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At least 19 recordsLinked to original sources
PubMed1989

The future of medical care for the medically indigent in Louisiana and its relationship to medical education.

The Charity Hospital system of care for the medically indigent in Louisiana has been underfunded both for operation and for capital for a number of years. As a consequence, care is declining in quality and medical education suffers. This article examines the problems, issues, and possible courses of action. Considered are operating authority and governance, organization and finance of care, and the likely impact on medical education; it does not reach conclusions or make recommendations. Rather, its purpose is to stimulate rational discussion about these important matters.

Delivery of Health Care↗
PubMedDate not supplied

Access to medical care in a medically indigent population.

OBJECTIVE: To study nature and extent of barriers to access to medical care in a single county and to define the nature of the illnesses in a population affected by those barriers. DESIGN: Descriptive study of consecutive patients not able to obtain medical care because of financial or other barriers. Financial barriers and medical diagnoses were categorized and the severity of illness and impact of unavailability of medical services were judged by a panel of internists using consensus analysis. The likelihood of obtaining care after refusal of assistance was also evaluated. SETTING: A social services eligibility office on the grounds of an urban, university teaching hospital that serves a largely medically indigent population. PATIENTS: 200 patients who presented to eligibility workers seeking financial assistance. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Sixty percent could not obtain care because they were illegal aliens, 40% could not obtain care because they did not meet the strict criteria of the assistance programs. Sixty percent of patients had a moderate to high likelihood of long-term disability from their illnesses; 38% of a subgroup were not able to find care four weeks after entering the study, and these patients appeared to have more severe disease than those who were able to find care. CONCLUSIONS: Many medically indigent persons with significant illnesses face serious financial barriers to access to medical care.

California↗
PubMed1989

A proposal for care for the medically indigent in the New Orleans area.

The medical care of the indigent in the New Orleans area is an acute problem because of growing deficiencies of funding support, an aging plant, limited equipment, and difficult working conditions at the Charity Hospital (New Orleans). This is the second part of a presentation dealing with the problems and opportunities for the Charity System both in New Orleans and in Louisiana. I have expressed opinions about the choices for the responsible entity, the planning, the location, the organization, the finance of care, and the continuing relationship of medical care to medical education. I propose to continue the Charity Hospital in a new facility. If a new facility is impossible close Charity Hospital over a five- to seven-year period, care should be delivered in various community hospitals in Orleans and Jefferson parishes. Outpatient and emergency care should be decentralized. Louisiana State University is the preferred choice as the planning and operating authority. I believe the continuing interrelationship of the care of the medically indigent and medical education (faculty, residents, and students) is important.

Hospitals, Public↗
PubMed1990

Local advocacy for the medically indigent. Strategies and accomplishments in one county.

Access to health care for the medically indigent has emerged as a major policy issue throughout the United States. Because no national health program ensures entitlement to basic services, practitioners and patients must cope with barriers to access on the local level. We report several separate but integrated strategies that a community-based coalition has used to achieve improvements in indigent care within a single county. Research strategies have involved short-term investigations of barriers to needed services so that local awareness of the problem would increase rapidly. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor, to modify the practices of local health care institutions, and to influence state and national policies that affect local conditions. Legal strategies have involved the participation of attorneys who represent clients unable to receive care and who could initiate litigation as appropriate. Each of these strategies contains weaknesses as well as strengths. Although such advocacy efforts do not achieve a coherent system that guarantees access, they can substantially improve the availability of local services.

California↗
PubMed1989

Cost estimate of health care coverage for the medically indigent in Hawaii.

The objective of the study was to estimate the cost of health insurance coverage of the medically indigent in Hawaii. The number of uninsured was estimated deductively from the coverages of those insurance companies doing business in the state, with an additional factor for persons with more than one policy coverage. Age and sex breakdowns of the uninsured were entered into actuarial tables and fee-for-service and HMO plan costs were obtained for the most prevalent health plan in the state. Annual coverage is estimated at US$46.090866 million and US$58.040700 million for fee-for-service and HMO plans, respectively. Seven potential sources of financing and five recommendations for further research are given.

