The use of preventive health services by disabled children

As a measure of the use of general pediatric health services we assessed disabled children's receipt of preventive health care in relation to a control group of nondisabled children, matched by age, family size, and region of residence. The study and control subjects were identified in a household survey conducted in Minnesota in 1976 and ranged in age from 1 to 18 years. The proportion who made a preventive health visit was nearly identical in both groups. Binary variable multiple regression showed that 9 percent of the variation in outcome was explained by the independent variables, which included demographic and socioeconomic characteristics and access to health care. Disability did not contribute significantly to the explained variation, but family structure, mother's education, and mother's use of preventive health services reached the 95 percent level of significance. The results suggest that children in a community who are identified as disabled are not at a disadvantage, in comparison with the nondisabled, in gaining access to preventive health services. The use of such services by all children appears to be low when information on using school health services is not available.     

Intermittent lack of health insurance coverage and use of preventive services

OBJECTIVES: This study examined the association between intermittent lack of health insurance coverage and use of preventive health services. METHODS: Analyses focused on longitudinal data on insurance status and preventive service use among a national sample of US adults who participated in the Health and Retirement Study. RESULTS: Findings showed that, among individuals who obtain insurance coverage after histories of intermittent coverage, relatively long periods may be necessary to reestablish clinically appropriate care patterns. Increasing periods of noncoverage led to successively lower rates of use of most preventive services. CONCLUSIONS: Intermittent lack of insurance coverage-even across a relatively long period-results in less use of preventive services. Studies that examine only current insurance status may underestimate the population at risk from being uninsured.     

Health insurance coverage and the use of preventive services by Mexican adults

The lack of health insurance coverage could be a potentially important deterrent to the use of preventive health care by older adults with high rates of chronic co-morbidities. We use survey data from 12 100 Mexican adults ages 50 and older who participated in the 2001 Mexican Health and Aging Study (MHAS) to analyze the relation between health insurance coverage and the use of preventive health-care services in Mexico. Uninsured adults were less likely to use preventive screenings for hypertension, high cholesterol, diabetes and (breast, cervical and prostate) cancer than insured adults. After adjusting for other factors affecting preventive care utilization in a logistic regression model, we found that these results still hold for high cholesterol and diabetes screening. Similar results hold for the population not working during the survey week and for adults earning below 200% of the poverty line. Our results suggest that insured adults are in a relatively better position to detect some chronic diseases - and have them treated promptly - than uninsured adults because they have better access to cost-effective preventive screenings. Recent public policy initiatives to increase health insurance coverage rates in Mexico could lead to substantially higher preventive health-care utilization rates and improvements in population health.     

Low-income children's preventive services use: implications of parents' Medicaid status

This article examines the effect of parents' Medicaid status on the use of preventive health services by young children. Using data from the 1996 Medical Expenditure Panel Survey (MEPS), we analyzed a logit model for receipt of any well-child visits (WCVs) that compared three groups of low-income children. The three groups, defined by the joint insurance status of children and their parents, involved Medicaid pairs (both the child and the parent had Medicaid throughout the year), mixed pairs (the child had Medicaid and the parent was uninsured), and uninsured pairs (both child and parent were uninsured). Medicaid coverage for children was positively associated with receipt of any WCVs. However, the utilization effect of Medicaid coverage for children was significantly larger when the parent was also on Medicaid instead of being uninsured. Considering uninsured children with uninsured parents in 1996, enrolling only the children in Medicaid would have increased the percentage with WCVs from 29 to 43 percent according to simulations with the logit model. If the parents were enrolled in Medicaid as well, the percentage of children with any WCVs would have increased to 67 percent.     

