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A patient discussing Internet health information with a health care provider (referred to as “patient–provider communication about Internet health information”) can contribute positively to health outcomes. Although research ha...
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A patient discussing Internet health information with a health care provider (referred to as “patient–provider communication about Internet health information”) can contribute positively to health outcomes. Although research has found that once Internet access is achieved, there are no ethnic differences in Internet health information seeking, it is unclear if there are ethnic differences in patient–provider communication about Internet health information. To help fill this gap in the literature, the National Cancer Institute's Health Information National Trends Survey 2005 was analyzed with Stata 9. Two sets of logistic regression analyses were conducted, one for a subsample of Internet users (n = 3,244) and one for a subsample of Internet users who are first-generation immigrants (n = 563). The dependent variable was patient–provider communication about Internet health information, which assessed whether survey participants had discussed online health information with a health care provider. The predictor variables included trust of health care provider, trust of online health information, Internet use, health care coverage, frequency of visits to health care provider, health status, and demographics. Among all Internet users, Whites had higher levels of patient–provider communication about Internet health information than Blacks and Asians. Similarly, among Internet users who are immigrants, Whites had higher levels of patient–provider communication about Internet health information than Blacks and Asians. While the digital divide is narrowing in terms of Internet access, racial differences in patient–provider communication about Internet health information may undermine the potential benefits of the information age.
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Socially advantaged individuals are better positioned to benefit from advances in biomedicine, which frequently results in the emergence of social inequalities in health. I use survey and in-depth interviews with pregnant women an...
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Socially advantaged individuals are better positioned to benefit from advances in biomedicine, which frequently results in the emergence of social inequalities in health. I use survey and in-depth interviews with pregnant women and their health care providers from four Midwestern clinics in the United States, conducted in 2009 and 2010. I compare socioeconomic differences in intake of two new prenatal supplements: Vitamin D and omega-3 fatty acid. Although socioeconomic differences in omega-3 fatty acid supplementation emerged, there were no differences in the use of vitamin D. I argue that providers may have contributed to the prevention of a health disparity in vitamin D supplementation by implementing an aggressive uniform protocol. These results suggest that providers not only serve as a conduit for the dissemination of new biomedical information, the strength and uniformity of their recommendations have the potential to prevent or exacerbate socioeconomic differences in health behaviors.
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摘要 :
Socially advantaged individuals are better positioned to benefit from advances in biomedicine, which frequently results in the emergence of social inequalities in health. I use survey and in-depth interviews with pregnant women an...
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Socially advantaged individuals are better positioned to benefit from advances in biomedicine, which frequently results in the emergence of social inequalities in health. I use survey and in-depth interviews with pregnant women and their health care providers from four Midwestern clinics in the United States, conducted in 2009 and 2010. I compare socioeconomic differences in intake of two new prenatal supplements: Vitamin D and omega-3 fatty acid. Although socioeconomic differences in omega-3 fatty acid supplementation emerged, there were no differences in the use of vitamin D. I argue that providers may have contributed to the prevention of a health disparity in vitamin D supplementation by implementing an aggressive uniform protocol. These results suggest that providers not only serve as a conduit for the dissemination of new biomedical information, the strength and uniformity of their recommendations have the potential to prevent or exacerbate socioeconomic differences in health behaviors.
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One commonly held explanation for high and rising health care costs in the United States points to the market power of health care providers. This third article of a 4-part series examines how the prices and quantities of health c...
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One commonly held explanation for high and rising health care costs in the United States points to the market power of health care providers. This third article of a 4-part series examines how the prices and quantities of health care services interact to influence health care expenditures. The article also reviews cost-containment strategies that are designed to reduce prices and quantities of services.
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David Kessner and colleagues’ paper can be safely
elected to the health services research ‘hall of fame’,
since the ‘tracer’ concept it proposed is now taken for
granted as a tool for assessing health care quality. The
au...
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David Kessner and colleagues’ paper can be safely
elected to the health services research ‘hall of fame’,
since the ‘tracer’ concept it proposed is now taken for
granted as a tool for assessing health care quality. The
authors proposed that a set of common health problems
be chosen as tracers of quality. Medical records for
patients with these problems would be sampled and
reviewed, and actual care compared with a predetermined
minimal standard of good practice. The example
the authors used was the care of hypertension in a
neighbourhood clinic where they found that 30% of
patients’ care did not meet minimal requirements for
good care. They suggested that this approach could be
used to compare care between providers.
The authors proposed that tracers should be frequent,
well defined conditions affected by medical care, with
agreed appropriate care and with a known epidemiology.
They suggested conditions such as otitis media, visual
disorders, iron deficiency anaemia, hypertension and
cervical cancer be used as tracers.
The 30 years since this publication have seen
transformation of the tracer idea in response to wider
changes in health care systems and health care analysis.
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Objective. The merits of mixed public and private health systems are debated. Although private providers have become increasingly important in the Indonesian health system, there is no comprehensive assessment of the quality of pr...
