Hispanic access to hospice services in a predominantly Hispanic community

Although the largest minority population in the United States, Hispanics are under-represented in hospice at the national level. The study purpose was to document Hispanic access to hospice services in an environment where Hispanics are a majority population. The framework for the study was Aday and Anderson's model for access to medical care. In this framework, access is not defined as availability of services and resources, but whether services are actually used by the people who need them. We completed retrospective chart reviews of 500 Medicare beneficiaries who died in four hospices. Study variables were decedent characteristics and access to hospice and hospice disciplines. Results showed that Hispanics and whites differed on characteristics known to influence access to health services, e.g., preferred language and type of caregiver Although the proportion of Hispanic elders dying in hospice was less than the proportion living in the community, the proportions of Hispanic elders who died in the community or died in their homes were not differentfrom the proportion that died in hospice. When access to hospice disciplines was compared between Hispanic and white decendents, the results showed one difference-more whites than Hispanics had access to volunteer services. Overall, the study showed that Hispanics were not underrepresented in hospice, and they had equal access to hospice disciplines. These findings differ from national data and may be associated with Hispanics being the majority population in the community. To learn how population dominance influences minority access to services, Hispanic access to hospice could be studied in locales with varying proportions of Hispanics in the population.     

Household exposure factors,asthma, and school absenteeism in a predominantly Hispanic community

The Passaic Asthma Reduction Effort (PARE) used an asthma symptom and household exposure factor questionnaire to screen 4634 elementary school children over a 4-year period in Passaic, New Jersey. During the first year, an additional 240 preschool children were also screened. Overall, 16% of the school children were reported by their parents to have been diagnosed with asthma. In all, 30% of responding families claimed to have at least one family member diagnosed with asthma and this was five times more likely if the target child had asthma. Exposures consistently associated with childhood asthma diagnosis included environmental tobacco smoke (ETS), presence of dampness/mold, roaches, and furry pets in the home. Diagnosis of asthma was primarily associated with all six symptoms used in the PARE questionnaire, and secondarily with environmental factors. Puerto Rican and black children had the highest asthma prevalence (26% and 33%), while Mexican children had the lowest (7%). Use of medications and school absenteeism among asthmatic children were associated with wheeze and night cough, but not with any specific environmental exposure. Increased school absenteeism by children undiagnosed with asthma was associated with ETS and dampness/mold in the home. Differences in asthma diagnosis and absenteeism in response to environmental factors were found across ethnic subgroups. Getting asthmatic children on medical management protocols and providing families with education about environmental risk reduction should aid in reducing morbidity in this ethnically complex population. Such coordinated efforts offer the promise of reducing school absenteeism.     

黑龙江省社区卫生服务纳入医保的现状与问题分析

在社区卫生服务纳入城镇医疗保险宏观政策已明确的情况下,调查研究黑龙江省将社区卫生服务纳入医保的现状与存在的问题,针对问题从社区卫生服务机构的内涵与外延两个角度探讨原因,并相应地提出促进社区卫生服务纳入医保的对策建议。     

上海市医疗保险总额预算管理的主要成效与问题

2002年以来,上海市医疗保险总额预算管理经历了探索期、发展期和成熟期三个阶段,主要做法包括总额预算、按月预付、分类缓付、按季结算,按季通报、半年考评,年终清算、考核和超支分担,推行“四项公开”和“三轮协商”办法等。经过改革,医疗费用增速得到有效控制,医院自我管理的积极性得到提高,进一步强化监管机制,从而为医院改革营造了良好环境,但目前的改革也面临一些问题：医疗机构内部管理不够规范,费用控制与参保人医疗需求之间矛盾突出;并且缺乏一系列有效的措施。建议从优化预算指标、强化监管、开展支付方式改革等方面进一步完善医疗保险总额预算管理。     

