共查询到20条相似文献,搜索用时 15 毫秒
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Richard H. Glazier Mohammad M. Agha Rahim Moineddin Lyn M. Sibley 《Annals of family medicine》2009,7(5):396-405
PURPOSE Universal coverage of physician services should serve to reduce socioeconomic disparities in care, but the degree to which a reduction occurs is unclear. We examined equity in use of physician services in Ontario, Canada, after controlling for health status using both self-reported and diagnosis-based measures.METHODS Ontario respondents to the 2000–2001 Canadian Community Health Survey (CCHS) were linked with physician claim files in 2002–2003 and 2003–2004. Educational attainment and income were based on self-report. The CCHS was used for self-reported health status and Johns Hopkins Adjusted Clinical Groups was used for diagnosis-based health status.RESULTS After adjustment, higher education was not associated with at least 1 primary care visit (odds ratio [OR] = 1.05; 95% confidence interval [CI], 0.87–1.24), but it was inversely associated with frequent visits (OR = 0.77; 95% CI, 0.65–0.88). Higher education was directly associated with at least 1 specialist visit (OR = 1.20; 95% CI, 1.07–1.34), with frequent specialist visits (OR = 1.21; 95% CI, 1.03–1.39), and with bypassing primary care to reach specialists (OR = 1.23, 95% CI 1.02–1.44). The largest inequities by education were found for dermatology and ophthalmology. Income was not independently associated with inequities in physician contact or frequency of visits.CONCLUSIONS After adjusting for health status, we found equity in contact with primary care for educational attainment but inequity in specialist contact, frequent visits, and bypassing primary care. In this setting, universal health insurance appears to be successful in achieving income equity in physician visits. This strategy alone does not eliminate education-related gradients in specialist care. 相似文献
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采用分层随机抽样的方法对广州市常住人口医药卫生可及性进行了电话调查。目前,广州城镇人口大多数自付过医药费用,相当一部分城镇人口自付的医药费用比例过高,药品费用在城镇人口自付的医疗费用项目中居首位,城镇人口自付医药费用的主要原因是没有其他选择。城镇人口医疗保障覆盖面还不高,30%的城镇人口没有参加任何一种医疗保障项目。城镇人口在就医时倾向于选择大医院。完善基本医疗保障制度,引导患者就医行为,推进医药分家体制改革,转变基本医疗保障费用支付方式和加大公共卫生投入改革有助于提高广州市目前城镇人口医疗卫生服务可及性。 相似文献
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Valentine M. Villa PhD Nancy D. Harada PhD Anh-Luu T. Huynh-Hohnbaum PhD 《Home health care services quarterly》2013,32(4):195-215
In 1995, the Veterans Health Administration reorganized its health services structure to emphasize ambulatory care. Successful health care planning and improving access to ambulatory care services now depends upon a better understanding of health care needs and outpatient services. Because the veteran population is heterogeneous, it is important to understand the health, access issues, and utilization of ambulatory care services in order to develop effective strategies and interventions to ensure access to and utilization of ambulatory care. Drawing on a focus group methodology with 86 Native American veterans, representing 34 tribes, this study is a qualitative examination of the health, access, use of the Department of Veterans Affairs Health Care services, barriers to health care, and satisfaction with care experienced by Native American veterans. Results reveal problems in accessing care, receiving appropriate care, and coordinating care within the VA health care system. Policy and program recommendations include increasing outreach and education efforts regarding the availability of benefits and services, improving coordination of services between the Indian Health Service and the VA, and reemphasizing the importance of patient-centered care. 相似文献
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Managed Care Organizational Characteristics and Health Care Use among Children with Special Health Care Needs 总被引:1,自引:0,他引:1
Elizabeth Shenkman Samuel S. Wu John Nackashi James Sherman 《Health services research》2003,38(6P1):1599-1624
Objective. To examine the relationship between features of managed care organizations (MCOs) and health care use patterns by children.
Data Sources. Telephone survey data from 2,223 parents of children with special health care needs, MCO-administrator interview data, and health care claims data.
Study Design. Cross-sectional survey data from families about the number of consequences of their children's conditions and from MCO administrators about their plans' organizational features were used. Indices reflecting the MCO characteristics were developed using data reduction techniques. Hierarchical models were developed to examine the relationship between child sociodemographic and health characteristics and the MCO indices labeled: Pediatrician Focused (PF) Index, Specialist Focused (SF) Index, and Fee-for-Service (FFS) Index, and outpatient use rates and charges, inpatient admissions, emergency room (ER) visits, and specialty consultations.
Data Collection/Extraction Methods. The telephone and MCO-administrator survey data were linked to the enrollment and claims files.