Actuarial Analysis↗
PubMed1992

Local advocacy for the medically indigent: strategies and accomplishments in one county.

Access to health care for the medically indigent has emerged as a major policy issue throughout the United States. Because no national health program assures entitlement to basic services, practitioners and patients must cope with barriers to access on the local level. The authors report several separate but integrated strategies that a community-based coalition has used to achieve improvements in indigent care within a single county. Research strategies have involved short-term investigations of barriers to needed services, so that local awareness of the problem would increase rapidly. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor, to modify the practices of local health care institutions, and to influence statewide and national policies affecting local conditions. Legal strategies have involved the participation of attorneys who represent clients unable to receive care and who could initiate litigation as appropriate. Each of these strategies contains weaknesses as well as strengths. Although such advocacy efforts do not achieve a coherent system guaranteeing access, they can substantially improve the availability of local services.

California↗
PubMedDate not supplied

A model for primary care delivery to a widely dispersed medically indigent population.

Access to Care is a unique program uniting private and public resources to provide primary care to the uninsured poor. The model was designed to serve a medically indigent population that is dispersed over a large geographic area, where clinics are not a practical option. Care for illness is provided in the offices of private physicians throughout the area and supported by laboratory, radiology, and pharmacy services. The program is designed for the estimated 88,000 persons in suburban Cook County, Illinois, with family incomes of less than twice the federal poverty level, who are uninsured and ineligible for Medicaid and Medicare. Supported by grants from foundations and local governments, the program, which has been in operation for 2 years in two demonstration areas, is administered by a private not-for-profit confederation of four health and social service organizations.

Delivery of Health Care↗
PubMedDate not supplied

Medically indigent women seeking abortion prior to legalization: New York City, 1969-1970.

If the efforts now underway to limit access to abortion services in the United States are successful, their greatest impact will be on women who lack the funds to obtain abortions elsewhere. There is little published information, however, about the experience of medically indigent women who sought abortions under the old, restrictive state laws. This article details the psychiatric evaluation of 199 women requesting a therapeutic abortion at a large municipal hospital in New York City under a restrictive abortion law. Thirty-nine percent had tried to abort the pregnancy. Fifty-seven percent had concrete evidence of serious psychiatric disorder. Forty-eight percent had been traumatized by severe family disruption, gross emotional deprivation or abuse during childhood. Seventy-nine percent lacked emotional support from the man responsible for the pregnancy, and the majority were experiencing overwhelming stress from the interplay of multiple problems exacerbated by their unwanted pregnancy.

Abortion, Legal↗
PubMedDate not supplied

Early postpartum rooming-in and maternal attachment behaviors in a group of medically indigent primiparas.

Introduction of rooming-in at the study site provided an opportunity to examine the impact of rooming-in on maternal attachment behaviors. Maternal attachment scores for 80 mothers who received rooming-in were compared to 72 mothers who delivered before rooming-in and 35 mothers who requested but did not receive rooming-in. All subjects were medically indigent primiparas with no intrapartum or postpartum complications and term healthy infants. The groups were not significantly different in maternal age, race, or ethnicity. Maternal attachment behaviors were recorded during an infant feeding. Rooming-in mothers had significantly higher maternal attachment scores than both control groups. Rooming-in had an independent effect on maternal attachment after the effects of maternal age, episiotomy or lacerations, epidural anesthesia, infant contact at delivery, and time of feeding observation had been accounted for. Of these prior factors, only maternal age had a significant impact on rooming-in. These results suggest that rooming-in helps primiparas to form early attachments to their babies, and that the impact of rooming-in cannot be explained by the mother's motivation for rooming-in. It is important to provide close contact with the infant during the early postpartum, especially for adolescents who may be at higher than average risk of mothering inadequacies.

Adolescent↗