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At least 19 recordsLinked to original sources
PubMed1991

The reaction of private physicians to price deregulation in France.

French private physicians are paid on a fee-for-service basis and nearly all of them are under contract to the Social Security, which refunds part of the medical fee to the whole population. Previously the prices of medical services were fixed, but since 1980, a new option has been possible: a doctor can choose to fix the price of his services freely, provided he pays a higher social insurance contribution. But the amount refunded by Social Security does not vary, so that the consumer has to bear the extra charge. Our purpose here is to identify the factors that influence the physician's option. In Section 2, we define a model of the private physician's economic behaviour, of the classic income-leisure type. In Section 3, empirical tests are performed on a sample of observations in 95 'départements', gathering information about private GPs on the one hand, and the whole population on the other. According to our results, GPs' decisions depend on characteristics of both supply of and demand for GPs' services. One of our conclusions is that GPs seem to make up for low activity levels with higher prices, on condition the income of their practice allows it.

Choice Behavior↗
PubMed1977

Variations in GP night visiting rates: medical organisation and consumer demand.

Specially obtained data for night visiting fees show a considerable increase in the number of claims made per general practitioner and per 1000 patients. There were also considerable variations between the 116 executive councils: in 1973-4 the range was from 3-8 to 17-0 per 1000 patients. To explain these variations, their relations with the local characteristics of family practice and of the population was explored using regression analysis. The factors most strongly associated with variations in implied visiting rates were found to be deputising services and the proportion of social class V in the population.

Adolescent↗
PubMed1987

Who should be blamed for being sick?

That individuals are responsible for staying healthy is becoming a truism of health promotion and health policy. However, it is unclear what the slogan means, whether it is true, and what the consequences would be or should be if it is. A careful examination of the contexts in which the notion of personal responsibility for health occurs reveals a number of distinct arguments for different policy ends, each relying in turn on key unstated assumptions whose validity is doubtful. There is no disputing the minimal claim that most of us would be healthier if we took better care of ourselves. However, assignment of responsibility for health to the individual is usually part of a more far-reaching reassessment of obligations and entitlements in health care and health policy. A assessment of the concept of personal responsibility for health should precede any attempt to draw broad conclusions on rights and duties in maintaining health.

Authoritarianism↗
PubMed1977

Money and mental disorder: toward behavioral cost accounting for primary prevention.

This paper reviews recent retrospective sociological research suggesting that rises as well as falls in the economy are associated with such indicators of mental disorder as suicide and mental hospitalization. The review emphasizes that a lag exists between economic change and the changes in associated mental indicators. It is suggested that these findings hold promise both for early warning for practitioners and for primary prevention. Also described is a survey in four centers of 93 community mental health workers, indicating that such workers are receptive to the use of such economic indicators but not well-informed about them. Suggestions are made for prospective research to relate economic change to mental disorder through such intervening constructs as life change and stress. Such research, it is hoped, would expand the capacities of community psychologists to account for the behavioral costs of economic policy alternatives.

Adaptation, Psychological↗
PubMed1992

A socioeconomic comparison of patients receiving prostheses in a two-tier delivery system.

It has been theorized that the legalization of providers of denture care other than dentists would make dentures more affordable to and therefore more often obtained by individuals of lower socioeconomic status. The delivery of dental prostheses by nondentists (denturists) has been legalized in Arizona, Colorado, Idaho, Maine, Montana, and Oregon. This study compares the socioeconomic and utilization patterns of two groups of patients receiving prostheses: (1) those whose prosthetic services were provided by dentists and (2) those whose services were provided by denturists. The sample included 135 participants; 31 individuals with 54 prostheses made by denturists and 104 individuals with 165 prostheses made by dentists. Application of the chi-square test and the Hollingshead Two-Factor Index of Social Position revealed no statistically significant correlation, (p less than 0.05) between the provider-based groups and standard socioeconomic variables. The history and pattern of choice of provider as well as level of satisfaction were also remarkable for the similarity displayed by the two groups. It would appear that the two groups are actually one homogeneous group served by two levels of providers.

Aged↗
PubMed1985

Objectives for medical education: expectations of society.

Since health care and the practice of medicine have become major topics for social and political comment a variety of expectations have emerged which, in a sense, define an idealized image of the medical profession and its work. Different sectors of the community tend to place different emphasis on specific aspects of doctors' roles. This paper reviews those specific expectations which have been expressed by patients, sociologists, allied health professionals, governments and health administrators, and derives from them objectives for medical education.

Administrative Personnel↗
PubMed1987

[Cognitive changes in decision making process underlying prosocial behavior].

Using a method of monitoring information acquisition, 76 subjects were instructed to simulate the information search process in which they selected a behavior from available behavioral alternatives which were expected to occur in a situation where donating behavior was needed. In order to measure the cognitive changes, they were asked to rate the importance of behavioral attributes both before and after the decision task. After the decision task, they were asked to rate the inner states. (1) Defensive cognitive changes were found which increased the importance of behavioral costs and decreased the importance of personal moral obligation feelings. This pattern of changes was consistent with the Schwartz & Howard model (1981, 1982, 1984). (2) The defensive cognitive changes were related to the information search strategies. This pattern of relationship partly confirmed the prediction derived from the Schwartz & Howard model (1981, 1982, 1984). (3) The result that the cognitive changes were not related to the inner states was inconsistent with the model of either Piliavin, Dovidio, Gaertner, & Clark (1981, 1982) or Schwartz & Howard (1981, 1982, 1984). An alternative model was proposed and discussed.