Principal Findings. The child's age, gender, and condition consequences were consistent predictor variables related to health care use and charges. The PF Index was associated with decreased outpatient use rates and charges and decreased inpatient admissions. The SF Index was associated with increased ER visits and decreased specialty consultations, while the FFS Index was associated with increased outpatient use rates and charges.
Conclusion. After controlling for sociodemographic and health characteristics, the PF, SF, and FFS indices were significantly associated with children's health care use patterns. 相似文献
Data Sources. Telephone survey data from 2,223 parents of children with special health care needs, MCO-administrator interview data, and health care claims data.
Study Design. Cross-sectional survey data from families about the number of consequences of their children's conditions and from MCO administrators about their plans' organizational features were used. Indices reflecting the MCO characteristics were developed using data reduction techniques. Hierarchical models were developed to examine the relationship between child sociodemographic and health characteristics and the MCO indices labeled: Pediatrician Focused (PF) Index, Specialist Focused (SF) Index, and Fee-for-Service (FFS) Index, and outpatient use rates and charges, inpatient admissions, emergency room (ER) visits, and specialty consultations.
Data Collection/Extraction Methods. The telephone and MCO-administrator survey data were linked to the enrollment and claims files.
Principal Findings. The child's age, gender, and condition consequences were consistent predictor variables related to health care use and charges. The PF Index was associated with decreased outpatient use rates and charges and decreased inpatient admissions. The SF Index was associated with increased ER visits and decreased specialty consultations, while the FFS Index was associated with increased outpatient use rates and charges.
Conclusion. After controlling for sociodemographic and health characteristics, the PF, SF, and FFS indices were significantly associated with children's health care use patterns. 相似文献
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《Journal of the American Medical Directors Association》2022,23(10):1721-1728.e19
ObjectivesEstimate mortality, cost, and health care resource utilization for Medicare beneficiaries aged ≥65 years who suffered a primary Clostridioides difficile infection (CDI) episode only or any recurrent CDI, and understand how outcomes covary with death.DesignRetrospective observational claims analysis.Setting and ParticipantsPatients aged ≥65 years who had an inpatient or outpatient CDI diagnosis claim to Medicare and continuous enrollment in Medicare parts A, B, and D during the 12-month pre- and post-index periods.MethodsUsing 100% Medicare Fee-for-Service claims data for 2009–2017, primary (pCDI, n = 345,893) and recurrent (rCDI: n = 151,596) CDI episodes were identified. Demographic and clinical characteristics, mortality, health care resource utilization, and costs (per patient per month) were summarized for 12 months before and up to 12 months after episode start. Regression models were estimated for hospitalization risk, hospital length of stay (LOS), and cost to adjust for comorbidities.ResultsCDI-associated deaths were almost 10 times higher after recurrent CDI (25.4%) than primary CDI (2.7%). Compared with survivors, decedents were older, had higher Charlson Comorbidity Index scores, and were more likely Black. Adjusting for comorbidities, during follow-up, decedents had higher hospitalization rates [pCDI: odds ratio (OR) = 1.83, P < .001; rCDI: OR = 2.58, P < .001], and recurrent CDI decedents had more intensive care unit use (OR = 2.34, P < .001) compared with survivors. Decedents also had a longer length of stay (pCDI: +3.2 days, P < .001; rCDI: +2.6 days, P < .001), and higher total cost (pCDI: +303%, P < .001; rCDI: +297%, P < .001).Conclusions and ImplicationsCDI is an important contributing diagnosis to all-cause mortality, particularly for recurrences. Prior to death, older Medicare beneficiaries who experienced CDI received longer, more intensive, and more costly care compared with survivors. Clinicians should be particularly attentive to prevention, identification, and appropriate treatment of CDI in older adults. Better treatments to reduce primary C difficile infection and recurrences in this vulnerable population can lower both mortality and economic burden. 相似文献
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Health Service Accessibility and Risk in Cervical Cancer Prevention: Comparing Rural Versus Nonrural Residence in New Mexico 下载免费PDF全文
Yolanda J. McDonald MA Daniel W. Goldberg PhD Isabel C. Scarinci PhD Philip E. Castle PhD Jack Cuzick PhD Michael Robertson BS Cosette M. Wheeler PhD 《The Journal of rural health》2017,33(4):382-392
