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Biomedical subjects

R F Boaz

Publications and source records attributed to R F Boaz.

13 recordsLinked to original sources
PubMed1994

Improved versus deteriorated physical functioning among long-term disabled elderly.

The usual prognosis for long-term disabled elderly is that they are not likely to improve or regain independent functioning. But computed transition probabilities reveal a significant proportion of improvement. Based on the National Long-Term Care Surveys of 1982 and 1984, this study identifies the personal characteristics that are associated with changed functional status between these 2 years and estimates how much each characteristic contributes to this change. The study distinguishes four mutually exclusive statuses of disabled older persons: improved, remaining unchanged, deteriorated-alive, and deteriorated-dead. It shows that cognitive impairment reported in 1982, high-risk medical events that occurred during the year before the 1982 interview, and hospitalization between 1982 and 1984 predict an increased risk of deterioration by 1984. However, similar estimates do not predict improvement. Yet, data compatible with reported improvement suggest that acute medical problems might have caused a temporary worsening of functional status. When the recovery from this status takes more than 3 months, the ensuing change may be recorded as a long-term disability in the initial survey and as an improvement over time. However, long-term disabled elderly seldom improve to such an extent that they regain complete independence in physical functioning. In this study, most of the elderly who improved ended with a functional status similar to that of persons whose ADL disabilities remained unchanged over time.

Activities of Daily Living↗
PubMed1994

Predicting the risk of "permanent" nursing home residence: the role of community help as indicated by family helpers and prior living arrangements.

OBJECTIVE: This study examines the difference between permanent and transitory residence in a nursing home with special emphasis on the extent to which the risk of a long nursing home stay is reduced by the availability of informal help in the community. DATA SOURCE: Secondary data were used, taken from the National Long-Term Care Surveys of 1982 and 1984. The 1982 NLTCS samples disabled elderly living in the community. For these community dwellers, the 1984 NLTCS provides information on continued residence in the community and on their nursing home episodes between 1982 and 1984. METHOD OF ANALYSIS: The analysis is based on estimates from a multinomial logit regression with three explicit categories: persons with at least one long nursing home stay (n = 292), persons with only short stays (n = 227), and persons who died without ever having had a nursing home stay (n = 945). The implicit category: persons living in the community in 1984 without having had any nursing home stay (n = 3,368). PRINCIPAL FINDINGS: This study demonstrates the systematic differences in the personal characteristics that predict the risk of long stays from those that predict short stays in a nursing home. Controlling for limitations in physical and cognitive functioning, the regression analysis shows that indicators of informal help in the community have a statistically significant and relatively large effect on the risk of long stays; but the effects of these indicators on the risk of short stays is numerically smaller and not statistically significant. Specifically, when the burden of caregiving is shared by a spouse and children, the risk of a long stay in a nursing home is reduced by 9.3 percentage points; in contrast, the risk is increased by 18 percentage points for childless elders who are living alone and by 45.8 percentage points for elders living with adults other than a spouse or children. CONCLUSION: The relatively strong effects of family helpers and living arrangements on the risk of long nursing home stays confirm the hypothesis that, after controlling for the effects of physical and cognitive functioning, adequate help in the community reduces the risk of permanent nursing home residence. But help in the community has no effect on the risk of short nursing home episodes because these episodes are likely to be extensions of acute hospital care. The findings provide essential information for designing a long-term care program because they suggest the magnitudes of the effects that such a program can have on reducing the risk of permanent nursing home residence.

Activities of Daily Living↗
PubMed1992

Paid work and unpaid help by caregivers of the disabled and frail elders.

Informal caregiving by women, and to a lesser extent by men, is a major source of assistance for the chronically disabled and most dependent older persons living in the community. However, because women's commitment to career employment may diminish, this source of help at the time when (according to demographic trends) the number of very old Americans will increase, the effect of employment on the time they devote to informal caregiving is an important social and economic issue. This study examines two related research questions: 1) how the time allocated to paid work affects the time devoted to unpaid caregiving and 2) how caregiving responsibilities affect work outside the home. The results differ for full-time and part-time work. Estimating a simultaneous equation model, it was found that 1) full-time employment by caregivers reduces the time they allocate to providing unpaid help by 20 hours a week and 2) female caregivers were much less likely than their male counterparts to have full-time jobs. Results also indicate that 1) part-time employment by caregivers has no statistically significant effect on caregiving and 2) caregiving has no effect on women's part-time employment.

Activities of Daily Living↗
PubMed1990

The validity of health limitations as a reason for deciding to retire.

Many studies of the decision to retire have found that self-reported poor health increases the probability of retirement. Yet doubts have been expressed about whether such reported health problems constitute a genuine reason rather than a socially acceptable justification for not working. Our analysis shows conclusively that the probability of dying within two years after retiring and the probability of seeking medical care at the time of retiring are much higher for all retirees who report work-limiting health problems and especially for those who report such problems and retire before age 65. These findings, which imply that those retirees who report work-limiting health problems do not use health as an excuse for retiring, have important implications for public policy. The 1983 Amendments to the Social Security Act specified a gradual increase in the age of entitlement to the full amount of annual benefits, from age 65 to age 67. This delay in benefits is likely to cause financial hardship for workers whose health problems impair their ability to work because they will not be able to offset their loss of benefits through earnings from continued work.

