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Biomedical subjects

R J Blendon

Publications and source records attributed to R J Blendon.

At least 19 recordsLinked to original sources
PubMed1996

All payer, single payer, managed care, no payer: patients' perspectives in three nations.

We present data on patients' experiences with access to and cost and quality of health services in the United States, Canada, and Germany. In general, patients report favorably about their care. U.S. respondents report more problems with access to care, even controlling for the severe problems of the uninsured. Differences in managed care versus fee-for-service plans in the United States mirror some of the problems observed in international comparisons--access to specialists and tests and waiting times for and quality of some services. Different cost containment strategies have measurable effects on patients' perspectives, particularly among patients who are sicker.

Adult↗
PubMed1995

The public and the welfare reform debate.

OBJECTIVES: To identify the core beliefs and policy preferences of the American public toward changing the welfare system and providing support for low-income families. DESIGN: Results are presented from 19 telephone and in-person surveys of adults nationwide between 1937 and February 1995. SETTING: At-home interviews with adults. PARTICIPANTS: Seventeen surveys; each survey involved 1000 to 2000 adults nationwide. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The results showed that the public supports strong welfare reform measures (eg, time limits and work requirements), but it is reluctant simply to cut off welfare benefits to people and leave them without some means of basic support. The surveys identified five underlying beliefs that shape the public's policy preferences: (1) welfare causes more harm than good because it discourages work and causes families to break up; (2) welfare should be a temporary transition to work, not a long-term subsidy for low-income families; (3) the country spends too much on welfare programs; (4) lack of economic opportunity as well as personal responsibility is the reason people need welfare; and (5) both government and people themselves have a shared responsibility for ensuring that people have a minimum standard of living. CONCLUSIONS: The outcome of the welfare reform debate will have a substantial impact on the 21% of the nation's children who now live in poverty. The jury is still out on what the public will support in the welfare reform debate. The Medicaid program is caught in the middle of the welfare reform debate, and its ultimate fate may rely on state rather than federal decision making.

Adult↗
PubMed1995

What happened to Americans' support for the Clinton health plan?

Within a twelve-month period public support for the Clinton plan fell from 71 percent to 43 percent. The administration lost substantial support among two politically important groups--the elderly and Democrats. This outcome was brought on by a series of key strategic and substantive misjudgments by the administration in the choices that it made in the development of its plan. These particular decisions inadvertently reinforced the public's deeply held cynicism that although health care reform was needed, the government in Washington would not do it right and would ultimately leave the middle class worse off than it was before.

Health Care Reform↗
PubMed1995

Who has the best health care system? A second look.

A 1994 opinion survey again shows Americans less satisfied with their health care system than Canadians and (West) Germans are with theirs. Americans also report more problems in paying for care and receiving needed services. However, overall satisfaction in Canada and Germany has fallen. Important cultural differences between the countries were identified. Americans have higher expectations for medicine and a stronger preference for spending more nationally on health care. The most dramatic difference is Americans' antipathy to government. Public confidence in heads of U.S. federal health agencies is the lowest of any institution or agency in the three countries.

Budgets↗
PubMed1994

The beliefs and values shaping today's health reform debate.

Survey results show that the American public comes to the health care reform debate with ambivalent feelings and a relatively low base of specific knowledge. But Americans also hold a set of core values that will shape their response to various proposals for national change. These include (1) a moral commitment to the uninsured; (2) a desire to achieve personal peace of mind; (3) a lack of self-blame; (4) a limited willingness to sacrifice; (5) reasoned self-interest in what changes are enacted; (6) a distrust of government; and (7) a healthy cynicism about the behavior of our major institutions.

Adult↗
PubMed1993

The effect of trauma and confinement on functional health and mental health status of Cambodians living in Thailand-Cambodia border camps.

OBJECTIVE: To assess the long-term impact of trauma and confinement on the functional health and mental health status of Cambodian displaced persons living on the Thailand-Cambodia border. DESIGN: Household survey of 993 adults randomly selected from household rosters. Household sample selection by multistage area probability sample. SETTING: Site 2, the largest Cambodian displaced-persons camp on the Thailand-Cambodia border. PARTICIPANTS: Adults 18 years of age and older selected at random within households; 98% of eligible persons selected agreed to participate. RESULTS: From 1975 through 1979 (Khmer Rouge regime), more than 85% reported lack of food, water, shelter, and medical care, brainwashing, and forced labor; 54% reported murder of a family member or friend; 36% reported torture; 18% reported head injury; and 17% reported rape or sexual abuse. During the refugee period between 1980 and 1990, 56% reported lack of food or water, 44% reported lack of shelter, 28% reported lack of medical care, 24% reported brainwashing, and 8% reported torture. Since 1980, reports of murder of a family member, head injury, and rape/sexual abuse have decreased to 5%. Reports of experiencing combat situations and shelling attacks have remained consistent between the two time periods, approximately 44% and 30%, respectively. From 1989 to 1990, 25% reported experiencing lack of food or water, and 5% to 10% reported serious injury, combat, and shelling conditions. More than 80% said they were in fair or poor health, felt depressed, and had a number of somatic complaints despite good access to medical services. Fifty-five percent and 15% had symptom scores that correlate with Western criteria for depression and posttraumatic stress disorder, respectively. Fifteen percent to 20% reported health impairments limiting activity, and moderate or severe bodily pain. Despite reported high levels of trauma and symptoms, social and work functioning were well preserved in the majority of respondents. CONCLUSIONS: Reports of extensive trauma, poor health status, and depressive symptoms of this population are of concern in predicting future morbidity and mortality. The health and mental health needs of Cambodian displaced persons and their impact on social and economic behavior should be addressed now that the Cambodians have been repatriated.

Adult↗