Pre-Professional Learning for Health Care Careers:

This articale, and the response/reply, explores the use of college students as volunteers in a chaplaincy department. Organization, ecperiences, and evaluation of the program are presented, along with a critique from a fellow chaplain. The author's response follows.     

Drift as Adaptation: Foster Care and Homeless Careers

Tension between policies mandating permanency planning and those requiring treatment in the least restrictive setting leaves many children labeled seriously emotionally disturbed, drifting through placements. An ethnographic study of boys in a residential treatment center in Central Texas suggests that the overrepresentation of former out-of-home care youth among the long-term homeless population may be viewed as the continuation into adulthood of a pattern of drift that began earlier while in out-of-home care. A close-up view of 12 residents of a residential treatment center suggests that forces of drift are more powerful than caseworkers and youth. Implications for policy and practice aimed at breaking the pattern are discussed.     

Health Care Coverage and the Health Care Industry

Objectives. We examined rates of uninsurance among workers in the US health care workforce by health care industry subtype and workforce category.Methods. We used 2004 to 2006 National Health Interview Survey data to assess health insurance coverage rates. Multivariate logistic regression analyses were conducted to estimate the odds of uninsurance among health care workers by industry subtype.Results. Overall, 11% of the US health care workforce is uninsured. Ambulatory care workers were 3.1 times as likely as hospital workers (95% confidence interval [CI] = 2.3, 4.3) to be uninsured, and residential care workers were 4.3 times as likely to be uninsured (95% CI = 3.0, 6.1). Health service workers had 50% greater odds of being uninsured relative to workers in health diagnosing and treating occupations (odds ratio [OR] = 1.5; 95% CI = 1.0, 2.4).Conclusions. Because uninsurance leads to delays in seeking care, fewer prevention visits, and poorer health status, the fact that nearly 1 in 8 health care workers lacks insurance coverage is cause for concern.For complex socioeconomic reasons, private health insurance, typically provided by an employer, is “the dominant mechanism for paying for health services” in the United States.^1(p79) According to the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute, analyses of data from the Current Population Survey (CPS) show that, in 2006, 54% of the US civilian, noninstitutionalized population had employer-sponsored health insurance; 5% had private, nongroup health insurance; and 26% had public health insurance coverage. Approximately 46 million US residents (16% of the population) are currently uninsured.² Numerous studies have shown that, relative to people with health insurance, uninsured people receive less preventive care, are diagnosed at more advanced disease stages, and, once diagnosed, tend to receive less therapeutic care and have higher mortality rates.^3–8Although national uninsurance trends are well-documented, the rate of uninsurance within the health care workforce has received scant attention. Given that health care employment rates are increasing at a more rapid pace than overall employment rates, this lack of attention is especially worrisome. According to the Bureau of Labor Statistics, nearly half of the 30 occupations in which employment opportunities are growing fastest are health care occupations. For example, whereas the Bureau of Labor Statistics projects that overall employment will increase about 10% from 2006 to 2016, employment opportunities for personal and home care aides are projected to increase nearly 51%, and opportunities for physical therapist assistants are expected to increase by a third. The Bureau of Labor Statistics also projects that, by 2016, new job opportunities for registered nurses will increase by approximately 24% (approximately 587 000 new jobs).⁹Although the overall employment outlook for health care workers is promising, what is less clear is to what degree employment in health care is associated with health insurance coverage. A 2001 General Accounting Office report suggested that one fourth of nursing home aides and one third of home health care aides were uninsured.¹⁰ The Kaiser Family Foundation reported that the uninsured rate among workers in the health and social services industry was 23% in 2007.¹¹ On the basis of a review of the literature in the health and human services occupations, Ebenstein concluded that the health insurance plans offered to direct care workers in the developmental disabilities field are “inferior … with less coverage and more out-of-pocket expenses” and that fewer direct care workers “are able to afford health coverage even if they are eligible.”^12(p132)Taking a more comprehensive look at the US health care workforce, Himmelstein and Woolhandler¹³ used 1991 CPS data to estimate uninsurance rates among physicians and other health care personnel. They reported that, overall, 9% of health care workers were uninsured, along with more than 20% of nursing home workers. Examining CPS data from 1988 to 1998, Case et al. found that uninsurance rates among all health care workers rose from 8% to 12%, that rates increased more for health care workers than for workers in other industries, and that rates differed according to occupation and place of employment.¹⁴ For example, occupation-specific uninsurance rates were 23.8% among health aides, 14.5% among licensed practical nurses, and 5% among registered nurses, whereas place-specific rates were 20% among nursing home workers, 8.7% among medical office workers, and 8.2% among hospital workers.¹⁵In their studies, Himmelstein and Woolhandler¹³ and Case et al.¹⁴ used national-level data to estimate uninsurance trends among health care workers. However, these trends were not adjusted for health care workers'' social, demographic, or economic characteristics, which would have helped explain variation across categories or over time. Moreover, with the growth of the health care workforce, estimates from these older studies probably do not reflect the current situation. As a result, the picture of uninsurance as it pertains to the health care workforce lacks the precision and currentness necessary for sound policy decisions. In an effort to expand knowledge in this area, produce more up-to-date estimates, and provide support for possible policy decisions, we used data from the National Health Interview Survey (NHIS) to examine uninsurance among workers in the health care industry.     

