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Biomedical subjects

D Mechanic

Publications and source records attributed to D Mechanic.

At least 55 records · Page 3Linked to original sources
PubMed1986

The challenge of chronic mental illness: a retrospective and prospective view.

The challenge of chronic mental illness lies in developing effective service delivery systems that will preserve patients' functioning and limit their disability. The author uses a review of changes and excesses of the past 30 years--including deinstitutionalization, relocation of patients to nursing homes, the domination of psychodynamic concepts, and the naivety and partial successes of the community mental health movement--as a basis for outlining manageable ways to meet this challenge. Care for the chronic patient must be developed within a long-term rehabilitative context and with wiser use of available benefits and funds, including consolidation of funding sources. Mental health advocates should coordinate activities rather than compete with one another, and case management should be based on more sophisticated concepts and training.

Chronic Disease↗
PubMed1986

Health care for the poor: some policy alternatives.

Changes in the financing and organization of medical care are most likely to affect adversely the poor who have significant needs for care, but face increasingly stringent eligibility criteria in Medicaid and other public programs. Americans estimated to have neither private nor public health insurance coverage number 33 million persons, and with increased cost pressures, voluntary and proprietary hospitals are less willing to treat such patients. One quarter of hospitals provide 60 percent of all care to the poor, and many of these nonprofit and public hospitals face economic difficulties and an erosion of public commitment. Alternative solutions include publicly subsidized premiums for the poor and near poor and assistance to financially stressed hospitals caring for large numbers of such persons. Mechanisms include all-payer systems, taxes on net hospital revenue or insurance premiums, or contributions from general tax revenues. Financing poses special problems, but it is also necessary to address the special needs of children and the elderly, the appropriate balance between technical and cognitive services, and new ways to maintain health and promote effective functioning. These issues pose challenges and opportunities for family practice.

Adult↗
PubMed1985

Introspectiveness and adolescent symptom reporting.

A new measure of introspectiveness--the tendency to devote diffuse attention to thoughts and feelings about the self--was used to investigate adolescent symptom reporting. Introspectiveness was correlated with psychological distress (r = .40) and with physical symptoms (r = .27) in a random sample of college freshmen, and remained the strongest correlate of distress and symptoms when controlling for a variety of other measures. Women, Jews, and certain Hispanic groups were higher on introspectiveness than other students. An unanticipated, but possibly significant, result was that economic discontinuities and discontinuities involving significant others had markedly different relationships with health. Strong associations between perceptions of parental characteristics, adolescent introspectiveness, and health suggested the importance of socialization processes for understanding distress and symptoms. Finally, measures of emotional sensitivity and time spent alone were associated with introspectiveness and symptom reporting. Taken together, these findings suggest the importance of introspectiveness and its correlates for understanding the processes leading to adolescent symptom reporting.

Adaptation, Psychological↗
PubMed1985

Cost containment and the quality of medical care: rationing strategies in an era of constrained resources.

The general public, physicians, and policy makers have all come to accept constraints on public expenditures for medical care as a reasonable means to redirect resources to competing sectors of national life, and to reflect changing political and social values. "Rationing" of facilities and services by explicit and implicit methods seems inevitable; the poor and disabled must not bear the brunt of stringency. The politics of competition and altered power relationships among providers offer new opportunities for system-wide reform.

Aged↗
PubMed1985

Physicians and patients in transition.

Despite growing consumerism and skepticism about authority in the culture as a whole, most patients continue to be pliant. If there is a serious threat to physician autonomy, it is more likely to come from third-party payers and new forms of medical practice, particularly the rise of for-profit hospital chains, than from patients. Though physicians are restless, they will learn to adapt to the new conditions of practice.

Delivery of Health Care↗
PubMed1979

Development of psychological distress among young adults.

Persons with high scores on psychiatric screening scales appear frequently in general medical settings, psychiatric outpatient clinics, and other agencies providing assistance, but there is considerable controversy concerning the appropriate interpretation of high scores on such scales obtained in community epidemiological studies. Data are presented from a 16-year follow-up study of children, first studied in 1961, examining developmental aspects of achieving high scores on such scales. Data come from the children themselves, their mothers, teachers, and school records. The findings are consistent with the hypothesis that such generalized distress reports are in part a learned pattern of illness behavior involving a focus on internal feeling states, careful monitoring of body sensations, and a high level of self-awareness.

Adolescent↗
PubMed1979

Some observations of mental illness and its treatment in the People's Republic of China.

A visit to the People's Republic of China provided impressions of the use of psychiatric concepts and the organization of mental health services. The Chinese report of low rates of mental illness appears to reflect narrow definitions of disorder and somatic expressions of personal and social distress which are viewed by health personnel as physical conditions. Acute mental health services are provided at commune and county hospitals, and special psychiatric hospitals are maintained for more intractable patients. Chronically disturbed patients may receive long term care in sanatoriums associated with large industries or may be maintained in home beds in their production brigades assisted by family and barefoot doctors. Psychiatric practice in teaching hospitals is similar to psychiatric practice in the West, although little attention is devoted in general medical care to psychosocial problems. Question for future visits and possible collaborative research are suggested.

Adult↗
PubMed1979

The stability of health and illness behavior: results from a 16-year follow-up.

In 1977, 302 young adults who were among 350 children first studied in 1961 responded to a questionnaire related to their health and illness behavior. Ten types of adult health and illness behaviors and orientations are examined including seat belt use, smoking, exercise, drinking, and risk taking. These patterns are associated only to a modest degree, and patterns of health and illness behavior appear to have low levels of continuity over a 16-year period (correlations varying from .02 to .20).

Adolescent↗
PubMed1978

Approaches to controlling the costs of medical care: short-range and long-range alternatives.

Cost containment requires changes either in patterns of consumption or in the way services are provided. Although the former includes prevention, changing social expectations and finding suitable substitutes for some types of care, the latter involves mix of personnel technologic inputs, auspices of care and the content of encounters. Ultimately, the future of medical care and cost containment depends on advances in biomedical and health-services research. In the short run, costs will be contained increasingly by rationing mechanisms. Whereas cost sharing is intended to affect consumer behavior, implicit rationing, as through capitation and prospective budgeting, is intended to encourage physicians to make tougher allocation decisions. Explicit rationing, in contrast, depends more on administrative decisions that limit physician discretion. A better understanding of the effects of different rationing technics on patient and physician behavior and the quality of care, as well as on cost, is required.

Attitude↗
PubMed1978

Effects of psychological distress on perceptions of physical health and use of medical and psychiatric facilities.

Psychological distress not only contributes to bodily symptoms but also affects the way people perceive their physical health status and their use of medical care. Reporting on a program of research, this paper reviews evidence that psychological distress is an important component of illness behavior and response and must be taken into account in the appropriate organization of medical services.

Attitude to Health↗
PubMed1978

Factors affecting children's use of physician services in a prepaid group practice.

This paper examines factors affecting children's use of physician services in a prepaid group practice. The independent measures come from questions asked of mothers in a survey interview, while the utilization data come from their children's medical records. All independent variables were measured prior to the period of utilization studied. The results provide some evidence in support of the view that physician utilization for children is affected by characteristics of the mother, as well as the child's age and health status. Somewhat different variables were related to whether health services were used at all as compared with magnitude of use. Special consideration is given to the effect of the mother's level of psychological distress on her propensity to use medical services for children. The results suggest that distress was relevant, but only for the white families included in the sample. Also, distress was more important in explaining extent of use than accounting for whether utilization occurred at all. Various hypotheses are examined to explore white-nonwhite differences.

Adult↗