我国城市社区卫生服务与医疗保险制度衔接机制研究

目的：分析城市社区卫生服务与医疗保险制度（以下简称社区医保）衔接中的问题,探索促进衔接的方法策略。方法：通过专家咨询、问卷调查法收集资料,采用机构间合作模式和主题框架法进行分析评价。结果：我国社区医保衔接机制处于发展中合作较低水平。在治理结构上缺乏集权化和有效的领导方式,政策环境缺乏对创新的支持;卫生、医保部门在目标上存在分歧,互信程度不高;工作中缺乏规范化的管理程序,合作技术方案不够健全。结论：建议加强体制改革,建立大卫生体制;推进运行机制改革,根据社区卫生特点改进社区医保技术方案;促进部门沟通合作;加强业务管理。     

The effects of public health insurance expansion on private health insurance in urban China

The public social health insurance coverage has rapidly increased in China in the last decade. The rapid market development and high economic growth also present an immense opportunity for the private insurance market. This paper uses the China Health and Nutrition Survey panel data and the difference-in-difference method to identify the causal effects of public health insurance expansion on private health insurance development in the case of expansion of the China Urban Residential Basic Medical Insurance (URBMI) program. The paper finds private health insurance enrollment is not affected by the introduction and expansion of URBMI. Rather, private health insurance plays supplementary roles. The findings present the challenges and opportunities for public policies to develop and regulate private health insurance to meet the market niches and provide health insurance to the demands of a heterogeneous population. The findings also have broader implications for other developing nations where public health insurance intends to rapidly expand towards the universal health coverage.     

The relationship between childhood adverse experiences and disability due to physical health problems in a community sample of women

The goal of this study was to examine the association of physical and sexual abuse in childhood, poverty, parental substance abuse problems and parental psychiatric problems with disability due to physical health problems in a community sample of women. We included 4,243 women aged 15-64 years from the Ontario Mental Health Supplement in the analysis. The associations were tested by multiple logistic regression. Ten percent of women had a disability due to physical health problems. Among women with a disability, approximately 40% had been abused while growing up. After controlling for income and age, disability showed the strongest association with childhood physical abuse, parental education less than high school and parental psychiatric disorder. The association with child sexual abuse was not significant. Given the high correlation between abuse and disability due to physical health problems, it is important to investigate approaches to identify women who are at increased risk of subsequent impairment.     

社区卫生服务纳入城镇职工基本医疗保险若干问题的思考

近年来,各地认真贯彻落实国家卫生部等10部委《关于发展城市社区卫生服务的若干意见》,深入开展社区卫生服务活动,已经取得了一定的成效。但在实施社区卫生服务的过程中,也存在机构准入、技术、补偿以及与相关改革政策的衔接等问题。课题组受国家卫生部的委托,对我国社区卫生服务纳入城镇职工基本医疗保险的有关政策进行探索。我们刊发这组稿件,旨在进一步开展对社区卫生服务有关政策的研究。通过调查研究,揭示矛盾、分析问题、制定对策,为有关部门完善社区卫生服务政策提供依据,以促进社区卫生服务稳步、健康发展。     

Outdoor air pollution and health effects in urban children with moderate to severe asthma

Particulate matter less than 2.5 μm in diameter (PM_2.5) is associated with asthma morbidity. Recent studies have begun examining the role of various constituents of PM_2.5, their potential sources, and their effects on health. We examine their role in asthmatic children. Thirty-six children 6–14 years with moderate/severe asthma from inner city areas in New York City were studied for 2-week periods (summer and winter) using diaries and lung function. Outdoor data, including PM₁₀, PM_2.5, elements, elemental/organic carbon, and criteria gases (NO₂, SO₂, and O₃) were collected at two sites. Odds ratios (ORs) relating daily pollutant concentrations to asthma indicators were calculated. During summer significant ORs>1 for symptom severity were obtained (O₃, PM_10, PM_2.5, and S); after adjustment for O₃, the ORs were no longer significant. During winter, Cu, Fe, Si, and Zn were significantly but negatively (ORs<1) associated with symptoms. Lag effects in winter suggested delayed effects (ORs>1) on symptoms (As, K, Pb, and V). Albuterol use increased during summer (O₃, PM₁₀, PM_2.5, Na, and S); after adjustment for O₃, only Na and S remained significant. Reduced pulmonary function was significantly associated with O₃ and Cl. Components of PM_2.5 are associated with asthma exacerbation in asthmatic children. Same-day pollutant associations with symptoms are seen in summer. In winter, our analysis suggests delayed adverse associations of PM_2.5 components.     

