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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]

Objective. We sought to test methods for generating epidemiological evidence on health conditions of small, dispersed minority communities. Methods. We used community-based mixed methods including a cross-sectional survey in 5 purposely selected settlements of Khorakané Romá (Gypsies of Muslim culture) in Italy to study the living conditions and health status of children aged from birth to 5 years. Results. In the 15 days prior to the survey, 32% of the children had suffered diarrhea and 55% had had a cough. Some 17% had experienced respiratory difficulties during the past year. Risk factors associated with these outcomes included years spent living at the camp, overcrowding, housing conditions, use of wood-burning stoves, presence of rats, and issues related to quality of sanitation and drains. Qualitative information helped define the approach and the design, and in the interpretation and consolidation of quantitative results. Conclusions. Guided by the priorities expressed by dispersed minority communities, small studies with little resources can provide a solid base to advocate for evidence-based participatory planning. Exact intervals appeared to be robust and conservative enough compared with other intervals, conferring solidity to the results. (Am J Public Health. 2008;98:2035-2041. doi:10.2105/AJPH.2007.129734) [ABSTRACT FROM AUTHOR]

I examined the 1995 and 2002 National Survey of Family Growth for patterns and trends in the use of sexual and reproductive health care services by US women according to type of provider. The percentage of women reporting receipt of contraceptive services rose between 1995 and 2002 (from 36% to 41%), and the level and mix of services received varied considerably according to type of provider. Women visiting publicly funded providers received a broader mix of services than did clients of private providers. (Am J Public Health. 2008;98:1814-1817. doi:10.2105/AJPH. 2007.124719) [ABSTRACT FROM AUTHOR]

Objectives. Profound and growing disparities exist in oral health among certain US populations. We sought here to determine the prevalence of oral health complaints among Harlem adults by measures of social class, as well as their access to oral health care. Methods. A population-based survey of adults in Central Harlem was conducted from 1992 to 1994. Two questions on oral health were included: whether participants had experienced problems with their teeth or gums during the past 12 months and, if so, whether they had seen a dentist. Results. Of 50 health conditions queried about, problems with teeth or gums were the chief complaint among participants (30%). Those more likely to report oral health problems than other participants had annual household incomes of less than $9000 (36%), were unemployed (34%), and lacked health insurance (34%). The privately insured were almost twice as likely to have seen a dentist for oral health problems (87%) than were the uninsured (48%). Conclusions. There is an urgent need to provide oral health services for adults in Harlem. Integrating oral health into comprehensive primary care is one promising mechanism. {Am J Public Health. 2002; 92:49-52) [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: We used the 1978 National Health and Nutrition Examination Survey to examine the prevalence of positive syphilis serologies in the US population. Analysis of risk markers--gender, age, marital status, education, income, and residence--indicates that all except gender are associated with syphilis seroreactivity, independent of race. Controlling for associated risk markers, the Black-White odds ratio of syphilis seroreactivity is 4.7 (95% CI = 2.7, 8.2). Current knowledge of racial differences in sexual and health care behavior does not explain the Black-White difference in the prevalence of syphilis seroreactivity. [ABSTRACT FROM AUTHOR]

Abstract: In order to put Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) Program in a national context, a nationwide mail survey and telephone follow-up to each of the 58 State Unit Directors on Aging in the United States and its territories identified 10 programs. The results reported in this article are specific to the seven state-level pharmaceutical assistance programs which were in operation during the fiscal year 1984-85. In general, the programs varied on select program characteristics and on their efforts to address major policy issues. Data from the non-program states indicated support, legislative efforts, and a high interest in fiscal concerns. The findings reflect a lack of program uniformity and have implications for program development and implementation. Suggestions on how to identify the "optimum" or best combination of program and policy options are discussed. [ABSTRACT FROM AUTHOR]

