Hospital Mergers

Abstract

When secular and sectarian (often Catholic) hospitals merge, women's reproductive healthcare services are often put in jeopardy. Some merger efforts are successful and others fail. Several issues arise as a result of this situation. First, what role do women's reproductive rights activists and their supporters play in effecting hospital merger decisions? This question does not assume that all women support women's rights organizations or that all women support a full range of reproductive rights. Secondly, what other factors seem to effect the outcome of merger discussions? In order to answer these questions, it is first necessary to understand the extent of Catholic hospital expansion and the nature of the hospital merger movement itself. These considerations will provide perspective for the two case studies of the American hospital merger movement that provide venues for examining the issues relating to participation and other factors that effect the outcome of merger talks. Cumberland and Baltimore are the two communities examined in this study. Though it would be a mistake to generalize to all merger situations based on these two cases, there are lessons that women's reproductive healthcare advocates can learn from the experiences of these two communities.

The issue of hospital mergers and the availability of reproductive healthcare services for women does raise an additional issue. Private sector decisions are being made that have a direct impact on public services, that is, the availability of a set of healthcare services in communities. This is not the direction that most public policy analysts consider.

The more frequently asked policy questions begin with public policy decisions and ask how they influence non-governmental decisions.     

Willingness to Use Formal Long-Term Care Services by Korean Elders and Their Primary Caregivers

This study examined predictors of older adults' and primary caregivers' willingness to use formal long-term care (LTC) services to understand possible use patterns of mandatory public LTC insurance programs in Korea. It focused on views regarding who (adult children or the government) should bear the responsibility for older adults' care. Logistic regression models were estimated using data from 1,168 older Korean adults aged 65 or older and their primary caregivers from a national survey. The results showed that older adults' and their caregivers' views on care responsibility were a dominant predictor of their willingness to use both formal home care services and nursing home care services. Both older adults and their family caregivers' willingness to use LTC services should be considered when predicting demand for LTC services. Efforts should promote the perspective that formal LTC services are an acceptable social norm.     

Travail salarié, travail domestique,travail au noir : l’économie domestique à l’épreuve de l’accession à la propriété

A survey conducted in a recent housing development located in an exurban township to the east of Lyon, France, investigated how owning a house affects the work for wages and work in the household of each person in a couple. Though an economic burden, a house can represent a family and occupational resource for low-income households in a context where wage earning is precarious. This is especially true for women with few skills who “choose” to specialize in day-care work, whether declared or not. Home ownership often reinforces the division of labor between men and women. The articulation of the occupational and household spheres also depends on the household's financial and social resources and on the distance from family networks of exchange and support.     

Spillover Impacts of a Reproductive Health Program on Elderly Women in Rural Bangladesh

This paper extends the program evaluation literature by investigating intra-household externalities generated by a reproductive health program, administered as a quasi-control experiment in rural Bangladesh. Although the program targeted only mothers and children in randomly selected treatment areas, using a reduced form demand approach and data from Matlab Health and Socio-economic Survey of 1996, we found a significantly positive spillover impact of this reproductive health program on the health of the never-targeted elderly women.

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.     

Family Resilience Predicts Socioeconomic Mobility of HUD Participants

Changing economic times and government policies are reshaping the way the U.S. Department of Housing and Urban Development (HUD) provides services nationwide; there is both a growing demand for housing and a desire to help families become self-sufficient. In this study, the authors examined factors that contribute to increased socioeconomic mobility through the lens of family resilience. Analyzing cross-sectional data from 411 families in the San Bernardino County HUD District using discriminant function analysis, results of this study show strong preliminary evidence that certain components of family resilience predict whether an individual head of household will have full-time employment. The results of this study provide implications for social service programs aimed at socioeconomic mobility.     