Outcomes management and asthma education in a community hospital: ongoing monitoring of health status

An outcomes management system was implemented to evaluate the effectiveness of an asthma education program and to test its feasibility as a quality improvement tool. The study demonstrated the value of continuous monitoring of health status and the advantages of a multidimensional approach to outcome assessment and program evaluation.     

A regional health collaborative formed By NewYork-Presbyterian aims to improve the health of a largely Hispanic community

Communities of poor, low-income immigrants with limited English proficiency and disproportionate health burdens pose unique challenges to health providers and policy makers. NewYork-Presbyterian Hospital developed the Regional Health Collaborative, a population-based health care model to improve the health of the residents of Washington Heights-Inwood. This area is a predominantly Hispanic community in New York City with high rates of asthma, diabetes, heart disease, and depression. NewYork-Presbyterian created an integrated network of patient-centered medical homes to form a "medical village" linked to other providers and community-based resources. The initiative set out to document the priority health needs of the community, target high-prevalence conditions, improve cultural competence among providers, and introduce integrated information systems across care sites. The first six months of the program demonstrated a significant 9.2?percent decline in emergency department visits for ambulatory care-sensitive conditions and a 5.8?percent decrease in hospitalizations that was not statistically significant. This initiative offers a model for other urban academic medical centers to better serve populations facing social and cultural barriers to care.     

北京0～14岁社区儿童哮喘患病率及相关症状分析

目的 了解北京市西城区0～14岁社区儿童哮喘患病率及其哮喘相关症状的临床分布特点,为进一步研究城市社区儿童哮喘预防与控制适宜技术提供依据.方法 于2009年1-6月采取分层整群抽样方法,对北京市西城区所属的德胜社区和西长安街社区共3 886名0～14岁儿童进行问卷调查.结果 北京市西城社区O～14岁儿童中,112例儿童曾经被医生诊断为哮喘,患病率为2.88%,＞5%的儿童表现有运动和/或夜间喘息咳嗽症状,＞4%的儿童近1年内至少患6次呼吸道感染,曾诊断鼻炎和湿疹的儿童分别为11%和21%.结论 北京城市儿童哮喘患病率在近20年间呈现增加趋势,托幼儿童是哮喘新发病例的主要人群,近1年内现患哮喘相关症状的城市社区儿童可能高于经临床就诊和诊断的儿童.     

The respiratory health impact of a large urban fire.

OBJECTIVES. In July 1988, a fire destroyed a huge supermarket warehouse in Richmond, Calif, sending smoke into residential neighborhoods for nearly a week. There was no organized public health response. To evaluate the respiratory health impact on the general population, a survey of emergency room visits and hospital admissions to the two acute-care hospitals serving the population downwind was conducted. METHODS. Medical records of 489 patients meeting specified diagnostic criteria during the week of the fire and several reference periods were abstracted. Ratios of proportions for respiratory diagnoses (i.e., emergency room visits for a given diagnosis/total emergency room visits) were calculated, comparing the fire week with the reference periods, and 1988 mortality data for the area were reviewed. RESULTS. Ratios of proportions for emergency room visits for asthma and all lower respiratory conditions increased significantly during the fire. Respiratory-related hospitalizations also increased. However, there was no observable increase in respiratory mortality. CONCLUSIONS. This fire was found to have had a moderate impact on the respiratory health of local residents. Public health intervention is indicated to prevent respiratory morbidity when extended exposure to structural fire smoke is predictable.     

社会医疗保险支付社区卫生服务机构开展健康管理的必要性和可行性

论述了社会医疗保险支付社区卫生服务机构开展健康管理的必要性,主要包括能促进社会医疗保险的发展,提高社会保险基金的使用效率及降低医疗费用,促进社区卫生服务的健康发展,提高我国公共卫生服务支出占卫生总费用的比例;探讨了社会医疗保险支付社区卫生服务机构开展健康管理的可行性,并简单分析了现实中存在的障碍。