Medicare beneficiary counseling programs: what are they and do they work?

Medicare beneficiaries face myriad rules, conditions, and exceptions under the Medicare program. As a result, State Information, Counseling, and Assistance (ICA) programs were established or enhanced with Federal funding as part of the Omnibus Budget Reconciliation Act (OBRA) of 1990. ICA programs utilize a volunteer-based and locally-sponsored support system to deliver free and unbiased counseling on the Medicare program and related health insurance issues. This article discusses the effectiveness of the ICA model. Because the ICA programs serve as a vital link between HCFA and its beneficiaries, information about the programs' success may be useful to HCFA and other policymakers during this era of consumer information.     

Adolescent clients of primary health care services. How do they live? Why do they seek help, and how do they express themselves?

The objective of this study was to characterize adolescent clients of community-based primary health care services in order to understand: 1) how they express themselves when they seek medical help; 2) the health care they receive; and 3) key social and family factors. Among 35 urban primary care services belonging to the municipal public health department in Pelotas, Rio Grande do Sul State, Brazil, 10 were randomly selected, and all individuals between 13 and 19 years of age who had previously had an appointment with a non-psychiatric physician were interviewed during a three-month period (n = 463). Use of the services has more of a more curative than preventive focus. Males seek medical help less frequently and mainly due to physical complaints. Females tend to express themselves on the basis of sexual problems. Few adolescents expressed their emotional problems, although some mentioned family and school problems as well as stressful situations.     

Low literacy Chinese patients: how are they affected and how do they cope with health matters? A qualitative study

Background  

Low literacy is common in Hong Kong and China, especially among the females and the elderly. These are often the patients with the greatest health care needs. However little is known about how low literacy affects the ability of patients to obtain adequate medical care and comply with the recommendations of health professionals.     

Drug treatment courts are popular but do they work and are they ethical and appropriate for Canada?

Currently Canada is experimenting with the implementation of drug treatment courts. Pilot projects are underway in both Toronto and Vancouver. In the U.S., drug courts emerged as a response to the overcrowding of the prison system, the end product of the revolving door of substance dependent people moving through the court system. However, this expansion was not accompanied by any rigorous evaluation or critical reflection as to whether drug treatment courts can achieve their desired outcomes or if they are appropriate for dealing with substance dependent offenders. The purpose of this article is to take a critical look at this phenomenon and to discuss whether the drug court model is suitable for Canada.     

Where do they go, whom do they consult, and why? Health-seeking behaviors in the northern areas of Pakistan

This study presents an ethnographic account of health-seeking behaviors and determinants of health service utilization of people living in the rural Northern Areas of Pakistan. Data was gathered from 2004 to 2005 through 10 gender-specific focus group discussions. Sociodemographic characteristics, economic conditions, cultural forces, physical and environmental conditions, and health care service features form the behaviors. The complex composition of health care systems drives us to study the most intricate phenomenon of health care-seeking behaviors. Inappropriate or delayed health care-seeking could lead to undesirable health outcomes, high fertility, unwanted pregnancies, medical complications, and amplified susceptibility to future illnesses. At times it results in a significant economic burden when a simple illness becomes drawn out because of improper health-seeking behaviors. This study is an effort to present relevant information to the policy makers to reorient the health care services to make them more acceptable. It is recommended that this research be used for designing behavior change communication modules or social marketing campaigns in raising awareness about health in the community and sensitizing health care providers to the needs of their clients.     

Lifestyle-related attitudes: do they explain self-rated health and life-satisfaction?

Background

Strategies to improve public health may benefit from targeting specific lifestyles associated with poor health behaviors and outcomes. The aim of this study was to characterize and examine the relationship between health and lifestyle-related attitudes (HLAs) and self-rated health and life-satisfaction.

Methods

Secondary analyses were conducted on data from a 2012 community wellness survey in Kirklees, UK. Using a validated HLA tool, respondents (n?=?9130) were categorized into five segments: health conscious realists (33%), balanced compensators (14%), live-for-todays (18%), hedonistic immortals (10%), and unconfident fatalists (25%). Multivariate regression was used to examine whether HLAs could explain self-rated health using the EQ-5D visual analog scale (EQ-VAS) and life-satisfaction. Health conscious realists served as the reference group.

Results

Self-rated health differed by HLA, with adjusted mean EQ-VAS scores being significantly higher (better) among balanced compensators (1.15, 95% CI 0.27, 2.03) and lower scores among unconfident fatalists (??9.02, 95% CI ??9.85, ??8.21) and live-for-todays (??1.96, 95% CI ??2.80, ??1.14). Balanced compensators were less likely to report low life-satisfaction (OR 0.75, 95% CI 0.62, 0.90), while unconfident fatalists were most likely to have low life-satisfaction (OR 3.51, 95% CI 2.92, 4.23).

Significance

Segmentation by HLA explained differences in self-rated health and life-satisfaction,with unconfident fatalists being a distinct segment with significantly worse healthperceptions and life-satisfaction. Health promotion efforts may benefit from considering the HLAsegment that predominates a patient group, especially unconfident fatalists.

     

Where do internal markets come from and can they work?

The basis for the argument in favour of the internal market as a means of allocating resources within the health care sector has never been made fully explicit. In particular, the link between the economic theory of market allocation and the specific pricing rules adopted by a number of health care sectors to allocate resources is rarely a focus of attention. Health sector objectives are rarely specified. The mechanisms which remedy failure in the exchange process are not explicitly defined. In short, the optimal structural conditions for the operation of internal markets are not known. The central argument pursued here is that, as this is the case, and using the UK as an example, there are no criteria to which purchasers or providers can turn to assess the operation of exchange within the internal market. Not surprisingly, the internal market dissolves into a number of individual bilateral agreements between purchasers and providers which may or may not increase efficiency in allocating health sector resources.