影响贵州省贫困地区农村妇女利用基本生育健康服务的因素分析

[目的]了解影响贵州省贫困地区农村妇女利用基本生育健康服务的因素。[方法]采用现况调查通过多阶段分层整群随机抽样,对195名育龄妇女进行入户问卷调查。[结果]经济收入、文化程度及就医距离是人群利用基本生育健康服务的主要障碍。[结论]建议政府加大对农村地区的经济投入,加强健康知识宣传与普及,加强农村妇幼卫生保健网络的建设,改善基本生育健康服务的可及性。     

经济相对落后地区农村卫生服务现况分析

[目的]为评估经济相对落后地区农村卫生服务需求与卫生资源利用情况,进一步推动农村医疗卫生服务改革,对沾化县9个乡镇990户3418名居民进行了调查。[结果]调查人群两周患病率为20.22%,两周就诊率24.6%。两周患病率与乡镇居民经济收入无显著相关性;应就诊而未就诊的9.99%,基层医疗条件、居住偏僻、就诊意识差是主要原因;应住院而未住院的为8.54%,未住院率与乡镇经济条件显负相关;病人主要选择在村卫生室就诊,住院多选在县级医院,平均住院天数为12.2d,住院费用3808元;医疗消费占总消费的比例有显著性差异,越是贫困地区越是负担严重。[结论]在相对落后地区,乡镇卫生院处置疾病能力较差,农村居民两周患病率较高,未就诊比例较大,疾病防治工作和卫生政策亟待加强。     

THE DEMAND FOR PRIVATE PSYCHIATRIC SERVICES IN A HEALTH INSURED POPULATION

This paper reports a study of the pattern of utilization of private psychiatric services by health insured persons who are members of a single large fund. The data show an increase in the average number of services per person consulting a psychiatrist with little change in the number of persons. There is a strong relation between private psychiatric contact rates and the socio-economic index of the LGA of patient residence. Contributor units containing a medical practitioner are examined as an example of the utilization pattern of a socially elite group. The financial and administrative significance of the findings is discussed. Very little information is available in Australia concerning the relationship between the demand for health services and the socioeconomic characteristics of the clients or potential clients of the health services. Since Australian governments have shown a substantial reliance on voluntary health insurance as a mechanism for financing health care, this lack of information is surprising. Studies in the United States of America and England suggest that the upper socio-economic classes receive more medical services than the lower, although these conclusions are not clear cut. It becomes a useful a priori hypothesis that a relationship between socio-economic status and the demand for medical services exists in Australia, even within a health insured population. In this paper we examine the utilization of private psychiatric services by persons who were members of a single large health insurance fund in New South Wales. Claim history and membership demographic data were obtained from the health fund computer record system for the years 1977, 1978 and the period January to June, 1979. Since this fund covers about onethird of all persons with private health insurance in that state, we believe that the study may rellect the relationships for health insured populations in Australia generally. Private psychiatric services have been examined, not only because the itemization of psychiatric services is simple and data analysis is easy, but also because there is ample anecdotal evidence that the demand for psychiatric services is determined partly by client status and education. This should help establish the existence or otherwise of some socioeconomic gradient with respect to the demand for services.     

The health status, health services utilization, and support networks of the rural elderly: a decade review.

Research from the 1980s on several dimensions of health and health care among the rural elderly is reviewed. Following a brief discussion of the demographic patterns and life conditions of the rural elderly, the current state of knowledge regarding health status, health services utilization, and the potential for informal and familial care of the elderly is examined. The review concentrates on studies that include comparisons between rural and urban populations and/or control for additional variables that are known to covary with residence. Such analyses permit the documentation of the effects of residential location on health indicators net of other factors. The review concludes that the rural elderly are relatively disadvantaged in terms of both health status and access to health care services, and have little if any advantage over the urban elderly in their access to informal sources of care. Following the review, an agenda for future research is identified.     

忠县农村卫生服务需要与利用及卫生适宜技术推广的必要性

[目的]了解重庆市忠县农村居民的健康水平、卫生服务的需要和利用现状,为农村卫生适宜技术推广的必要性提供依据。[方法]采用现场调查研究,通过多阶段分层整群随机抽样,对忠县农村居民600户进行统一问卷调查。[结果]与全国农村平均水平相比,忠县农村居民的卫生服务呈现高需要量、低利用率、利用主要在基层医疗机构的特点。[结论]为了满足忠县农村居民的卫生服务需要,提高其对卫生服务的利用,该县应进一步健全医疗保障制度,在基层医疗卫生机构推广卫生适宜技术。     

SOUTH AUSTRALIA'S REORGANISATION OF COUNTRY HEALTH SERVICES

ABSTRACT: The South Australian Health Commission is currently implementing the regionalisation of health services in country areas within a Funder Owner Purchaser Provider model. This arrangement is one of the first of its kind in Australia and is unique in that one organisation, the Country Health Purchasing Unit, is to be established with the responsibility of purchasing all health services for rural South Australians. Health services will be provided through seven rural regions, by public and private health providers in the Adelaide metropolitan area, and statewide services. This reorganisation of health services in South Australia is designed to bring about better co-ordination and integration of rural health services and improvements in community participation and involvement in the provision of health services.     