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Objectives: Substantially increased funding for health care services occurred in Taiwan after the implementation of a national health insurance plan in 1995. This study attempts to examine the impact of this national health insurance plan on the utilization of prenatal and intrapartum care services. Methods: Nationally representative surveys of all pregnant women in Taiwan in 1989 (1,662 participants) and in 1996 (3,626 participants) were included in the analysis. We first compared the distribution of birth characteristics between the two surveys. We then calculated the rate of utilization of various prenatal and intrapartum care services in the two surveys in the overall sample and in subsamples, stratified by maternal education, age, and parity. Results: The utilization of most prenatal and intrapartum care services, especially the complicated laboratory tests, increased in 1996 compared to 1989. For example, the proportion of women who received amniocentesis increased from 1.62% in 1989 to 5.60% in 1996 and German measles testing increased from 5.96% to 27.11%. By contrast, the proportion of women who received consultation services was stable over time, or for family planning, consultation declined from 33.21% to 27.00%. These changes in utilization over time were consistently observed across different maternal education, age, and parity groups. Conclusions: The utilization of prenatal and intrapartum care services, especially for the more expensive services, has substantially increased in Taiwan since the implementation of the national health insurance. For countries considering similar national health insurance plan, it may be helpful to consider cost-containing measures before the implementation of such a plan. 相似文献
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通过研究虚拟医疗发展历程、虚拟医疗相关技术以及虚拟医疗发展前景,针对虚拟医疗的时空压缩特性,推断出虚拟医疗将对人们就医方式产生的深刻影响,包括①检验、诊断、治疗分离,就医活动的高效化;②平台服务,就医流程的智慧化;③目标转变、医疗服务的日常化。基于此,利用虚拟医疗优化了现有就医流程,通过远程高效的虚拟医疗技术在社区医院等基层医院实现检查、诊断、开具处方药、注射等基础医疗服务,而手术等高端医疗服务仍由核心医院提供,从而达到分流病患、优化医疗服务体验、充分利用医疗资源的目的。 相似文献
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目的 调查儿童保健服务利用情况,并对其影响因素进行分析.方法 采取分层随机抽样的方法进行调查,运用x2检验、多元Logistic回归等统计方法进行影响因素分析.结果 儿童健康体检和“五苗”接种率利用率较高,新生儿疾病筛查、新生儿访视和儿童保健指导利用率较低;居住地、家庭收入、母亲文化程度和儿童出生方式等是影响儿童保健服务利用的重要因素.结论 提高对儿童保健服务的关注程度,通过健康教育等措施不断提升儿童保健服务利用率. 相似文献
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《Journal of the American Medical Directors Association》2023,24(6):798-803.e1
ObjectivesTo compare health care and home care service utilization, mortality, and long-term care admissions between long-term opioid users and nonusers among aged home care clients.DesignA retrospective cohort study based on the Resident Assessment Instrument–Home Care (RAI-HC) assessments and electronic medical records.Setting and ParticipantsThe study sample included all regular home care clients aged ≥65 years (n = 2475), of whom 220 were long-term opioid users, in one city in Finland (population base 222,000 inhabitants).MethodsHealth care utilization, mortality, and long-term care admissions over a 1-year follow-up were recorded from electronic medical records, and home care service use from the RAI-HC. Negative binomial and multivariable logistic regression, adjusted for several socioeconomic and health characteristics, were used to analyze the associations between opioid use and health and home care service use.ResultsCompared with nonusers, long-term opioid users had more outpatient consultations (incidence rate ratio 1.26; 95% CI 1.08−1.48), home visits (1.23; 1.01−1.49), phone contacts (1.38; 1.13−1.68), and consultations without a patient attending a practice (1.22; 1.04−1.43) after adjustments. A greater proportion of long-term opioid users than nonusers had at least 1 hospitalization (49% vs 41%) but the number of inpatient days did not differ after adjustments. The home care nurses’ median work hours per week were 4.3 (Q1-Q3 1.5−7.7) among opioid users and 2.8 (1.0−6.1) among nonusers. Mortality and long-term care admissions were not associated with opioid use.Conclusions and ImplicationsLong-term opioid use in home care clients is associated with increased health care utilization regardless of the severity of pain and other sociodemographic and health characteristics. This may indicate the inability of health care organizations to produce alternative treatment strategies for pain management when opioids do not meet patients’ needs. The exact reasons for opioid users’ greater health care utilization should be examined in future. 相似文献
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Studies on health care practices, financing, and organization increasingly rely on Medicare and other expanded data sets.
These studies are of critical importance for public policy and for the development of strategies to contain escalating health
care costs, but they often use data that have been corrupted by fraud and abuse. Mistaken conclusions, as to the effectiveness
of policy and procedures, are likely being reached in studies that have used corrupted data. Researchers need to consider
the suspect nature of results obtained from the corrupted data, and determine methods for making the data more valid. 相似文献