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Biomedical subjects

D Mechanic

Publications and source records attributed to D Mechanic.

At least 73 records · Page 4Linked to original sources
PubMed1978

Considerations in the design of mental health benefits under National Health Insurance.

The existing insurance coverage for mental health benefits provides incentives for hospital as compared with community care and reinforces a medical approach to psychological disability. Moreover, the structure of benefits favors the affluent as compared with the disadvantaged and provides little assistance for the community integration of the chronic mental patient. In considering mental health benefits under National Health Insurance we must be careful to avoid reinforcing these patterns. It is suggested that NHI include a mental health resource development fund intended for building a stronger network of community mental health care and that the pattern of insurance benefits under NHI be consistent with developing psychiatric services on a capitation basis.

Community Mental Health Services↗
PubMed1978

Prospects and problems in health services research.

Health services research has an important--and unique--role in affecting the climate of policy formulation and in defining future options. This very uniqueness, however, places the endeavor in a vulnerable position between the usual rigors of scientific investigation and the desire for simplicity and comprehensibility on the part of administrators and legislators. A constituency must be found to nurture the continuance of this modest but invaluable research activity.

Delivery of Health Care↗
PubMed1977

Illness behavior, social adaptation, and the management of illness. A comparison of educational and medical models.

Motivational needs and coping are important aspects of illness response. Clinicians must help guide illness response by suggesting constructive adaptive opportunities and by avoiding reinforcement of maladaptive patterns. This paper examines how the patient's search for meaning, social attributions, and social comparisons shapes adaptation to illness and subsequent disability. It proposes a coping-adaptation model involving the following five resources relevant to rehabilitation: economic assets, abilities and skills, defensive techniques, social supports, and motivational impetus. It is maintained that confusion between illness and illness behavior obfuscates the alternatives available to guide patients through smoother adaptations and resumption of social roles.

Adaptation, Psychological↗
PubMed1976

Stress, illness, and illness behavior.

This paper examines adaptation as a transactive process involving the skills and capacities of individuals and their supporting groups on the one hand, and the types of challenges they face on the other. Many difficulties in understanding stress processes in illness result from the confusion between illness and illness behavior. It is argued that the medical record is as much a history of the individual's behavior and social selection processes as it is a reflection of levels of physical health. Various examples are discussed, illustrating how medical records can be misleading in research examining the relationship between stress and illness, and how influences attributed to stress may be the result of illness behavior. The paper concludes by examining alternative conceptual models for studying the relationships between life challenges, illness behavior and illness.

Adaptation, Psychological↗
PubMed1976

The effects of social characteristics on the utilization of preventive medical services in contrasting health care programs.

This study, based on household interviews of employed individuals and their families, examines the effects of type of health insurance program and various sociodemographic factors on patterns of use of preventive medical services. A major concern of the paper is to explore the issue of whether participants in prepaid group practice use preventive services more than those in alternative insurance plans. The results show little differences in utilization among subscribers in a prepaid group plan as compared with a comparable sample of those in Blue Cross-Surgical Care plans. However, children in the prepaid plan, as compared with those in the more traditional Blue Cross plans, were more likely to receive general checkups and tuberculin skin tests in the prior year. Contrary to expectations, we found that in the employed population studied, black adults reported more preventive medical utilization than whites, and the black-white difference was the strongest single sociodemographic correlate of adult utilization of preventive care. The reporting of general checkups for children was highest among single-child families, for children under five years of age, and for those with better educated parents.

Adult↗
PubMed1976

The effect of psychological distress on physician utilization: a prospective study.

This paper examines the hypothesis that psychological distress is causally related to physician utilization among enrollees in a prepaid group practice. Measures of distress are constructed from questions included in a servey interview, while the utilization data come from medical records. Distress levels were measured prior to the period of utilization studied. The results show a positive relationship between distress and physician utilization, which persists even when a variety of sociodemographic, attitudinal, and health status variables have been controlled. The results are discussed in terms of a perspective that emphasizes social-psychological needs as triggers for physician utilization

Adult↗
PubMed1975

Some problems in the measurement of stress and social readjustment.

Although the Social Readjustment Rating Scale has been a useful stimulant to the study of life change and illness, it has important limitations. The existing scale cannot be used to determine the role of varying types of life changes (e.g., favorable or adverse) in the occurrence of illness. Other problems discussed are ambiguity of items, the confounding of independent and dependent variables, and lack of item specification. Suggestions are made for improved measurement of life change and for more effective study of life change and illness.

Athletic Injuries↗
PubMed1975

The orginization of medical practice and practice orientations among physicians in prepaid and nonprepaid primary care settings.

Data are presented on office-based general practitioners and pediatricians working in varying practice settings. Fee-for-service physicians spend more time in direct patient care activities than those in prepaid practice, and devote more time to each patient. The data suggest that the patient load characteristic of general practice in prepaid groups encourages a more assembly line practice which is less responsive to patients than the pattern characteristic of fee-for-service practice. Prepaid physicians work during scheduled hours and may deal with increased load by processing patients more rapidly. Fee-for-service physicians tend to respond to increased demand by working longer hours. The responsiveness of primary care physicians to patient problems seems to reflect primarily their social orientations to medical practice and the time pressures they face. Varying practice settings result in different techniques of coping with the pressures of practice. Data are also presented on sociodemographic and professional characteristics of primary care physicians in varying settings, workload, use of diagnostic and laboratory procedures, social orientations to medical practice, satisfactions and dissatisfactions, and attitudes toward sociopolitical aspects of medical care. Suggestions are offered for improving the responsiveness of prepaid practice.

Adult↗
PubMed1975

Factors affecting the choice between prepaid group practice and alternative insurance programs.

This paper examines the basis for the selection of prepaid group practice in a dual-choice situation, and the social, attitudinal, and health characteristics of populations choosing prepaid programs in contrast to other plans. When asked in an open-ended way why they made the decisions they did, those selecting prepaid group practice most frequently referred to the more comprehensive coverage provided and to the fact that at the time of choice they lacked a continuing or adequate relationship with a physician. Enrollees in the prepaid program were better educated and, contrary to previous research, more likely to be unmarried. There was little evidence that enrollees in the prepaid plan brought with them distinctive kinds of attitudes and orientations toward illness and medical care. Enrollees in the prepaid program were also comparable to those retaining an alternative health insurance option on a number of indicators of health status. However, prepaid practice enrollees tended to report more chronic conditions than persons who declined to enroll in the prepaid program. Although the overrepresentation of persons with chronic illnesses is not large, data drawn from a related study suggests that persons with several chronic conditions tend to be heavy users of medical services.

Adult↗