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: We compared ambulatory and inpatient surgery utilization by age level for procedures known to be frequently performed on un ambulatory basis. Our scope of data was the Crouse Irving Memorial Hospital in Syracuse, New York during 1984. The hospital operates one of the largest freestanding ambulatory surgery programs in the United States. The study included 8.348 ambulatory procedures 42 per ¢ of all operations performed under the aegis of this institution. At the aggregate, the inpatient surgery included a somewhat lower proportion of young adults and a higher proportion of individuals aged 65 and over than did outpatient surgery. For specific procedures however, age distributions differed. Ambulatory procedures included lower percentages of elderly than did inpatient utilization for inguinal hernia repair, carpal tunnel release, destruction of larynx lesions, hernia repairs, destruction of skin lesions and other operations, while ambulatory utilization for lens procedures included higher percentages of elderly patients than did inpatient utilization. Physician practice patterns also appeared to influence the setting of certain procedures. The study data suggested that persons involved in health planning should evaluate ambulatory surgery use on an age and procedure-specific basis, and utilization review should evaluate procedures on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Abstract: In this study, excess rates of pneumonia and influenza (P&I) associated hospitalization during influenza A epidemics which occurred in the United States between 1970-78 were computed utilizing unpublished data from the National Hospital Discharge Survey (NHDS). Excesses occurred at rates of 35, 93, and 370 per 100,000 persons per epidemic for age groups 15-44, 45-64, and 65+ years. There was no evidence of a persisting excess or a compensatory decline in P&I hospitalization during post-epidemic months. An average excess of about 172,000 hospitalizations per epidemic at a cost in excess of $300 million was computed. The study quantifies a major impact of epidemic influenza upon health and health services, much of which may be preventable, and illustrates an important use of unpublished data contained in the NHDS. [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]

Surveys of a national sample of 193 subsidized rural primary cure programs were conducted in 1981 and 1982 to determine what adaptations the programs might anticipate making given a reduction in their subsidy and what actual changes they made after the implementation of new federal policies, and in the face of severe economic recession. During the period between the two surveys, nine of the 193 programs closed. The remaining programs changed dements of their operation, finances, and staffing, but these changes do not, in all cases, appear to be a direct response to subsidy reductions or increases. The programs exhibited adaptiveness and strength in the face of a potentially hostile environments. [ABSTRACT FROM AUTHOR]

As the initial step in a five-year project to improve control of high blood pressure in Edgecombe County, North Carolina, a survey was conducted in 1980 to determine the prevalence of hypertension and to identify factors which might constitute barriers to the use of medical care by hypertensives. This report summarizes the findings for the 539 hypertensives identified through the baseline survey. In general, Black hypertensives reported more access problems than Whites. Within race, however, males and females differed very little on selected measures of potential access to medical care. Among women, lower scores on potential access were strongly associated with being untreated, whereas for men, concerns about the safety of anti-hypertensive drug therapy were associated with being unaware. On a summary measure of the actual use of medical care in response to symptoms, both male and female treated hypertensives scored higher than their untreated counter-parts. The implications of these and other findings for community-based blood pressure control activities are discussed. [ABSTRACT FROM AUTHOR]

This 1982 national survey of all operational health maintenance organizations (HMOs) provides information on the current status of mental health services, benefits, costs, and utilization within HMOs, updating and augmenting a 1978 study. Approximately 94 per cent of the responding HMOs offered mental health service coverage: over one-half (54 per cent) offered alcohol and drug abuse service coverage. The present coverage benefits and utilization of mental health services within HMOs continue to reflect greater variability vis-a-vis other health services within HMOs. Over one half (57 per cent) of the HMOs, provided for 30 days of inpatient mental health coverage (per member per year). Three out of four (77 per cent) of the health plans provided for 20 ambulatory visits (per member per year). The mean mental health hospital utilization rate was 32 days (per 1,000 members per year). The mean mental health ambulatory utilization rate was 0.33 encounters (per member per year). Further studies should investigate the combined influence of organization characteristics, mental health service organization characteristics, and service benefits on the costs and utilization of HMO mental health services. [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]

The Reagan Administration has adopted the policy guidelines developed over the previous few years in the disease prevention and health promotion initiative of the Carter Administration. Broad national consensus had been sought in the formulation of 226 measurable objectives for the decade. We classify the prevention objectives according to their position in an implied causal chain: 1) improved programs, 2) increased public and professional awareness, 3) reduced risk factors, and 4) improved health status. Prior to 1980, the data systems and periodic surveys sponsored by federal agencies and national organizations covered only four of the 42 objectives in the public and professional awareness category, whereas at least half of the objectives in each of the other three categories were covered by available national data sources, mostly federal. Sample surveys are needed to measure the majority of the currently unmeasured objectives in all four categories. Private and state health interview surveys are needed to supplement the federal capacity, especially in the face of federal cutbacks in survey capacity. [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]