Utilization of maternal health care services in Southern India

This paper examines the patterns and determinants of maternal health care utilization across different social settings in South India: in the states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. Data from the National Family Health Survey (NFHS) carried out during 1992-93 across most states in India are used. Results show that utilization of maternal health care services is highest in Kerala followed by Tamil Nadu, Andhra Pradesh and Karnataka. Utilization of maternal health care services is not only associated with a range of reproductive, socio-economic, cultural and program factors but also with state and type of health service. The interstate differences in utilization could be partly due to variations in the implementation of maternal health care program as well as differences in availability and accessibility between the states. In the case of antenatal care, there was no significant rural-urban gap, thanks to the role played by the multipurpose health workers posted in the rural areas to provide maternal health care services. The findings of this study provide insights for planning and implementing appropriate maternal health service delivery programs in order to improve the health and well-being of both mother and child.     

The Role of Federally Funded Health Centers in Serving the Rural Population

CONTEXT: Federally funded health centers attempt to improve rural health by reducing and eliminating access barriers to primary care services. PURPOSE: This study compares rural health center patients with people in the general rural population for indicators of access to preventive services and health outcomes. METHODS: Data from the annual reporting system for federally funded health centers, the 1999 Uniform Data System, and published national census data were used to provide sociodemographic comparisons. Selected health status indicators, preventive services utilization, and health outcomes were obtained from a survey of health center patients, and the results were compared with the National Health Interview Survey and National Vital Statistics. FINDINGS: Unlike the nation's rural population, the majority of rural health center patients are of minority race/ethnicity, live at or below poverty, and are either uninsured or on Medicaid. Despite having higher prevalence of traditional access barriers than the general rural population, rural health center patients are significantly more likely to receive certain preventive services and also to experience lower rates of low birthweight, particularly for African American infants. However, rural health center patients are not more likely to have received influenza vaccination or up-to-date mammogram screening. CONCLUSIONS: Health centers provide access to essential preventive care for many of the most vulnerable rural residents. A national strategy to expand the rural health center network will likely help to ensure improved health for the considerable proportion of rural residents who still lack access to appropriate services.     

Do individual and program factors matter in the utilization of maternal care services in rural India?: a theoretical approach

Current studies on the utilization of maternal care services in India focus on individual factors. In the present study, we use the theoretical model developed by Andersen and Newman [1973. Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly, 51(1), 95-124] to understand the utilization of maternal care services in rural areas of India. This theoretical model uses individual and welfare program-or system factors-to study health care utilization. Data collected through the National Family Health Survey-2 are used in the present study. The results suggest that in addition to individual characteristics, program and system factors influence the utilization of maternal care in rural areas. Program factors, particularly educational activities promoting the benefits of maternal care services carried out through mahila mandal and anganwadi centers, are important in increasing the use of maternal care services in rural areas. Additionally, the results indicate that the mere presence of a private health care facility need not necessarily improve utilization. Increase in utilization is observed among households if the health worker visited these households during pregnancy. More state-specific studies incorporating both program and individual characteristics are recommended to further strengthen our understanding of the utilization of health care services in general and maternal care services specifically.     

Adequate Access to Posthospital Home Health Services: Differences Between Urban and Rural Areas

The health care environment in rural areas changed dramatically in the 1980s. Policy-makers are concerned that these changes have reduced access to care among residents of rural areas. This study measures adequate access to Medicare home health services and determines whether it differs for urban and rural beneficiaries. Adequate access to care is measured by whether a patient with a specific health condition received a level of skilled services predetermined as appropriate for that condition. The predetermined levels of care were developed in an earlier study and were found to correlate with adverse outcomes. This study focused on patients with diabetes mellitus and surgical hip procedures to concentrate on access to skilled nursing services and physical therapy services. To conduct the analysis, a data base was constructed that included both patient utilization and health status data, drawing on three different data sources: Medicare hospital claims data, Medicare home health bill record data, and home health plan of treatment data from patients' utilization review forms (forms 485 and 486). The analysis samples consisted of 404 patients with diabetes and 876 patients who had surgical hip procedures. Significant differences were found between urban and rural areas in access to home health services. The largest differences were found in access to physical therapy services, but differences in access to skilled nursing services also exist. The data suggest that the availability of skilled care services may cause these differences.     

