Journal of health & social policy最新文献

While racial, ethnic, and socioeconomic health disparities in maternal and child health persist among women, few studies describe experiences of low-income women during pregnancy. We undertook a qualitative study of women's self-reported experiences with home visitors to gain understanding of priorities for participation and service delivery. Lay health home visitors provided satisfactory services and maintained close relationships with their clients. The mother-to-mother relationship is critical in facilitating continued participation in and ensuring positive health and social outcomes from lay health home visitation services. Many women lacked sufficient social support during their pregnancy and received this from the health visitor. Appropriate integration of lay health visitors with traditional prenatal care may alleviate many of the deleterious stressors that low-income women experience and may ultimately impact racial, ethnic, and socioeconomic disparities in maternal and child health.

Over five decades of independence, India has made rapid strides in various sectors. However, its performance in social sectors and particularly the healthcare sector has not been too rosy. Being the State's responsibility the healthcare has traditionally been influenced by individual State's budgetary allocation. Consequently inter-state disparity in availability and utilization of health services and health manpower are distinctly marked. This has implications for achievement of Health for All for the nation as a whole. Keeping in view the significance of studying inter-state variations in healthcare, this study focuses on the performance of healthcare sector in 15 major States in India. This is attempted through a comparative analysis of various parameters depicting availability of health services, their utilization and health outcomes. Our analysis depicts the prevalence of considerable inequity favoring high income group of States. In terms of healthcare resources, for instance, it indicates that the high income States hold a superior position in terms of: per capita government expenditure on medical and public health, total number of hospitals and dispensaries, per capita availability of beds in hospitals and dispensaries and health manpower in rural and urban areas. These parameters of availability have an impact on utilization levels and health outcomes in these States. A comparative profile of high and low income States as well as middle and low income States, both in rural and urban areas, reaffirms a greater financial burden in availing treatment at OPD and inpatient in low income States. In line with the higher financial burden and low per capita health expenditure, the health outcome indicators also depict a disconcerting situation in regard to low income States. These States are marked by lower life expectancy and higher incidence of diseases as well as high mortality rates. In this regard, demand as well as supply side constraints are observed which restrain the optimum utilization of existing health services. Among the low income States the main constraints on the demand side include illiteracy, malnutrition, and lack of infrastructure in accessing the facilities. Certain state specific supply side factors add significantly to under-utilization in low income States. In some of the States, however, corrective actions have been initiated to overcome the problem of the quality and low utilization of health facilities. In due course of time, it is likely that proper implementation of these measures may result in improved utilization level of existing health services, which may be useful to improve health status indicators. Nonetheless, overcoming the current levels of regional disparities in healthcare across three income groups of States may also require additional resources. The latter could be mobilized through assistance of donor agencies and appropriate mix of social and private insurance. Ultimately mitigating the problem o

This article presents a comparative analysis of euthanasia and physician-assisted suicide policy in The Netherlands and the state of Oregon in the United States. The topics of euthanasia and physician-assisted suicide are discussed in the context of the historical setting of The Netherlands and the United States with special emphasis placed on public opinion, role of the courts and the legislative bodies, and opinions of physicians. Major similarities and differences in the laws of The Netherlands and Oregon are discussed. The article examines whether the passage of the law has led to a slide down the slippery slope in The Netherlands and Oregon as had been suggested by the opponents of the law. The article concludes that the empirical evidence does not support the contention of the opponents. However, the author argues that the potential for this happening is much greater in The Netherlands than in Oregon.

This study reports data about the real story behind the current trend of mandated interorganizational collaboration of health and human service agencies. By means of qualitative design (N-22), public health managers were interviewed about the extent and nature of their collaborative efforts in the Healthy Babies, Healthy Children (HBHC) Program in Ontario, Canada. Using a conceptual framework of resource exchange theory, this study found that relational processes specifically: (a) previous relationships with other agencies and (b) interpersonal relations namely: informality, local community, open communication and resolving conflicts were the reasons for successful collaborations. Implications are directed toward: health and social planners, administrators, board members, funding bodies and policy-makers. The study offers new knowledge about a subject which has received minimal attention in the literature.