Stereotypes about caregiving and lessons from the Swedish panorama of care

This article analyzes the panorama of care provision in Sweden from the informal carers' perspective. We consider informal care, publicly financed services, for-profit agencies and voluntary organizations, using a survey conducted in 2009. Most cared-for persons with minor needs living in a separate household are helped also by others, but only a tenth use public services or other providers. About half of cared-for persons with major needs living in a separate household receive care also from other informal carers as well as public services. Only 1 in 10 of them relied on no one else beyond the carer interviewed. Among intra household carers—a minority of all persons cared for—it was common that the carer was alone in his/her commitment, without any contributions from public services or others. For the large majority of informal carers it is not a solitary undertaking as the commitment is often shared with family members and others and/or public services. The results suggest that ideal types about complementarity and substitution may understate the complex interplay between informal care and the public services (and potential other providers). The findings may suggest a need for more empirical research about ‘Care Cultures’ and expose simplistic representations of welfare societies; informal care plays a major—and increasing—role also in Sweden, a country with extensive public services.     

College women’s sexual and reproductive health screening behaviors and the role of mother–daughter communication

Abstract

Objective: The study investigated the role of mother–daughter communication and race in college women’s decisions to pursue sexual health screening services. Participants: Participants were 301 college women who primarily identified as White and Asian American (M_age = 19?years). Methods: Participants completed an online survey that assessed mother–daughter communication about sex and responded to items pertaining to pursuing sexual health screening services. Results: Maternal communication predicted daughters’ screening behaviors and sexual anxiety mediated the negative association between conservative communication from mothers and screening behaviors. Asian American college women were less likely than White college women to report that they received frequent and open communication about sex from their mothers and reported higher levels of sexual anxiety. Conclusions: Mothers should be aware of the implications their communication patterns may have on their daughters’ sexual and reproductive health, and college women’s sexual anxiety should be addressed in order to increase utilization of screening services.     

Structural adjustment,women, and agriculture in Cameroon

This article assesses the impact of economic structural programs on the agricultural activities of women's groups in Cameroon, and explores women's ways of coping with the reduction in individual and family income and the loss of public services. It examines the role of 25 women's groups in both rural and urban areas of Cameroon's northwest and southwest provinces in a study conducted from April to June 1999. Economic structural adjustment caused a tremendous increase in the workload of women that are farming usually in lots distant from their homes that yield poor returns. Land for food-crop cultivation has become increasingly scarce, and inputs have become substantially unaffordable. Income generated from the sale of crops is inadequate to supply the economic and social needs of the family. Moreover, the burden of their work has increased as they cope with housework, child-care, and food production, in addition to an expanded participation in paid employment. Moreover, women spend longer working hours than men, meeting both household responsibilities and their outside work. Women have devised strategies to cope with this economic crisis, but they need organizations that will support them with the important resources to be able to operate. Rural women seem to be coping better than urban women cope. In extreme cases, some women in urban areas resort to prostitution to cope with life in this crisis setting.     

Adverse Childhood Experiences and Healthcare Costs in Adult Life

ABSTRACT

The current study aims to present the prevalence of adverse childhood experiences and examine the healthcare costs associated with primary, allied, and specialist healthcare services. The Australian Longitudinal Study on Women’s Health is a general health survey of four nationally representative age cohorts. The current study uses 20 years of survey and administrative data (1996–2015) from the cohort born 1973–1978. Overall, 41% of women indicated at least one category of childhood adversity. The most commonly reported type of childhood adversity was having a household member with a mental illness (16%), with the most commonly reported ACES category being psychological abuse (17%). Women who had experienced adversity in childhood had higher healthcare costs than women who had not experienced adversity. The healthcare costs associated with experiences of adversity in childhood fully justify a comprehensive policy and practice review.     

The Impact of Public Housing Policy on Family Social Work Theory and Practice

Social workers are the professionals most engaged with families living in low-income and subsidized housing and most familiar with the problems associated with inadequate housing. Yet the discussion of public housing policy has been left largely to economists and housing activists and the clear implications for family social work practice have not been made clear. To connect these critical policy and practice issues, this article provides a theoretical foundation and a review of the research supporting the use of housing vouchers to combat race and class segregation, joblessness, family breakdown, inferior public services, child abuse, mental illness and crime victimization.     

