Search

The research reported here is a case study of mandated consolidation in the organization of Alberta's health care system. Informed by the concept of organizational context, this study illustrates the complexity of factors affecting outcomes of mandated change and draws implications for theory and practice. Consolidation of separate agencies was initiated in 2008. Data were obtained through 2020 via interviews of key informants, reviews of official documents, and searches of news media. Ultimately, the mandate appears to have succeeded, but at substantial and potentially avoidable cost. An understanding of multiple dimensions of context can contribute to successful strategies for change. [ABSTRACT FROM AUTHOR]

California's employed Latinos are less likely to have private health insurance than most other segments of the US population and face a variety of other barriers to obtaining health care. To better understand the availability and adequacy of health services for these individuals, researchers analyzed data from a telephone survey of 1,000 randomly-selected, employed adults. Among all survey respondents, a significant percentage obtained their health care from sources fully or partially dependent on government financing. Among the uninsured (30.7 percent of the sample), a majority of those who had a regular source of care received services from publicly-supported providers. Dissatisfaction with care was infrequent (less than 5 percent of the total sample) and apparently no greater among those receiving care from public sources than among those served by private doctors. These findings underscore the importance of the public sector in providing health cave for the underserved, the high quality of the services provided (or partially supported) by the public sector, and the seriousness of the consequences for the disadvantaged should public support for their healthcare diminish. [ABSTRACT FROM AUTHOR]

This article provides guidelines for promoting an association of quality with managed care, particularly among women. Consumer suspicion regarding the quality of managed care suggests that marketers still have hard work ahead of them. Research has shown that women, when selecting a managed care plan for their families, identify personal relationships with physicians, medical expertise, speed of access and comprehensiveness of services as important signs of quality. It is noted that market segmentation creates diversity in the different indicators consumers use to identify signs of quality. Female consumers are a crucial market segment for positioning managed care. INSET: Learning From Other Industries.

Abstract: This study compares diagnosis and commencement of treatment for cancer among persons with fully financed fee-for-service coverage, persons with copaid fee-for-service coverage, and persons in an HMO (health maintenance organization). A total of 242 subjects actively employed at the time of their diagnosis were interviewed, typically within six months of beginning cancer treatment. After sex, age, income, education, residence turban vs rural, and disease site and stage had been controlled, those who made copayments were found to have waited an average of 1.25 months longer (95 per ¢ confidence limit (cl) +/- .88) between initial suspicion or illness and obtaining a definitive diagnosis than those with full insurance coverage. Time from diagnosis until the beginning of treatment averaged .83 months longer (95 per ¢ cl +/- .41) for HMO members than those in fee-for-service. These relations were strongest in income categories equal to or exceeding $20,000 per year. (Am J Public Health 1987: 77:464-466.) [ABSTRACT FROM AUTHOR]

This article focuses on cost containment and initiation of care for cancer in a medicare-eligible population. Providing quality health care to the elderly while containing costs has become a key policy dilemma for the Social Security system. To contain costs, the federal government has often considered encouraging medicare beneficiaries to join Health Maintenance Organizations (HMOs) and requiring them to pay a higher percentage of the charges for their care. Supporters of HMOs argue that these organizations, free from the temptation in fee-for-service settings to provide more services than necessary, deliver care more economically. Investigations in both the United States and Canada indicate that copayment significantly reduces utilization of services, while a broad range of research studies suggests that lack of disposable income and inadequate insurance coverage cause at least some individuals to forego necessary care. These findings raise issues about possible impacts of recent cost-containment proposals on the quality of care received by Medicare beneficiaries with limited resources and progressive, life-threatening illnesses.