Search

This paper examines the uses of some health status indices in measuring equity of access to medical care. Empirical examples are provided using data from national surveys of the U.S. population conducted from 1964 through 1976. A simple indicator, mean number of physician visits, suggests that between 1963 and 1976 the poor improved their position relative to the rest of the population and, indeed, currently enjoy the highest level of access. However, a second measure, the use-disability ratio indicates that the poor may still receive less care relative to their need. A third measure, the symptoms-response ratio suggests how norms of appropriate behavior might be incorporated into an access measure. [ABSTRACT FROM AUTHOR]

Objectives. This paper analyzes the impact of seven chronic conditions (three nonfatal: arthritis, visual impairment, hearing impairment; four fatal: ischemic heart disease, chronic obstructive pulmonary disease, diabetes mellitus, malignant neoplasms) on US adults aged 18 and older. Impact refers to how readily a condition prompts activity limitations, physician visits, and hospital stays. Methods. Data come from three national health surveys and vital statistics. For comparability, a single disease classification scheme was applied, and new rates were estimated. Frequency, impact, and prominence of the target conditions are studied via rates, ratios of rates, and ranks, respectively. Results. In young adulthood, the nonfatal conditions prompt limitations less readily than do the fatal ones, but by older ages, arthritis and visual impairment have a limiting impact equivalent to that of fatal conditions. Despite high prevalence and limitations, nonfatal conditions stand well below fatal conditions for health services use. Conclusions. Although statistics on frequency, impact, and prominence all indicate conditions' "importance," they give only weak clues about specific service needs of affected persons. The persistent finding that nonfatal conditions do not receive health services care commensurate with their prevalence and impact reflects long-standing imbalanced attention on fatal conditions in research and medical care. [ABSTRACT FROM AUTHOR]

The article presents a position paper from the American Public Health Association relative to the availability of nutrition status data to local health agencies in the U.S. The association encourages that there be adequate personnel and funding to make surveillance data collected by the Center for Disease Control available to all the states and territories of the U.S. It also encourages that there be enough funding and manpower to enable the administrators of the Health and Nutrition Examination Survey of the National Center for Health Statistics to formulate a method to make data available and more useful to local communities and develop future surveys to accomplish the purpose.

Abstract: In October 1983, a retrospective survey was initiated to determine if patients reported to the Centers for Disease Control as having recurrent tuberculosis truly had recurrent disease and, if so, why they had developed tuberculosis again. Twenty-three health jurisdictions provided information on 800 patients diagnosed as having recurrent tuberculosis during 1981 and 1982. We found that 199 (25 per ¢) of the cases did not meet the criteria for recurrent disease. Of the remaining 601 recurrent cases, 20 per ¢ had no chemotherapy prescribed for their previous episodes of tuberculosis, 20 per ¢ were prescribed inadequate or inappropriate therapy, and 33 per ¢ were not compliant with their prescribed therapy regimens. Patients who, during their original episode of tuberculosis, received the major portion of their medical care from physicians in private practice were more compliant than those treated by other health care providers. However, those same patients were more likely to have received inappropriate therapy than patients treated by other providers. Better patient and physician education, closer monitoring, and greater use of preventive therapy and directly observed therapy are necessary to resolve these problems. [ABSTRACT FROM AUTHOR]

Abstract: In a nationwide survey we found 72 PKU (phenylketonuria) patients who had terminated diet but later returned to diet. Sixty-one patients resumed diet due to clinical problems. Age at initial diet discontinuation ranged from three to 20 years. The most prevalent problems reported were poor school performance, and mood and/or behavior changes. Following diet reinstitution, only positive changes were noted for 42 patients, no changes for 19 patients, and 11 had one or more negative changes. Improvements and blood phenylalanine levels were not significantly correlated, but only Il patients maintained levels < 10 mg/dl. The number of improvements was significantly correlated with length of time on diet (p < 0.001 ). After a median of 10 months on diet. 22 patients had again discontinued due 10 poor diet control, lack of motivation, poor formula tolerance, lack of apparent benefits and/or changes [or the worse, Median time on diet for the 50 second-time continuers was two years nine months. [ABSTRACT FROM AUTHOR]