Household welfare and women empowerment through microcredit financing: Evidence from Malaysia microcredit

Microcredit financing is considered a crucial vehicle to flourish the socioeconomic conditions of women and women empowerment, especially among those who are from low-income households and deprived of access to financial services. Nevertheless, the literature arrived with a conflicting conclusion about its effect and women demonstrate that microcredit has small or no effect. This study is intended to scrutinize the impact of a productive loan provided by Amanah Ikhtiar Malaysia (AIM) on women household welfare and empowerment. A cross-sectional survey was employed through the distribution of a questionnaire to 495 of old and new borrowers. We observe that microcredit has significant positive effects on borrowers’ household income and personal asset acquisition. However, even though the effect of microcredit empowers women borrowers in households’ decisions-making, it has no effect on women control over minor financials.     

Predictors of out-of-pocket medical expenditures in low-income households

From a sample of low-income households, out-of-pocket medical expenses are found to average about $25 per month. For each household, these expenses vary with annual income, type of insurance for medical care, priority of medical expenses, ethnicity, and number of ill family members. Expenses are reported for households with different socioeconomic characteristics and composition. Multiparticipation in insurance programs is shown. Fourteen percent of the survey participants say they have no insurance, public or private. Thirty-three percent participate in Medicaid.Flora L. Williams is an Associate Professor in Consumer Sciences and Retailing at Purdue University, West Lafayette, IN 47907. She received her Ph.D. from Purdue University and includes family economic well-being, and financial problems and expenditures among her research interests.Amy Hagler received her M.S. from Purdue University in Consumer Sciences and Retailing.Mary Pritchard is an Associate Professor in the Department of Human and Family Resources at Northern Illinois University, DeKalb, IL 60115-2854. Her Ph.D. was earned at Purdue and her areas of research focus on family economic well-being and economic socialization of adolescents.Marshall A. Martin is a Professor of Agricultural Economics at Purdue University. His research addresses agriculture and food policy, and economic assessment of emerging agricultural technology.William C. Bailey is an Assistant Professor of Marketing at the University of Indianapolis, 1400 E. Hanna Avenue, Indianapolis, IN, 46227-3697. He received his Ph.D. from Texas Tech University and focuses his research on economic psychology and health care cost.     

Household Headship Among Married Women: The Roles of Economic Power, Education, and Convention

Household headship historically has been equated with being the main economic provider of the household, a position usually occupied by men. This paper uses a change in the United States Census definition of household headship to examine whether headship for married women is associated with being the primary breadwinner in a marriage versus other non-economic explanations. According to microdata from the 1990 United States Census, women who are the main income providers in a marriage are much more likely to be household heads than women in co-provider marriages. There also is support for an egalitarian ideology explanation; that is, when both spouses are highly educated, the wife is more likely than the husband to be household head net of her relative economic independence in that marriage. Yet the force of convention remains strong given the low prevalence of headship among married women. The new census definition was meant partly to reflect the changing economic status of women. However, the reality is that conventional gender behaviors persist in household headship.     

Coverage Bias in Traditional Telephone Surveys of Low-Income and Young Adults

The proportion of adults with only wireless telephones is growingrapidly. Using 2006 data from the National Center for HealthStatistics’ National Health Interview Survey, this articleis among the first to reveal that noncoverage of this populationcan result in nonnegligible bias for traditional random-digit-diallandline telephone surveys that do not call wireless telephonenumbers. In 2006 in the United States, 17 percent of low-incomeadults with household income below 200 percent of the federalpoverty thresholds, 25 percent of young adults aged 18–29years, and 32 percent of low-income young adults lived in householdswith only wireless telephones. Within each of these three subgroups,we compared wireless-only adults and adults with landline telephoneson demographic characteristics and 13 key indicators of healthstatus, health behaviors, health care service use, and healthcare access. Even after statistical adjustments that accountfor demographic differences between adults living in householdswith and without landlines, telephone surveys of landlines willunderestimate the prevalence of health behaviors, such as bingedrinking, smoking, and HIV testing. Obesity may be overestimatedand physical activity may be underestimated for low-income youngadults. No significant bias is predicted for other measuresof health status and health insurance coverage. Sample weightingprocedures that incorporate adjustments for multiple demographiccharacteristics are necessary to help attenuate coverage biasin traditional telephone surveys, but may not be sufficientfor behavioral risk factor surveys of low-income and young adults.     