Access to Transportation and Health Care Utilization in a Rural Region

CONTEXT: Access to transportation to transverse the large distances between residences and health services in rural settings is a necessity. However, little research has examined directly access to transportation in analyses of rural health care utilization. PURPOSE: This analysis addresses the association of transportation and health care utilization in a rural region. METHODS: Using survey data from a sample of 1,059 households located in 12 western North Carolina counties, this analysis tests the relationship of different transportation measures to health care utilization while adjusting for the effects of personal characteristics, health characteristics, and distance. FINDINGS: Those who had a driver's license had 2.29 times more health care visits for chronic care and 1.92 times more visits for regular checkup care than those who did not. Respondents who had family or friends who could provide transportation had 1.58 times more visits for chronic care than those who did not. While not significant in the multivariate analysis, the small number who used public transportation had 4 more chronic care visits per year than those who did not. Age and lower health status were also associated with increased health care visits. The transportation variables that were significantly associated with health care visits suggest that the underlying conceptual frameworks, the Health Behavior Model and Hagerstrand's time geography, are useful for understanding transportation behavior. CONCLUSIONS: Further research must address the transportation behavior related to health care and the factors that influence this behavior. This information will inform policy alternatives to address geographic barriers to health care in rural communities.     

The effects of geography and spatial behavior on health care utilization among the residents of a rural region

OBJECTIVE: This analysis determines the importance of geography and spatial behavior as predisposing and enabling factors in rural health care utilization, controlling for demographic, social, cultural, and health status factors. DATA SOURCES: A survey of 1,059 adults in 12 rural Appalachian North Carolina counties. STUDY DESIGN: This cross-sectional study used a three-stage sampling design stratified by county and ethnicity. Preliminary analysis of health services utilization compared weighted proportions of number of health care visits in the previous 12 months for regular check-up care, chronic care, and acute care across geographic, sociodemographic, cultural, and health variables. Multivariable logistic models identified independent correlates of health services utilization. DATA COLLECTION METHODS: Respondents answered standard survey questions. They located places in which they engaged health related and normal day-to-day activities; these data were entered into a geographic information system for analysis. PRINCIPAL FINDINGS: Several geographic and spatial behavior factors, including having a driver's license, use of provided rides, and distance for regular care, were significantly related to health care utilization for regular check-up and chronic care in the bivariate analysis. In the multivariate model, having a driver's license and distance for regular care remained significant, as did several predisposing (age, gender, ethnicity), enabling (household income), and need (physical and mental health measures, number of conditions). Geographic measures, as predisposing and enabling factors, were related to regular check-up and chronic care, but not to acute care visits. CONCLUSIONS: These results show the importance of geographic and spatial behavior factors in rural health care utilization. They also indicate continuing inequity in rural health care utilization that must be addressed in public policy.     

BARRIERS TO CANCER SCREENING AMONGST WOMEN WITH MENTAL HEALTH PROBLEMS

The involvement of women with mental health problems in cancer screening was examined in order to explore service delivery options among this particular group. Structured interviews were used to identify the utilization of cancer screening and barriers experienced in accessing such screening among this group. The sample of women reported similar utilization rates of cancer screening as the general female population of the same Australian state. However, they identified a number of barriers to effective access to cancer screening. In response to the interview finding that consumers valued screening services from a well-known provider in a familiar environment, a series of women's health clinics were offered within a mental health service. This experience is described and was used to try to better understand barriers to cancer screening experienced by women with mental health problems. The women's health clinics were most efficiently offered in conjunction with hospital-based psychiatric services.     

Pattern of medical care services utilization in Fiji

The present study was designed to analyze sociodemographic and health related factors that influence the utilization of medical care services in Fiji by using the method of discriminant function. Some sociodemographic and health related independent variables had significant effects on the two patterns of modern and traditional medical services utilization. Discriminant function coefficients for sex, age and race are large enough to suggest the importance of discriminating between two patterns of medical care utilization. This suggests that traditional medical service is coexistent with modern medicine in Fiji and might play an extremely important role in providing health care for rural communities in the same way as modern medicine.     

How Healthy is Life in the Bush? Problems Associated with the Assessment of Health Status in Rural Australia

ABSTRACT: In order to ensure that adequate and appropriate health care services are provided to rural inhabitants, it is vital to have a comprehensive understanding of their health care needs. The lack of conclusive evidence on the health status of rural inhabitants to date reflects problems associated with how best to measure health status, and the fact that insufficient research has been conducted to ascertain whether health status differs within rural Australia. This article evaluates different measures used to assess rural health status. It also reports the results of a study which investigates whether the pattern of ill health varies between farm and small rural town residents, and according to remoteness from health care services.     

