How does cot death prevention advice influence parents' behaviour?

Objective   To explore parents' understanding of the recommended cot death prevention strategies, and to discuss what they are doing in practice. If there is a difference between knowledge and implementation measures, possible reasons for this will be considered.
Study design   A qualitative study using thematic analysis, aimed at finding out attitudes and opinions of parents about cot death prevention measures. Twelve participants were interviewed from two disadvantaged communities in south Birmingham.
Results   Parents found that much of the cot death prevention advice they were provided with was conflicting and caused confusion. As such, many parents chose to follow advice from non-healthcare sources. Some parents were carrying out preventative measures but were not aware of the reason for doing it. Many felt they did not receive enough advice relating to cot death prevention.
Conclusion   Cot death health promotion advice appears to be inadequate among patients from a deprived socioeconomic background. Some of these issues could be resolved with increased training addressing these matters.     

How does provider supply and regulation influence health care markets? Evidence from nurse practitioners and physician assistants

Nurse practitioners (NPs) and physician assistants (PAs) now outnumber family practice doctors in the United States and are the principal providers of primary care to many communities. Recent growth of these professions has occurred amidst considerable cross-state variation in their regulation, with some states permitting autonomous practice and others mandating extensive physician oversight. I find that expanded NP and PA supply has had minimal impact on the office-based healthcare market overall, but utilization has been modestly more responsive to supply increases in states permitting greater autonomy. Results suggest the importance of laws impacting the division of labor, not just its quantity.     

Has the influence of managed care waned? Evidence from the market for physician services

Managed care has been the dominant organization of health care coverage in the United States, and seeks to achieve cost control by constraining services. The restrictive practices of managed care organizations have been widely criticized and the role of managed care in constraining health care services may be declining. Physician behavior is also believed to be influenced by the practices of managed care organization. This study examines the evolving nature of managed care and its restrictive effects on the provision of physician services. Physicians can choose whether and to what extent they are involved in managed care, so it is an endogenous decision. We employ instrumental variables method to correct for this endogeneity. Using data from the Community Tracking Study physician surveys from 2000–2001 and 2004–2005, we find that managed care organizations have became relatively less restrictive over time in terms of limiting the provision of physician services, compared to non-managed care organizations. These results suggest that managed care and non-managed care are converging in their effects on the provision of physician services.     

How much do junior staff influence patient throughput in a surgical unit?

A study was undertaken of inpatient throughput in a surgical department on a 'split site' District General Hospital. The study compared the individual contribution of equally qualified and experienced surgical registrars working at both sites. The results show that one registrar was associated with a statistically significant higher patient throughput, which appeared to be the result of a more expeditious approach to patient management. There was no evidence of an accompanying reduction in the quality of care delivered. The additional throughput amounted to approximately 300 extra patients in two years, and made a substantial contribution to the surgical workload in the District.     

How does a national poverty programme influence sexual debut among Kenyan adolescents?

Cash transfer programmes have recently emerged as promising interventions for HIV prevention among adolescents in Africa. However, the pathways through which risk reduction occurs are not well understood. We examine data on 1429 adolescents and youth from the Kenya Cash Transfer for Orphans and Vulnerable Children, which has been shown to result in delayed sexual debut among adolescents. We explored three potential mediating pathways: schooling, socio-economic status and psycho-social status. None of these hypothesised mediators greatly altered the main effect. However, school attendance had a larger protective effect on sexual debut among females but was only increased by the programme among males. This gendered pattern of effects may explain why we did not see a mediating effect of the cash transfer through schooling, despite schooling's protective effects against early sexual debut. Results also suggest that cash transfer programmes in Africa can contribute to the reduction of HIV related risk behaviours.     

Pulse oximetry in general practice: How would a pulse oximeter influence patient management?

The pulse oximeter is a vital piece of equipment in secondary care for the non-invasive monitoring of oxygen saturation. With the increasing affordability of the oximeter and recognition of its clinical applications, there is an increasing interest in its role in primary care. The decision was made that a systematic review was not feasible due to the lack of data concerning the influence of pulse oximetry on patient management and on the extent of oximetry use in the general practice setting. In this article, a selection of studies is presented looking into its clinical use and limitations. The role and potential of the oximeter as a screening tool and aid in the assessment of hypoxia in a variety of clinical situations in primary care is discussed.     

Does physician weight affect perception of health advice?