County characteristics and racial and ethnic disparities in the use of preventive services

BACKGROUND: Studies examining predictors of preventive service utilization generally focus on individual characteristics and ignore the role of contextual variables. To help address this gap in the literature, the present study investigates whether county-level characteristics, such as racial and ethnic composition, are associated with the use of preventive services. METHODS: Data from the Medical Expenditure Panel Survey and the Area Resource Files (1996-1998) are used to identify the individual- and county-level predictors of five types of preventive services (n = 49,063). RESULTS: County racial or ethnic composition is associated with the utilization of certain preventive services, net of individual-level characteristics. Specifically, individuals in high percent Hispanic counties are more likely to report cholesterol screenings, while those in counties with more blacks are more likely to have regular mammograms. Moreover, county racial or ethnic composition modifies the relationship between individual race or ethnicity and preventive use. In particular, Hispanic individuals who reside in high percent black counties report higher levels of utilization for most preventive services compared to Hispanics living in other counties. CONCLUSIONS: Physical and social environments are key determinants of health behaviors and outcomes. Future studies should take into account the racial or ethnic composition of an area and how this interacts with individual race or ethnicity when investigating predictors of preventive care use.     

The direct and indirect effects of cost-sharing on the use of preventive services

OBJECTIVE: To test empirically a model for estimating the direct and indirect effects of different forms of cost-sharing on the utilization of recommended clinical preventive services. DATA SOURCES/SETTINGS: Stratified random sample of 10,872 employees, 18-64 years, who had belonged to their plan for at least one year, from seven large companies that were members of the Pacific Business Group on Health (PBGH) in 1994. DATA COLLECTION: The 1994 PBGH Health Plan Value Check Survey. 1994 PBGH data on requirements for employee out-of-pocket patient cost-sharing for 52 different health plans. DESIGN: Five equations were derived to estimate the direct and indirect effects of two forms of cost-sharing (copayments and coinsurance/deductibles) in two forms of managed care (HMOs and PPO/indemnity plans) on four clinical preventive services: mammography screening, cervical cancer screening, blood pressure screening, and preventive counseling. Probit models were used to estimate elasticities for the indirect and direct effects. PRINCIPAL FINDINGS: Both forms of cost-sharing in both plan types had negative and significant indirect effects on preventive counseling (from -1 percent to -7 percent). The direct effect of cost-sharing was negative for preventive counseling (-5 percent to -9 percent) and Pap smears (from -3 percent to -9 percent) in both HMOs and PPOs, and for mammography only in PPOs (-3 percent to -9 percent). The results of the effects on blood pressure screening are inconclusive. CONCLUSIONS: Both the direct and indirect effects of cost-sharing negatively affected the receipt of preventive counseling in HMOs and PPOs. As predicted, the direct negative effect of cost-sharing was greater than the indirect effect for Pap smears and mammography. Eliminating cost-sharing for these services may be important to increasing their utilization to recommended levels.     

Barriers to Pacific women's use of cervical screening services

OBJECTIVE: The present study explored barriers to the use of cervical screening information and services from the perspective of Pacific women. METHOD: Qualitative, face-to-face interviews based on a snowball sampling approach were used in Palmerston North, New Zealand, in 1997, to assess attitudes among 20 Pacific women. RESULTS: The study found a high level of awareness of a local cervical screening program. Specific barriers determined were: a resistance to being defined as socially problematic, embarrassment, belief in the sacred nature of human sexuality, an anxiety about lack of confidentiality within small community groups, and a perceived relationship between cervical smears and sexual activity. CONCLUSIONS: Participants strongly preferred that information on cervical screening should be transmitted by interpersonal means, though pamphlets on screening services were also sought. The women agreed that the preferable role of a Pacific Island health professional would be in disseminating information, rather than actually serving as a smear-taker. IMPLICATIONS: The need for smear-taking should not be stereotyped as a 'Pacific problem'. Multi-racial images of women should be used in advertising to demonstrate that cervical smears are necessary regardless of ethnicity. Information providers need to show great sensitivity when providing information relevant to human reproduction or sexuality.     