In this investigation structure, process, and outcome measures of quality in for-profit and not-for-profit board and care homes are compared. We find one structural measure (providing nursing care), three process measures (food quality, staff treat residents with respect, and staff verbally abuse residents), and two outcomes measures (cleanliness of the facility and complaints to Ombudsman) to be significant. Moreover, the directions of these effects are all consistent, with for-profit facilities rated more poorly that not-for-profit facilities. These results are discussed emphasizing their implications for efficient and effective resident care.

Understanding how to respond effectively and efficiently to crime victims and their offenders, and identifying what policies assist victims in having their victimization redressed is a major social concern. Social workers have contact with these vulnerable populations in many different ways, yet the social work profession, in general, is unfamiliar with how to redress victims through restorative justice. Restorative justice is an innovative method of viewing crime, and a paradigm shift is required when considering the application and implication of various forms of restorative justice. It is imperative to keep various justice options available, as the effects of crime are detrimental. Though reported rates of juvenile and adult crime have decreases during the last decade, the costs associated with crime to society remain high. Many victims do not report crimes, and if professionals such as medical personnel fail to identify crimes, then these costs may be even higher than currently reported. Regardless, however, of the costs associated with crime, victims deserve having justice evaluated, at least in part, in terms of what they need and want. Likewise, it is imperative to evaluate the effects of victim- offender mediation (VOM), a form of restorative justice, on offenders as they too deserve potential rehabilitation and the chance to redress the harm they caused their victim(s). This paper discusses crime effects, provides an overview of VOM, and concludes with policy recommendations concerning the use of victim-offender mediation.

We examine the effect of a large, comprehensive maternity and infant care (MIC) program on birthweight and infant mortality in an economically depressed urban population. The study is based on linked birth, infant death and program files for 1985-87 Cleveland and East Cleveland, Ohio, birth cohorts (N = 31,415). Taking into account differences in risk factors, Black MIC infants experienced lower neonatal and endogenous mortality, but White MIC infants had higher postneonatal and exogenous mortality than their same race, non-MIC counterparts. Birthweight distributions were also more favorable for Black than White clients. We discuss the policy implications of our findings.

A review of the literature revealed mixed reviews on the impact of managed care on mental health service delivery. Research supports that managed care contributes to a reduction in inpatient costs and an increase in outpatient service use. Other studies suggest that there are problems with access and quality of care. An additional issue is whether or not, and to what extent, mental health services are "carved out" from physical health for patients. This study discusses the findings of a qualitative analysis of Medicaid managed care recipients on the barriers and enabling factors to obtaining mental health services in a full carve-out managed care model. Results indicate that reduced access, quality of care problems, and a lack of integration of care exist. Additionally, recipients' interactions with managed care, service providers, and caseworkers affect their mental health care. The results also report on the tactics used by recipients to cope with service problems. Implications for social work practice and research are discussed and recommendations for service delivery and evidence-based education are delineated.

Since its inception, the Family and Medical Leave Act of 1993 (FMLA) has been a source of controversy in American politics. Its enactment allowed leave for employees and their family members for serious medical conditions, while maintaining their employment status. This study is an exploratory look into the utilization and effectiveness of the FMLA for 45 caregivers of children with chronic illnesses. Results of a survey indicated that being female (p <.01), unmarried (p <.05), and having an annual income less than 35,000 dollars (p <.001) have significant negative effects on the eligibility, utilization, and effectiveness of the FMLA for caregivers of ill children. The authors argue for improved dissemination of FMLA eligibility to employees and employers, and a reexamination of the eligibility criteria.

This study analyzes administrative data from the Maryland Health Services Cost Review Commission to compare differences by race in the use of 17 major procedures performed in hospitals and the corresponding mortality rates. African Americans discharged from Maryland hospitals were less likely than whites to have received most of these procedures while hospitalized. The largest differences were seen for "referral sensitive surgeries" such as percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery, total knee replacement, and total hip replacement. In contrast, African Americans were found to have substantially higher rates than white patients in the use of four procedures performed in the hospital: amputation of part of the lower limb, surgical debridement, arteriovenostomy, and bilateral orchiectomy. The types of procedures for which African American hospital patients have higher rates raise questions about whether there is a need for more comprehensive and continuous follow-up care with primary care physicians for the underlying health conditions associated with these procedures.