Building Knowledge About Health Services Utilization by Refugees

The objective of this study was to compare the utilization of outpatient physician, emergency department and hospital services between refugees and the general population in Calgary, Alberta. Data was collected on 2,280 refugees from a refugee clinic in Calgary and matched with 9,120 non-refugees. Both groups were linked to Alberta Health and Wellness administrative data to assess health services utilization over 2 years. After adjusting for age, sex and medical conditions, refugees utilized general practitioners, emergency departments and hospitals more than non-refugees. A similar proportion in the two groups had seen a general practitioner within 1 week prior to their emergency department visit; however, refugees were more likely to have been triaged for urgent conditions and female refugees seen for pregnancy-related conditions than non-refugees. Refugees were more likely to have had infectious and parasitic diseases. Refugees utilized health services more than non-refugees with no evidence of underutilization.     

Health Services Utilization: Framework and Review

Five different approaches that have been used to study the utilization of health services are reviewed: the sociocultural, sociodemographic, social-psychological, organizational, and social systems. Studies characterizing each approach are described and the limitations of each perspective are outlined. It is suggested that social system models that explicate causal structures and that incorporate features of all the other approaches may provide important new insights into utilization behavior.     

黑龙江省卫生资源分布与服务利用状况分析及其改善策略思考

根据黑龙江省历年的卫生统计数据以及国家第三次卫生服务调查黑龙江省扩点调查数据库,对黑龙江省主要卫生资源的分布以及服务利用状况进行了分析,提出了在卫生资源配置和利用方面存在的主要问题及改善卫生资源分布与利用公平性和效率的策略思考。     

天津市医疗机构精神卫生服务资源和利用状况调查

目的了解天津市医疗机构精神卫生服务资源和利用情况,为制定天津市精神卫生服务规划提供基础数据。方法使用《天津市医疗机构精神卫生服务状况调查问卷》调查并分析天津市18个区县365家医疗机构2006年精神卫生资源分布情况及精神卫生服务提供和利用情况。结果 2006年天津市有60家医疗机构提供精神卫生服务,共拥有精神科医生561人,精神科护士885人,精神科床位4281张,按人口密度计算分别为5.4/10万、8.5/10万、4.1张/万。全年总住院10449人次,门诊为434120人次。精神卫生资源相对集中于市内六区和其他六区,精神专科医院较综合医院的精神卫生资源更为丰富,三级医院所拥有的资源又明显多于一、二级医院。住院服务的利用主要在市内六区和精神专科医院,门诊服务利用主要在市内六区和非精神专科医院。结论天津市精神卫生资源处于国内较高水平,但是资源的分布和服务的利用极为不均衡,存在资源相对短缺和利用不足。     

Acculturation and Cross-Border Utilization of Health Services

Health services from Mexico constitute an important source of care for U.S. residents living along the U.S.-Mexico border. Data from The Cross-Border Utilization of Health Care Survey (n = 966) were used to estimate logit models that related acculturation, as measured by generational status, to the use of medication, physician, dental, and inpatient services from Mexico by U.S. residents in the Texas border region. Relative to first-generation Mexican immigrants, later-generation Mexican-Americans were progressively less likely to go to Mexico for health services. This finding holds with or without adjusting for the effects of selected demographic and socioeconomic variables. Addressing unmet needs in medical care in the southwestern U.S. border area should go beyond a simple expansion of health insurance coverage--it is also important to deliver health services that are sensitive to generational differences within the population in terms of linguistic and cultural barriers to health care access.     

Utilization and Referral Patterns for Home Health Services:

This paper presents and discusses utilization and referral patterns for home health services in Mississippi. The universe of agencies delivering services in an eleven (1 1) county sample area is surveyed for patient demographic characteristics, modes of referral to home care and diagnostic characteristics. Comparisons are made of diagnoses of the 65 and over population utilizing home health services and a sample of hospital discharges in that same age group. A home health diagnostic index is derived and used in a home health "needs" determination formula.     

Utilization of Mental Health Services by Minority Urban Adults: Psychosocial Predictors

Although most mental disorders have their first onset by young adulthood, there are few longitudinal studies of these problems and related help-seeking behavior. The present study examined some early and current predictors of the use of mental health services among African-American and Puerto Rican participants in their mid-30s. The 674 participants (52.8 % African Americans, 47.2 % Puerto Ricans; 60.1 % women) in this study were first seen in 1990 when the participants attended schools serving the East Harlem area of New York City. A structural equation model controlling for the participants’ gender, educational level in emerging adulthood, and age at the most recent data collection showed significant standardized pathways from both ethnicity (β = −0.28; z = −4.82; p < 0.001) and psychological symptoms (β = 0.15; z = 2.41; p < 0.05), both measured in emerging adulthood, to smoking in the early 30s. That, in turn, was associated with certain physical diseases and symptoms (i.e., respiratory) in the mid-30s (β = 0.16; z = 2.59; p < 0.05). These physical diseases and symptoms had a cross-sectional association with family financial difficulty in the mid-30s (β = 0.21; z = 4.53; p < 0.001), which in turn also had a cross-sectional association with psychiatric disorders (β = 0.30; z = 5.30; p < 0.001). Psychiatric disorders had a cross-sectional association with mental health services utilization (β = 0.65; z = 13.25; p < 0.001). Additional pathways from the other domains to mental health services utilization in the mid-30s were also supported by the mediating role of psychiatric disorders. Results obtained from this research offer theoretical and practical information regarding the processes leading to the use of mental health services.     