社区预防服务的需求和有偿服务需求意向分析

现有的社区预防服务已经不能完全满足居民的需要，居民的卫生服务需求侧重于慢性病防治、脆弱人群与家庭保健。价格合理的有偿服务在居民中有一定需求，这主要包括各种上门服务、各种预防性体检和筛查,城郊结合地区居民对有偿预防服务的需求最大；有偿签约服务的需求价格弹性为－4．19。     

Behavioral risk factors and use of preventive services among veterans in Washington State

BACKGROUND: Little is known about the special preventive health needs of U.S. veterans and the 3.6 million users of VA health care. METHODS: The Washington State version of the 1999 Behavioral Risk Factor Survey included three new questions about veteran status and use of VA health care. Data on this population-based sample of 3,608 adults were used to compare sociodemographic, health, and behavioral characteristics between veterans and nonveterans and between VA users and nonusers. RESULTS: Veterans were nearly 13 years older than nonveterans. VA users were socioeconomically worse off and had poorer health status than nonusers. Current smoking among males was more common among veterans than among nonveterans (24% vs 18%). This difference persisted after controlling for age, race, education, and income and held across all age groups. Use of several screening tests varied little in relation to veteran or VA user status. CONCLUSIONS: The BRFSS has become a rich source of data on veteran health. Veterans and VA users have distinct sociodemographic profiles that must be considered when comparing health-related characteristics. Cigarette smoking is especially prevalent among veterans--an excess unexplained by sociodemographic differences.     

Vaccinations and preventive screening services for older adults: opportunities and challenges in the USA

Vaccinations and disease-screening services occupy an important position within the constellation of interventions designed to prevent, forestall or mitigate illness: they straddle the worlds of clinical medicine and public health. This paper focuses on a set of clinical preventive services that are recommended in the USA for adults aged 65 and older, based on their age and gender. These services include immunisations against influenza and pneumococcal disease, and screening for colorectal and breast cancers. We explore opportunities and challenges to enhance the delivery of these interventions, and describe some recently developed models for integrating prevention efforts based in clinician offices and in communities. We also report on a state-level surveillance measure that assesses whether older adults are 'up to date' on this subset of preventive services. To better protect the health of older Americans and change the projected trajectory of medical costs, expanded delivery of recommended vaccinations and disease screenings is likely to remain a focus for both US medicine and public health.     

Barriers to the use of preventive health care services for children.

This article describes findings from interviews of parents targeted for outreach efforts that encouraged them to use Medicaid''s Early and Periodic Screening, Diagnosis and Treatment(EPSDT) Program. Begun in the 1970s, the EPSDT program held out the promise of ensuring that needy children would receive comprehensive preventive care. With only one-third of eligible children in the United States receiving EPSDT checkups, the program has yet to fulfill its promise. This study sought to understand parents'' perceptions of barriers to using EPSDT by interviewing (a) 110 parents who did not schedule EPSDT checkups for their children after being exposed to outreach efforts and (b) 30 parents who did. Although the EPSDT Program is designed to provide health care at no charge and to provide assistance with appointment scheduling and transportation, these low-income parents identified significant barriers to care. Reasons for not using EPSDT services included (a) competing family or personal issues and priorities; (b) perceived or actual barriers in the health care system; and (c) issues related directly to problems with the outreach efforts. Parents who successfully negotiated these barriers and received EPSDT services encountered additional barriers, for example, scheduling and transportation difficulties, long waiting room times, or care that they perceived to be either unresponsive to their medical needs or interpersonally disrespectful. The implications for future outreach efforts and improving access to preventive health care services are discussed.     

Acculturation, access to care and use preventive health services by Vietnamese women

PURPOSE OF THE PAPER. The purposes of this study were to examine the relationships between acculturation and (1) access to health services and (2) use of preventive services among Vietnamese women in western Massachusetts. METHODS. The telephone survey method was conducted with 141 Vietnamese women ages 18 years or over. PRINCIPAL FINDINGS. Of the acculturation variables, language acculturation was significantly related to having a routine place for health care and a regular provider. Women tended to have better access to health service with an increase in the length of residence in the US. Length of residence in the US was an independent predictor of prior use of Pap test and clinical breast examination. CONCLUSIONS. Utilization level of preventive health services among study group participants was low. The findings indicate that length of residence and increase in language capacity (more English usage) lead to more adequate access to health care. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS. This study is particularly relevant to Vietnamese American women in the U.S. KEY WORDS. Vietnamese women; acculturation; preventive heaslth services; Massachusetts.