Kids Into Health Careers: A Rural Initiative

Purpose: To describe a project that introduces middle school and high school students living in Pennsylvania's rural geographic regions to nursing careers through outreach extended to students regardless of gender, ethnicity, or socioeconomic status. Method: The authors employed many strategies to inform students about careers in nursing. The methods included: working with guidance counselors, participating in community health fairs, taking part in school health career fairs, collaborating with Area Health Education Centers, serving on volunteer local education advisory boards, developing a health careers resource guide, and establishing a rural health advisory board. Findings: Developing developmentally appropriate programs may have the potential to pique interest in nursing careers in children of all ages, preschool through high school. Publicity is needed to alert the community of kids into health care career programs. Timing is essential when planning visits to discuss health care professions opportunities with middle and high school students. It is important to increase the number of high school student contacts during the fall months. Targeting high school seniors is particularly important as they begin the college applications process and determine which school will best meet their educational goals. Conclusions: Outcome measures to determine the success of health career programs for students in preschool through high school are needed. Evaluation methods will be continued over the coming years to assess effectiveness.     

Hispanic Preferences for Health Care Providers and Health Care Information

In a 1994 telephone survey, only 13% of 522 adult Hispanic respondents in the Southwest used media as the main source of information for physicians, while 19% used media for information regarding health services. Family and friends were main sources. About 75% of the respondents had a family physician with the mother (68%) making health care decisions for the family. A large majority of respondents said that neither the physician's sex, nor race were factors in choosing physicians.     

居民就医选择与基层医疗机构的竞争性分析

目的探索影响城乡居民选择基层医疗机构就诊的影响因素,并为基层医疗机构发展提出建议。方法采用Logistic回归对中国健康与营养调查2009年截面数据进行分析。结果疾病严重程度、医疗保险状况、有无工作以及户籍是影响居民选择基层医疗机构就诊的关键因素。结论应当针对这些方面对目前政策做出调整以增强基层医疗机构竞争力。     

Long Term Care and Home Health Care

No abstract available for this article.     

亚健康与保健

本文采用文献综述和临床观察等方法,对亚健康的概念及其表现特征进行描述与阐释,探讨亚健康的起因,并结合中医经络学和治未病理论以及本人亲身体验,提出了干预亚健康的10种简便易行的保健方式与方法,旨在对人们进一步认识亚健康、预防亚健康有所裨益。     

Managed Care Organizational Characteristics and Health Care Use among Children with Special Health Care Needs

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.     

基本卫生保健制度与初级卫生保健的比较分析

主要从基本卫生保健和初级卫生保健的内涵入手,对基本卫生保健制度与初级卫生保健的联系与区别进行了研究,从目标和条件等方面分析了两者的联系,并从体系的完善、涵盖的范围、工作的重点和支持的力度等方面分析了二者的区别.     

融入社区的医疗与养老

医疗与养老一直都是大众和学界的热门话题,是国家持续推进的两项重要民生事业,关乎我们未来健康生活的保障问题.三甲医院、养老机构越来越多,硬件设施和软件服务越来越好,但是仍旧无法满足社会的需求.推行分级诊疗、预防保健、居家养老是适合我国当前国情和实际的卫生保障和卫生服务之路.这不仅是机制的转变,也是社会观念、生活习惯的重新...     

Medicaid Managed Care and Health Care for Children

Objective. Many states expanded their Medicaid managed care programs during the 1990s, causing concern about impacts on health care for affected populations. We investigate the relationship between Medicaid managed care enrollment and health care for children.
Data Sources and Measures. Repeated cross-sections of Medicaid-covered children under 18 years of age from the 1996/1997 and 1998/1999 Community Tracking Study Household Surveys ( n =2,602) matched to state-year CMS Medicaid managed care enrollment data. For each individual, we constructed measures of health care utilization (provider and emergency department visits, hospitalizations, surgeries); health care access (usual source of care, unmet medical needs, put-off needed care); and satisfaction (satisfaction overall, with doctor choice, and with last visit).
Study Design. Regression analysis of the relationship between within-state changes in Medicaid managed care enrollment rates and changes in mean utilization, access, and satisfaction measures for children covered by Medicaid, controlling for a range of potentially confounding factors.
Principal Findings. Increases in Medicaid health maintenance organization (HMO) enrollment are associated with less emergency room use, more outpatient visits, fewer hospitalizations, higher rates of reporting having put off care, and lower satisfaction with the most recent visit. Medicaid primary care case management (PCCM) plans are associated with increases in outpatient visits, but also with higher rates of reporting unmet medical needs, putting off care, and having no usual source of care.
Conclusions. Both Medicaid HMO and PCCM plans can have important impacts on health care utilization, access, and satisfaction. Some impacts may be positive (e.g., less ED use and more outpatient provider use), although concern about increasing challenges in access to care and satisfaction is also warranted.