从卫生资源与卫生服务利用流向看分级诊疗实施效果——以某市为例

根据某市2014—2016年《卫生计生事业发展分析报告》,分析卫生资源分布与卫生服务利用流向,评价分级诊疗运行效果,并提出推进分级诊疗的政策建议。     

对我国卫生资源配置和使用几个深层次问题的思索

我国卫生资源既贫乏又浪费已成为业内人士的共识,但又是一个困扰我国卫生事业发展的实际而又紧迫的问题,这个问题解决不好,就会人为无谓地降低我国卫生事业的公益性和福利性的“含金量”。,作者认为：要使我国有限的生效充分而合理利用,就要立足于我国的基本国情,在确保市场的微观调节的前提下,必须运用政府的宏观调控行为和政策指导手段,尽可能为管理体制的改革扫描障碍和给予法制保障。     

Health Services Utilization and Costs of Care in Terminal Cancer:

This study examines utilization of health services and costs of care for cancer patients during the last 6 months of life broken down into 3 time periods, and the relationship with costs of patient characteristics and home-carelhome-hospice use. The data werc derived from a retrospective study of a random samplc of 133 adult cancer deaths in Monroe County. Data sources included revicw of medical records, including hospital billing records, and interviews with physicians and surviving relatives. Sixty-five patients (49%) used home care services; their total costs of care were somewhat higher than those of non-users even after controlling for age, marital status and length of the terminal care period. The implications of the upcoming hospice legislation arc discussed in the light of these results.     

Utilization of Child Health Services by Children in Single-Parent and Two-Parent Families

With the increase in single-parent families questions have been raised concerning the adequacy of the access to care for children residing in these families A year of visits to primary health care sources are compared for a random sample of elementary school children residing with one or two-parent families Contrary to expectations concerning the medical disenfranchisement of sigleparent children when socioeconomic status, ethnicity, and children and youth project enrollment are controlled, no differences are found in use/ nonuse of facilities or range of visits Further studies should take into account parental employment as a separate and possibly more important factor than number of parents in the home when studying use of pediatric services.     

Clinical Preventive Services for Older Adults: The Interface Between Personal Health Care and Public Health Services

Healthy aging must become a priority objective for both population and personal health services, and will require innovative prevention programming to span those systems. Uptake of essential clinical preventive services is currently suboptimal among adults, owing to a number of system- and office-based care barriers.To achieve maximum health results, prevention must be integrated across community and clinical settings. Many preventive services are portable, deliverable in either clinical or community settings. Capitalizing on that flexibility can improve uptake and health outcomes.Significant reductions in health disparities, mortality, and morbidity, along with decreases in health spending, are achievable through improved collaboration and synergy between population health and personal health systems.BETWEEN 2010 AND 2050, the population of Americans aged 65 years and older is expected to more than double, swelling to nearly 89 million. This “silver tsunami,” composed mostly of Baby Boomers (the first of whom crossed the 65-year line in 2011), will pose serious challenges for our nation’s public health and health care systems, along with state and federal budgets, family finances, and private sector profitability. Healthy aging, too often viewed as a peculiar product of luck or luxury, must become a priority objective for both population and personal health services—and will require innovative prevention programming to span those systems.Chronic illness currently represents an estimated 83% of total US health expenditures and 99% of Medicare spending.1 Increasing rates of costly chronic conditions, many of which are not well managed,2–5 are associated with significant Medicare spending increases.6,7 Each year, more than half of Medicare beneficiaries are treated for 5 or more chronic conditions.6 The average Medicare enrollee sees 2 primary care physicians and 5 specialists working in 4 different practices annually8; those with 5 or more chronic conditions see an average of 14 different physicians a year.9 Care fragmentation results in suboptimal uptake of clinical preventive services (CPS) among US adults3,10: only 33% of women and 40% of men aged 65 years and older are fully up to date with all preventive services recommended for all adults in this age range,11 and less than a quarter of adults aged 50 to 64 years have received all these services.12 Even if adults receive recommended disease screening, a positive finding may not lead to effective treatment: although blood pressure screening in older adults is relatively high, hypertension is controlled in only half of patients.13Preventing chronic diseases and keeping chronically ill older adults healthier are imperatives to drive improvements in health, quality of life, and value in US health spending.14 Population-based primary prevention works to avert disease. It must be reinforced with patient-focused primary prevention and coupled with effective secondary prevention to detect illness as well as tertiary prevention aimed at better managing existing illness and preventing additional disease and disability. To achieve maximum health results, prevention must be integrated across community and clinical settings. Many preventive services are portable—deliverable in either clinical or community settings. Capitalizing on that flexibility can improve uptake and health outcomes.Optimal use of CPS—particularly for cardiovascular conditions—could avert an estimated 50 000 to 100 000 deaths per year among adults younger than 80 years and 25 000 to 40 000 deaths per year among those younger than 65 years.15 Increasing uptake of selected high-value CPS to 90% could produce an additional 1.89 million quality-adjusted life years.16 Outside clinical settings, the Trust for America’s Health has estimated that an investment of $10 per person per year in community-based programs tackling physical inactivity, poor nutrition, and smoking could yield more than $16 billion in medical cost savings annually within 5 years—a return on investment of $5.60 for every $1 spent, without considering the additional gains in worker productivity, reduced absenteeism at work and school, and enhanced quality of life.17 Significant reductions in health disparities, mortality, and morbidity—and attendant decreases in health spending—are achievable through improved collaboration and synergy between population health and personal health systems.18 We discuss essential CPS for older adults, emerging delivery models that encompass health care and community settings to boost uptake, and public health priorities in a changing US health system.