Impact of rural hospital closures in Saskatchewan, Canada

Canada's health care system has undergone major changes since 1990. In Saskatchewan, 52 small rural hospitals funded for less than eight beds stopped receiving funding for acute care services in 1993. Most were subsequently converted to primary health care centers. Since then, concerns have been raised about the impact of the changes on rural residents' access to care, their health status, and the viability of rural communities. To assess the impact of hospital closures on the affected communities, we conducted a multi-faceted, province-wide study. We looked at hospital use patterns, health status, rural residents' perceptions of the impact of these hospital closures, and how communities responded to the changes. We found the hospital closures did not adversely affect rural residents' health status or their access to inpatient hospital services. Despite widespread fears that health status would decline, residents in these communities reported that hospital closures did not adversely affect their own health. Although some communities continue to struggle with changes to health care delivery, others appear to have adapted as a result of strong community leadership, the development of widely accepted alternative services, and local support for creating innovative solutions. Good rural health care does not depend on the presence of a very small hospital that cannot, in today's environment, provide genuinely acute care. It requires creative approaches to the provision of primary care, good emergency services, and good communication with the public on the intent and outcomes of change.     

Limitations of secondary data for strategic marketing in rural areas.

Market research is an important element of the strategic marketing process. By understanding the healthcare needs of a market area, hospital and health system managers can set priorities for new services and allocate resources appropriately. The process of market research often begins with an evaluation of health status and socioeconomic indicators collected from secondary sources. Unfortunately, indicators that have been recommended in the literature may not be feasible for use in rural markets because of their lack of statistical precision or inability to differentiate healthcare service needs. This study evaluated the statistical precision and variability of 79 secondary health status and socioeconomic measures reported at the county level in Iowa, USA, a largely rural state. Our findings suggest that many readily available health status and socioeconomic indicators do not discriminate need among rural health care markets. Only six health status and two socioeconomic indicators met our statistical precision and variability criteria. These findings have important implications for managers planning health services in rural localities. Managers of rural health systems may need to employ alternative market research methods, such as analysis of claims-based utilization rates or community health surveys.     

Brutal neglect: Australian rural women's access to health services

Access to health services in rural Australia has been particularly problematic because of the vast geographical areas and the sparse population distribution across the inland. The focus on health servicing has been very much on primary health care with most attention being giving to the distribution of doctors in rural Australia. This study takes a closer look at rural health servicing through the eyes of women in rural Australia. Drawing on a survey of 820 women, the study revealed that a focus on primary health care may be resulting in a lack of attention to women's health in areas, such as maternity models of care, domestic violence and mental health. The study also reveals the disquiet of Australian rural women at the poor state of health services.     

SERVING RURAL AUSTRALIA WITH REPRODUCTIVE HEALTH EXPERTISE

ABSTRACT: This study aimed to review the use of reproductive health services in Family Planning clinics by women from rural (non-metropolitan) Australia through a retrospective analysis of data collected at clinics of seven state/territory Family Planning Organisations (FPO). From a total of 146 157 client visits to FPO clinics between July 1998 and June 1999, 42 497 (29.1%) were by clients who lived outside metropolitan areas. Some 97% of clients were women. Our results show the use of reproductive health services by women from rural areas was different from the services used by women from metropolitan areas. There were fewer male clients, more women over 40 years of age, and fewer clients from a non-English speaking background. More of the attendees had pension cards and fewer were privately insured. We concluded there is considerable demand for reproductive health services among the rural population and reproductive health care needs to be expanded to reach rural women.     

Cancer in Rural Versus Urban Populations: A Review

Rural-urban comparisons have identified higher age-, race-, and sex-adjusted cancer incidence and mortality rates in urban populations for most anatomic sites, suggesting that rural populations are at lower risk from cancer. Conversely, findings that rural cancer patients are diagnosed at later stages of disease, that higher proportions of rural cancer cases are unstaged at diagnosis, and that rural cancer patients are at a more advanced stage of illness when referred to home health care agencies, suggest that rural cancer patients are disadvantaged when compared to their urban counterparts. This paper summarizes rural-urban patterns of cancer mortality, incidence, and survivorship since 1950; outlines rural-urban differences in utilization of health care services; questions the appropriateness of using rural-urban comparisons of cancer mortality and incidence to evaluate access to cancer care; and suggests potential approaches to the question of whether rural residents have access to cancer care comparable to that available to urban residents.