Census tract of residence and the use of C.M.H.C. services

Conclusion As the need grows to understand how health care can be targeted, in the relative absence of money price, to those who need it most, studies on the effects of travel distance and other measures of time price will become increasingly important. And in order to assure the equitable distribution of services it will also be important to understand how travel distance is ade facto rationing mechanism. The methods used in this investigation easily could be applied to subscribers of Health Maintenance Organizations to determine the effect of travel distance on the utilization of preventative medical services as opposed to more expensive secondary and tertiary care.Out-of-pocket payments for health care are relatively insignificant for many people for many different reasons. In order to ration scarce services and in order to plan for the implementation of health, mental health, and other human service policies it is important to understand what other factors apart from money act as prices in the demand for services. Travel distance as a surrogate for time price, as we have seen, plays a significant role in the demand for mental health services. Time has value to us; it is worth something. And time must be given up in order to attain certain things and services so that some benefit can be derived from them. This is really rather a simple notion, but one that is too often overlooked. The idea that price has to do with more than just money (which is, after all, something of man's own making) is well expressed by Adam Smith inThe Wealth of Nations where he writes: The real price of every thing, what every thing really costs to the man who wants to acquire it, is the toil and trouble of acquiring it.Stephen L. White, Ph.D. is Associate Professor of Health Policy and Management, College of Public Health, University of South Florida, 13301 North 30th Street, Tampa, FL 33612. The author is grateful to Ralph Berry, Ph.D. and Thomas G. McGuire, PhD. for comments on an earlier version of this paper. He is also grateful to the Northern Rhode Island Community Mental Health Center for access to data.     

Frau Professor Dr. C. Coronini

Ohne ZusammenfassungDie in diesem Heft vereinigten Arbeiten sind Frau Prof. Dr. C. Coronini zum 70. Geburtstag gewidmet.     

Immediate Retrospects on the I.P.C.

This study examines the long-term psychiatric consequences, pain interference in daily activities, work loss, and functional impairment associated with 9/11-related loss among low-income, minority primary care patients in New York City. A systematic sample of 929 adult patients completed a survey that included a sociodemographic questionnaire, the PTSD Checklist, the PRIME-MD Patient Health Questionnaire, and the Medical Outcomes Study Short Form-12 (SF-12).

Approximately one-quarter of the sample reported knowing someone who was killed in the attacks of 9/11, and these patients were sociodemographically similar to the rest of the sample. Compared to patients who had not experienced 9/11-related loss, patients who experienced loss were roughly twice as likely (OR = 1.97, 95%; CI = 1.40, 2.77) to screen positive for at least one mental disorder, including major depressive disorder (MDD; 29.2%), generalized anxiety disorder (GAD; 19.4%), and posttraumatic stress disorder (PTSD; 17.1%). After controlling for pre-9/11 trauma, 9/11-related loss was significantly related to extreme pain interference, work loss, and functional impairment. The results suggest that disaster-related mental health care in this clinical population should emphasize evidence-based treatments for mood and anxiety disorders.