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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]

Abstract: This paper presents analyses of recent natioanl survey data on access to medical care. In particular, information on major access indicators and special problems associated with the economic and political climate of the 1980s collected in a 1982 national telephone survey of 6.610 United Scales adults and children, representing some 4.802 families, is compared with previous national stirrers for kef population subgroups--by age. place of residence, income, race, insurance coverage, and type of regular source of care In general, the findings show that favorable progress has been made, but some inequities continue to persist. Some traditionally disadvantaged groups are more likely to have a regular family doctor, private insurance coverage, have been to a doctor, or had certain preventive tests and procedures than was true for them in the past. On the other hand, compared to the more economically and/or socially advantaged groups in 1982, they have still not "caught up" entirely. There also is evidence that they may be hardest hit by the exacerbation of the financial barriers to care thai result from unemployment, inflation, and cutbacks in health program eligibility and benefits that have characterized the decade of the 1980s. [ABSTRACT FROM AUTHOR]

Abstract: The hours worked by physicians are affected by changes in a number of factor, including attitudes rewards labor-leisure tradeoffs, the characteristics of the physician workforce, and the level of demand for medical services. This paper analyzes changes in the hours worked per week by office-base physicians over the decade 1970-80. Overall. there has been a statistically significant decline in hours of approximately 3 per ¢ or 1.5 hours per week. This decline was fairly uniform across most physician characteristics, although the decline was greater for those in primary care specialties. Female physicians increased their average hours worked, although this increase was not statistically significant. In terms of the delivery of killed medical services, the decline in total hours was largely offset by an increase in the percentage of total hours devoted to patient care. The question of whether these trends will continue has important implications for the validity of projections of a physician surplus, in the near future. [ABSTRACT FROM AUTHOR]

The article focuses on the introduction of the identification of a geographical unit for distribution analysis of physician specialists, as part of a study of dermatological care conducted by the American Academy of Dermatology in the U.S. Spatial distribution of primary care practitioners should be examined in relation to smaller population and geographic units than the distribution of physicians providing subspecialty care. The U.S. Postal Service has designated the Zipcode Sectional Area with the first three digits of the five-digit Zipcode number for the management of mail distribution. It is said to be a useful tool in studying physician distribution.

Objectives. The aim of this study was to examine the US and Canadian systems from the unique perspective of physicians who have practiced in both Canada and the United States. Methods. Questionnaires were sent to 355 Canadian physicians who graduated from US medical schools and 347 US physicians who graduated from Canadian medical schools. Results. The overall response rate was 59% (65% of US-graduated Canadian physicians and 54% of Canadian-graduated US physicians). Thirty-six percent of the respondents were "dual experience" physicians; that is, they had practiced medicine in both countries after completing their medical training. Physicians who left Canada were more likely than those who left the United States to indicate dissatisfaction with the health care system as a reason for leaving. Respondents expressed greater professional satisfaction with their current country of practice, but overall, dual-experience physicians in the United States favored that system only slightly more than the Canadian system, whereas those in Canada rated the Canadian system significantly better than the US system. Conclusions. The comparatively weak rating of the US system by dual-experience physicians underlines the need for health care reform. [ABSTRACT FROM AUTHOR]

Abstract: To determine whether differences exist in the performance of United States Medical Graduate (USMG) and Foreign Medical Graduate (FMG) House Staff physicians, inpatient hospital audits evaluating individual physician performance on patient histories and physical examinations were conducted in 14 Maryland and Pennsylvania non-federal, short-term hospitals. A total of 3,204 medical records were abstracted from eight diagnostic categories for 898 house staff physicians. 556 of which were USMGs and 342 were FMGs. The results from these audits indicate that while there is evidence of a strong hospital/type of physician interaction for many of the diagnoses, there was no significant overall difference in performance of USMG and FMG house staff physicians. The largest and most consistent differences in physician performante were associated with hospital characteristics, not physician characteristics. [ABSTRACT FROM AUTHOR]

The article focuses on the implications of a medical service known as contract or lodge practice to the health insurance in the U.S. In a lodge practice, a medical practitioner agrees to provide medical service to group of patients, such as members of benevolent organizations, fraternal lodges, or employees of industrial companies, for a fixed remuneration per year. It has been noted that this form of medical practice usually leads to substandard applications because some of the physicians provide slipshod services. They are pursuing this service as a means of obtaining a reputation and a clientele. The prevalent practice of these physicians was rooted from the point of view of a practitioner who felt exploited and threatened economically, particularly by the health insurance.