Sources of parenting support in early fatherhood: Perspectives of United States Air Force members

We conducted semi-structured focus groups with men in the United States Air Force (N = 39) to examine fathers' access to parenting information during the transition to parenthood, and to determine methods for engaging fathers in intervention. Results of content analysis highlight fathers' motivation to develop and maintain positive relationships with their partners and children despite substantial challenges, including multiple deployments, family moves, and demanding work responsibilities. Fathers emphasize the importance of information in facilitating the transition to parenthood, especially in the key domains of effective co-parenting and communication, children's developmental milestones, and appropriate use of discipline. Results underscore that men tend to rely more on informal sources of parenting information (e.g., spouse/partner, family members, friends) than on formal sources of information (e.g., pediatricians, social workers).     

Sexual and reproductive health policies for foster youth in California: A qualitative study of child welfare professionals' experiences and perceptions of policies

Child welfare professionals and foster parents increasingly suggest the importance of establishing clear and consistent policies and procedures to address the sexual and reproductive health of youth in foster care. The present study examines the content and context of such policies across 18 California counties through a search of publically available county policy documents, and surveys and expert interviews with child welfare professionals (N = 22). A policy framework for agenda setting and policymaking was used to guide the data collection and analysis process. Child welfare professionals were aware of multiple sources of information, support and services for foster youths' sexual and reproductive health, though few practiced in counties with formal policies that outline the resources and support that youth should receive. Participants demonstrated widespread recognition that issues of youth sexual and reproductive health were significant; posing challenges to youth, foster parents and child welfare staff. Identified policy solutions included: 1) training for social workers and foster parents; 2) collaborative partnerships with public health nurses and community providers; 3) data tracking and monitoring of outcomes to assess youth needs and evaluate the impact of programs and policies; and 4) involvement by advocacy organizations in defining problems and advocating for improved services and support for youth in care. Social workers largely perceived that support from child welfare administrators and policy leaders is necessary to prioritize this issue and initiate policy formation. Additional research is needed to further examine the impact of policy mandates on social workers, foster parents and youth in foster care.     

Deficits in young men's knowledge about accessing sexual and reproductive health services

Objective: The current study aimed to examine (1) gender differences in college students' knowledge of sexual and reproductive health care (K-SRHC) service access points, and (2) the relationship between demographic and psychosocial factors and college students' overall K-SRHC service access points. Methods and Participants: Self-report online surveys were administered to 18- and 19-year-old college students from a northern California public university (N = 183; 39.9% men; 32.2% Latino). Results: Women reported higher overall K-SRHC service access point scores than men. Findings indicated that gender and family planning self-efficacy were the strongest correlates of K-SRHC service access points. Men with a regular source of health care had higher K-SRHC service access points than men without. Conclusions: Results suggest that college men need additional education about how to access sexual and reproductive health services to support their own and their partner's health.     

Time for a change? Predictors of child care changes by low-income families

Instability in child care arrangements can negatively affect children's development, especially in low-income families. However, few studies have examined what predicts changes over time in child care arrangements. This paper presents findings from a unique multiyear study tracking child care use in low-income families. We estimate rich quantitative models to analyze the relationships among child, household, and care provider characteristics and four different types of changes. We find turnover in child care arrangements to be common in this low-income population. Over a period of six months, half of the children changed primary provider. Child care changes were frequently related to job loss, changes in family composition, or the changing availability of caregivers. While concerns have been raised that short spells of child care subsidy receipt cause child care instability, we found that subsidy use was not associated with higher rates of change. In addition, we found that the lower a parent's assessment of the child's experience in a particular arrangement in the prior time period, the higher the likelihood of changing providers by the next survey wave. These results indicate that low-income parents recognize quality factors and change arrangements to improve the quality of care.