Adult↗
PubMed1976

Citizen participation in the decision-making activities of formal social service agencies: an unreasonable goal?

In the past, attempts by social service agencies to include nonprofessional area residents in program planning and policy-making activities have met with little success. Such failures may be due in part to mistrust and a feeling that the agencies and their programs have little relevance to the problems faced by most people. Perhaps an alternative way of developing resident participation in community action programs would be to move the planning and decision-making process away from the trained experts associated with formal institutions to the residents within the neighborhoods themselves. The people living within a defined community would decide which problems they wish to address, and then use resources available within the community to solve them.

Community Mental Health Services↗
PubMed1985

Patient predictors of hospice choice. Hospital versus home care programs.

Research findings indicate cost savings associated with home care hospices, while hospital-based hospices can be as expensive as conventional care. Based on National Hospice Study data, this article identifies the characteristics of patients admitted to hospital-based and home care hospices in those areas of the country where a choice of hospice model was possible. Multivariate logistic regression indicates that the significant discriminating factors between the two patient populations relate to the availability of supportive care at home and the severity of nursing care problems at the time of hospice entry. Reinforcing selected pre-existing differences, an examination of prehospice had longer episodes of care than was the case for home care hospice patients.

Activities of Daily Living↗
PubMed1989

Defining and measuring stabilization of patients during 4 years of intensive community support.

The first 4 years of an intensive community support program were evaluated in terms of key variables of patient stabilization. Patients (N = 196) had previously demonstrated an inability to manage themselves without repeated and/or lengthy hospitalizations. During program participation, there were significant reductions in hospital days and events (80%), jail incarcerations and charges, billings per patient, and stressful events. Patients reported increased satisfaction both with their lives and the program. The results support the value of continued multidimensional and multimethod examinations of patient stabilization.

Activities of Daily Living↗
PubMed1987

Foster home care for the frail elderly as an alternative to nursing home care: an experimental evaluation.

This paper describes a program (Community Care Program) in which some elderly hospital patients who were candidates for nursing home placement were placed in foster homes. Caregivers were carefully trained and supervised. A total of 112 elderly inpatients were randomly assigned to placement in a nursing home or a foster care home. Patients and caregivers were interviewed at 3, 6, 9, and 12 months after placement. Community Care Program patients were more likely to maintain or improve ADL (activities of daily living) and mental status scores. They also had better nursing outcomes and were more likely to get out of the house than were nursing home patients. Nursing home patients had higher life satisfaction, and participated in more social and recreational activities. The Community Care Program was 17 per cent less costly than nursing home care. The results suggest that foster care may be a viable alternative for a segment of the nursing home population.

Activities of Daily Living↗
PubMedDate not supplied

A school-based smoking prevention program for adolescent girls in New York City.

Teenaged girls comprise the largest percentage of new cigarette smokers in the United States today. Factors contributing to smoking initiation include peer pressure, family and social influences, cigarette availability, and cigarette advertising. Because three-quarters of smokers become dependent on cigarettes by age 20, smoking prevention programs aimed at the adolescent population have great potential. The proposed program outlined is directed at girls 12 to 18 years of age in New York City. Among the objectives are increasing students' knowledge of the short- and long-term health effects of smoking and awareness of the social factors which lead to smoking. Participants would be taught social skills and behaviors which could help them to resist initiating smoking, by such activities as assertiveness training through role playing. Endurance sports activities would be emphasized while learning of the effects of smoking on physical conditioning. The costs of such a program are estimated, and classroom activities are outlined.

Adolescent↗
PubMed1977

Health care cost-containment regulation: prospects and an alternative.

Regulation of the health care system to achieve appropriate containment of overall costs is characterized by Professor Havighurst as requiring public officials to engage, directly or indirectly, in the rationing of medical services. This rationing function is seen by the author as peculiarly difficult for political institutions to perform, given the public's expectations and the symbolic importance of health care. An effort on the part of regulators to shift the rationing burden to providers is detected, as is a trend toward increasingly arbitrary regulation, designed to minimize regulators' confrontations with sensitive issues. Irrationality and ignorance are found to plague regulatory decision making on health-related issues, even though it is the consumer who is usually thought to suffer most from these disabilities. The author argues that consumer choice under some cost constraints is a preferable mechanism for allocating resources because it better reflects individuals' subjective preferences, has a greater capacity for facing trade-offs realistically, and can better contend with professional dominance of the resource allocation process. In view of the unlikelihood of regulation that is both sensitive and effective in containing costs, the author proposes that we rely primarily on consumer incentives to reform the system. A simple change in the tax treatment of health insurance or other health plan premiums, to strengthen consumers' interest in cost containment while also subsidizing needy consumers, is advocated. Steps to improve opportunities for innovation in cost containment by health insurers, HMOs, and other actors are outlined briefly.

Choice Behavior↗