Abstract: Personal and telephone interview surveys were conducted simultaneously during 1981 in the same area (four counties on the area of Tampa Bay, Florida and utilizing the same interview schedule. Following completion of the surveys, validity checks were made with the medical providers reported by a subsample of respondents to each mode. The telephone survey yielded a lower response rate but cost less than half the personal interview. There was some evidence of nonresponse bias in the telephone survey, and some relatively minor differences in responses were found between the two modes, but there was no conclusive evidence that the response differences resulted from mode effects. Telephone respondents appeared to be somewhat more accurate in their reporting of visits to medical provides, although accuracy comparisons must be interpreted with caution in view of the disparate success experienced for the two modes in securing permission forms for the release of medical record information. [ABSTRACT FROM AUTHOR]

In 1977 the National Center for Health Services Research, US Department of Health and Human Services, undertook a survey of 40,000 individuals in the United States, soliciting information on expenditures and sources of payment for health services including prescribed medicines. Differences in the use of prescribed medicines by age, sex, ethnic/racial background, family income, and perceived health status were found across and within therapeutic categories. More than one-fifth of expenditures were for cardiovascular-renal agents. Sources of payment were similar in all but a few therapeutic categories. [ABSTRACT FROM AUTHOR]

Abstract: The method of data collection in household health surveys can be a major determinant of cost and data quality. A survey strategy can comprise mail. telephone, or home interview methods, individually or in combination to follow up non-respondents. The purpose of this study in Montreal was to compare cost and data quality of various strategies. Strategies which began with mail or telephone contact, followed by the two other methods, provided response rates as high as a home interview strategy (all between 80 and 90 percent), for one-half the cost of home interviews when used as the sole method. The telephone response rate was higher than the mail response rate. Comparing different follow-up approaches to strategies beginning with mail or telephone, it proved less costly, and equally effective, to use home interviewing as a last resort for persistent non-respondents. Validity of response (comparing individual responses with records of a government health insurance data bank) and willingness to answer sensitive questions were greatest in mail strategy. [ABSTRACT FROM AUTHOR]

A set propositions is offered to provide a frame of reference for proposed strategies to improve healthful behavior by placing personal choice-making in the context of societal option-setting. The health status of populations at a given point in time is seen as a result of customary personal choice-making. These choices in turn are limited by both the perceived and actual options available to individuals, depending on their personal and their community's resources, from which to make choices, Most people, most of the time will make the easiest choices, i.e., will do the things, develop the patterns or life-styles, which seem to cost them less and/or from which they will gain more of what they value in tangible and/or intangible terms. The range of options available to them, and the ease with which they may choose certain ones over others, is typically set by organizations, public and private, formal and informal. The more powerful the organization, i.e., the more effective it is in carrying out its policies, the more it affects the populations, whether or not these effects are immediately perceived by individuals in their day-by-day choicemaking. Implications for health education strategies are noted. [ABSTRACT FROM AUTHOR]

We surveyed 1196 Black health and political leaders on their perceptions about the US Department of Health and Human Services' Healthy People 2000 public health goals. Respondents identified reducing the incidence of acquired immunodeficiency syndrome, improving maternal and infant health, and controlling sexually transmitted diseases as the three most important public health goals for Black Americans that are amenable to intervention. The leaders assigned nearly all responsibility for prevention efforts to the federal government and the individual. With the American health care system now in flux, Black leaders need to organize to see that these priority issues are addressed. [ABSTRACT FROM AUTHOR]

Of the 47 states that participated in a 1983 survey of State Health Departments, 30 were found to have public health standards in place or started. Most states' standards emphasize the range of services to be provided, but substantial variations were found in how standards are formulated, adopted, and used by state and local agencies. (Am J Public Health 1985; 75:649-650) [ABSTRACT FROM AUTHOR]