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Objective. The merits of mixed public and private health systems are debated. Although private providers have become increasingly important in the Indonesian health system, there is no comprehensive assessment of the quality of private facilities. This study examined the quality of physical resources of public and private facilities in Indonesia from 1993 to 2007. Design and Setting. Data from the Indonesian Family Life Surveys in 1993,1997, 2000 and 2007 were used to evaluate trends in the quality of physical resources for public and private facilities, stratified by urban/rural areas and Java-Bali/outer Java-Bali regions. Main Outcome Measures. The quality of six categories of resources was measured using an adapted MEASURE Evaluation framework. Results. Overall quality was moderate, but higher in public than in private health facilities in all years regardless of the region. The higher proportion of nurses and midwives in private practice was a determinant of scope of services and facilities available. There was little improvement in quality of physical resources following decentralization. Conclusions. Despite significant increases in public investment in health between 2000 and 2006 and the potential benefits of decentralization (2001),the quality of both public and private health facilities in Indonesia did not improve significantly between 1993 and 2007. As consumers commonly believe the quality is better in private facilities and are increasingly using them, it is essential to improve quality in both private and public facilities. Implementation of minimum standards and effective partnerships with private practice are considered important.
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? 2023 The AuthorsExpanding networks of government primary health centers (PHCs) to bring health services closer to communities is a longstanding policy objective in LMICs. In pluralistic health systems, where public and private p...
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? 2023 The AuthorsExpanding networks of government primary health centers (PHCs) to bring health services closer to communities is a longstanding policy objective in LMICs. In pluralistic health systems, where public and private providers compete for patients, PHCs are often not the preferred source for care. This study analyzes the market for primary care services in the Indian state of Bihar to understand how choice of primary care provider is influenced by distance, cost and quality of care. This study is based on linked surveys of rural households, PHCs, and private primary care providers conducted in 2019 and 2020. Most rural residents lived in proximity to a primary care provider, though not a qualified one. Within a 5-km distance, 60% of villages had a PHC, 90% had an informal provider, 35% an Indian systems of medicine practitioner, and 10% a private MBBS doctor. Most patients sought care from informal providers irrespective of PHC distance; only 25% of patients living in the PHC's vicinity sought care there. Reducing distance to the PHC by 1 km marginally increased the likehood of the PHC being selected, and reduced the likelihood of private clinics being selected. Reducing patient's costs at PHCs increased the likelihood of the PHC being selected and reduced the likelihood of private clinics and private hospitals being selected. Improved clinical quality at PHCs had no effect on patient selection of PHCs, private clinics, or hospitals. Illness severity reduced the likelihood of PHCs or private clinics being selected, and increased the likelihood of private hospitals selected. Wealthier patients were marginally more likely to use PHCs, substantially more likely to use private hospitals, and less likely to use private clinics. Expanding PHC network coverage or improving their quality of care is not sufficient to make PHCs more relevant to local health needs. An orientation towards essential public health functions, as well as, a community-centered approach to the organization of primary health care system is necessary.
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Policy Points: Health policy in the United States has, for more than a century, simultaneously and paradoxically incentivized the growth as well as the commercialization of nonprofit organizations in the health sector. This policy...
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Policy Points: Health policy in the United States has, for more than a century, simultaneously and paradoxically incentivized the growth as well as the commercialization of nonprofit organizations in the health sector. This policy paradox persists during the implementation of the Affordable Care Act of 2010.
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This study employs statistical modeling and mapping techniques to analyze the availability and accessibility of audiologists (practitioners who diagnose and treat hearing loss) in the United States at the county scale. The goal is...
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This study employs statistical modeling and mapping techniques to analyze the availability and accessibility of audiologists (practitioners who diagnose and treat hearing loss) in the United States at the county scale. The goal is to assess the relationships between socio-demographic and structural factors (such as health policy and clinical programs which train audiologists) and audiologist availability. These associations are analyzed at the county level, via a mixed effects hurdle model. At the county level, the proportion of older adults reporting difficulty hearing is negatively associated with audiologist supply. The findings show that audiologists tend to locate in metropolitan counties with higher median household incomes, younger populations, and lower proportions of older adults reporting hearing difficulty, suggesting an inverse care-type relationship between audiologist availability and need for hearing health services. Notably, neither state legislation requiring insurance plan coverage of hearing services for adults or Medicaid coverage of audiology services were significant predictors of audiologist supply at the county level.
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Abstract Background Rural areas have historically struggled with shortages of healthcare providers; however, advanced communication technologies have transformed rural healthcare, and practice in underserved areas has been recogni...
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Abstract Background Rural areas have historically struggled with shortages of healthcare providers; however, advanced communication technologies have transformed rural healthcare, and practice in underserved areas has been recognized as a policy priority. This systematic review aims to assess reasons for current providers’ geographic choices and the success of training programs aimed at increasing rural provider recruitment. Methods This systematic review (PROSPERO: CRD42015025403) searched seven databases for published and gray literature on the current cohort of US rural healthcare practitioners (2005 to March 2017). Two reviewers independently screened citations for inclusion; one reviewer extracted data and assessed risk of bias, with a senior systematic reviewer checking the data; quality of evidence was assessed using the GRADE approach. Results Of 7276 screened citations, we identified 31 studies exploring reasons for geographic choices and 24 studies documenting the impact of training programs. Growing up in a rural community is a key determinant and is consistently associated with choosing rural practice. Most existing studies assess physicians, and only a few are based on multivariate analyses that take competing and potentially correlated predictors into account. The success rate of placing providers-in-training in rural practice after graduation, on average, is 44% (range 20–84%; N ?=?31 programs). We did not identify program characteristics that are consistently associated with program success. Data are primarily based on rural tracks for medical residents. Discussion The review provides insight into the relative importance of demographic characteristics and motivational factors in determining which providers should be targeted to maximize return on recruitment efforts. Existing programs exposing students to rural practice during their training are promising but require further refining. Public policy must include a specific focus on the trajectory of the healthcare workforce and must consider alternative models of healthcare delivery that promote a more diverse, interdisciplinary combination of providers.
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