Biomedical subjects

S A Gorman

Publications and source records attributed to S A Gorman.

4 recordsLinked to original sources

PubMed1998

Women in New York City's Medicaid program: a report on satisfaction, access, and use.

This article analyzes the experiences of women in New York City's Medicaid program regarding their satisfaction with, access to, and use of medical care during an early phase of a managed care enrollment initiative. Data for this study are from a 1994 survey of New York City Medicaid beneficiaries (1,221 women) as well as from focus group discussions. Differences in reported satisfaction levels, access, and use between managed care enrollees and conventional Medicaid beneficiaries are examined, as are differences between women in fair and poor health and those in excellent, very good, and good health. Multivariate analyses found that women enrolled in Medicaid managed care overall were significantly more likely to report greater satisfaction with access, interpersonal quality, technical skills, and arrangements for choosing a personal doctor; equivalent use; and better access compared to those in conventional Medicaid. Female managed care beneficiaries who reported worse health, however, were significantly more likely than those in better health to also report less satisfaction in 13 dimensions of medical care. Continued evaluation of Medicaid managed care is warranted, particularly as more vulnerable groups are enrolled.

Adolescent↗

PubMed1997

Sensitization during visual habituation sequences: procedural effects and individual differences.

Although individual differences in visual habituation have long been interpreted in terms of processes derived from comparator theory, research over the last decade has suggested that arousal or arousability as manifest in sensitization may contribute to infants' attentional profiles, and thus, to individual differences in those profiles. We explored this possibility by habituating 4-month-old infants to 4 x 4, 10 x 10, or 20 x 20 checkerboards in a fixed-trial paradigm. The first specific aim was to examine the attentional characteristics of infants with habituation patterns showing sensitization versus those that did not. The second specific aim was to determine whether patterns of attention suggestive of sensitization effects reported in past research might be attributable to the use of illuminated interstimulus intervals (ISIs). Trends were observed for sensitization to occur more frequently with more complex than with less complex checkerboards. Infants who showed looking patterns characteristic of sensitization looked longer and did not habituate as readily as infants who did not show sensitization. Finally, different ISIs did not engender different levels of sensitization, but dark ISIs significantly increased infants' looking times to stimuli during trials.

Arousal↗

PubMed1996

Evaluation of Medicaid managed care. Satisfaction, access, and use.

OBJECTIVE: To evaluate the effects of managed care on Medicaid beneficiaries' satisfaction with, access to, and use of medical care during early implementation of an enrollment initiative. DESIGN: Cross-sectional survey of a random sample of Medicaid beneficiaries in 5 managed care plans and in the conventional Medicaid program. SETTING: New York, NY. PARTICIPANTS: Adults aged 18 to 64 years who received Medicaid insurance benefits through Aid to Families With Dependent Children or State Home Relief and had been enrolled in a managed care plan or receiving benefits under conventional Medicaid for at least 6 months. Of the 2500 enrollees in managed care plans and the 600 other beneficiaries in conventional Medicaid whom we surveyed, 1038 enrollees and 410 nonenrollees responded. OUTCOME MEASURES: Beneficiaries' ratings of overall satisfaction and 13 dimensions of satisfaction related to access, interpersonal and technical quality, and cost; reports of access, including regular source (location) of care, waiting time for appointment, waiting time in office, and ability to obtain care; and reports of use, including inpatient, emergency department, and ambulatory visits. RESULTS: Compared with beneficiaries in conventional Medicaid, managed care enrollees in general gave higher ratings of satisfaction. The results were not consistent, however, between the proportion who were extremely satisfied and the proportion who were extremely dissatisfied. Managed care enrollees had significantly greater odds of being extremely satisfied (excellent and very good ratings), but fewer differences were statistically significant for levels of extreme dissatisfaction (fair and poor ratings). With regard to access, managed care enrollees had significantly greater odds of having a usual source of care (odds ratio [OR], 2.33) and seeing the same clinician there (OR, 2.72) and had significantly shorter appointment and office waiting times. Managed care and conventional Medicaid beneficiaries reported no significant differences in obtaining or delays in getting needed care and in inpatient or emergency department use. CONCLUSIONS: Medicaid managed care enrollees in New York City reported better access to care and higher levels of satisfaction compared with conventional Medicaid beneficiaries. Differences between these findings and those for privately insured populations highlight the pitfalls of generalizing from other groups to Medicaid for policy purposes. Given growing reliance on consumer satisfaction surveys for clinical and public policy, future research should focus on factors that explain extreme satisfaction vs extreme dissatisfaction. New York State's initiative, which has been associated with careful state and local monitoring, merits continuing evaluation as managed care enrollment grows and may become mandatory.

Adult↗

PubMed1989

Patients' reactions and physician-patient communication in a mandatory surgical second-opinion program.

To assess patients' reactions to a mandatory second surgical opinion program and to measure the accuracy of communication between these patients and their physicians, questionnaires were sent to New York City municipal employees, retirees, and dependents who had received second-opinion consultations. The most frequent reactions, among 902 respondents, were that the consultations provided reassurance (59%), helped in deciding whether to proceed with surgery (49%), and provided a chance to ask important questions (29%). Relatively few patients felt that the program caused anxiety (12%) or confusion (5%). Patients were generally pleased with the administrative aspects of the program but less satisfied with the consultant physicians they had seen. Twelve percent of patient-physician pairs disagreed about the advice that had been communicated in their second-opinion consultation visits. Nonconcordance rates varied greatly with the nature and complexity of the advice rendered and were higher among patients who stated that their consultants' explanations were not thorough and understandable. In addition to their cost-containment functions, mandatory surgical second-opinion programs can be supportive and informative. Systematic feedback from patients can be used to enhance these strengths, to correct programmatic deficiencies, and to improve the accuracy of communication.

Attitude↗