The article investigates the effectiveness of nurse clinicians' service delivery in the U.S. In this study, the researchers compare the effectiveness of nurse clinicians with that of physicians with regard to health status of the patients, time spent with the health provider, and time spent in the clinic. The general approach and evaluative measures utilized in examining these areas should be applicable in the study of the effectiveness of other health care providers. The investigator found patient interviews effective in obtaining information of patients' perceived health status. The patient questionnaire or similar patient interviews should be administered to patients in other studies to obtain information about their knowledge and behavior relevant to service delivery.

Quite a few people in public health have been thinking what Dr. Freedman says, and are wondering where we are really going. The fragmentation and the attitudes to which he addresses himself must be seen in terms of the need for development of comprehensive health services for all Americans. [ABSTRACT FROM AUTHOR]

The article reports on the compulsory health insurance in California in 1934-1935. According to health surveys in the 1920s and 1930s, poverty and ill health were closely associated. There is an estimated forty percent of the American people who were not receiving adequate medical care as well as medical physicians who were experiencing financial difficulty. Adoption of health insurance was urged by other groups saying that without some method of spreading the risk of medical costs, the diagnostic and therapeutic value of modern medicine would remain beyond the reach of those who needed care the most.

Some experts contend that physicians have lost position of authority in the past 40 years. Others argue the opposite, yet neither side bases its arguments on empirical data. This study examined longitudinal variables measuring authority positions held by physicians. Data on the relative position of physicians in medical school show that medical doctors held 65.6% of the sampled positions in 1970 vs 72.8% in 1990. Yet, in the wider society and within the nonmedical school portion of the health sector, other data indicate that physicians occupy a smaller proportion of authority positions. [ABSTRACT FROM AUTHOR]

We evaluated a program for improving influenza immunization performance in a health maintenance organization (HMO). The HMO implemented several interventions successively from 1984-87: a postcard reminder to members at high risk for complications of influenza, a computer-generated reminder to the physician at the time of any primary care visit by high-risk patients, performance feedback to chiefs of service, and, finally, retrospective feedback to each physician comparing his/her performance with that of the other physicians. We examined immunization rates for a group of members older than age 65, a high-risk group under age 65, and a group of diabetic members who had not been subject to the reminders (vs a group who had been covered by the program). Vaccination rates were increased in those diabetic members who received reminders. Nevertheless, among members younger and older than age 65 whose experience was observed over three flu seasons, a significant increase in vaccination rates was not achieved until physician feedback was added to the program. We conclude that each element of the reminder and feedback program has contributed to the overall increase in vaccination rates at the HMO and that effective ongoing influenza immunization programs can be implemented in practice settings with appropriate systems support. (Am J Public Health 1990; 80:534-536.) [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to assess changes in the physician-population ratio in non-SMSA Minnesota counties between 1965 and 1985 using county specific data published by the American Medical Association. The physician-population ratio actually decreased by 2 per ¢ for primary care physicians and by 11 per ¢ for family practitioners in the non-SMSA counties. The large increase in the number of physicians in Minnesota has not translated into improved access to primary care physicians in Minnesota's rural areas. [ABSTRACT FROM AUTHOR]

The article discusses the physician's response and the reasons behind their unwillingness to be involved in child abuse and neglect cases in the U.S. These reasons include lack of experience, inability to acquire the facts, emotional connections with the family and other aspects. Studies showed several types of physicians who have responded to cases of child abuse and neglect. Physicians also agree that authorized agencies must resolve the immediate needs of the abused children by building an awareness protection program in the community.

Sixty STD patients were followed during the course of their clinic visit which averaged 2.75 professional contacts. Based on audiotape analysis, virtually all patients received a diagnosis; however, 25 percent of the patients did not receive any information about treatment or prevention, and only 57 percent of patients were given complete information. Patient recall of the information they were given averaged about 43 percent. Patients not seen by a physician during their clinic visit achieved higher recall rates than patients seen by a physician. (Am J Public Health 1990; 80:605-606.) [ABSTRACT FROM AUTHOR]

The article focuses on the methods used in examining the quality of care provided by health care institutions in the U.S. Various literature were provided in the journal by various authors on the method of assessment of quality of care given by institutions of which customers may base their choice of institutions or professionals. Although the primary objective of the study is to offer consumer information at the same time it also convinces and helps institutions and physicians to introduce and maintain policies and systems that result to high quality of care in consideration with cost.