Aged↗
PubMed1989

Does having more time after retirement change the demand for physician services?

Various aspects of the demand for ambulatory services of physicians have been studied by researchers, but so far the effect of increased availability of nonwork time due to retirement on demand has not been examined. This study investigated whether discouraging early retirement (which was the intent of the 1983 Amendments to the Social Security Act) will reduce the use of medical services because persons who continue to work have less time than retirees for visits to doctors. This study found that, for men whose health does not interfere with work and who have had no in-hospital care in the study year, retirement does not increase the demand for ambulatory services when compared with being a part-time or full-time employee. However, compared with full-time self-employment, retirement increases the probability of using any physician services in the year by 14% and the number of physician visits by two visits. Although the self-employed have more control over their work time than employees, they may be more affected than employees by the loss of output and earnings associated with absence from the workplace.

Aged↗
PubMed1979

Utilization review and containment for hospital utilization: some implications of providing care in the "most appropriate setting".

The study examines the potential for savings in the use of hospital resources if utilization review policies succeed in curtailing excessive use of hospital facilities. Excessive use is defined as the utilization of hospital care when ambulatory care is medically feasible and acceptable. A utilization review policy would be expected to counteract the tendency to substitute inpatient for outpatient treatment by assuring that all patients with identical medical problems and demographic traits would be treated in an identical least cost setting regardless of their social and economic circumstances. It might, thus, ascertain that the use of hospital facilities would not be systematically affected by patients' non-medical or socioeconomic characteristics. Specifically, the study distinguishes between two types of utilization control policies, pre-admission certification and concurrent or continuing-stay review of hospital episodes, and asks how each can contain excessive utilization. It concludes that continuing-stay review is not likely to have any appreciable effect on shortening hospital episodes because the effects of nonmedical factors on extended stay are small and concentrated among patients whose diagnoses might not qualify them for hospitalization under a pre-admission screen. However, pre-admission certification has a considerable potential for containment of hospital utilization through the reduction in the number of admissions. Also, as a corollary, the study shows that utilization review policies should not be evaluated, as they often are, in terms of their effect on length-of-stay, but rather in terms of their effects on hospital admissions and case mix.

Analysis of Variance↗
PubMed1978

Paying for medical care: the burden on the disabled. The relationship between the distribution of income and the distributions of medical services and payments.

The study measures the economic vulnerability of disabled persons whose impaired health interfered with their earning ability. This population segment, about one sixth of the total population, represents the extreme both in terms of sensitivity to health problems and losses in economic power. The major findings are given in a nutshell. 1) Inadequate income did not bar the disabled individuals from contact with the medical care system except in the case of the weakest among the weak, the aging women without husbands. This finding suggests that the restraining effect of income can become strong enough to overcome the concern with ill-health, although the inhibiting effect of economic constraints weakens when the concerns with health problems intensifies. (2) Once contact with the health care system had been extablished, there was no evidence to suggest that lack of means to pay for medical services had restricted the quantity of services rendered to the disabled, although inability to pay might have affected the setting in which care was provided. 3) The needed medical care was obtained at a considerable financial sacrifice. As Table 6 shows, the level of direct out-of-pocket payments imposed a heavy burden on low and moderate income households, and this burden eased gradually as household income-levels increased.

Adolescent↗
PubMed1975

Equity in paying for health care services under a national insurance system.

The debate over the future of the health care delivery system evolves around the policy issue of what constitutes a fair distribution of the medical services which are considered essential to prolonging life, curing disease, and relieving pain. A case can be made that a socially equitable distribution implies that consumption of medical services is independent of the consumer's income and payment for them unrelated to utilization. The present paper examines to what extent the provisions for financing a national health insurance system are likely to advance or hinder the fair distribution of health care services. Almost all bills specify a mix of direct (cost-shared) and indirect (prepaid) financing. When cost-sharing is based on the quantity of services or on the level of medical expenditure, it helps divert medical care and health insurance benefits to high-income persons at the expense of their low-or moderate-income counterparts. When indirect payments or premium levels are determined by insurance risks rather than by income, they may be too high for persons with moderate means, and are likely to exclude such persons from the national insurance program. When health insurance is tied to salaried employment, it discriminates against the unemployed and the self-employed. To rectify such inequities, some NHI proposals specify separate insurance plans for the disadvantaged. Such programs, which require income-testing to determine eligibility, are likely to be plagued by administrative complications currently engulfing other means-tested social welfare programs. The present paper makes some recommendations for the purpose of avoiding these difficulties and fostering equity in health care.

Deductibles and Coinsurance↗