Gender and geographic differences in Medicare service utilization during the last six months of life

ABSTRACT

End-of-life issues are important for senior women, particularly rural women, who are more likely than their urban counterparts to live alone. The role of residence as a factor for health-care utilization among Medicare beneficiaries during the last six months of life has yet to be investigated. The purpose of this study is to examine whether service utilization in the last six months of life differs across gender and rurality. The sample was restricted to fee-for-service Medicare beneficiaries who died between July 1, 2013, and December 31, 2013 (n = 39,508). The odds of rural beneficiaries using home health (aOR 0.87; 95% CI 0.81–0.93) and/or hospice (aOR 0.82; 95% CI 0.77–0.87) in the last six months of life were lower than urban beneficiaries. Female beneficiaries were more likely to use support services such as hospice (aOR 1.24; 95% CI 1.18–1.29) and/or home health services (aOR 1.07; 95% CI 1.02–1.13) than male beneficiaries. The odds of female beneficiaries using inpatient (aOR 1.14; 95% CI 1.08–1.20) and/or outpatient (aOR 1.06; 95% CI 1.01–1.12) were higher than male beneficiaries. This research is important as we examine the range of health services used during the last six months of life, by gender and rurality. Future research is needed to understand how access to health services, residential isolation, and age- and disease-related factors relate to women’s observed greater use of inpatient, outpatient, hospice, and home health services in the last six months of life.     

案例教学法在卫生事业管理学教学中的应用研究

为加强医学院校课堂教学质量,促进医学院校卫生事业管理学的教学改革和研究,我们基于层次分析法（AHP）的模糊数学,对皖南医学院卫生事业管理学实施案例教学法的整体教学效果进行综合评价研究,评价结果显示：案例教学法是医学院校课堂教学的一种有效方法,有利于改善教学效果和提高学生的综合素质.     

The health care system of the People's Republic of China: Between privatization and public health care

Chinese health care policy has undergone numerous reforms in recent years that have often led to new challenges, inciting the need for further reform. The most recent reforms attempt to find a middle path between public health care provision and commercial private insurance. In this way, China is following in the footsteps of countries that initially increased the role of privatization in the 1990s and at the beginning of the 21st century, but are now gearing towards public health care. However, this process of constant reform has led to a lack of transparency in the functioning of the health care system, provoking a loss in public trust. There remains an important degree of uncertainty about the future direction of developments in China. Nonetheless, a dual financing approach to health care using tax finance and social insurance might yet crystallize, offering a potential model to inform developments in other countries.     

Possibilities for Intervention in Domestic Violence: Frame Analysis of Health Care Professionals’ Attitudes

ABSTRACT. Violence is a serious problem, and social and health care providers are in a key position for implementing successful interventions. This qualitative study of 6 focus groups with professionals (n = 30) examines the health care professionals’ ways of framing a domestic violence intervention. Of special interest here is how professionals see their own roles in the process of recognizing and helping victims of domestic violence. By using Erving Goffman's frame analysis, this study identifies several frames that either: a) emphasize the obstacles to intervention and justify nonintervention, or on the contrary, b) question these obstacles and find justifications for intervention. The possibilities for intervention are further explored by analyzing the ways in which the dynamics between the different frames allow redefinition of domestic violence interventions. Despite the challenges involved in a domestic violence intervention, there seems to be potential for change in personal attitudes and reform of professional practices. The research findings underline the role of social and health care professionals as members of a larger chain of service providers working collaboratively against domestic violence. Implications for practice and directions in policy and future research are suggested.     

Measuring Family Caregiver Perceptions of Support in Caring for Children and Youth With Mental Health Concerns

ABSTRACT

This correlational study assessed how families of children with mental illness perceived the levels of support they received from informal and formal resource providers and the associations between perceived support and child outcomes. Adult caregivers (N = 904) of youth receiving public mental health care services were administered the Family Caregiver Perceptions of Support Scale developed by the authors to assess family caregiver perceptions of support prior to and at termination of services. Factor analysis identified three types of caregiver anticipated supports: informal support resources, support for treatment plan influence, and health care resources. The domains were significantly and positively associated with one another but did not uniformly correlate with youth mental health outcomes. The study provides preliminary evidence that treatment gains in youth mental health outcomes are observed when caregivers perceive support in treatment processes. Suggestions for future research are made, stressing the importance of caregivers and providers working together and describing needs related to future scale improvements.     

Dilemmas in Creating an Intern/Field Instructor Supervision Group in a School Setting: Thoughts on Role and Authority

ABSTRACT

Being guests in a host system, a school-based health program (SBHP), presents social workers with complex challenges that underscores the need for regular, supportive supervision. Group supervision is especially useful in bridging this gap, reducing isolation, and uniting a social work team dispersed across four different schools. This article reports on efforts to strengthen a social work component in a four-unit SBHP through the creation of a bi-weekly supervision group. Due to the hierarchical mixed membership of field instructors, interns and program administrator, this group addressed challenges and opportunities around role, authority, and power dynamics.     

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.     

The Meaning of Gender While Aging With Paralytic Polio

The purpose of this article is to report the influence of gender on aging with childhood onset paralytic polio. The hermeneutic phenomenological exploration of gender was done using multiple qualitative interviews with 25 women, age 55 to 75 years of age, who had polio since before 14 years of age. We noted three themes: (a) the movement of her body, (b) integrating body and gender, and (c) gender discrepancies. Findings are discussed in the context of gendered expectations and the women's bodies.     

“Talking in a New Way”: Older Individuals' Experiences of Group Work in an Acute Psychiatric Ward

Group work is frequently used in mental health, however qualitative studies on service-users' views are rare. Semistructured interviews explored 12 participants' experiences of a café-style social group and a mutual-aid group offered on an older persons psychiatric ward in Christchurch, New Zealand. The values of the strengths-based approach underpinning the groups were reflected back in the experience of an affirming environment, an exchange of strengths, and the capacity to change. The appeal of the café-style may be culturally specific to European women however, reinforcing the importance of an awareness of culture and diversity.