little” or “considerable” activity limitations due to emotional or physical problems. Hispanics and Anglos were statistically equal in probability of self-reported fair to poor health. Important in relation to studies outside of Utah, we find little support for the epidemiologic paradox, the usual finding of more favorable health for Hispanics than for whites. As with ethnicity, we find little difference between non-Mormon and Mormons with respect to health. The most notable exception is that Mormon Hispanics are at a significantly greater risk of emotional problems than Catholic Hispanics in Utah.     

Foster Care: How We Can,and Should,Do More for Maltreated Children

Foster care provides round-the-clock substitute care for nearly 700,000 U.S. children who are temporarily or permanently separated from their family of origin each year. Each state manages its own foster care system according to federal regulations. Despite numerous large-scale federal policy reforms over the past several decades, substantial concerns remain about the experiences and outcomes of children in the foster care system. The most recent effort to reform foster care, the Family First Prevention Services Act of 2018, attempts to both reduce the use of foster care and increase the quality of care. In this report, we review how policy has shaped the experiences and outcomes of children in foster care, where policy has succeeded, and where it falls short of achieving its goals. We then identify opportunities for federal and state policy to better support the safety, health, and well-being of children in foster care.     

Income inequality and health outcomes in the United States: An empirical analysis

A growing body of research suggests a relationship between health and income inequality. This study specifically analyzes the correlation between income inequality, measured by state-level Gini coefficients from the American Community Survey (ACS), and individual behavioral, physical, and mental health outcomes from the Behavioral Risk Factor Surveillance System (BRFSS) for 2006 through 2014. After controlling for demographic and socioeconomic characteristics, health insurance status, year trends, and state fixed effects, income inequality was found to have significant relationships with behavioral, physical, and mental health outcomes, including heavy drinking, obesity, exercise, diabetes, heart attack, heart disease, physical and mental health problems, and depression, and often the impact on low-income individuals is slightly smaller than on the high-income group. The research suggests that economic policies to address the rising income inequality in the United States might serve to also address some of our nation’s most troubling health statistics.     

Health Policy in the Asian NIEs

This paper compares the health policies of Hong Kong, South Korea, Singapore and Taiwan with the purpose of drawing policy lessons. The study finds two distinct policy clusters: Hong Kong and Singapore on the one hand, and Korea and Taiwan on the other. With respect to provision of health care, the former rely largely on public hospitals for delivering inpatient care while the latter rely on private hospitals. In matters of financing, they are similar in that out‐of‐pocket is a major source of financing in all four countries. However, they are also different because Korea and Taiwan have universal health insurance while the city states do not. The study concludes that public provision of hospital care, as in Hong Kong and Singapore, yields more favourable outcomes than many mainstream economists would have us believe. Conversely, private provision in combination with social insurance, as found in Korea and Taiwan, severely undermines efforts to contain health care costs.     

Family conflict and future concerns: Opportunities for social workers to better support Chinese immigrant caregiver employees

ABSTRACT

This paper explores the experiences of Chinese immigrant caregiver employees (CEs) residing in Southern Ontario, Canada. Qualitative analysis of participant interviews with thirteen Mandarin Chinese immigrant CEs revealed family conflicts due to cultural differences and an intergenerational gap between CEs and their care recipients. CEs also had future concerns in regards to their own health and the lack of long-term care facilities that offer cultural services for immigrant seniors. These findings provide an opportunity for social workers to collaborate with other service providers to provide ethno-specific and culturally sensitive health, community. and employment services to immigrant ethnic minority CEs.     

Does residential segregation help or hurt? Exploring differences in the relationship between segregation and health among U.S. Hispanics by nativity and ethnic subgroup

In order to unpack whether and how self-rated health of Hispanics is linked to residential segregation from non-Hispanic whites, this study employs multi-level analysis combining data from the 1997–2002 National Survey of America's Families (n = 16,753 Hispanic respondents across 82 metropolitan areas) with metropolitan area segregation scores derived from restricted-use Census 2000 data. Separate analyses by nativity (U.S.-born vs. foreign-born Hispanics) and ethnic subgroup (comparing Mexicans, Puerto Ricans, and Cubans) are also conducted. Net of individual-level controls, findings reveal a small significant negative effect of segregation on health for all Hispanics and for Mexicans in the sample. Nativity does not have a significant interaction effect. Evidence of a positive segregation/health link is found for Cubans, challenging the assumption that segregation is always bad for minority health. This research highlights the value of multi-level analysis in examining segregation as a social determinant of health, and reveals key Hispanic subgroup differences.     

Mental health practice in primary care: Some perspectives concerning the future of social work in organized delivery systems

Abstract

The rise of managed care as the dominant form of healthcare delivery in the U.S. clearly has dramatic implications for the profession of social work. Thus far and for good reasons, the professional dialog about managed care has largely focused on . the threats posed to the professional agenda of social work by managed care in its various forms. This article considers some of the more positive aspects of the transformation from fee‐based to population‐based healthcare systems, in particular the vigorous trend toward multidisciplinary primary care and collaborative mental health practice in primary care settings. It is argued that the market forces behind this trend also promote the emergence of models of social work practice that better integrate historically dichotomized aspects of health and mental health practice. Also considered are implications for social work education and the division of labor among the healthcare professions.