BACKGROUND: Obesity is considered a growing health threat in the United States. Although physicians have an important role in counseling their patients for obesity prevention and treatment, physicians themselves are often overweight. There are few data regarding how physician body weight might affect patient receptiveness to obesity counseling. METHODS: A 43-item survey instrument was developed that consisted of three scales related to physician characteristics, health locus of control, and perceptions on receiving health advice from overweight physicians. The survey was administered to 226 patients in five physician offices. Two of the physicians were classified as obese using BMI calculations, and three were nonobese. The responses from the surveys were grouped into those from obese and nonobese physicians. RESULTS: Significant differences were found for patient receptiveness to counseling for treatment of illness (P = 0.038) and health advice (P = 0.049), with the patients of nonobese physicians indicating greater confidence scores. The difference for weight and fitness counseling did not reach significance (P = 0.075). Analysis revealed that patient BMI was not a significant covariate nor were items related to physician characteristics in general or health locus of control. CONCLUSIONS: Patients seeking care from nonobese physicians indicated greater confidence in general health counseling and treatment of illness than patients seeing obese physicians. It is not known if this can be translated into increased success in obesity prevention and treatment.     

Access to physician services: does supplemental insurance matter? Evidence from France

In France, public health insurance is universal but incomplete, with private payments accounting for roughly 25% of all spending. As a result, most people have supplemental private health insurance. We investigate the effects of such insurance on the utilization of physician services using data from the 1998 Enquête sur la santé et la protection sociale, a nationally representative survey of the non-institutionalized French population. Our results indicate that insurance has a strong and significant effect on the utilization of physician services. Individuals with supplemental coverage have substantially more physician visits than those without. While French patients have greater freedom than patients in other countries to choose to see a specialist rather than a general practitioner, we find no evidence that supplemental insurance affects this decision.     

How does retiree health insurance influence public sector employee saving?

Economic theory predicts that employer-provided retiree health insurance (RHI) benefits have a crowd-out effect on household wealth accumulation, not dissimilar to the effects reported elsewhere for employer pensions, Social Security, and Medicare. Nevertheless, we are unaware of any similar research on the impacts of retiree health insurance per se. Accordingly, the present paper utilizes a unique data file on respondents to the Health and Retirement Study, to explore how employer-provided retiree health insurance may influence net household wealth among public sector employees, where retiree healthcare benefits are still quite prevalent. Key findings include the following:

• -Most full-time public sector employees anticipate having employer-provided health insurance coverage in retirement, unlike most private sector workers.
• -Public sector employees covered by RHI had substantially less wealth than similar private sector employees without RHI. In our data, Federal workers had about $82,000 (18%) less net wealth than private sector employees lacking RHI; state/local workers with RHI accumulated about $69,000 (or 15%) less net wealth than their uninsured private sector counterparts.
• -After controlling on socioeconomic status and differences in pension coverage, net household wealth for Federal employees was $116,000 less than workers without RHI and the result is statistically significant; the state/local difference was not.

     

How does the employer contribution for the federal employees health benefits program influence plan selection?

Market reform of health insurance is proposed to increase coverage and reduce growth in spending by providing an incentive to choose low-cost plans. However, having a choice of plans could result in risk segmentation. Risk-adjusted payments have been proposed to address risk segmentation but are criticized as ineffective. An alternative to risk adjustment is to subsidize premiums, as in the Federal Employees Health Benefits Program (FEHBP). Subsidizing premiums may also increase total premium spending. We find that there is little risk segmentation in the FEHBP and that reducing the premium subsidy would lower government premium spending and slightly increase risk segmentation.     

How does network structure affect partnerships for promoting physical activity? Evidence from Brazil and Colombia

The objective of this study was to describe the network structure and factors associated with collaboration in two networks that promote physical activity (PA) in Brazil and Colombia. Organizations that focus on studying and promoting PA in Brazil (35) and Colombia (53) were identified using a modified one-step reputational snowball sampling process. Participants completed an on-line survey between December 2008 and March 2009 for the Brazil network, and between April and June 2009 for the Colombia network. Network stochastic modeling was used to investigate the likelihood of reported inter-organizational collaboration. While structural features of networks were significant predictors of collaboration within each network, the coefficients and other network characteristics differed. Brazil's PA network was decentralized with a larger number of shared partnerships. Colombia's PA network was centralized and collaboration was influenced by perceived importance of peer organizations. On average, organizations in the PA network of Colombia reported facing more barriers (1.5 vs. 2.5 barriers) for collaboration. Future studies should focus on how these different network structures affect the implementation and uptake of evidence-based PA interventions.